HB 1115: RELATING TO UNIVERSAL IMMUNIZATION FUNDING PROGRAM.

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 fourteen states have adopted programs known as "Universal Purchase" or "Universal Select" (collectively, UP), which provide 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 were able to 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.

     The purpose of this Act is to establish a universal immunization funding program, to be administered by the department of health.

     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 or group health insurance policy, plan, contract, or agreement issued or delivered in the State;

     (2)  By a group health insurance policy evidenced by a certificate of insurance issued or delivered to an individual residing in the State;

     (3)  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

     (4)  As a participant or beneficiary of a health cost sharing program.

     "Assessed entity" means an insurer that is not federally funded and is governed by article 10A of chapter 431, a nonprofit mutual benefit society governed by article 1 of chapter 432, a fraternal benefit society governed by article 2 of chapter 432, or a health maintenance organization governed by chapter 432D.

     "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 or group health insurance policy, plan, contract, or agreement issued or delivered in the State;

     (2)  By a group health insurance policy evidenced by a certificate of insurance issued or delivered to an individual residing in the State;

     (3)  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

     (4)  As a participant or beneficiary of a health cost sharing program.

     "Department" means the department of health.

     "Director" means the director of health or the director's 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 mutual benefit society, a health maintenance organization, 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, living fully virulent organisms, or part thereof, or any other treatment intended to trigger an immune response that is authorized by the United States Food and Drug Administration, recommended by the national Advisory Committee on Immunization Practices of the United States Centers for Disease Control and Prevention, or has been authorized for purchase by the director for the purposes of producing or increasing immunity to particular diseases.  "Immunization" includes any other substance designated as such by order of the director.

     "Program" means the universal immunization funding program established under this part.

     "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 assessed 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 federal or state funds, for the succeeding year no later than one hundred twenty days prior to the commencement of each state fiscal year;

     (2)  Add estimates to cover the department's operating costs for the 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 each 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 shall accrue 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.  The 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 shall not impose more than one interim assessment per year, except in the case of a public health emergency declared in accordance with federal or state law.

     (f)  For purposes of assessments, medical loss ratio calculations, and reimbursement by plan sponsors, all association assessments shall be considered pharmaceutical or medical benefit costs and not regulatory or administrative costs.

     (g)  If the department discontinues operation of the program for any reason, any unexpended assessments, including unexpended funds from prior assessments in the universal immunization purchase special 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 program shall report to the Hawaii immunization registry pursuant to section 325-122 all 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, fees, and other costs of enforcement 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 shall take effect on July 1, 3000.

Report Title:

Universal Immunization Funding Program; Immunization Purchasing; Universal Immunization Purchase Special Fund; Appropriation

Description:

Establishes the Universal Immunization Purchase Program and Universal Immunization Purchase Special Fund into which the fees will be deposited to finance the distribution of immunizations free of charge to qualifying health care providers.  Appropriates funds.  Effective 7/1/3000.  (HD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

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 fourteen 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 assessed 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.

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.

STAND. COM. REP. NO.  516

Honolulu, Hawaii

                , 2025

RE:   H.B. No. 1115

      H.D. 1

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Madame:

     Your Committee on Health, to which was referred H.B. No. 1115 entitled:

"A BILL FOR AN ACT RELATING TO UNIVERSAL IMMUNIZATION FUNDING PROGRAM,"

begs leave to report as follows:

     The purpose of this measure is to establish the Universal Immunization Purchase Special Fund to finance the distribution of immunizations to qualifying health care providers free of charge.  

     Your Committee received testimony in support of this measure from the Department of Health; American Academy of Pediatrics, Hawai‘i Chapter; Hawai‘i Public Health Institute; Children's Doctors L.L.C.; and numerous individuals.  Your Committee received testimony in opposition to this measure from the Biotechnology Innovation Organization; Fathers and Mothers for Children Kauai Chapter; and numerous individuals.  Your Committee received comments on this measure from the Tax Foundation of Hawai‘i.

     Your Committee finds that "Universal Purchase" programs are programs that enable states to leverage bulk purchasing and federal immunization programs to establish a streamlined procurement, oversight, and distribution system for all recommended vaccines for children and adults.  Your Committee further finds that the purchase of immunizations is done by the State and private health care providers or health systems.  This practice requires private health care providers to take on considerable costs, as they must pay for their immunizations up front in addition to costs incurred for securing and storing the immunizations.  Your Committee believes that establishing a Universal Immunization Funding Program in Hawaii will reduce the financial and administrative burden borne by private health care providers and systems and lower incidences of immunization-preventable diseases by increasing access to immunizations.

     Your Committee has amended this measure by:

     (1)  Amending the definition of "immunization";

     (2)  Changing the effective date to July 1, 3000, to encourage further discussion; and

     (3)  Making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.

     Your Committee respectfully requests your Committee on Finance, should it deliberate on this measure, to consider an appropriation of between $2,800,000 and $3,600,000 and an additional one-time appropriation of $934,000 for fiscal year 2025-2026 for startup costs for the Universal Immunization Funding Program.

     As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 1115, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 1115, H.D. 1, and be referred to your Committee on Finance.

Respectfully submitted on behalf of the members of the Committee on Health,