The National Immunization Program Presents:

1
The Epidemiology of U.S. Immunization Law

• The National Immunization Program Presents
• Understanding and Strengthening State
• Insurance Laws Providing Immunization Coverage
• NET CONFERENCE July 9, 2004 12 1 pm
• Presented by Sara Rosenbaum, J.D.
• Learn about
• A new project providing technical assistance to
  state policy makers,
• program administrators, and others seeking
  improvement in
• immunization coverage and performance
  standards.
• Available technical assistance tools including
• -- model health insurance legislation with
  customized model laws for all states,
• -- hands-on technical assistance in the
  development of contractual performance

2
33 jurisdictions (32 states DC) maintain an
immunization coverage law SLIDE 1
VT
NH
WA
ME
MT
ND
MA
OR
MN
NY
SD
WI
RI
MI
ID
WY
PA
AK
IA
NE
DE
OH
NV
IL
IN
UT
WV
CT
VA
CA
CO
KS
MO
MD
KY
NC
DC
TN
AZ
AR
SC
OK
NM
GA
MS
AL
TX
LA
FL
Law (AR,CA,CO,CT,DE,DC,FL,GA,HI,IL,KS,LA,MD,M
A,MI,MN,MS,MO,MT,NE,NJ,NM,NY,NC,ND,OH, OK,PA,RI,TX
,VA,W.VA,WI) No Law (AL,AK,AZ, HI, IN,
IA,KY, ME, NV, NH, O R,SC, SD, TN, UT,VT,WA,WY)

HI
GWU/SPHHS/CHSRP Analysis of State Immunization
Laws, Winter 2003
3
States with immunization laws and/or universal
programs (n 51) SLIDE 2
VT
NH
WA
ME
MT
ND
MA
OR
MN
NY
SD
WI
RI
MI
ID
WY
PA
AK
IA
NE
DE
OH
NV
IL
IN
UT
WV
CT
VA
CA
CO
KS
MO
MD
KY
NC
DC
TN
AZ
AR
SC
OK
NM
GA
MS
AL
TX
LA
FL
Law Only (AR, CA, CO, DE, DC, FL, GA, IL, KS,
LA, MD, MI, MN, MS, MO, MT, NE, NJ, NY, OH, OK,
PA, TX, VA, WVA, WI)

Law and
Universal (MA, NM, NC, RI)

