An act relating to issuing immunization recommendations

Program eligibility narrowed from 'all Vermonters' to 'all Vermonters individuals domiciled in the State,' potentially excluding non-domiciled residents from free immunization access.

Vaccine purchasing provision now requires the lowest available cost 'identified by the Department,' giving the Department explicit authority over vendor and pricing determinations rather than a general lowest-cost standard.

Vermont Immunization Advisory Council membership reduced from approximately 14 members to 9. Removed seats for Board of Nursing, Board of Pharmacy, practicing pharmacist, and advanced practice registered nurse. Added explicit licensing requirements (26 V.S.A. chapter 23 or 33) for physician and researcher members.

Removed the requirement that the Department prominently display immunization information on its website and the requirement to disclose when Commissioner recommendations differ from Vermont Immunization Advisory Council recommendations.

Removed the restriction that the Advisory Council chair 'shall not be the Commissioner,' allowing the Commissioner to serve as council chair.

Standing order provision changed from 'within the scope of the health care professional's practice' to 'within the scope of the health care professional's scope of practice,' using more precise legal terminology for scope-of-practice limitations.

Recommendation language changed from passive 'are recommended to receive' to active 'should receive,' making the Commissioner's immunization recommendations more directive in tone.

Removed the provision that the Secretary of Education and public schools representative shall not vote on advice regarding recommended immunizations, eliminating a conflict-of-interest safeguard.

Added an explicit effective date section: 'This act shall take effect on July 1, 2026.'

The Immunization Funding Advisory Committee will receive only 'administrative support' from the Department of Health rather than 'administrative and technical support,' reducing the level of departmental resources allocated to the committee.

The definition of 'recommended immunization' shifts from being based on CDC/ACIP practice guidelines to being based on recommendations issued by the Commissioner of Health pursuant to section 1130a. This gives Vermont its own state-level immunization recommendation authority instead of deferring to federal guidance.

The universal access goal language changes from 'individuals domiciled in the State' to simply 'all Vermonters,' broadening who is covered by the no-cost immunization program.

The Vermont Immunization Advisory Council membership is expanded to include the executive officer of the Board of Nursing, the executive officer of the Board of Pharmacy, a practicing advanced practice registered nurse, and a practicing pharmacist. Public schools and independent schools are now separate seats rather than a combined 'public and independent schools' seat.

New subsection 1130a(e) requires the Department to prominently display information about recommended immunizations on its website, including how to access them, and to include a disclosure in any documents if the Commissioner's recommendations differ from those of the Vermont Immunization Advisory Council.

A new voting restriction is added: the Secretary of Education (or designee) and the representative of public schools shall not vote on advice regarding recommended immunizations as defined in section 1130.

Purchasing language changes from 'at the lowest available cost identified by the Department' to 'consistent with the goals of the program... at the lowest available cost,' giving the Department more discretion in purchasing decisions.

Immunization Funding Advisory Committee appointment language is modified throughout to add 'or designee' options for several members and to clarify that insurer representatives are appointed by the Commissioner from each of the state's largest three private health insurers.

The bill is restructured from a complex 15-section format with separate effective-on-passage, effective-2031, and repeal sections into a simpler structure. The old version included an explicit repeal of section 1130a on July 1, 2031 (Sec. 14) and a dedicated effective dates section (Sec. 15), which are reorganized in the new version.

Pharmacist prescribing authority under 26 V.S.A. section 2023 is modified to reference 'recommendations established in accordance with 18 V.S.A. section 1130a' rather than directly referencing ACIP-approved immunization schedules, aligning pharmacist authority with the new state recommendation framework.

The Committee support language changes from 'administrative support' to 'administrative and technical support' from the Department of Health.

The immunization program's universal access goal was narrowed from 'all Vermonters' to 'all Vermonters individuals domiciled in the State,' potentially excluding non-domiciled residents.

The Vermont Immunization Advisory Council membership was expanded from approximately 9 to 14 members, adding the executive officer of the Board of Nursing, the executive officer of the Board of Pharmacy, a practicing advanced practice registered nurse, and a practicing pharmacist as new appointed members.

