H 545 — An act relating to issuing immunization recommendations

BILL AS PASSED BY THE HOUSE H.545 Page 5 of 33 (D) three representatives of health insurers, one from each of the State’s largest private health insurers, as determined by the number of covered lives, appointed by the Commissioner of Health;

(E) a representative of the American Academy of Pediatrics, Vermont chapter, appointed by the Commissioner of Health;

(F) a representative of the American Academy of Family Medicine, Vermont chapter, appointed by the Commissioner of Health;

and (G) a representative of employers that self-insure for health coverage, appointed by the Commissioner of Health.

(2) The Committee shall select a chair from among its members at the first meeting of each calendar year.

The Committee shall receive administrative support from the Department of Health.

(3) By January 1 of each year, the Committee shall provide to the Commissioner the annual fiscal assessment and the per-member per-month cost for pediatric vaccines recommended immunizations based on the total number of pediatric covered lives reported by health insurers and the per- member per-month cost for adult vaccines recommended immunizations based on the total number of adult covered lives reported by health insurers.

(h) If federal purchase requirements do not further the goal of ensuring universal access to vaccines recommended immunizations for all, the Commissioner may, following consultation with the Immunization Funding BILL AS PASSED BY THE HOUSE H.545 Page 6 of 33 Advisory Committee, discontinue the program with six months’ advance notice to all health care professionals and to all health insurers with Vermont covered lives.

(i) The Department may adopt rules under 3 V.S.A.

chapter 25 to implement this section.

Sec.

2.

18 V.S.A.

§ 1130a is added to read:

§ 1130a.

RECOMMENDED IMMUNIZATIONS (a) The Commissioner shall periodically issue recommendations regarding:

(1) which immunizations children and adults should receive;

(2) the recommended age at which each immunization should be given;

(3) the number of immunization doses that should be administered;

(4) the amount of time between doses of an immunization;

and (5) any other recommendations regarding immunizations necessary to ensure the maintenance of public health and disease prevention in the State.

(b) Prior to issuing recommendations under subsection (a) of this section, the Commissioner shall:

(1) consult with the Vermont Immunization Advisory Council, established under section 1131 of this title;

and (2) consider recommendations for immunizations issued by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), the American BILL AS PASSED BY THE HOUSE H.545 Page 7 of 33 Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), the American College of Physicians (ACP), and any other organizations the Commissioner may deem necessary.

(c) A health care professional who prescribes, dispenses, or administers an immunization in accordance with the recommendations issued pursuant to subsection (a) of this section shall be immune from civil and administrative liability for immunization-caused adverse events, unless the health care professional’s actions regarding prescribing, dispensing, or administering an immunization constituted gross negligence, recklessness, or intentional misconduct.

(d) The Commissioner may issue a standing order authorizing health care professionals, including pharmacists, to prescribe, dispense, or administer recommended immunizations, or any combination thereof, to the extent that prescribing, dispensing, or administering recommended immunizations is within the scope of the health care professional’s scope of practice.

(e) As used in this section, “health care professional” and “recommended immunization” have the same meanings as in section 1130 of this title.

Sec.

3.

18 V.S.A.

§ 1131 is amended to read:

§ 1131.

VERMONT IMMUNIZATION ADVISORY COUNCIL (a) Creation.

There is created the Vermont Immunization Advisory Council for the purpose of providing education policy, medical, and BILL AS PASSED BY THE HOUSE H.545 Page 8 of 33 epidemiological expertise and advice to the Department with regard to the safety of immunizations and immunization schedules.

(b) Membership.

The Council shall be composed of the following members:

(1) a representative of the Vermont Board of Medical Practice, appointed by the Governor;

(2) the Secretaries of Human Services and of Education or their designees;

(3) the State epidemiologist or designee;

(4) the Department of Health’s Immunization Program Manager or designee;

(5) a practicing pediatrician licensed pursuant to 26 V.S.A.

chapter 23 or 33, appointed by the Governor;

(6) two individuals who are professors, researchers, or physicians licensed pursuant to 26 V.S.A.

chapter 23 or 33, or any combination these individuals, with expertise in infectious disease and human immunizations, appointed by the Governor;

(7) a family or internal medicine physician licensed pursuant to 26 V.S.A.

chapter 23 or 33, appointed by the Governor;

(5)(8) a representative of both public and independent schools, appointed by the Governor;

and BILL AS PASSED BY THE HOUSE H.545 Page 9 of 33 (6)(9) any other persons deemed necessary by the Commissioner.

