An Act To Establish the Universal Childhood Immunization Program
Maine Legislature, Session 124, LD 1408
Committee Amendment CA_A_H792 (House)
Committee: Immunization Practices, optimizing public and private resources and lowering the cost of providing immunizations to children
Amends: 5 MRSA §12004-G, 22 MRSA §1066

COMMITTEE AMENDMENT ·A " 
to H.P. 984, L.D. 1408, Bill, "An Act To 
Establish the Universal Childhood Immunization Program" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 5 MRSA §12004-G, sub-§15-B is enacted to read: 
IS-B. 
Human Services: 
Maine Vaccine 
Not Authorized 
Immunization 
Board 
Sec. 2. 22 MRSA §1066 is enacted to read: 
§1066. Universal Childhood Immunization Program 
MRSA § 1 066 
1. 
Program established. 
The Universal Childhood Immunization Program is 
established to provide all children from birth until 19 years of age in the State with access 
to a uniform set of vaccines as determined and periodically updated by the Maine 
Vaccine Board. The program is administered by the department for the purposes of 
expanding access to immunizations against all diseases as recommended by the federal 
Department of Health and Human Services, Centers for Disease Control and Prevention 
Advisory Committee on Immunization Practices, optimizing public and private resources 
and lowering the cost of providing immunizations to children. The program is overseen 
by the Maine Vaccine Board. 
2. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Advisory committee" means the Advisory Committee on Immunization Practices 
of the United States Department of Health arid Human Services, Centers for Disease 
Control and Prevention or its successor organization. 
. 
B. "Assessed entity" means a health insurance carrier licensed under Title 24-A or a 
3rd-party administrator registered under Title 24-A. 
Page I - 124LRI4S9(02)-I 
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to H,P, 984, L.D, 1408 
C, "Board"means the Maine Vaccine Board established in subsection 3, 
D, "Child" means a person who has not attained 19 years of age and who resides in 
the State. 
E. "Covered life months" means the number of months during a calendar year that a 
person is covered under a health insurance plan provided by a health insurance 
carrier. 
F. "Fund" means the Childhood Immunization Fund established in subsection 7. 
G, "Health insurance carrier" means: 
(1) . An insurance company licensed in accordance with Title 24-A to provide 
health insurance; 
. 
(2) A health maintenance organization licensed pursuant to Title 24-A, chapter 
iQ.;, 
(3) A preferred provider arrangement administrator registered pursuant to Title, 
24-A, chapter 32; 
(4) A fraternal benefit society as defined in Title 24-A, section 4101; 
(5) A nonprofit hospital or medical service organization or health plan licensed 
pursuant to Title 24; , 
(6) A multiple-employer welfare arrangement approved by the superintendent 
under Title 24-A, section 6603; or 
(7) A self-insured employer subject to state regulation as described in Title 24-A, 
section 2848-A. 
H. "New vaccine" means a vaccine recommended by the advisory committee for 
which an initial federal contract price is established by the United States Department 
of Health and Human Services, Centers for Disease Control and Prevention between 
October 1 st and July 1st. 
I. "Program" means the Universal Childhood Immunization Program established in 
subsection I. 
J. "Provider" means a person licensed by this State to provide health care services to 
individuals or a partnership or corporation made up of those persons. 
K. "Service agent" means a person or entity qualified by good business reputation, 
training, education and experience to administer the fund and perform responsibilities 
assigned by the board. 
A service agent must hold all licenses, registrations and 
permits required to engage in activities or undertake responsibilities assigned by the 
board. 
L. "Superintendent" means the Superintendent of Insurance. 
M. "Total costs of the fund" means the costs of vaccines provided under the program 
to children projected to be covered by assessed entities during the succeeding 
program year and the annual operating expenses of the board, including costs the 
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COMMITTEE AMENDMENT -It" to H.P. 984, L.D. 1408 
board may incur for staff, a service agent, legal representation, administrative support 
services and other expenses approved by the board: 
3. Maine Vaccine Board. The Maine Vaccine Board is established pursuant to this 
subsection to oversee the program. 
. A. The board consists of 10 members. 
(1) The commissioner shall serve as an ex officio, nonvoting member. 
