[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3598 Introduced in House (IH)]







109th CONGRESS
  1st Session
                                H. R. 3598

To amend the Public Health Service Act to provide for increased funding 
    for the Centers for Disease Control and Prevention to carry out 
 activities toward increasing the number of medically underserved, at-
risk adults who are immunized against vaccine-preventable diseases, to 
   require a study regarding standards for the measurement of use by 
    beneficiaries under the Medicare and Medicaid Programs of adult 
immunizations for influenza, to amend title 5, United States Code, with 
 respect to the Federal Employees Health Benefits Program and certain 
             immunization services, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 28, 2005

 Ms. Roybal-Allard (for herself, Mr. Wicker, Mr. Waxman, Mr. Grijalva, 
    Mrs. Davis of California, Ms. Woolsey, Mr. Farr, Ms. Solis, Mr. 
  Cardoza, Ms. Zoe Lofgren of California, Ms. Matsui, Mrs. Capps, Ms. 
  Eshoo, Mr. Honda, Mr. Costa, Mr. Royce, Mr. Inslee, Mr. Pastor, Mr. 
  Salazar, Mr. Menendez, Mr. Baca, Mr. Becerra, Mrs. Napolitano, Mr. 
    Gutierrez, Ms. Linda T. Sanchez of California, Mr. Serrano, Ms. 
   Velazquez, Mr. Reyes, Mr. Leach, Mr. English of Pennsylvania, Mr. 
    Walsh, Mr. Bonner, Mr. Castle, Mrs. Johnson of Connecticut, Mr. 
   Crenshaw, Ms. Jackson-Lee of Texas, Mr. Gonzalez, and Ms. Loretta 
    Sanchez of California) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
the Committees on Ways and Means and Government Reform, for a period to 
      be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to provide for increased funding 
    for the Centers for Disease Control and Prevention to carry out 
 activities toward increasing the number of medically underserved, at-
risk adults who are immunized against vaccine-preventable diseases, to 
   require a study regarding standards for the measurement of use by 
    beneficiaries under the Medicare and Medicaid Programs of adult 
immunizations for influenza, to amend title 5, United States Code, with 
 respect to the Federal Employees Health Benefits Program and certain 
             immunization services, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Total Health Requires Improved 
Vaccination Efforts Act of 2005'' or the ``THRIVE Act of 2005''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Since the 1990s, the United States has achieved and 
        maintained high levels of childhood immunization, yet certain 
        problems persist within the national immunization system. Data 
        from the Centers for Disease Control indicate the following:
                    (A) Immunization coverage rates among adults are 
                well below those achieved among children.
                    (B) Significant racial and ethnic disparities exist 
                between coverage rates among adults.
                    (C) Many at-risk adults are not getting the 
                vaccines they need to prevent diseases such as 
                influenza, pneumococcal pneumonia and hepatitis B.
            (2) Vaccine-preventable diseases in adults cause a 
        staggering number of deaths and illnesses each year. Research 
        shows that the following applies each year in the United 
        States:
                    (A) 200,000 individuals are hospitalized due to 
                influenza complications and approximately 36,000 will 
                die.
                    (B) 33,000 people suffer from invasive pneumococcal 
                disease and 5,000 will die.
                    (C) 80,000 individuals become newly infected with 
                hepatitis B, and of these 5,000 will die.
                    (D) Pneumonia and influenza together are the sixth 
                leading cause of death among older adults.
            (3) The Centers for Disease Control and Prevention 
        (``CDC'') estimates that the overall cost to the Nation from 
