Requiring coverage of certain immunizations recommended by the Advisory Committee on Immunization Practices

(a)

Group health plans and health insurance coverage

(1)

PHSA

(A)

In general

Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following new section:

2799A–11.

Coverage of certain immunizations recommended by the Advisory Committee on Immunization Practices

(a)

In general

With respect to plan years occurring during the date of the enactment of this section, or beginning on or after the date of the enactment of this section and before January 1, 2030, a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for immunizations that had in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved as of October 25, 2024, including such an immunization involving a vaccine as updated or changed after such date under an approved supplemental application to a biological product licensed under section 351 on or before such date.(b)

Special rule

Subsection (a) shall not apply in the case of an immunization administered during the minimum interval established under section 2713(b) with respect to such immunization.

(B)

Conforming amendment

Section 1302(e)(1)(B)(i) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(e)(1)(B)(i)) is amended by striking section 2713 and inserting sections 2713 and 2799A–11 of the Public Health Service Act.(2)

ERISA

(A)

In general

Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section:

726.

Coverage of certain immunizations recommended by the Advisory Committee on Immunization Practices

(a)

In general

With respect to plan years occurring during the date of the enactment of this section, or beginning on or after the date of the enactment of this section and before January 1, 2030, a group health plan and a health insurance issuer offering group health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for immunizations that had in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved as of October 25, 2024, including such an immunization involving a vaccine as updated or changed after such date under an approved supplemental application to a biological product licensed under section 351 of the Public Health Service Act (42 U.S.C. 262) on or before such date.(b)

Special rule

Subsection (a) shall not apply in the case of an immunization administered during the minimum interval established under section 2713(b) of the Public Health Service Act (42 U.S.C. 300gg–13(b)) with respect to such immunization.

(B)

Clerical amendment

The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended by inserting after the item relating to section 725 the following new item:

Sec. 726. Coverage of certain immunizations recommended by the Advisory Committee on Immunization Practices.

(3)

IRC

(A)

In general

Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:

9826.

Coverage of certain immunizations recommended by the Advisory Committee on Immunization Practices

(a)

In general

With respect to plan years occurring during the date of the enactment of this section, or beginning on or after the date of the enactment of this section and before January 1, 2030, a group health plan shall provide coverage for and shall not impose any cost sharing requirements for immunizations that had in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved as of October 25, 2024, including such an immunization involving a vaccine as updated or changed after such date under an approved supplemental application to a biological product licensed under section 351 of the Public Health Service Act (42 U.S.C. 262) on or before such date.(b)

Special rule

(B)

Clerical amendment

The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:

Sec. 9826. Coverage of certain immunizations recommended by the Advisory Committee on Immunization Practices.

(b)

Medicare

Section 1860D–2(b)(8)(B) of the Social Security Act (42 U.S.C. 1395w–102(b)(8)(B)) is amended—(1)by striking with recommendations and inserting

with—(i)recommendations

;

(2)by striking the period at the end and inserting ; or; and (3)by adding at the end the following new clause:

(ii)for plan years occurring during the date of the enactment of this clause, or beginning on or after the date of the enactment of this clause and before January 1, 2030, in the case of a vaccine with respect to which such a recommendation is revoked with respect to the individual involved on or after October 25, 2024, including such a vaccine as updated or changed after such date under an approved supplemental application to a biological product licensed under section 351 of the Public Health Service Act on or before such date, the most recent recommendation that was in effect with respect to such vaccine and such individual prior to such revocation.

(c)

Medicaid

(1)

In general

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—(A)in subsection (a)(13)(B)—(i)by striking individual, approved and inserting

individual—(i)approved

; and

(ii)by adding at the end the following new clause:

(ii)for the period beginning on the date of the enactment of this clause and ending on December 31, 2029, approved vaccines, and the administration of such vaccines, that were recommended by such advisory committee with respect to the individual involved as of October 25, 2024, including such a vaccine as updated or changed after such date under an approved supplemental application to a biological product licensed under section 351 of the Public Health Service Act on or before such date; and

; and

(B)in subsection (r)(1)(B)(iii), by—(i)striking section 1928(c)(2)(B)(i) and inserting clause (i) of section 1928(c)(2)(B); and(ii)inserting , subject to the limitation described in clause (iii) of such section after pediatric vaccines.(2)

Coverage for pregnant individuals

Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in the matter following subparagraph (G) by inserting medical assistance for vaccines described in section 1905(a)(13)(B) and the administration of such vaccines, after complicate pregnancy,. (3)

Program for distribution of pediatric vaccines

Section 1928 of the Social Security Act (42 U.S.C. 1396s) is amended—(A)in subsection (c)(2)(B)—(i)in clause (i), by striking clause (ii) and inserting clauses (ii) and (iii); and(ii)by adding at the end the following new clause:

(iii)For the period beginning on the date of the enactment of this clause and ending on December 31, 2029, the provider will not take into account any change in the schedule described in clause (i) that removes the recommendation to administer a pediatric vaccine with respect to the vaccine-eligible child involved if such pediatric vaccine was recommended with respect to such child under such schedule as of October 25, 2024, including with respect to such pediatric vaccine as updated or changed after such date under an approved supplemental application to a biological product licensed under section 351 of the Public Health Service Act on or before such date.

; and

(B)in subsection (e), by inserting For purposes of the preceding sentence, during the period beginning on the date of the enactment of this sentence and ending on December 31, 2029, the Secretary may not take into account any revision of such list that occurs on or after October 25, 2024, that removes a pediatric vaccine from such list if such vaccine was included in such list as of such date, including with respect to such vaccine as updated or changed after such date under an approved supplemental application to a biological product licensed under section 351 of the Public Health Service Act on or before such date. after the period at the end.(4)

State flexibility in benefit packages

Section 1937(b) of the Social Security Act (42 U.S.C. 1396u–7(b)) is amended by adding at the end the following new paragraph:

(9)

Coverage of adult vaccines

Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless such coverage includes (and does not impose any deduction, cost sharing, or similar charge for) the medical assistance described in section 1905(a)(13)(B).

(d)

CHIP

Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended—(1)in subsection (c), by adding at the end the following new paragraph:

(13)

Required coverage of certain vaccines recommended by the Advisory Committee on Immunization Practices

Regardless of the type of coverage elected by a State under subsection (a), the child health assistance provided for a targeted low-income child shall include coverage, during the period beginning on the date of the enactment of this paragraph and ending on December 31, 2029, of vaccines, and the administration of such vaccines, that had in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the child involved as of October 25, 2024, including such a vaccine as updated or changed after such date under an approved supplemental application to a biological product licensed under section 351 of the Public Health Service Act on or before such date.

; and

(2)in subsection (e)(2), by inserting vaccines described in subsection (c)(13) administered during the period beginning on the date of the enactment of such subsection and ending on December 31, 2029 (and the administration of such vaccines), before services described in section 1916(a)(2)(G).