Resolution on Point-of-Service Reimbursement Exposed

The Resolution on Point-of-Service was considered at ALEC's 37th Annual Meeting on August 7, 2010 by the Health and Human Services Task Force. This bill was part of the ALEC task force agenda between 2010 and 2012, but due to incomplete information, it is not known if the bill passed in a vote by legislators and lobbyists at ALEC task force meetings, if ALEC sought to distance itself from the bill as the public increased scrutiny of its pay-to-play activities, or if key operative language from the bill has been introduced by an ALEC legislator in a state legislature in the ensuing period or became binding law.

ALEC Draft Bill Text

SUMMARY

This resolution encourages school-based influenza vaccine programs and urges the State Insurance Commissioner and the State Department of Health to convene a stakeholder meeting regarding private insurance coverage of school-based influenza vaccination programs.

RESOLUTION

WHEREAS, Every year in the United States, on average, more than 200,000 people are hospitalized from influenza-related complications and about 36,000 people, mostly in the elderly, die from influenza-related causes; and

WHEREAS, The most effective strategy for preventing influenza is annual vaccination; and

WHEREAS, School-aged children ages five to 19 years have the highest rates of influenza infection, and school-aged children are the major vectors for influenza transmission that spread the virus to adults and the elderly in the community, causing substantial socioeconomic impact; and

WHEREAS, The U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends universal vaccination for influenza; and

WHEREAS, Influenza vaccination rates for school-aged children are extremely low, ranging from 21.1% (high-risk) to 33% (healthy) during the 2006-07 influenza season, and new immunization strategies are needed to improve vaccination in this population; and

WHEREAS, The potential threat of an influenza pandemic underscores the importance of building a school-based vaccination infrastructure as federal pandemic preparedness plans call for the vaccination of an unprecedented number of children with the pandemic vaccine, potentially in the school setting; and

WHEREAS, School-based influenza vaccination programs have grown substantially in recent years and have been particularly successful in schools in which a majority of children qualify for the vaccine though the federal Vaccines for Children program; and

WHEREAS, A barrier in school-based influenza vaccination programs is the reimbursement of the vaccine’s cost to children who have private insurance that covers the influenza vaccine but does not recognize the school setting as a “point of service” for administration of the vaccine; and

WHEREAS, Private insurance’s recognition of alternative delivery venues, such as schools, for the administration of the influenza vaccine would increase access for all school-aged children to receive vaccination to protect themselves and their communities from influenza.

NOW THEREFORE BE IT RESOLVED that school-based influenza vaccination programs should be encouraged to help increase school-aged children’s access to immunization, help protect them from influenza-related illness and reduce school absenteeism due to influenza, and help provide protection to the community at large.

BE IT FURTHER RESOLVED that the {insert state legislature} strongly urges the {insert state insurance commissioner} and {insert state department of health} to convene a meeting with private insurers, the public health community, and vaccine stakeholders to discuss ways to encourage private insurers who already cover influenza vaccination to cover all reasonable and customary expenses, including the cost of the vaccine and administration fee, incurred when the influenza vaccine is administered outside of the physician’s office in a school or other related settings.