        these vaccine-preventable diseases of adults exceeds $10 
        billion per year.
            (4) Recommended adult immunizations are cost effective and 
        would produce significant savings for the health care system of 
        the United States. According to current research and CDC 
        statistics:
                    (A) Influenza vaccine saves $14.71 per person 
                vaccinated between the ages of 18 and 63.
                    (B) Influenza vaccine saves $182 in medical costs 
                for each person vaccinated aged 65 or over.
                    (C) Pneumococcal vaccine saves $8.87 in medical 
                costs per person vaccinated aged 65 or over.
                    (D) Hepatitis B vaccine saves $100 million in 
                medical costs for every 1 million high-risk adults 
                vaccinated.
            (5) The shortage of influenza vaccine for the 2004-2005 
        season revealed a number of weaknesses in the adult 
        immunization infrastructure in the United States: insufficient 
        vaccine to meet demand; uneven distribution of vaccine; and 
        impaired abilities to administer vaccine to those in greatest 
        need. Such problems undermine public health and confidence in 
        the public health system, create confusion and uncertainty, and 
        destabilize the vaccine market place.
            (6) These deficiencies in adult immunization in the United 
        States are further exacerbated by decreasing Federal and State 
        resources for immunizations:
                    (A) The Federal budget for immunizations has 
                decreased over the last five years, shifting more of 
                the immunization infrastructural costs to states 
                already facing budget shortfalls.
                    (B) With most currently available State and Federal 
                immunization resources directed toward childhood 
                immunization, adult immunization policies and programs 
                are increasingly at risk.
                    (C) The diminishing resource base compromises the 
                abilities of State health departments to collect data 
                about adult immunization, assess immunization rates and 
                conduct and implement strategic planning to protect 
                adults from vaccine-preventable diseases.
            (7) There is, therefore, a vital need to enhance the 
        Nation's efforts to protect adults against vaccine-preventable 
        diseases. Establishing a strong and effective adult 
        immunization infrastructure in the Unites States makes good 
        sense:
                    (A) From a public health perspective it will better 
                prepare the health care system for an anticipated 
                influenza pandemic.
                    (B) From a homeland security preparedness stance it 
                will enable the public health community to respond more 
                quickly and effectively to biological threats.
                    (C) From a biomedical standpoint it will encourage 
                American adults to capitalize on newly developed 
                vaccines for other diseases such as cervical cancer and 
                shingles.
            (8) There are proven ways to bolster the adult immunization 
        system:
                    (A) Rigorous studies have shown that removing 
                financial barriers increases vaccination rates among 
                adults.
                    (B) Measuring how well providers deliver 
                immunizations increases vaccination rates.
                    (C) Existing performance measurement systems are 
                excellent incentives to ensure that health care workers 
                are immunized against infectious diseases that could 
                potentially spread to vulnerable patients.
                    (D) Health education campaigns are proven ways to 
                positively impact immunization behaviors.

