AB 2093 Summary

• Prohibits health care service plans from requiring physicians or physician groups to assume financial risk for acquisition or administration costs of required childhood and adolescent immunizations, effective January 1, 2011.

• Requires health care service plans and health insurers to reimburse physicians for vaccine administration costs at no less than the amount specified in the current annual Medicare physician fee schedule, including physician time, clinical staff time, office staff time, and practice expenses.

• Mandates reimbursement for immunizations not part of the current contract at the lowest of: physician's actual acquisition cost, average wholesale price, or lowest acquisition cost through plan-available sources, within 45 days of receipt of documentation.

• Exempts services provided under Public Employees' Retirement System, Medi-Cal, and Healthy Families Program contracts from these reimbursement requirements.

• Allows physician groups to assume financial risk for immunization costs only if experiential data has been negotiated with the plan or if the group has an exclusive contract to serve a specific geographic area.