New Mexico Register / Volume XXXVII, Issue 13 / July
14, 2026
TITLE 7 HEALTH
CHAPTER 5 VACCINATIONS AND IMMUNIZATIONS
PART 4 VACCINE PURCHASING FUND
7.5.4.1 ISSUING AGENCY: Department of health, public health division.
[7.5.4.1
NMAC - Rp, 7.5.4.1 NMAC 7/14/2026]
7.5.4.2 SCOPE: These regulations govern the procedures for
establishing and administrating a statewide vaccine purchasing program to
purchase vaccines for all children in New Mexico (NM), including children
eligible for the vaccines for children program and insured children.
[7.5.4.2
NMAC - Rp, 7.5.4.2 NMAC 7/14/2026]
7.5.4.3 STATUTORY AUTHORITY: This rule is promulgated pursuant to Sections
24-5A-1 through 24-5A-9 of the Vaccine Purchasing Act, NMSA 1978; Section 9-7-6
of the Department of Health Act, NMSA 1978; and Section 24-1-3 of the Public
Health Act, NMSA 1978.
[7.5.4.3
NMAC - Rp, 7.5.4.3 NMAC 7/14/2026]
7.5.4.4 DURATION: Permanent.
[7.5.4.4
NMAC - Rp, 7.5.4.4 NMAC 7/14/2026]
7.5.4.5 EFFECTIVE DATE: July 14, 2026, unless a later date is cited
at the end of a section.
[7.5.4.5
NMAC - Rp, 7.5.4.5 NMAC 7/14/2026]
7.5.4.6 OBJECTIVE: The objective of this rule is to establish
standards and administer a statewide vaccine purchasing program to:
A. expand access to
childhood immunizations recommended by the New Mexico department of health;
B. maintain and
improve immunization rates;
C. facilitate the
acquisition by providers of vaccines for childhood immunizations recommended by
the department; and
D. leverage public
and private funding and resources for the purchase, storage, and distribution
of vaccines for childhood immunizations recommended by the department.
[7.5.4.6
NMAC - Rp, 7.5.4.6 NMAC 7/14/2026]
7.5.4.7 DEFINITIONS:
A. Definitions beginning with
“A”: [RESERVED]
B. Definitions beginning with “B”: [RESERVED]
C. Definitions beginning with “C”: [RESERVED]
D. Definitions beginning with “D”: “Department”
means the department of health.
E. Definitions beginning with “E”: [RESERVED]
F. Definitions beginning with
“F”: “Fund” means the vaccine purchasing fund.
G. Definitions beginning with
“G”: “Group health plan” means an employee welfare benefit plan to the
extent that the plan provides medical care to employees or their dependents
under the Employee Retirement Income Security Act of 1974 directly or through
insurance, reimbursement or other means.
H. Definitions beginning with “H”:
(1) “Health
insurance coverage” means benefits consisting of medical care provided
directly or through insurance or reimbursement or other means under any
hospital or medical service policy or certificate, hospital or medical service
plan contract, or health maintenance organization contract offered by a health
insurance issuer.
(2) “Health insurer” means any entity
subject to regulation by the office of the superintendent of insurance that:
(1) provides
or is authorized to provide health insurance or health benefit plans;
(2) administers
health insurance or health benefit coverage; or
(3) otherwise
provides a plan of health insurance or health benefits.
I. Definitions beginning with “I”: “Insured
child” means a child under the age of 19 who is eligible to receive health
insurance coverage from a health insurer or medical care pursuant to a group
health plan.
J. Definitions beginning with “J”: [RESERVED]
K. Definitions beginning with “K”: [RESERVED]
L. Definitions beginning with “L”: [RESERVED]
M. Definitions beginning with “M”: [RESERVED]
N. Definitions beginning with “N”: [RESERVED]
O. Definitions beginning with “O”: “Office
of the superintendent” means the office of the superintendent of insurance.
P. Definitions beginning with “P”:
(1) “Policy”
means any contract of health insurance between a health insurer and the insured
and all clauses, riders, endorsements and parts thereof.
(2) “Provider”
means an individual or organization licensed, certified, or otherwise
authorized or permitted by law to provide vaccinations to insured children.