SEC. 3. CENTERS FOR DISEASE CONTROL AND PREVENTION; PROGRAM FOR 
              INCREASING IMMUNIZATION RATES FOR ADULTS.

    (a) Activities of Centers for Disease Control and Prevention.--
Section 317(j) of the Public Health Service Act (42 U.S.C. 247b(j)) is 
amended by adding at the end the following paragraphs:
    ``(3)(A) For the purpose of carrying out activities toward 
increasing immunization rates for adults through the immunization 
program under this subsection, and for the purpose of carrying out 
subsection (k)(2), there are authorized to be appropriated $75,000,000 
for fiscal year 2006, and such sums as may be necessary for each of the 
fiscal years 2007 through 2010. Such authorization is in addition to 
amounts available under paragraphs (1) and (2) for such purposes.
    ``(B) In expending amounts appropriated under subparagraph (A), the 
Secretary shall give priority to adults who are medically underserved 
and are at risk for vaccine-preventable diseases.
    ``(C) The purposes for which amounts appropriated under 
subparagraph (A) are available include (with respect to immunizations 
for adults) payment of the costs of storing vaccines, outreach 
activities to inform individuals of the availability of the 
immunizations, and other program expenses necessary for the 
establishment or operation of immunization programs carried out or 
supported by States or other public entities pursuant to this 
subsection.
    ``(D)(i) Of the amounts appropriated under subparagraph (A), the 
Secretary may, for three consecutive fiscal years during the fiscal 
years 2006 through 2010, reserve in the aggregate for such three years 
not more than $25,000,000 to make grants to not more than four States 
for the purpose of carrying out demonstration projects to provide 
immunizations against influenza to individuals who are in the age group 
19 through 64, are uninsured with respect to such vaccine, and are at 
high risk with respect to influenza.
    ``(ii) In making grants pursuant to clause (i), the Secretary shall 
give preference to any State that--
            ``(I) has a low rate of adult immunizations for influenza 
        and pneumococcus among populations that are at high risk with 
        respect to such diseases; or
            ``(II) has a racial or ethnic minority group for which 
        there is a significant disparity in the rate of adult 
        immunizations for influenza and pneumococcus as compared to the 
        general population of the State.
    ``(iii) A grant may be made pursuant to clause (i) only if the 
State involved agrees that, before the demonstration project under such 
clause begins providing immunizations, the State will, for purposes of 
determining the effects of the project, make an estimate of the rate of 
immunizations with influenza vaccine in the population that will be 
served by the project.
    ``(iv) Upon the request of a State that will carry out a 
demonstration project under clause (i), the Secretary shall provide 
technical assistance to the State with respect to making the estimate 
described in clause (iii) and with respect to identifying intervention 
and comparison sites for the project.
    ``(v) For purposes of this subparagraph:
            ``(I) An individual shall be considered to be uninsured 
        with respect to influenza vaccine if the individual does not 
        have benefits with respect to the cost of such vaccine under a 
        health insurance policy or plan (including a group health plan, 
        a prepaid health plan, or an employee welfare benefit plan 
        under the Employee Retirement Income Security Act of 1974).
            ``(II) With respect to influenza, an individual shall be 
        considered to be at high risk if the individual meets the high-
        risk criteria identified by the Advisory Committee on 
        Immunization Practices (an advisory committee established by 
        the Secretary).
    ``(4)(A) The Secretary shall annually submit to the Congress a 
report that--
                    ``(i) evaluates the extent to which the 
                immunization system in the United States has been 
                effective in providing for adequate immunization rates 
                for adults, taking into account the applicable year 
                2010 health objectives established by the Secretary 
                regarding the health status of the people of the United 
                States; and
                    ``(ii) describes any issues identified by the 
                Secretary that may affect such rates.
    ``(B) For each fiscal year for which demonstration projects under 
paragraph (3)(D) are being carried out, the report under subparagraph 
(A) shall include information on--
            ``(i) the effectiveness of the projects in increasing the 
        rate of immunizations with influenza vaccine in the populations 
        involved;
            ``(ii) demographic information on the individuals to whom 
        the projects have provided immunizations (including with 
        respect to race and ethnicity); and
            ``(iii) the types of health care entities that have been 
        involved in the projects.
    ``(5) In carrying out this subsection and paragraphs (1) and (2) of 
subsection (k), the Secretary shall consider recommendations regarding 
immunizations that are made in reports issued by the Institute of 
Medicine.''.
    (b) Research, Demonstrations, and Education.--Section 317(k) of the 
Public Health Service Act (42 U.S.C. 247b(k)) is amended--
            (1) by redesignating paragraphs (2) through (4) as 
        paragraphs (3) through (5), respectively; and
            (2) by inserting after paragraph (1) the following 
        paragraph:
    ``(2)(A) The Secretary, directly or through grants under paragraph 
(1), shall provide for the following:
            ``(i) The Secretary shall coordinate with public and 
        private entities (including nonprofit private entities), and 
        develop and disseminate guidelines, toward the goal of ensuring 
        that immunizations are routinely offered to adults by public 
        and private health care providers.
            ``(ii) The Secretary shall cooperate with public and 
        private entities to obtain information for the annual 
        evaluations required in subsection (j)(4)(A)(i).
    ``(B)(i) The Secretary, directly or through grants under paragraph 
(1), shall provide for a campaign of education on the importance of 
adults receiving immunizations. Such campaign shall have--
            ``(I) a component directed toward the general public;
            ``(II) a component or components directed toward health 
        professionals, providers of health insurance and plans, and 
        employers; and
            ``(III) components directed toward particular populations 
        for which the rate of immunizations is low relative to the 
        general population.
    ``(ii) In carrying out the campaign under clause (i), the Secretary 
shall seek to use innovative educational methods, and shall seek to 
meet the following goals:
            ``(I) Increase the demand for immunizations.
            ``(II) Correct misconceptions and unjustified concerns 
        about the safety of vaccines.
            ``(III) Promote the inclusion in health insurance and plans 
        of coverage of immunizations for adults.
            ``(IV) Promote the use of evidence-based approaches for 
        improving the rate of immunizations.
    ``(iii) The Secretary shall provide for an evaluation, including 
through surveys, of the effects of the campaign under clause (i) on the 
knowledge, attitudes, and practices of the populations described in 
subclauses (I) through (III) of such clause.''.

