What is the New Hampshire Vaccine Association assessment, and what is it for?
New Hampshire has a universal vaccine purchasing program in which the state uses a federal, contracted price list to purchases vaccines at the lowest rate possible for all children, regardless of insurance coverage or income. The New Hampshire Vaccine Association was created by statute (RSA 126-Q) to assess assessable entities for the cost of vaccines provided to insured children under 19 years of age in New Hampshire. NHVA does not set vaccine policy or create vaccine laws. Vaccines for publicly insured, underinsured, and uninsured children are paid for with either the federally funded Vaccines for Children (VFC) program dollars and New Hampshire state funds.
The funds raised by the New Hampshire Vaccine Association are used by the State of New Hampshire’s Department of Health and Human Service’s Immunization Program. New Hampshire’s program equitably shares the cost of the program via public and private resources that pay for the vaccines while providing healthcare cost savings and lowering administrative burden on providers.
Is the assessment voluntary and are insurers the only ones responsible for paying for vaccines administered to children in New Hampshire?
The assessment is not voluntary as RSA 126-Q establishes a mandatory assessment. HMOs, third-party administrators, insurance companies, health service corporations, and other payers are "assessable entities" subject to assessment [RSA 126-Q:1(II)]. “Assessable coverage” includes health coverage, stop loss coverage, group excess loss insurance, or a group health plan [RSA 126-Q:1(I)]. Vision, dental, and pharmacy only plans are not considered “assessable coverage” if they are offered separately from medical benefit plans. “Assessable lives” are all children under 19 years of age residing in the state who have assessable coverage written or administered by an assessable entity [(RSA 126-Q:1(III)].
The updated RSA 126-Q makes both stop loss insurers and TPAs (or any other entity providing administrator services to an employer health plan) liable for the child covered life assessment now applicable [See RSA 126-Q:1(I-III)]. In accordance with the statute, NHVA is working “. . . to assure that no assessable life is counted more than once.” [RSA 126-Q:3(p)]. RSA 126-Q:3(p) goes on to say that “Unless otherwise determined by the board, the assessable entity responsible for the payment of the provider’s administrative costs for childhood vaccines shall be the entity responsible for reporting assessable lives and payment of the corresponding assessment.” Unless otherwise specifically agreed among the responsible entities in writing, all applicable child covered lives should be reported (and assessments paid) by the entity that pays medical benefit claims for the respective children.
How and when is the assessment rate set?
The assessment rate is calculated based on estimated vaccine costs and program expenses. Assessable entities are required to pay a quarterly assessment for each of their assessable lives. Assessable lives (sometimes referred to as “covered lives”) are defined by statute as “all children under 19 years of age residing in the state who have assessable coverage written or administered by an assessable entity.” The rate is set each fall for the upcoming calendar year and the assessable entities are notified of the rate.
When are assessments due?
Assessments are due 45 days after the end of each calendar year quarter. This means that a quarterly report and payment are due on or before each February 15, May 15, August 15, and November 15.
If my company has zero covered lives, am I still required to report every quarter?
No. An entity with zero covered lives should file a zero covered lives report. There are two types of zero covered lives reports: yearly and permanent. You should file a yearly zero covered lives report when you know you will not have any child covered lives for the rest of the fiscal year. You should file a permanent zero covered lives report when you know that you will never have any child covered lives.
Please note that if you file one of these reports, but later your company actually has assessable lives, you must start reporting regularly beginning with the first quarter in which you have assessable lives.
Where do I go to complete a quarterly assessment report or to file a zero covered lives report?
Please go to www.nhvaccine.org and click the “For Payers” tab or the “Submit a Filing” button. If you have never filed a report before, this process will also allow you to register to obtain access to complete a filing.
Please contact Erin Meagher at 603-225-6633 or firstname.lastname@example.org if you have any questions or need assistance.
What forms of payment are accepted?
Payments can be made by check or electronically. Electronic payment is preferred. Checks should be made out to the “New Hampshire Vaccine Association” and mailed to:
New Hampshire Vaccine Association
Lighthouse Payment Services, Inc.
PO Box 4110
Woburn, MA 01888-4110
All ACH/EFT payments go to:
Bank of New Hampshire
ABA Routing #: 211770271
Account #: 851031104
Payer Name: ------
Payer Fed ID: xx-xxxxxxx
Indicate if payment includes multiple payers or invoices
Are there penalties for late payment or non-payment?
A late fee of .000493 times the balance times the number of days past due is added to the amount due. This corresponds roughly to 18% per annum. Additionally, RSA 126-Q:5 provides for severe and mandatory fines for non-payment. Further sanctions may also be imposed pursuant to other insurance laws and regulations.
How can healthcare providers participate in the program?
All health care providers who vaccinate children are encouraged to contact the New Hampshire Department of Health and Human Service's Immunization Program at (603) 271-4482 to enroll. The program benefits providers by removing financial burdens associated with providing immunization services. Medical providers do not have to purchase vaccines with their own money and await reimbursement from insurance companies. Instead, the program makes it possible for all providers to receive state-supplied vaccines for all children at no cost. This means providers can offer better continuity of care because all children can receive immunizations in their medical homes. Providers bill insurers for the vaccine administration fee. Patients are still responsible for the cost of administering the vaccine if their medical plan does not pay the entire cost.