An Act to Reduce Cost
Maine Legislature, Session 132, LD 0093
Committee Amendment CA_A_H728 (House)
Amends: 22 MRSA §1066

COMMITTEE AMENDMENT "/-f" to H.P, 58, L,D. 93, "An Act to Reduce Cost
and Increase Access to Disease Prevention by Expanding the Universal Childhood
Immunization Program to Include Adults"
Amend the bill by inserting after section 2 the following;
'See. 3. 22 MRSA §1066, sub-§2, ^A-l is enacted to read:
' A-l, AAF" means an assessment adjustment factor to adjust for variations between
health insurance carriers to maintain equity in assessment allocations among assessed
entities/
Amend the bill by insertmg after section 7 the following;
'See. 8. 22 MRSA §1066, sub-§3, ^, as enacted by PL 2009, c, 595, §2, is
amended to read;
B, With tho exception of the representative of tho pharmaceutical manufacturing
industry, who sorves a one year term, the 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 serve until the appointment of the member's successor.
Sec. 9. 22 MRSA §1066, sub-§3, ^D, as enacted by PL 2009, c, 595, §2, is
amended to read:
D, The board shall meet 4 not fewer than 2 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 admmister the program and the fund.
Sec. 10. 22 MRSA §1066, sub-§3, ^E, as enacted by PL 2009, c, 595, §2, is
amended to read:
E, By January 1, 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 1st. In making its determination, the board shall consider;
COMMITTEE AMENDMENT
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COMMITTEE AMENDMENT "Pc " to H,P, 58, L.D. 93
(1) 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, by direct manufacturer purchase. through the
Minnesota Multistate Contracting Alliance for Pharmacy or a successor
organization or by any other low-cost bulk purchase option;
(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.'
Amend the bill by striking out all of section 8 and inserting the following;
'See. 8. 22 MRSA §1066, sub-§5, as enacted by PL 2009, c. 595, §2, is amended
to read;
5. Assessments. By January 1»2011 and annually thereafter, the board shall determine
an assessment one or more assessments for each assessed entity in accordance with this
subsection. The board shall provide a mechanism to protect against duplicate counting of
children individuals. The board may conduct an audit of the number of covered life months
for children individuals 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, as it determines
aBpropriate following a public hearmg. establish one or more subfunds by age and
coverage type and, for each subfund:
(1) Determine the total costs of the fefid subfund for the succeeding program year;
(2) Add a reserve of up to 10% of the total costs of the fafid subfund under
subparagraph (1) for unanticipated costs associated with providing vaccines to
children individuals covered by the assessed entity;
f2-A) Add an administrative allowance for the department of up to 10% of the
total costs of the subfund;
(3) Subtract the amount of any unexpended assessments collected in the preceding
year and any unexpended interest accrued to the fend subfund during the preceding
year; and
(4) Calculate the assessment on a monthly basis per ehild individual to be paid by
an assessed entity by dividing the amount determined in accordance with
subparagraphs (1), (2)^_(2hA) and (3) by the number of children individuals
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 each subfund established pursuant to paragraph A for the succeeding program year
no later than January 1,2011 and annually thereafter.
COMMITTEE AMENDMENT
COMMITTEE AMENDMENT "/4-" to H,P, 58, L.D. 93
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C. Begirmmg July 1, S044 2025, the assessment must be paid on a quarterly basis as
follows;
(1) An assessed entity shall pay a quarterly assessment for each subfund
established pursuant to paragraph A equal to the monthly assessment rate per eW
mdividual as described under paragraph A, subparagraph (4) multiplied by the
number of ehild individual member months covered by the assessed entity in the
preceding calendar quarter; and
(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 mterkn assessments determined under paragraph
E, with the actual costs of vaccines provided under the program to children individuals
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 for the respective subfund established pursuant to
paragraph A 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
interun 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
Sei-vice 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 individuals covered by assessed entities, the State is not
5 required to cover the cost of vaccines for those children individuals.
H. For any subfund established pursuant to paragraph A after June 2025. after one year
of operation and until discontinued by a 2/3 vote of the board determining that the
8 adjustments described in this paragraph are not needed to maintain eauity_jn assessment
allocations among assessed entities, the follpwingapolY:
(\) Amiuallv, assegsed entities^ ^ be determmed bv the
board to be necessary for the purposes of this subsection and reasonably convenient
for the a^^^ of the AAF
for each entity, to multiply by the otherwise applicable assessment amount to adjust
for variations between entities in the split between partjcmatme and
COMMITTEE AMENDMENT
COMMITTEE AMENDMENT "H " to H,P. 58, L.D, 93
nonoarticipatine providers in vaccine costs of that entity's covered individuals.