(c) Powers and duties Duties.

The Council shall:

(1) review and make recommendations regarding the State’s immunization schedule for attendance in schools and child care facilities;

and (2) provide any other advice and expertise requested by the Commissioner, including advice regarding immunization recommendations issued by the Commissioner pursuant to subsection 1130a(a) of this title.

(d) Assistance.

The Council shall have the administrative, technical, and legal assistance of the Department.

(e) Meetings.

(1) The Council shall convene at the call of the Commissioner, but no less than once each year.

(2) The Council shall select a chair from among its members at the first meeting.

(3) A majority of the membership shall constitute a quorum.

Sec.

4.

EFFECTIVE DATE This act shall take effect on July 1, 2026.

§§ 1130 1130 is amended to read:

IMMUNIZATION FUNDING BILL AS PASSED BY THE HOUSE H.545 Page 10 of 33 (a) As used in this section:

* * * (b)(1) The Department of Health shall administer an immunization program with the goals of ensuring universal access to vaccines recommended immunizations for all Vermonters at no charge to the individual and reducing the cost at which the State may purchase vaccines recommended VT LEG #386921 v.1 AS PASSED BY HOUSE H.545 Page 2 of 24 immunizations.

BILL AS PASSED BY THE HOUSE H.545 Page 11 of 33 (2) The Department shall solicit, facilitate, and supervise the participation of health care professionals, health care facilities, and health insurers in the immunization program in order to accomplish the State’s goal of universal access to recommended immunizations at the lowest practicable cost to individuals, insurers, and State health care programs.

VT LEG #386921 v.1 AS PASSED BY HOUSE H.545 Page 3 of 24 (d) The immunization program shall provide for distribution of the vaccines recommended immunizations to health care professionals and health care facilities for administration to patients.

(e) Health insurers shall remit to the Department the cost of vaccines recommended immunizations, as established by the Commissioner of Health BILL AS PASSED BY THE HOUSE H.545 Page 12 of 33 based on the recommendation of the Immunization Funding Advisory Committee established in subsection (g) of this section.

VT LEG #386921 v.1 AS PASSED BY HOUSE H.545 Page 4 of 24 (C) a representative, appointed by the Director of the Vermont Blueprint for Health, nominated by the Director of the Blueprint and appointed by the Commissioner of Health;

BILL AS PASSED BY THE HOUSE H.545 Page 13 of 33 (D) three representatives of health insurers, one from each of each appointed by the State’s largest three private health insurers, as determined by the number of covered lives, appointed by the Commissioner of Health;

(3) By January 1 of each year, the Committee shall provide to the Commissioner the annual fiscal assessment and the per-member per-month cost for pediatric vaccines recommended immunizations based on the total number of pediatric covered lives reported by health insurers and the per- VT LEG #386921 v.1 AS PASSED BY HOUSE H.545 Page 5 of 24 member per-month cost for adult vaccines recommended immunizations based on the total number of adult covered lives reported by health insurers.

BILL AS PASSED BY THE HOUSE H.545 Page 14 of 33 (h) If federal purchase requirements do not further the goal of ensuring universal access to vaccines recommended immunizations for all, the Commissioner may, following consultation with the Immunization Funding Advisory Committee, discontinue the program with six months’ advance notice to all health care professionals and to all health insurers with Vermont covered lives.

§§ 1130a 1130a is added to read:

§§ 1130a. 1130a.

and VT LEG #386921 v.1 AS PASSED BY HOUSE H.545 Page 6 of 24 (5) any other recommendations regarding immunizations necessary to promote the maintenance of public health and disease prevention in the State.