Q. Definitions beginning with “Q”: [RESERVED]
R. Definitions beginning with “R”: [RESERVED]
S. Definitions beginning with “S”: [RESERVED]
T. Definitions beginning with “T”: [RESERVED]
U. Definitions beginning with “U”: [RESERVED]
V. Definitions beginning with “V”: “Vaccines
for children program” means the federally funded program that provides
vaccines at no cost to eligible children pursuant to Section 1928 of the
federal Social Security Act.
W. Definitions beginning with “W”: [RESERVED]
X. Definitions beginning with “X”: [RESERVED]
Y. Definitions beginning with “Y”: [RESERVED]
Z. Definitions beginning with “Z”: [RESERVED]
[7.5.4.7
NMAC - Rp, 7.5.4.7 NMAC 7/14/2026]
7.5.4.8 DUTIES OF THE DEPARTMENT: The department shall:
A. purchase vaccines for children in New Mexico, including
children eligible for the vaccines for children program and insured children;
B. invoice each health insurer and group health plan to
reimburse the department for the cost of vaccines provided directly or
indirectly by the department to such health insurer’s or group health plan’s
insured children;
C. maintain a list of registered providers who receive
vaccines for insured children that are purchased by the state and provide such
list to each health insurer and group health plan with every invoice;
D. report the failure of a health insurer to reimburse the
department within 30 days of the date of the invoice to the office of the superintendent
in order for the office of the superintendent to pursue the proper sanctions or
monetary penalties pursuant to their rules and the Vaccine Purchasing Act;
E. report the failure of a health insurer or group health
plan to reimburse the department within 30 days of the date of the invoice to
the office of the attorney general for collection of the invoice amount,
including a civil penalty of five hundred dollars ($500) for each day from the
date the payment is due;
F. credit all receipts collected from health insurers
and group health plans pursuant to the Vaccine Purchasing Act to the fund;
G. no later than July 1, 2015, and July 1 of each year
thereafter, the department shall estimate the amount to be expended annually by
the department to purchase, store and distribute vaccines recommended by the department
to all insured children in the state, including a reserve of ten percent of the
amount estimated; and
H. no later than September 1, 2015, and each quarter
thereafter, the department shall invoice each health insurer and each group
health plan for one-fourth of its proportionate share of the estimated annual amount
and reserve calculated pursuant to Subsection E of 7.5.4.10 NMAC.
[7.5.4.8
NMAC - Rp, 7.5.4.8 NMAC 7/14/2026]
7.5.4.9 PROVIDER PROHIBITIONS: To avoid duplication of payment, any
providers who administer vaccines are prohibited from billing health insurers
and group health plans for the cost of any vaccine which was provided to them
by the department.
[7.5.4.9
NMAC - Rp, 7.5.4.9 NMAC 7/14/2026]
7.5.4.10 PROCESS AND PROCEDURES:
A. No later than July 1, 2015, and July
1 of each year thereafter, the department shall estimate the amount to be
expended annually by the department to purchase, store, and distribute vaccines
recommended by the department to all insured children in the state, including a
reserve of ten percent of the amount estimated.
B. By the due date established by the
office of the superintendent, but no later than August 15, 2015, each health
insurer and group health plan shall report to the office of the superintendent’s
director of life and health, P.O. Box 1689, Santa Fe, NM 87504,
the number of children it insured who
were under the age of 19 as of December 31, 2014, excluding from such reports
children who are enrolled in medicaid or in any
medical assistance program administered by the department, or the health care
authority, and children who are American Indian or Alaska Natives. All such reports to the office of the superintendent
shall be copied to the department at vpa.fund@state.nm.us.
C. By the due date established by the
office of the superintendent, but no later than July 1 of each year subsequent
to August 15, 2015, each health insurer and group health plan shall annually
report to the office of the superintendent’s director of life
and health, P.O. Box 1689, Santa Fe, NM 87504, the number of children it insures who will be under the age of 19 as of
December 31 of the previous year, excluding from such reports children who are
enrolled in medicaid or in any medical assistance
program administered by the department, or the health care authority, and
children who are American Indian or Alaska Natives. All such reports to the office of the superintendent
shall be copied to the department at vpa.fund@state.nm.us.
D. Each health insurer and group health
plan, when reporting number of children pursuant to this section, shall also
provide a designated point of contact to the department and to the office of the
superintendent to include: name, title,
address, e-mail address, and office phone number no later than August 15, 2015,
and by July 1 of each subsequent year. In
the event that the point of contact changes prior to the billing cycle
referenced in the table below, then an updated point of contact shall be provided
to the department and the office of the superintendent as soon as practicable
after the change occurs, but no later than 30 days after the change.
