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HD 923

An Act to preserve and protect public health

194th Legislature (2025-2026) Introduced by Frank Moran

Massachusetts Medicaid vaccine administration reimbursements must be at least CMS regional rates for all vaccines for Medicaid-eligible adults and children; effective Jan 1, 2026.

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Bill Summary · HD 923

Summary: Bill HD 923 — An Act to preserve and protect public health

Overview

  • Bill Number: HD 923 (House Docket No. 923)
  • Title: An Act to preserve and protect public health
  • Sponsor: Representative Frank A. Moran (Lawrence)
  • Session/Status: Filed and introduced in the 2025-2026 Massachusetts General Court; status not explicitly stated in the provided material
  • Effective date: January 1, 2026
  • Core aim: Ensure Medicaid vaccine administration reimbursements are at least the CMS regional rate for all providers administering vaccines to Medicaid-eligible adults and children

Purpose and Intent

The bill seeks to align Massachusetts Medicaid vaccine administration reimbursement with federal standards by guaranteeing that reimbursement rates for administering vaccines do not fall below the Centers for Medicare & Medicaid Services (CMS) regional reimbursement rate. The intent is to reduce under-reimbursement disparities, improve access to immunizations, and support public health by ensuring providers are adequately compensated for vaccine administration.

Key Provisions

  • Section 83 added to Chapter 118E of the General Laws:
    • Reimbursement rates for vaccine administration for all immunizations (covering all vaccines) for Medicaid-eligible adults and children shall be no less than the CMS regional reimbursement rate.
    • This minimum applies to billing through any Massachusetts Medicaid immunization payment providers or pharmacy benefit managers (PBMs).
  • Effective date: The statute would take effect on January 1, 2026.

Affected Parties

  • Medicaid-eligible recipients in Massachusetts (adults and children) receiving vaccines.
  • Healthcare providers who administer vaccines (e.g., doctors, clinics, pharmacies) that bill Medicaid for vaccine administration.
  • Massachusetts Medicaid immunization payment providers and PBMs that process vaccine-related reimbursements.
  • The Massachusetts Department of Public Health and related Medicaid program administrators may also be affected insofar as implementation and oversight are concerned, though the text does not specify additional administrative changes.

Implementation and Timeline

  • Introduction/Filed: January 14, 2025 (House Docket No. 923; presented by Rep. Moran)
  • Public health/policy goal is to place MA Medicaid vaccine administration reimbursements at or above CMS regional rates
  • Effective date for compliance: January 1, 2026

Fiscal and Policy Considerations

  • Potential increase in Medicaid program costs for vaccine administration reimbursements to meet or exceed CMS regional rates.
  • Could standardize reimbursement across providers and payers, reducing variability and potential access barriers for immunizations.
  • May influence provider participation and vaccine access, especially in settings that serve Medicaid populations.

Notes and Context

  • The bill is titled “An Act to preserve and protect public health,” but the specific substantive change enacted by the bill centers on reimbursement rates for vaccine administration under Medicaid.
  • The text provided focuses exclusively on the reimbursement rate requirement; no other public health or health system provisions are included in the bill as filed.

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

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