directing the department of health and human services to provide notice of medical and religious exemptions from immunization requirements and relative to notice of drug pricing options.

Removed the provision that would have expanded child care scholarship eligibility to families with gross monthly income up to 95 percent of state median income (amending RSA 167:83, II(r)).

Removed the provision that would have redirected 50 percent of tobacco tax surplus revenue to DHHS for administering and expanding child care scholarship eligibility (amending RSA 78:24).

Removed the provision that would have redirected 50 percent of liquor commission fund monthly surplus to DHHS for child care scholarship purposes (amending RSA 176:16).

Removed the provision that would have redirected 50 percent of alcoholic beverage fee surplus to DHHS for child care scholarship purposes (amending RSA 178:26).

Added an effective date section: Section 1 (immunization exemption notice) takes effect 90 days after passage; the remainder (drug pricing options) takes effect January 1, 2027.

The immunization notice requirement was narrowed from applying to any communication, publication, posting, advertisement, website, social media post, or other location where DHHS promotes vaccination, down to only printed or electronic materials about required childhood immunizations distributed in connection with school and child care enrollment.

The notice format was changed from bold, capitalized, starred print that must be at least as prominent as the main headline and cannot appear in footnotes or disclaimers, to a simple statement reading 'Medical and religious exemptions are available under New Hampshire law' with a website link on an existing page.

Rulemaking authority changed from mandatory ('shall adopt rules') to permissive ('may adopt rules').

The entire penalty section was removed. The House version made violations of the immunization notice requirement a misdemeanor (for individuals) or felony (for organizations), and required disciplinary action against DHHS employees who distributed non-compliant promotional material.

The provision allowing parents to use any written signed statement (rather than a specific DHHS form) to attest to religious objection for immunization exemption was removed entirely.

New provision expands child care scholarship program eligibility to families whose gross monthly income is less than or equal to 95 percent of state median income for their family size, subject to availability of funds.

50 percent of any surplus tobacco tax revenue over the year's planned revenue is redirected to DHHS to administer and expand the child care scholarship program (remainder goes to general fund).

50 percent of any monthly surplus in the liquor commission fund over that month's planned revenue is redirected to DHHS for the child care scholarship program (remainder goes to general fund).

50 percent of any monthly surplus from beverage license fees over that month's planned revenue is redirected to DHHS for the child care scholarship program (remainder goes to general fund).

The entire annual compliance report section (former Section 4) was deleted. This had required the department to submit a yearly written report to legislative committees listing all promotional campaigns, whether required notices were included, any violations, and civil penalties assessed, with the report posted publicly on the department's website.

The penalty for department employees who distribute non-compliant promotional material was changed from a civil penalty of up to $1,000 per violation (deposited in the general fund) to internal disciplinary or corrective action handled by the commissioner under RSA 21-I and applicable personnel rules. This shifts enforcement from a financial penalty to an internal HR matter.

The list of covered actions by department employees was expanded from 'authorizes or distributes' to 'authorizes, approves, or distributes,' adding 'approves' as a separately covered action.

The fiscal note changed from recurring annual costs ($43,000 in FY2027, $45,500 in FY2028, $47,500 in FY2029) to a single one-time cost of $43,500 in FY2027 only. A new methodology section explains this reflects a part-time medical health services specialist needed for the first year to communicate changes to providers, with full compliance expected within nine months including rule development.