E. The annual amount to be reimbursed by
each health insurer or group health plan shall be a fraction, the denominator
of which is the total number of insured children reported by all health
insurers and group health plans and the numerator of which is the number of
insured children reported by such health insurer or group health plan,
multiplied by the total amount as determined by the department to be expended
annually in the corresponding year. Payments
shall be remitted to the department’s fiscal agent in the manner directed by
the department in the invoice with a corresponding notification of remittance
to vpa.fund@state.nm.us.
F. No later than September 1, 2015, and
each quarter thereafter, the department shall invoice each health insurer and
each group health plan for one-fourth of its proportionate share of the
estimated amount and reserve calculated pursuant to Subsection E of 7.5.4.10 NMAC. The due dates are as follows:
|
Billing
Cycle: |
Department’s
Invoice Date: |
Insurer’s
and Group Health Plan’s Due Date: |
|
July
1 to September 30 |
September
1 |
October
1 |
|
October
1 to December 31 |
December
1 |
January
1 |
|
January
1 to March 31 |
March
1 |
April
1 |
|
April
1 to June 30 |
June
1 |
July
1 |
[7.5.4.10
NMAC - Rp, 7.5.4.10 NMAC 7/14/2026]
7.5.4.11 AUTHORIZED
USES OF THE VACCINE PURCHASING FUND:
A. Money in the fund shall be expended
only for the purposes specified in the Vaccine Purchasing Act, by warrant
issued by the secretary of finance and administration pursuant to vouchers
approved by the secretary of health.
B. The fund shall be audited in the same
manner as other state funds are audited, and all records of payments made from
the fund shall be open to the public.
C. Any balance remaining in the fund
shall not revert or be transferred to any other fund at the end of a fiscal
year.
D. Money in the fund shall be invested
by the state investment officer in accordance with the limitations in Article
12 Section 7 of the constitution of New Mexico. Income from investment of the fund shall be
credited to the fund.
E. The fund shall be used for the
purchase, storage, and distribution of vaccines, as recommended by the department,
for insured children who are not eligible for the vaccines for children
program.
F. The department may update its
estimated amount to be expended annually and its reserve to take into account
increases or decreases in the cost of vaccines or the costs of additional
vaccines that the department determines should be included in the statewide
vaccine purchasing program and adjust the amount invoiced to each health
insurer and group health plan the following quarter.
G. The
department shall credit any balance remaining in the fund at the end of the
fiscal year toward the department’s purchase of vaccines the following year;
provided that the department maintains a reserve of ten percent of the amount
estimated to be expended in the following year.
[7.5.4.11
NMAC - Rp, 7.5.4.11 NMAC 7/14/2026]
7.5.4.12 UNAUTHORIZED USES OF THE VACCINE
PURCHASING FUND:
The fund shall not be used:
A. for the purchase, storage, and
distribution of vaccines for children who are eligible for the vaccines for
children program;
B. for administrative expenses
associated with the statewide vaccine purchasing program; or
C. to pass through a federally
negotiated discount pursuant to 42 U.S.C. 1396s.
[7.5.4.12
NMAC - Rp, 7.5.4.12 NMAC 7/14/2026]
7.5.4.13 INITIAL ADMINISTRATIVE REVIEW OF
INVOICE BY THE DEPARTMENT:
A. Each health insurer or group health
plan shall have the right to request an initial administrative review of their
invoice by the department in the event of a dispute over the invoice amount
only. Any other grievances shall be
initiated with the office of the superintendent pursuant to their rules. Criteria for the initial administrative review
of the invoice shall be available from the department of health immunization
program. Any informal hearing or administrative review of the invoice pursuant
to the office of the superintendent’s rules can only be commenced after the
department’s initial administrative review of the invoice is completed and the health
insurer or group health plan receives notification by mail that the
administrative review request has been completed by the department.
B. The health insurer or group health
plan may submit a letter requesting an initial administrative review of the
invoice and any supporting documents to the immunization program manager or
designee within 10 working days of receipt of the department’s invoice. Such requests shall be submitted to the
immunization program manager at P.O. Box 26110, Santa Fe, NM 87502-6110, and via
email at vpa.fund@state.nm.us. The health insurer
or group health plan shall send a copy of the request to the office of the
superintendent of insurance.