(2) The Treasurer of State shall serve as an ex officio, nonvoting member. 
(3) The Governor shall appoint 8 members, as follows: 
fa) Three representatives of health insurance carriers, appointed from a list 
of nominees submitted. by a statewide association of health insurance 
carriers; 
(b) Three representatives of providers in the State, appointed from lists of 
nominees submitted by statewide associations of providers, including 
associations of primary care providers, allopathic and osteopathic physicians, 
nurse practitioners and persons with expertise in public health; 
(c) 
A representative of employers that self-insure for health coverage, 
appointed from lists of nominees submitted by statewide associations of 
employers; and 
. 
(d) 
A representative of the pharmaceutical manufacturing industry, 
appointed from a list of nominees submitted by a statewide association of 
pharmaceutical manufacturers. 
B. 
With the exception of the representative of the pharmaceutical manufacturing 
industry, who serves a one-year term, the term of an appointed member to the board 
is 3 years. 
All members, with the exception of the representative of the 
pharmaceutical manufacturing industry, may serve successive terms. 
A member 
whose term has expired may s~rve until the appointment of the member's successor. 
C. The board shall elect a chair from among its members to serve a 2-year term or 
for the duration of that person's term. The chair may serve successive terms. Five 
voting members constitute a quorum. Decisions of the board require the affirmative 
vote of 5 members. 
D. The board shall meet 4 times per year and when a meeting is called by the chair 
and shall oversee the fund and program and adopt policies and procedures to 
administer the program and the fund. 
E. By January I, 2011 and annually thereafter, the board shall determine the list of 
vaccines to be made available by the program during the succeeding program year 
beginning July I st. In making its determination, the board shall consider: 
(I) Vaccines recommended by the advisory committee that are available under 
contract with the United States Department of Health and Human Services, 
Centers for Disease Control and Prevention; 
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COMMITTEE AMENDMENT l1 "to H.P. 984, L.D. 1408 
(2) Recommendations of the department, based on the department's review of the 
advisory committee recommendations; and 
(3) Clinical and cost-benefit analyses. 
The board shall review new vaccines and update the list of vaccines to be made 
available through the program on a timely basis in accordance with the considerations 
described in this paragraph. 
F. 
The board shall contract for staff, administrative support services and, if 
necessary, legal representation; review financial, cost and other information about the 
program annually or more often as determined by the chair; and pay the costs of the 
service agent under subsection 9, legal representation and contracted services from 
the fund. 
4. Program requirements. The program shall make available to providers vaccines 
as determined by the board pursuant to subsection 3, paragraph E. 
5. 
Assessments. 
By January 1, 20 II and annually thereafter, the board shall 
determine an assessment for each assessed entity in accordance with this subsection. The 
board shall provide a mechanism to protect against duplicate counting of children. The 
board may conduct an audit of the number of covered life months for children as reported 
by an assessed entity. An assessment determination made pursuant to this subsection is an 
adjudicatory proceeding within the meaning of Title 5, chapter 375, subchapter 4. 
A. In determining the amount of the assessment, the board shall: 
(1) Determine the total costs of the fund for the succeeding program year; 
(2) Add a reserve of up to 10% of the total costs of the fund under subparagraph 
(1) for unanticipated costs associated with providing vaccines to children covered 
by the assessed entity; 
(3) 
Subtract the amount of any unexpended assessments collected in the 
preceding year and any unexpended interest accrued to the fund during the 
preceding year; and 
(4) Calculate the assessment on a monthly basis per child to be paid by an 
assessed entity' by dividing the amount determined in accordance with 
subparagraphs (1), (2) and (3) by the number of children projected to be covered 
by the assessed entity during the succeeding program year divided by 12. 
B. The board shall provide the assessed entity with notice of the assessment amount 
for the succeeding program year no later than' January 1, 2011 and annually 
thereafter. 
C. Beginning July I, 20 II, the assessment must be paid on a quarterly basis as 
follows: 
(1) An assessed entity shall pay a quarterly assessment equal to the monthly 
assessment rate per child as described under paragraph A, subparagraph (4) 
mUltiplied by the number of child member months covered by the assessed entity 
in the preceding calendar quarter; and 
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COMMITTEE AMENDMENT"A" to I--LP, 984, LD. 1408 
(2) The assessment must be paid within 45 days following the close of the 
calendar quarter. 
