Click on any document below to download it.
|22 MSRA §1066 (pdf)|
Statute adopted in 2010 that created the Maine Vaccine Board.
MVB Child Covered Lives FAQ
C01. What is the Maine Vaccine Board?
The Maine Vaccine Board (“MVB”) is a State of Maine governmental agency established by 22 MRSA §1066 to oversee Maine’s Universal Childhood Immunization Program.
C03. What if MVB collects too little?
If MVB’s estimates produce funds which are too low to meet the needed vaccine costs, MVB is allowed to issue a supplemental assessment. Initial experience and MVB’s reserve methodology indicate that no supplemental assessment should be needed, but that cannot be stated with absolute certainty.
C04. What if MVB collects too much?
MVB funds may be used only to purchase childhood vaccines for free distribution for the benefit of Maine’s children, pay its reasonable expenses and build the reserve allowed by 22 MRSA §1066. The statute prohibits use of MVB funds for other purposes. If MVB collects more than is needed in any given fiscal year, that amount is carried over and used to reduce the next fiscal year’s assessment rate.
C05. How is each entity’s share determined?
MVB’s statutory assessment, which funds childhood vaccine purchases, is based upon the number of child covered life months. The assessment amount is determined each quarter based upon the total child covered lives per month of that entity in the previous quarter multiplied by the MVB assessment rate.
C06. Are all lives covered or just child covered lives?
Just child covered lives. The assessment is based upon child covered lives of children residing in the State of Maine. A “child” is defined by the statute as any person under age 19. Accordingly, if the insurer or TPA (or other covered entity) would pay for health care benefits for administration of a vaccine to that child, that is a child covered life for purpose of the assessments under the statute.
C08. Are child covered lives under ERISA plans covered?
Yes. Legislative history concerning the statute on this point is very clear. All childhood vaccines administered in the State of Maine will be free under the Universal Childhood Immunization Program established by 22 MRSA §1066. This assessment is the means by which costs are recovered for children whose benefits are funded by private (i.e., non-federally funded) vaccine plans for children. The Board definitively ruled on this question at its October 11, 2011 board meeting.
C10. Do both the employer and the insurer or TPA administering the plan benefits pay the assessment for a given child?
No. The MVB, in accordance with statutory guidance, desires that steps be taken to avoid paying the assessment more than once for any child covered life. Generally speaking, the MVB will look first to the entity which would have written the check paying for the administration of the vaccines as the responsible entity for payment of the assessment. However, to avoid double counting, and to accommodate the needs of specialty plans and private contractual arrangements, MVB will allow another entity to make payment of the assessment if that is confirmed in writing as part of the self-assessment reporting system.
C11. When is the assessment payment due?
MVB operates on a calendar year basis. Each quarterly assessment is due forty-five days following the close of the quarter. Accordingly, the first assessment due for the year is due on or before May 15 based upon child covered life months in the months of January, February, and March. Assessments continue to be due each quarter thereafter on August 15, November 15, and February 15.
C12. Must I still report each year even if I have no covered lives?
Yes. Every insurer and TPA having a license in the State of Maine, along with certain other entities specifically identified in the statute, must report once each a year. A “zero-covered-lives” shortcut has been added to MVB’s self-assessment reporting system so that a report can be completed, literally, in less than five minutes.
C13. What do I report if the only plans I administer have no medical benefits?
Zero. If there are no medical benefits afforded by the plans administered, then the entity would report “0” as its covered lives for each month. This is true even if some persons under the age of 19 have benefits under the plan. For example, if a TPA is administering an eye-care-only benefit plan, then it would report “0” covered lives to MVB.
C14. Must I report each quarter if I have no medical benefits?
No. For entities such as the one described in the preceding Q&A, if it has zero covered lives and continues to have zero covered lives for the balance of the year, then an initial zero-covered-lives report is required for the first quarter, with a brief explanation such as the one above. In that event, so long as no child covered lives arise in the balance of the year, no other report is required until the first quarter of the following year.
C15. What about college plans?
Most college plans will require reporting, because typically some of the students are under age 19. Every person resident in the State of Maine under age 19 must be reported as a child covered life.
C16. What if a child from a Maine primary insured attends school out of state—is that life counted?
Generally yes. Unless the plan (i) definitively knows (a) the child’s PCP is out of state and (b) the child is out of state year round, and (ii) also adopts a practice of counting students attending schools in Maine whose parents reside out of state, that covered life should be counted. Accordingly the default rule for college age children, where a specific year-round residence address is unknown, will be to utilize the state of the primary insured under the plan.
C17. Does the assessment apply to Maine children who are full time students outside the State of Maine?
Yes. See answers above. Generally a licensed entity will be required to pay assessments for all child (i.e., under age 19) covered lives for dependents of any primary plan beneficiary resident in the State of Maine. However, as noted above, an entity which reports as Maine child covered lives children attending college in the State of Maine who reside in the State of Maine from plans created outside the State of Maine may be permitted to exclude from Maine covered lives counts some children of primary beneficiaries in the State of Maine who are full-time, year-round residents at a college outside the State of Maine. However, this would require clear demonstration as to the uniform application of commercially reasonable residency determination rules. (See prior Q&As.) The recommended, and generally more straightforward approach, is to determine child residency based on the residency of the primary plan beneficiary.
C18. Are stop-loss and limited benefit medical products assessable?
Yes. However, in many cases there may be contractual arrangements in place whereby another assessable entity also is involved in processing of medical benefits claims. In that case, if the entity is able to confirm, in writing, that another entity will be paying the assessment, then the lives would not be counted. It is the policy of MVB to avoid double counting of child covered lives and to work cooperatively whenever multiple entities are involved in a particular benefit package. Generally, MVB will accept the determination among those entities as to which of those entities is responsible for reporting and paying the assessments on the respective child covered lives.
C20. Are accident only and hospital indemnity plans subject to the assessment?
Generally no. If no primary care medical benefits are provided and no payments would be made for the administration of the vaccines under any circumstances under the plan, then generally individuals covered by such a plan are not considered “covered lives” under the statute. Kindly note, however, that newborns often receive initial vaccines in the hospital, so if that benefit is covered under the plan then that child is a child covered life.
C21. If we administer only health savings accounts are we required to report covered lives?
No. Health savings accounts are not health insurance and lives affected by such accounts are not considered covered lives for purposes of the assessment. Such lives would be reported by the administrator of the high deductible health plan (or other medical benefits plan) for which such health savings account provides funding or supplemental direct payments. TPAs involved exclusively in the administration of health savings accounts should provide a zero-covered-lives report once each year as described in the filing videos.
C22. What if I’m still not sure if I have to count certain child lives?
Start here: If your organization pays or is responsible for any claims payments for health benefits delivered in the State of Maine for individuals under age 19, begin with the assumption that you must report those as child covered lives. Another way to look at the topic is this – if any child for which your organization makes or is responsible for payments for any health benefits receives free vaccines through the State of Maine’s Universal Childhood Immunization Program, that child life must be reported as a covered life and the assessment payment must be made by your organization unless you have conclusive written assurance that another organization is reporting and paying assessments for that same child and such payments are, in fact, timely made.