A new voting restriction was added: the Secretary of Education (or designee) and the representative of public schools are prohibited from voting on advice regarding recommended immunizations as defined in section 1130.

A transparency requirement was added requiring the Department to prominently display information about recommended immunizations on its website, and to include a disclosure in any documents if the Commissioner's recommendations differ from those of the Vermont Immunization Advisory Council.

The Council chair selection provision was modified to specify that the chair 'shall not be the Commissioner,' preventing the Commissioner of Health from presiding over the advisory body.

Section 1130a(a)(5) changed from 'necessary to promote the maintenance of public health' to 'necessary to ensure the maintenance of public health,' strengthening the standard from promotion to assurance.

The language in section 1130a(a)(1) changed from 'which immunizations children and adults are recommended to receive' to 'which immunizations children and adults should receive,' shifting from a passive descriptive tone to an active prescriptive one.

A sunset/reversion structure was added: Sections 1-7 take effect on passage but only until July 1, 2031. Sections 8-13 then take effect on July 1, 2031 to restore the prior legal framework. Section 14 explicitly repeals the new Section 1130a (Commissioner's immunization recommendations) on July 1, 2031. The introduced version had a single effective date of July 1, 2026 with no expiration.

The Commissioner may issue standing orders authorizing health care professionals, including pharmacists, to prescribe, dispense, or administer recommended immunizations within the scope of their practice.

The Vermont Immunization Advisory Council membership was significantly expanded. The introduced version had 6 member categories. The passed version has 14, adding: Board of Nursing executive officer, Board of Pharmacy executive officer, State epidemiologist, Immunization Program Manager, a practicing pediatrician, two infectious disease experts, a family or internal medicine physician, an advanced practice registered nurse, and a practicing pharmacist. A new rule was added that the Secretary of Education and public schools representative cannot vote on recommended immunizations advice.

New pharmacist authority was added (Section 6): pharmacists may prescribe, order, or administer recommended immunizations for patients 18 and older under a state protocol, and influenza/COVID-19 vaccines for patients 5 and older consistent with recommendations established under Section 1130a.

New pharmacy technician authority was added (Section 7): technicians may administer immunizations to patients 18+ (per the pharmacist protocol), influenza/COVID-19 to patients 5+, must follow ACIP schedules, and must have a trained licensed pharmacist present and able to assist.

The scope of universal access was narrowed slightly: the introduced version referenced 'all Vermonters individuals domiciled in the State' while the passed version uses 'all Vermonters' without the domicile qualifier.

A new Section 1130a was added authorizing the Commissioner of Health to periodically issue recommendations on which immunizations children and adults should receive, at what ages, how many doses, and timing between doses. The Commissioner must consult the Vermont Immunization Advisory Council and consider recommendations from ACIP, AAP, AAFP, ACOG, ACP, and other organizations before issuing recommendations.

Health care professionals who prescribe, dispense, or administer immunizations in accordance with the Commissioner's recommendations are immune from civil and administrative liability for immunization-caused adverse events, unless their actions constituted gross negligence, recklessness, or intentional misconduct.

The definition of 'recommended immunization' in Section 1130(a)(4) was changed. The introduced version defined it by reference to ACIP/CDC practice guidelines. The passed version defines it as vaccines recommended by 'practice guidelines for children and adults established by the Commissioner pursuant to section 1130a,' shifting the source of authority from federal ACIP guidelines to the Commissioner's own recommendations.

New insurance coverage mandates were added in Sections 4 and 5 (effective until July 1, 2031) requiring group insurance policies and individual/small employer health benefit plans to cover recommended immunizations without co-payment, coinsurance, or deductible, but only for immunizations that have an ACIP recommendation in effect.

The purchase source language was modified: the introduced version said vaccines would be purchased 'at the lowest available cost identified by the Department' while the passed version simply says 'at the lowest available cost,' removing the Department's role in identifying cost.