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SD 1782

An Act preserving and protecting public health

194th Legislature (2025-2026) Introduced by Sal DiDomenico

Sets a floor: vaccine administration must be reimbursed at least the CMS regional reimbursement rate for all MassHealth/immunization claims, including PBMs; effective Jan 1, 2026.

House concurred
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Bill Summary · SD 1782

Summary: Senate Bill SD 1782 — An Act preserving and protecting public health

Overview

  • Bill number: SD 1782 (Senate) / Senate Docket No. 1782
  • Title: An Act preserving and protecting public health
  • Introduced: February 27, 2025
  • Current status: House concurred
  • Official source: Amends Chapter 118E (Massachusetts General Laws), adding a new section at the end of the chapter
  • Primary sponsor: Sen. Sal N. DiDomenico (Middlesex and Suffolk)

What the bill would do

  • Establish a minimum reimbursement floor for vaccine administration.
  • Specifically, for all immunizations given to Medicaid-eligible adults and children, the reimbursement rate for providers cannot be lower than the Centers for Medicare & Medicaid Services (CMS) regional reimbursement rate.
  • The requirement applies to all vaccine administration billed through Massachusetts Medicaid immunization payment providers or through any pharmacy benefit manager (PBM) used by MassHealth.

Key provisions

  • Amendment: Adds Section 83 to Chapter 118E.
  • Reimbursement standard: No less than the CMS regional reimbursement rate for vaccine administration.
  • Scope: Applies to all immunizations administered to Medicaid-eligible individuals (both adults and children).
  • Billing channels: Must apply to claims submitted via Massachusetts Medicaid immunization payment providers and any PBMs involved in vaccine payments.
  • Effective date: January 1, 2026.

Who is affected

  • Medicaid providers who administer vaccines (physicians, clinics, hospitals, pharmacies, and other immunization providers) who bill MassHealth or PBMs.
  • Medicaid-eligible adults and children who receive vaccines (the patient base impacted by reimbursement practices).
  • Massachusetts MassHealth program administration and related entities responsible for immunization payments and PBM contracts.

Potential impact

  • Policy aim: Ensure vaccine administration reimbursement floors align with CMS regional rates, reducing potential underpayment to providers.
  • Access implications: Could improve provider participation in vaccine programs for Medicaid beneficiaries, potentially improving timely access to immunizations.
  • Financial implications: May affect MassHealth expenditures and PBM billing workflows; any CMS rate adjustments could flow through to Massachusetts reimbursement floors automatically if adopted.

Timeline and procedural history

  • Legislative actions:
    • Filed: January 16, 2025 (Senate Docket No. 1782)
    • Referred: February 27, 2025 to the Committee on Health Care Financing
    • House action: Concurred (indicating both chambers reached agreement on the bill’s terms)
  • Effective date: January 1, 2026 (operationalization date for the new reimbursement floor)

Notes

  • The bill focuses narrowly on establishing a minimum reimbursement rate for vaccine administration tied to CMS regional rates and requires alignment across MassHealth and PBM-based immunization payments.
  • No specific dollar amounts are provided in the text; the relevance rests on the CMS regional rate as the floor.

Compiled from official sources — confirm details with the bill’s official record.

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