C. Within 10 working days of receipt of
the request for an initial administrative review of the invoice, the department
of health’s immunization program manager or designee shall review the request
for an initial administrative review of the invoice and any supporting
documents. After the administrative
review is complete the department’s immunization program manager or designee
shall notify the health insurer or group health plan by mail if the invoice
amount will remain unchanged or modified.
D. If a modified invoice is issued by
the department then payment is due within five days of
receipt of the modified invoice or on the due date identified in the original
invoice, whichever is later. Payment is
due regardless of whether the health insurer or group health plan intends to further
pursue an administrative review or informal hearing of the invoice with the
office of the superintendent or an appeal to district court. Failure to remit
payment will result in the department reporting the failure of a health insurer
or group health plan to reimburse the department to the office of the attorney
general for collection of the invoice amount, including a civil penalty of five
hundred dollars ($500) for each day from the date the payment is due.
E. If the invoice remains unchanged then
the invoice amount is due within five days of receipt of the department’s
decision or on the due date identified in the original invoice, whichever is
later. Payment is due regardless of
whether the health insurer or group health plan intends to further pursue an
administrative review or informal hearing of the invoice with the office of the
superintendent or an appeal to district court. Failure to remit payment will result in the
department reporting the failure of a health insurer or group health plan to
reimburse the department to the office of the attorney general for collection
of the invoice amount, including a civil penalty of five hundred dollars ($500)
for each day from the date the payment is due.
F. If the health insurer or group
health plan continues to dispute the invoice amount, then it may request an
informal hearing or administrative review with the office of the superintendent
pursuant to the office of the superintendent’s rules as authorized by the
Vaccine Purchasing Act. The health
insurer or group health plan shall notify the immunization program manager if
they are pursuing an informal hearing or administrative review of the invoice
with the office of the superintendent via email at vpa.fund@state.nm.us.
[7.5.4.13
NMAC - Rp, 7.5.4.13 NMAC 7/14/2026]
7.5.4.14 RIGHT TO AN INFORMAL HEARING OR ADMINISTRATIVE REVIEW
WITH THE OFFICE OF THE SUPERINTENDENT AND THE RIGHT TO APPEAL; PENALTIES:
A. A health insurer aggrieved pursuant
to the Vaccine Purchasing Act may request an informal hearing or an
administrative review with the office of the superintendent pursuant to their
rules. The health insurer shall notify the immunization program manager if they
are pursuing an informal hearing or administrative review with the office of
the superintendent via email at vpa.fund@state.nm.us.
B. A health insurer aggrieved pursuant
to the Vaccine Purchasing Act may appeal from an order of the superintendent
made after an informal hearing or an administrative hearing pursuant to Section
59A-4-20, NMSA 1978. The appeal from the
office of the superintendent’s order shall be taken to the district court
pursuant to the provisions of Section 39-3-1.1 NMSA 1978.
C. A health insurer
or group health plan that fails to file a report pursuant to Subsections B and
C of 7.5.4.10 NMAC shall pay a
late filing fee of five hundred dollars ($500) per day for each day from the
date the report was due.
D. The office of superintendent may
require a health insurer or group health plan subject to the Vaccine Purchasing
Act to produce records that were used to prepare the report required under Subsections
B and C of 7.5.4.10 NMAC. If the office of superintendent determines
that there is other than a good faith discrepancy between the number of insured
children reported and the number of insured children that should have been
reported, the health insurer or group health plan shall pay a civil penalty of
five hundred dollars ($500) for each report filed for which the office of
superintendent determines there is such a discrepancy.
E. Failure of a health insurer or group
health plan to make timely payment of an amount invoiced pursuant to the
Vaccine Purchasing Act and this rule shall subject the health insurer or group
health plan to a civil penalty of five hundred dollars ($500) for each day from
the date the payment is due.
[7.5.4.14
NMAC - Rp, 7.5.4.14 NMAC 7/14/2026]
HISTORY
OF 7.5.4 NMAC: [RESERVED]
History
of Repealed Material: 7 5.4 NMAC, Vaccine Purchasing Fund, filed 8/17/2015
- Repealed effective
7/14/2026.
Other: 7 5.4 NMAC, Vaccine Purchasing Fund, filed
8/17/2015, Replaced by 7 5.4
NMAC, Vaccine Purchasing Fund, effective 7/14/2026.