After reviewing the staff analysis of House Bill 1873 (97-98 session), the Pennsylvania Health Care Cost Containment Council does not find evidence to recommend the passage of this legislation in its current form. While we recognize that prevention-through immunization-is an effective method in combating this chronic disease, we did not find evidence to recommend acceleration of the hepatitis B immunization program as currently outlined in this bill.
Starting in August of 1997, children enrolling in school were required to receive the hepatitis B vaccine. House Bill 1873 calls for the Secretary of Health to place hepatitis B on the list of diseases that require immunization for attendance at school after August 1, 1999. This bill, then, would serve as a "catch-up" program for students in higher grades - those who enrolled in school before August of 1997 (i.e., students in 4th through 12th grades in 1999).
We note the following points:
While House Bill 1873 does not specifically call for a mandated benefit, every new immunization benefit, in effect, becomes a mandated insurance benefit through the mechanics of the Childhood Immunization Insurance Act of 1992. Under this act, insurers are required to provide coverage for immunizations recommended by the Centers for Disease Control and Prevention. Hepatitis B is currently one of the recommended immunizations.
Issues of practicality were raised with vaccinating all students from grades 4th to 12th by August 1, 1999. In order to comply with this "catch-up" measure, over 700,000 students will have to receive the full hepatitis B immunization by August 1, 1999. For full immunization against the hepatitis B virus, three separate doses are administered over a 5 to 12 month time frame.
We note that there are several immunization programs already established in Pennsylvania. The Department of Health has developed programs to assure that children are immunized against the hepatitis B virus. In 1997, the Division of Immunization of the Pennsylvania Department of Health implemented the Hepatitis B Catch-Up Project, which aims at vaccinating seventh grade students against the virus. The Department of Health is also working to make the vaccine more accessible to the public through the Vaccine for Children's Program. The Department also implemented the federally funded Prenatal Hepatitis B Prevention Program. This program is designed to assure the availability of treatment and follow-up for high-risk infants born to hepatitis B positive women.
In lieu of the "catch-up" measure called for in House Bill 1873, an alternative solution was submitted by the Pennsylvania Chapter of the American Academy of Pediatrics. They recommend "that the requirement of House Bill 1873 be phased in with the 6th and 11th grade physicals until all children are 'caught up.'"
House Bill 1873 would not interfere with the current mandate of immunizing students enrolling in school. At issue is whether all 4th to 12th graders should receive the hepatitis B immunization before the next school year. The Council did not receive sufficient information indicating that there is a need to immunize over 700,000 students against the hepatitis B virus by August 1, 1999. With regard to cost, this initiative represents a one-time cost estimated to be between $21.9 million and $52.7 million.
Finally, the Council's enabling legislation provides for a preliminary staff review of submitted materials to determine if documentation received is sufficient to proceed with the formal Mandated Benefits Review process outlined in Act 34 of 1993. We conclude that neither supporters nor opponents of the bill provided sufficient information to warrant a full review by a Mandated Benefits Review Panel; nor, given the documentation received, do we believe a panel of experts would come to conclusions different than the ones reached here.
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