D, After the close of a program year, the board shall reconcile the total assessments 
paid by assessed entities, including interim assessments determined under paragraph 
E, with the actual costs of vaccines provided under the program to children covered 
by assessed entities during that program year and the annual operating expenses of 
the program during that program year. Any unexpended assessments must be used to 
reduce the assessment in the succeeding program year as required under paragraph A, 
subparagraph (3 ). 
. 
E. The board may determine an interim assessment for new vaccines that the board 
has made available through the program pursuant to subsection 3, paragraph E. The 
board shall calculate the interim assessment in accordance with paragraph A, and the 
interim assessment is payable the calendar quarter that begins no less than 30 days 
following the establishment of the federal contract price. The board 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. If the combination of funding available from the United States Department of 
Health and Human Services, Centers for Disease Control and Prevention, Vaccines 
for Children Program and the immunization grant program under the federal Public 
Health Service Act, Section 1928 of the Social Security Act, 42 United States Code, 
Section 1396s is insufficient to provide coverage for vaccines for the children who 
qualify for vaccines under the Vaccines for Children Program, money from the fund 
may not be used to cover the cost of vaccines. for children who would otherwise be 
provided vaccines under the Vaccines for Children Program. 
G. 
If the assessments under this subsection are insufficient to cover the cost. of 
vaccines to be provided to children covered by assessed entities, the State is not 
required to cover the cost of vaccines for those children. 
6. Failure to pay assessment. If an assessment under subsection 5 is not paid on the 
due date established by the board, the provisions of this subsection apply. 
A. The board shall submit a report to the superintendent listing each assessed entity 
that has failed to pay an assessment under subsection 5. 
B. If an assessed entity has not paid an assessment under subsection 5 within 45 days 
following the close of the calendar quarter, interest accrues at 12% per annum on or 
after the due date. Interest paid under this paragraph must be deposited into the fund. 
Upon application, the board may waive s'uch interest payments for good cause shown. 
The superintendent may take any action authorized under Title 24-A to enforce collection 
of any unpaid assessment or fine and may impose any penalty authorized under Title 
24-A for noncompliance with this section if the assessed entity has engaged in a pattern 
of conduct that demonstrates a lack of good faith in complying with the requirements of 
this subsection. 
7. Fund. The Childhood Immunization Fund is established for the sole purpose of 
funding the program, including any costs of vaccines provided under the program to 
children and any costs the board may incur for staff, a service agent, administrative 
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COMMITTEE AMENDMENT·A .. to H.P. 984, L.D. 1408 
support services, legal representation and contracted services. The fund is administered 
by the board or the service agent, which shall act as a fiduciary and manage and invest the 
fund in conformance with prudent investor standards and maintain complete records of all 
assets, investments, deposits, disbursements and other transactions ofthe fund. All money 
and securities in the fund must be held in trust by the Treasurer of State for the purpose of 
making payments under this section and are not money or property for the general use of 
the State. 
The Treasurer of. State is the custodian of the fund and may make 
disbursements only upon written direction from the board or the service agent. All 
assessments collected pursuant to this section, all interest on the balance in the fund and 
all income from any other source must be deposited into the fund. The fund does not 
lapse. No portion of the fund may be used to subsidize other programs or budgets. 
8. 
Reporting~ By January 15th of each year the board shall report to the joint 
standing committee of the Legislature having jurisdiction over health and human services 
matters regarding the operation of the program, the progress of the program in expanding 
access to immunizations for children and the assets, investments and expenditures of the 
fund. 
9. Service agent. The board, by written contract, may delegate administration of the 
fund to a service agent. The service agent: 
A. May contract with attorneys acceptable to the board for legal representation for 
the board; 
B. 
May leyy assessments, institute collection procedures, including legal action if 
necessary, and deposit money in the fund with the Treasurer of State if those funds 
are not needed to meet immediate cash flow demands; and 
C. Shall make recommendations to the board regarding policies, rules and standards 
necessary for the proper administration of the fund. 