Law and Universal Select (CT, HI,
ND) Universal or Universal Select Only (AK,
ID, ME, NV, NH, SD, VT, WA, WY) No Law and No
Universal or Universal Select (AL, AZ, IN, IA,
KY, OR, SC, TN, UT)
HI
GWU/SPHHS/CHSRP Analysis of State Immunization
Laws, Winter 2003
4
State immunization laws that incorporate the ACIP
coverage standard for some or
all children under 18 (n 6) SLIDE 3
VT
NH
WA
ME
MT
ND
MA
OR
MN
NY
AK
SD
WI
RI
MI
ID
WY
PA
IA
NJ
NE
OH
NV
IL
IN
DE
UT
WV
CT
VA
CA
CO
KS
MO
MD
KY
NC
DC
TN
AZ
AR
SC
OK
NM
GA
MS
AL
TX
LA
FL
California, Hawaii, Maryland, Montana, New
Jersey, and Pennsylvania laws require
immunization coverage based on the ACIP
recommendations.
HI
GWU/SPHHS/CHSRP Analysis of State Immunization
Laws, Winter 2003
5
Costsharing provisions in state insurance laws
(n 33) SLIDE 4
VT
NH
WA
ME
MT
ND
MA
OR
MN
NY
AK
SD
WI
RI
MI
ID
WY
PA
IA
NJ
NE
OH
NV
IL
IN
DE
UT
WV
CT
VA
CA
CO
KS
MO
MD
KY
NC
DC
TN
AZ
AR
SC
OK
NM
GA
MS
AL
TX
LA
FL
PROHIBITS COSTSHARING (AR, HI, KS, MN, MO, MS,
NY, NC, OK, TX, VA, WI, WV)
SILENT REGARDING ALL COSTSHARING (CA, CT, DE,
DC, MA, MI) PERMITS ALL COSTSHARING (IL, LA, NM,
OH) PERMITS COPAYMENTS/PROHIBITS DEDUCTIBLE (CO,
NE, PA) SILENT ON COPAYMENTS/PROHIBITS DEDUCTIBLE
(FL, GA, MD, MT, NJ) PERMITS COPAYMENTS/SILENT RE
DEDUCTIBLE (ND, RI)
HI
GWU/SPHHS/CHSRP Analysis of State Immunization
Laws, Winter 2003
6
Comprehensive Immunization Laws Composite
Range (Pediatric Coverage Only)
SLIDE 5
7
Composite 2 More limited age standards (n 1)
SLIDE 6
VT
NH
WA
ME
MT
ND
MA
OR
MN
NY
AK
SD
WI
RI
MI
ID
WY
PA
IA
NJ
NE
OH
NV
IL
IN
DE
UT
WV
CT
VA
CA
CO
KS
MO
MD
KY
NC
DC
TN
AZ
AR
SC
OK
NM
GA
MS
AL
TX
LA
FL
Hawaiis law requires coverage for children up to
age six, under ACIP standards, and prohibits
copayments and deductibles.
HI
GWU/SPHHS/CHSRP Analysis of State Immunization
Laws, Winter 2003
8
Composite 3 More limited age and costsharing
standards (n 2) SLIDE 7
VT
NH
WA
ME
MT
ND
MA
OR
MN
NY
AK
SD
WI
RI
MI
ID
WY
PA
IA
NJ
NE
OH
NV
IL
IN
DE
UT
WV
CT
VA
CA
CO
KS
MO
MD
KY
NC
DC
TN
AZ
AR
SC
OK
NM
GA
MS
AL
TX
LA
FL
Hawaiis law requires coverage for children up to
age six, under ACIP standards, and prohibits
copayments and deductibles. Pennsylvanias law
requires coverage for children, under ACIP
standards, and permits copayments.
HI
GWU/SPHHS/CHSRP Analysis of State Immunization
Laws, Winter 2003
9
Composite 4 More limited age standards,
copayment, and coverage standards (n 15)
SLIDE 8
VT
NH
WA
ME
MT
ND
MA
OR
MN
NY
AK
SD
WI
RI
MI
ID
WY
PA
IA
NJ
NE
OH
NV
IL
IN
DE
UT
WV
CT
VA
CA
CO
KS
MO
MD
KY
NC
DC
TN
AZ
AR
SC
OK
NM
GA
MS
AL
TX
LA
FL
HIs law requires coverage for children up to age
six, under ACIP standards, and prohibits
copayments and deductibles. PAs law requires
coverage for children, under ACIP standards, and
permits copayments. AR, KS, MN, MS, MO, NE, NY,
NC, OK, TX, VA, WV, WIs laws requires coverage
for children, according to any standard, either
permits or prohibits copayments, prohibits
deductibles.
HI
GWU/SPHHS/CHSRP Analysis of State Immunization
Laws, Winter 2003
10
Accessing the Project Website SLIDE 9

• 1. www.gwhealthpolicy.org/immunization
• -- Access the Introduction Page to the
  initiative
• State Statute Report Link
• -- Access the Model Statute and the U.S. Map
• Map Link to Map of State Statutes Recommended
  Language
• -- Access the Map of U.S., click on any state
  to find Tables
• From Map page go to the Tab labeled Reports
• -- Access reports of state laws and Medicaid.