BILL AS PASSED BY THE HOUSE H.545 Page 15 of 33 (b) Prior to issuing recommendations under subsection (a) of this section, the Commissioner shall:

(d) The Commissioner may issue a standing order authorizing health care professionals, including pharmacists, to prescribe, dispense, or administer VTrecommended LEGimmunizations, #386921or v.1any AScombination PASSEDthereof, BYto HOUSEthe H.545extent Pagethat 7BILL ofAS 24PASSED recommendedBY immunizations,THE orHOUSE anyH.545 combinationPage thereof,16 toof the33 extent that prescribing, dispensing, or administering recommended immunizations is within the scope of the health care professional’s practice.

§§ 1131 1131 is amended to read:

VT LEG #386921 v.1 AS PASSED BY HOUSE H.545 Page 8 of 24 (1) a representative the executive officer of the Vermont Board of Medical Practice, appointed by the Governor or designee;

BILL AS PASSED BY THE HOUSE H.545 Page 17 of 33 (2) the executive officer of the Vermont Board of Nursing or designee;

VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 918 of 2433 (c) Powers and duties Duties.

VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1019 of 2433 * * * Effective on Passage until July 1, 2031:

§§ 4042 4042 is amended to read:

* * * (ii) recommended immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved as defined in 1818 V.S.A. V.S.A.

§§ 1130; 1130;

* * * VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1120 of 2433 Sec.

§§ 1811 1811 is amended to read:

§§ 1130; 1130;

PRESCRIBING * * * VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1221 of 2433 (b) A pharmacist may prescribe in the following contexts:

§§ 1130 1130 for patients 18 years of age or older, vaccinations recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) and administered consistently with the ACIP-approvedACIP- approved immunization schedules, as may be amended from time to time;

(viii) for patients five years of age or older, influenza vaccine immunization, COVID-19 vaccine immunization, and subsequent formulations VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1322 of 2433 or combination products thereof consistent with the recommendations established in accordance with 18 V.S.A.

§§ 1130a; 1130a;

VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1423 of 2433 (d) Pharmacy technicians shall administer only those immunizations that:

§§ 1130 1130 is amended to read:

* * * VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1524 of 2433 (4) “Recommended immunization Immunizations” means a vaccine or other immunizing agent that provides protection against a particular disease or pathogen and the application of the immunizations as recommended by the practice guidelines for children and adults established by the Commissioner pursuant to section 1130a of this title Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC).

VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1625 of 2433 (3) The Department shall gather and analyze data regarding the immunization program for the purpose of ensuring its quality and maximizing protection of Vermonters against diseases preventable by immunization.

VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1726 of 2433 (g)(1) The Immunization Funding Advisory Committee is established to provide the Commissioner with an annual per-member per-month cost for recommended immunizations for the pediatric population, an annual per- member per-month cost for recommended immunizations for the adult population, and a recommendation for the amount of the yearly immunization assessment.

VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1827 of 2433 (i) The Department may adopt rules under 3 V.S.A.

§§ 1131 1131 is amended to read:

* * * VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 1928 of 2433 (e) Meetings.

§§ 4042 4042 is amended to read:

* * * (ii) recommended immunizations as defined in 1818 V.S.A. V.S.A.

§§ 1130 1130 for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 2029 of 2433 the Centers for Disease Control and Prevention with respect to the individual involved;

§§ 1811 1811 is amended to read:

* * * (ii) recommended immunizations as defined in 1818 V.S.A. V.S.A.

§§ 1130 1130 for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved;

VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 2130 of 2433 * * * * * * Effective on July 1, 2031:

§§ 2023 2023 is amended to read:

VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 2231 of 2433 (vii) recommended immunizations as defined in 18 V.S.A.

§§ 1130 1130 for patients 18 years of age or older, vaccinations recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) and administered consistently with the ACIP-approvedACIP- approved immunization schedules, as may be amended from time to time;

§§ 1130a; 1130a;

§§ 2042a 2042a is amended to read:

and VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 2332 of 2433 (3) pursuant to the schedules and recommendations of the Advisory Committee on Immunization Practices’ recommendations for the administration of immunizations, as those recommendations may be updated from time to time;

VTBILL LEG #386921 v.1 AS PASSED BY THE HOUSE H.545 Page 2433 of 2433 * * * Effective on July 1, 2031:

IMMUNIZATION RECOMMENDATIONS 18 V.S.A.

§§ 1130a 1130a (recommended immunizations) is repealed on July 1, 2031.

VT LEG #386921 v.1