Read the full stored bill text
HB1115
HOUSE OF REPRESENTATIVES
H.B. NO.
1115
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO UNIVERSAL IMMUNIZATION FUNDING PROGRAM.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
����
SECTION
1.
�
The legislature finds that f
ourteen
states have adopted programs known as
"
Universal Purchase
"
or
"
Universal Select
"
(collectively, UP), providing state-purchased access to some or all recommended
immunizations to children and adults in those states.
�
UP immunization purchases occur at a
discounted price through contracts otherwise intended for more established and
familiar immunization purchasing programs such as the Vaccines For Children
Program (Pub. L. 103-66) and Public Health Services Act, Section 317 Immunization
Program (Pub. L. 78-410).
�
Other varied
state approaches include superseding private sources of coverage and assessing health
insurance plans for the cost of the program and disallowing provider use of
private immunization stock.
����
The legislature further finds that states
with UP programs that allow state health officials to manage the supply of immunizations
lowered health care providers
'
administrative costs and
ensured that the states can quickly supply immunizations to vulnerable patient
groups during emergencies or immunization shortages.
�
The potential benefits to Hawaii
'
s
health care and public health system make investment in a UP program
worthwhile.
����
SECTION 2.
�
Chapter 321, Hawaii Revised Statutes, is amended by adding a new part to
be appropriately designated and to read as follows:
"
PART
���
.
�
UNIVERSAL IMMUNIZATION FUNDING PROGRAM
����
�
321-
��
�
�
Definitions.
�
As used in this part, unless
�
the context otherwise requires:
����
"Adult
covered lives" means all adults under the age of sixty-five who have
immunizations covered:
����
(1)
�
By
an individual health insurance policy issued or delivered in the State;
����
(2)
�
By
a group health insurance policy issued or delivered in the State;
����
(3)
�
By
a group health insurance policy evidenced by a certificate of insurance issued
or delivered to an individual residing in the State;
����
(4)
�
By
an employee benefit plan of a self-insured entity or a government plan for any
employer or government entity that has an office or other worksite located in
the State or has two or more employees; or
����
(5)
�
As
a participant or beneficiary of a health cost sharing program.
����
"Assessed
entity" means any insurer in the State, that is not federally funded,
issuing individual and group accident and health or sickness insurance
policies, individual or group hospital or medical service plan contracts, and
nonprofit mutual benefit society, fraternal benefit society, and health
maintenance organization health plans.
����
"Assessment"
means the association member liability with respect to
immunization
costs determined in accordance with this part.
����
"Child
covered
lives" means all children aged
eighteen years or younger who have immunizations covered:
����
(1)
�
By
an individual health insurance policy issued or delivered in the State;
����
(2)
�
By
a group health insurance policy issued or delivered in the State;
����
(3)
�
By
a group health insurance policy evidenced by a certificate of insurance issued
or delivered to an individual residing in the State;
����
(4)
�
By
an employee benefit plan of a self-insured entity or a government plan for any
employer or government entity that has an office or other worksite located in
the State or has two or more employees; or
����
(5)
�
As
a participant or beneficiary of a health cost sharing program.
����
"Department"
means the department of health.
����
"Director"
means the director of health or designee.
����
"Estimated
adult immunization cost" means the estimated cost to the State for the
purchase and distribution of adult immunizations
purchased
at the federal discount rate.
����
"Estimated
pediatric immunization cost" means the estimated cost to the
State
for the purchase and distribution of child immunizations purchased at the
federal discount rate.
����
"Health
carrier" means an entity subject to the insurance laws and rules of the
State, or subject to the jurisdiction of the insurance commissioner, that
contracts or offers to contract to provide, deliver, arrange for, pay for, or
reimburse any of the costs of health care services, including an insurance
company, a health maintenance organization, a mutual benefit society, or any
other entity providing a plan of health insurance,
health
benefits, or health services.
����
"Health
cost sharing program" means any cost sharing or similar program that
seeks
to share the costs of health care services and that in the preceding twelve
months either has coordinated payment for or reimbursed over $10,000 of costs
for health care
services
delivered in the State or
communicated by mail or electronic media to residents of the State concerning
their potential participation.
����
"Immunization"
means any preparation of killed microorganisms, living attenuated organisms, or
living fully virulent organisms of mRNA or any other injectable treatment
intended to trigger an immune response that is authorized by the United States
Food and Drug Administration and recommended by the national Advisory Committee
on Immunization Practices of the United States Centers for Disease Control and
Prevention and has been authorized
for
purchase by
the director for the purposes of producing or artificially increasing immunity
to particular diseases.
�
For purposes of
this part, "immunization" shall include any other substance
designated as such by order of the director.
����
"Provider"
means a person licensed by the State to administer immunizations or provide
health care services or a partnership or corporation or other entity made up of
those persons.
����
�321-
����
Universal immunization purchase special
fund; established.
�
(a)
�
There is established in the state
treasury the universal immunization purchase special fund into which shall be
deposited
fees,
fines, and cost reimbursements paid by a
ssessed
entities.
�
The fund shall be administered and
expended by the department.
����
(b)
�
Expenditures from the fund shall be used for
the purchase of
immunizations
and the administration of the
program, at no cost to providers, to administer to individuals who are not
eligible to receive immunizations at no cost through other programs.
����
(c)
�
The department may contract with other
entities for any services pursuant to this part.
����
�321-
����
Assessments.