11
Uniform Act on Insurance Coverage of All
Immunizations SLIDE 10
SECTION 1. DEFINTIONSFor the purposes of this
act beneficiary means a person or persons
specified by a policyholder as eligible to
receive benefits under the insurance contract or
policy. co-insurance means the percentage of a
providers negotiated fee the enrollee must pay
for care, up to a yearly defined
maximum. co-payment means a cost-sharing
arrangement in which a beneficiary pays a
specified charge for a specified service. The
beneficiary is usually responsible for payment at
the time the service is rendered. cost-sharing
means a method of reimbursement for health care
services that holds the patient responsible for a
portion or percentage of the charge with an
attending strategy to serve as a means of
reducing utilization. covered benefit means a
written health care benefit document that
outlines the benefit package to be provided to
either individual beneficiaries or a purchasing
group or employer, with a corresponding sum for
each service specified for beneficiaries by an
insurer in the state. deductible means a
specific dollar amount you must pay before the
benefit plan begins paying for covered
services. dependent means an enrolled health
plan member who has coverage tied to that of the
sponsor may be a spouse or an unmarried child,
or a stepchild or legally adopted child of either
the beneficiary or the beneficiarys spouse,
whose primary domicile is with the beneficiary,
except for the other arrangements as approved by
the plan often dependent children status is also
delineated by those under the age of 18, or
children attending college full-time under a
specified age. ''health benefits plan'' means a
group or individual insurance policy or contract,
medical or hospital service agreement, membership
or subscription contract, or similar group or
individual arrangements provided by a carrier for
the purpose of providing, paying for, or
reimbursing expenses for health services
network means a health benefit plan that
operates through a series of contracts with
multiple physician groups and hospitals to
provide a defined group of providers from which a
health plan member may choose from to receive
covered health services. Services obtained from
providers included in the defined group charge
the health plan member an agreed upon discounted
fee. State means a State of the United
States, the District of Columbia, Puerto Rico,
the US Virgin Islands, or any territory or
insular possession subject to the jurisdiction of
the US.
12
Uniform Act on Insurance Coverage of All
Immunizations SLIDE 11
SECTION 2. SUBSTANCE OF THE ACT Covered
Immunization Services To the extent permitted by
federal law, any health benefit plan issued,
renewed, extended, or modified for delivery in
this state, must include at a minimum,
immunizations as a covered benefit for all
beneficiaries and their dependents, regardless of
age according to the most recent schedules
recommended by the Advisory Committee on
Immunization Practices (ACIP), of the U.S.
Department of Health and Human Services. Cost
Sharing Provisions (A) Health Benefit Plans will
pay 100 of the charges for the ACIP-Recommended
immunizations. For purposes of this paragraph,
charges include the cost of the biological
product and any costs associated with the
administration of such product. (1) (B) Health
Benefit Plans subject to this act must explicitly
provide these services, the services shall not be
subject to any co-payment, coinsurance,
deductible, or dollar limit provisions in the
health benefit plan. (c) Network Provisions
(1) Health benefit plans will cover all
immunizations regardless of whether the
immunization is obtained in or out of the plans
network.
13
Uniform Act on Insurance Coverage of All
Immunizations SLIDE 12
SECTION 3. UNIFORMITY OF APPLICATION AND
CONSTRUCTION In applying and construing this
Uniform Act, consideration must be given to the
need to promote uniformity of the law with
respect to its subject matter among States that
enact it. SECTION 4. SHORT TITLE. This Act may
be cited as the Uniform Immunization Act.
SECTION 5. SEVERABILITY CLAUSE. The provisions
of this Act are severable. If any provision of
this Act or its application is held invalid, that
invalidity shall not affect other provisions or
applications of this Act which can be given
effect without regard to the provision or
application that has been held to be
invalid. SECTION 6. EFFECTIVE DATE. The
provisions of this Act shall apply to any health
benefit plan issued, renewed, extended, or
modified for delivery in this state on or
after Options (1) Date of enactment. A
date (x) days after the date of enactment. (X)
days after (insert description of regulations or
other guidance) is issued by (insert name of
administering agency) SECTION 7. APPLICATION TO
EXISTING RELATIONSHIPS Drafter may want to
include special rules that describe how the
provisions of this Act apply to any health
benefit plan issued, renewed, extended, or
modified for delivery in this state before the
effective date described in Section 6.
14
Project Staff SLIDE 13

Alexandra Stewart, J.D. Director, Assistant
Research Professor, Department of Health Policy

202-530-2331
stewarta_at_gwu.edu Marisa Cox, M.A., Research
Associate, Department of Health Policy

202-530-2307
mcox_at_gwu.edu Alexis Lee, J.D., Research
Associate, Department of Health Policy

202-416-0413
alee1_at_gwu.edu Phyllis Borzi, J.D., M.A., Research
Professor, Department of Health Policy

202-530-2312
borziph_at_gwu.edu Sara Rosenbaum, J.D., Hirsh
Professor and Chair, Department of Health Policy

202-530-2343
sarar_at_gwu.edu FOR INFORMATION, PLEASE
VISIT www.gwhealthpolicy.org/immunization