10. Freedom from liability. There is no liability on the part of, and a cause of action 
may not arise against, a member of the board for any acts or omissions in the 
performance of the member's duties underthis section. This immunity does not extend to 
willful neglect or malfeasance that would otherwise be actionable~ 
11. Rules. The department and the board shall jointly adopt rules to implement this 
section. Rules adopted pursuant to this subsection are routine technical rules pursuant to 
Title 5, chapter 375, subchapter 2-A. 
Sec. 3. Staggered terms. Notwithstanding the Maine Revised Statutes, Title 22, 
section 1066, subsection 3, paragraph B, with respect to the initial appointees to the 
Maine Vaccine Board under Title 22, section 1066, subsection 3, paragraph A, 
subparagraph (3), divisions (a) and (b), the Governor shall appoint one representative of 
health .insurance carriers and 2 representatives of providers to terms of 2 years and the 
remaining members to 3-year terms. 
Sec. 4. Appropriations and allocations. 
The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Universal Childhood Immunization Program NI05 
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COMMITTEE AMENDMENT "A" to H.P. 984, L.D, 1408 
Initiative: Provides a baseline allocation of funds for the costs of purchasing vaccines for 
children and for the authorized operating expenses of the newly established Maine 
Vaccine Board. 
CHILDHOOD IMMUNIZATION TRUST FUND 
Unallocated 
CHILDHOOD IMMUNIZATION TRUST FUND 
TOTAL 
SUMMARY 
2009-10 
$0 
$0 
2010-11 
$500 
$500 
This amendment is the majority repor1; of the committee. The amendment replaces 
the bill. 
It establishes the Universal Childhood Immunization Program to provide all 
children 18 years of age or younger in the State with access to a uniform set of vaccines. 
The program is administered by the Department of Health and Human Services for the 
purposes of optimizing public and private resources and lowering the cost of providing 
immunizations to children by leveraging contract prices for vaccines established through 
the United States Department of Health and Human Services, Centers for Disease Control 
and Prevention. The program and the Childhood Immunization Fund are overseen by the 
Maine Vaccine Board, The program costs associated with vaccines for children covered 
by health insurance carriers and 3rd-party administrators are funded by assessments on 
those entities. Any costs associated with vaccines for children covered by the United 
States Department of Health and Human Services, Centers for Disease Control and 
Prevention, Vaccines for Children Program are the responsibility of the State. 
Assessments are deposited into the fund, which does not lapse, to be used only for the 
purposes of the Universal Childhood Immunization Program. The board is required to 
repOli annually to the joint standing committee of the Legislature having jurisdiction over 
health and human services matters. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/25/10 frac.. 
LD 1408 
LR 1459(02) 
An Act To Establish the Universal Childhood Immunization Program 
Fiscal Note for Bill as Amended by Committee Amendment 'A" 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
2009-10 
Appropriations/Allocations 
2010-11 
Projections 
2011-12 
Projections 
2012-13 
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Childhood Immunization Trust Fund 
$0 
$500 
$500 
$500 . 
Fiscal Detail and Notes 
Provides a baseline allocation of $500 for the costs of the newly established Universal Childhood Immunization 
program including purchasing vaccines for children and for the authorized operating expenses of the newly established 
Maine Vaccine Board. Assumes that by January 1, 2011, the Maine Vaccine Board will begin to implement the new 
program including establishing the process for the purchasing of vaccines; contracting for staff, a service agent and 
other administrative services; and establishing the assessment to be paid by health insurance carriers and third-party 
administrators registered under MRSA 24-A. The costs of the program and the amount of the assessment will be 
determined by the board and cannot be determined at this time. 
The costs associated with acting as the custodian of the Childhood Immunization Trust Fund can be absorbed by the 
Office of the Treasurer within existing budgeted resources. The costs of the Bureau ofInsurance in the Department of 
Professional and Financial Regulation to enforce the collection of unpaid assessments are assumed to be minor and 
can be absorbed utilizing existing budgeted resources. The costs of the Department of Health and Human Services for 
rulemaking and other support services can be absorbed utilizing existing budgeted resources. 
LRI459(02) - Fiscal Note - Page 1 of 1 
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