The service agent shall comnute the AAF annually for each entity based on
supplied data:
f2) Annually. AAF calculations must be completed during the first Quarter of each
calendar year; and
(3) Each assessment amount otherwise calculated m__accordance with this
subsection must be multiplied by the AAF for the respective entity to compute the
final^assessment due,'
Amend the bill by insertmg after section 11 the following;
'See. 12. Appropriations and allocations. The following appropriations and
allocations are made,
HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Maine Center for Disease Control and Prevention 0143
Initiative; Establishes 2 Public Health Educator IE[ positions in the Maine Center for
Disease Control and Prevention program, effective July 1, 2026, to expand the Universal
Childhood Immunization Program to provide immunizations to and cover the costs of
recommended vaccines for adults in the State and provides funding for related All Other
costs.
FEDERAL EXPENDITURES FUND
POSITIONS - LEGISLATIVE COUNT
Personal Services
All Other
FEDERAL EXPENDITURES FUND TOTAL $0 $221,561
IMedical Care - Payments to Providers 0147
Initiative: Reduces funding to reflect cost savings in the Medical Care - Payments to
Providers program resulting from the procurement of vaccines for adults in the MaineCare
program at the discounted United States Centers for Disease Control and Prevention price
beginning July 1, 2026.
GENERAL FUND 2025-26 2026-27
AHOther $0 ($302,107)
GENERAL FUND TOTAL $0 ($302,107)
FEDERAL EXPENDITURES FUND 2025-26 2026-27
AllOther $0 ($482,180)
FEDERAL EXPENDITURES FUND TOTAL $0 ($482,180)
HEALTH AND HUMAN SERVICES,
DEPARTMENT OF
DEPARTMENT TOTALS 2025-26 2026-27
2025-26
0,000
$0
$0
2026-27
2,000
$202,025
$19,536
COMMITTEE AMENDMENT
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COMMITTEE AMENDMENT "^A-" to H,P, 58, L.D. 93
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GENERAL FUND $0 ($302,107)
FEDERAL EXPENDITURES FUND $0 ($260,619)
DEPARTMENT TOTAL - ALL FUNDS $0 ($562,726)
Sec. 13. Effective date. This Act takes effect July 1,2026,'
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section
number to read consecutively.
SUMMARY
This amendment makes changes to the bill, which amends the law governing the
Universal Childhood Immunization Program to expand the program to provide
immunizations to and cover the costs of recommended vaccines for adults m the State. It
removes references to the United States Centers for Disease Control and Prevention
Advisory Committee on Immunization Practices, It specifies the process for distributmg
total annual program costs among payers by adding assessment calculation language, It
adds other options for the purchase of low-cost vaccines, in addition to the federal Vaccines
for Children Program. It adds an appropriations and allocations section and an effective
date of July 1,2026,
FISCAL NOTE REQUIRED
(See attached)
COMMITTEE AMENDMENT
Approved: 06/06/25 i-KL-
LD93 LR 253(02)
An Act to Reduce Cost and Increase Access to Disease Prevention by Expanding the Universal
Childhood Immunization Program to Include Adults
Fiscal Note for Bill as Amended by Committee Amendment 'j^f' / ^-'
Committee: Health and Human Services
Fiscal Note Required: Yes
Fiscal Note
Projections Projections
FY 2025-26 FY 2026-27 FY 2027-28 FY 2028-29
Net Cost (Savings)
General Fund $0 ($302,107) ($553,935) ($553,°'c'>
Appropriations/AHocations
General Fund $0 ($302,107) ($553,935) ($553,935)
Federal Expenditures Fund $0 ($260,619) ($648,754) ($641,677)
Revenue
Federal Expenditures Fund $0 ($260,619) ($648,753) ($641,677)
Fiscal Detail and Notes
Expanding the State's Universal Childhood Immunization Program to cover the costs of recommended vaccines for
adults will enable the Department of Health and Human Services to procure vaccine for adults in the MaineCare
program at the US. Centers for Disease Control and Prevention discounted vaccine prices. The bill includes General
Fund deappropriations to the Department of Health and Human Services of $302,107 in fiscal year 2026-27 based on
the cost savings from the discounted vaccine prices available to the MaineCare program. It also includes Federal
Expenditure Fund deallocatious for the FMAP match, Projected General Funds deappropriations and Federal
Expenditure Fund deallocations are larger in future years as the changes in the bill are fully implemented.
The bill also includes Federal Expenditure Funds allocations to the department of $221,561 in fiscal year 2026-27 for
two federally-funded Public Health Educator ffl positions to implement the changes to the immunization program.
LR0253(02) - Fiscal Note - Page 1 of 2
G"AW72?)
rd
The bill is expected to increase costs to the State Employee Health Plan (SEI-IP) through the assessments collected
from insurers for adult vaccines purchased by the Universal Childhood Immunization Program and reduce costs to the
SEHP as adult vaccines covered by the program will be available to medical providers at no cost, reducing insurance
claims for adult vaccines. A more precise estimate of the net fiscal impact camiot be determined at this time,
LR0253(02) - Fiscal Note - Page 2 of 2