�
(a)
�
The
director
shall determine regular
immunization assessment rates as follows:
����
(1)
�
Provide
estimated child immunization costs and estimated adult immunization costs, not
covered by any other state or federal funds, for the succeeding year no later
than one hundred twenty days prior to the commencement of each fiscal year;
����
(2)
�
Add
estimates to cover the department's operating costs for the universal
immunization purchase special fund program;
����
(3)
�
Add
a reserve of up to ten per cent of the sum of the preceding fiscal year and for
unanticipated costs;
����
(4)
�
Add
a working capital reserve in such amount as may be reasonably determined by the
director;
����
(5)
�
Subtract
the amount of any unexpended fund balance, including any net investment income
earned, as of the end of the preceding fiscal year; and
����
(6)
�
Calculate
a per-child covered life per month and per-adult covered life per month amount
to be self-reported and paid by all assessed entities by dividing the annual
amount determined in accordance with paragraphs (1) through (5) by the number
of children and adults, respectively, projected to be covered by the assessed
entities during the succeeding program year, divided by twelve.
����
(b)
�
No later than forty-five days following the
close of the state fiscal year, the department shall provide an accounting of
immunization
purchase funds not covered by any state or other program to determine the final
amount needed to cover the prior fiscal year.
����
Unless
determined by the director, any assessed entity that would otherwise be
responsible for reimbursement to any provider for any immunization
administration shall be responsible for reporting the child covered life and
adult covered life and for payment of the corresponding assessment to the
department.
����
(c)
�
At any time after one full calendar year of
operation under subsections (a) and (b), the director may make changes to the
assessment
collection
mechanism.
�
Any such changes shall be reflected in an
updated plan of operation available to the public.
����
(d)
�
If an
assessed
entity has not paid in accordance with this section, interest accrues at one
per cent per month, compounded monthly on or after the due date.
����
(e)
�
The director may determine an interim
assessment for new immunizations or public health emergencies and shall
calculate a supplemental interim assessment using the methodology outlined
under subsection (a) for regular assessments, but payable over the remaining
fiscal year, and such interim assessment shall be payable together with the
regular assessment commencing the calendar quarter that begins no less than
thirty days following the establishment of the federal contract price.
�
The director may not impose more than one
interim
assessment
per year, except in the case of a
public health emergency declared in accordance with state or federal law.
����
(f)
�
For purposes of assessments, medical loss
ratio calculations, and reimbursement by plan sponsors, all association
assessments are considered pharmaceutical or medical benefit costs and not
regulatory or administrative costs.
����
(g)
�
If the department discontinues operation of
the universal immunization funding program for any reason, any unexpected
assessments, including unexpended funds from prior assessments in the
immunization purchase fund, shall be refunded to payees in proportion to the
respective assessment payments by payees over the most recent eight quarters
before
discontinuation
of program operations.
����
�321-
����
Reports and audits.
�
(a)
�
Each assessed entity shall report its number
of child and adult covered lives according to a schedule determined by the
director and respond to any requests by the director related to covered lives
or assessments due.
�
Any assessed entity
that fails to respond to an audit request within ten business days of the
receipt of notification of audit request shall be responsible for prompt
payment of fees of any outside auditor engaged by the department to determine
such
information
and shall make all records
requested by the department-engaged auditors available for inspection and
copying at such location within the State as specified by the
auditor
.
����
(b)
�
Each provider administering immunizations in the
State that are supplied via federal vaccination programs or the universal
immunization funding program shall report to the Hawaii immunization registry
pursuant to section 325-122, such data related to immunizations as the department
determines is necessary for disease prevention, control, and immunization
inventory management and accountability purposes.
����
(c)
�
Failure to cure non-compliance with any
reporting, auditing, or assessment obligation to the department within thirty
days from the postmarked date of written notice of noncompliance may subject
the assessed entity to fines established pursuant to subsection (d).
�
Any monetary fine, fee, or cost
reimbursement
shall be remitted to the universal immunization purchase special fund.
����
(d)
�
Any entity that violates this chapter shall
be fined no more than $1,000 for each separate offense.
�
Each date of violation shall constitute a
separate offense.
�
The assessed entity
shall also pay for reasonable attorney's fees and any other costs of
enforcement under this section.
�
Any
action taken to impose or collect the penalty provided for in this subsection
shall be
considered
a civil action.
����
�321-
����
Immunity.
�
Apart from liabilities of assessed entities
pursuant to this part, there shall be no liability on the part of and no cause
of action against the department, independent contractors, or employees for any
action or omission in the course of operating the universal immunization
purchase program.
����
�321-
����
Rulemaking.
�
The department may adopt rules pursuant to
chapter
91 to carry out the purposes of this part.
����
�321-
����
Available choices.
�
The department shall maintain a list of immunizations,
including all brand choices available for purchase by the State on the United
States Centers for Disease Control and Prevention contract, for which costs are
funded pursuant to this part.
����
�321-
����
Immunization cost reimbursement to
providers; limits.
�
This part shall have no impact on amounts paid to providers to
administer immunizations.
�
No provider
may bill any assessed entity or any other person for any immunizations supplied
at no cost by the State."
����
SECTION
3.
�
There is appropriated out of the
general revenues of the State of Hawaii the sum of $__________ or so much
thereof as may be necessary for the fiscal year 2025-2026 to be deposited into
the universal immunization purchase special fund.
����
SECTION
4.
�
There is appropriated out of the
universal immunization purchase special fund the sum of $__________ or so much
thereof as may be necessary for fiscal year 2025-2026 for startup operations
and initial procurements for the universal
immunization
funding program.
����
The
sum appropriated shall be expended
by the department of health for the purposes of this Act.
����
SECTION 5.
�
This Act, upon its approval, shall take effect on July 1, 2025.
INTRODUCED BY:
_____________________________
BY REQUEST
Report Title:
Universal Immunization Funding Program; Immunization
Purchasing; Universal Immunization Purchase Special Fund
Description:
Establishes the Universal Immunization Purchase Special
Fund into which the fees will be deposited to finance the distribution of
immunizations free of charge to qualifying healthcare providers.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.