SEC. 4. MEDICARE AND MEDICAID PROGRAMS; STANDARDS TO MEASURE USAGE AND 
              COVERAGE OF ADULT IMMUNIZATIONS.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Administrator of the Centers for Medicare & Medicaid 
Services, shall establish standards for the measurement of use by 
beneficiaries under the medicare and medicaid programs of adult 
immunizations for influenza.
    (b) Study for Use of Standards as a Quality Measure.--The 
Secretary, acting through the Administrator of the Centers for Medicare 
& Medicaid Services, shall conduct a study to determine the feasibility 
and advisability of including adult immunization for influenza by 
medicare and medicaid beneficiaries, as a performance measure under 
quality initiatives conducted by the Secretary under the medicare and 
medicaid programs.
    (c) Measurement of Usage by Health Care Workers.--The Secretary, 
acting through the Administrator of the Centers for Medicare & Medicaid 
Services, shall establish standards for the measurement of use by 
health care workers, as defined by the Secretary for purposes of this 
section, working in a provider of services (as defined in section 
1861(u) of the Social Security Act (42 U.S.C. 1395x(u)) of adult 
immunizations for influenza.
    (d) Assessment of Best Practices to Improve Coverage of Adult 
Immunizations.--The Secretary of Health and Human Services, acting 
through the Agency for Healthcare Research and Quality, shall conduct a 
study of the best practices of health insurers and managed care 
organizations to encourage the use of adult immunizations for influenza 
by enrollees of such insurers and organizations, such as informed 
refusal and other interventions.

SEC. 5. STUDY ON ADULT IMMUNIZATION FOR INFLUENZA FOR HEALTH CARE 
              WORKERS AS A QUALITY INDICATOR FOR PURPOSES OF 
              ACCREDITATION.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study to determine the feasibility and advisability of 
including as a requirement of accreditation of a provider of services 
(as defined in section 1861(u) of the Social Security Act (42 U.S.C. 
1395x(u)) compliance with recommended adult immunizations, including 
influenza, for all health care workers employed by the provider of 
services. Any such requirement should include a provision for informed 
refusal by the health care worker of the immunization and appropriate 
documentation of usage and refusal of such immunizations.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
on the study conducted under subsection (a), and shall include in that 
report a description of the difficulties of implementing such a 
requirement as well as recommendations for the resolution of those 
difficulties.

SEC. 6. FEHBP COVERAGE OF QUALIFIED IMMUNIZATION SERVICES.

    (a) In General.--Section 8902 of title 5, United States Code, is 
amended by adding at the end the following:
    ``(p)(1) A contract may not be made or a plan approved which does 
not (A) offer qualified immunization services to eligible enrollees, 
and (B) provide for the waiver of any deductible that might otherwise 
apply with respect to any such services provided to any such enrollee.
    ``(2) For purposes of this subsection--
            ``(A) the term `qualified immunization services' means--
                    ``(i) pneumococcal vaccine and its administration; 
                and
                    ``(ii) influenza vaccine and its administration; 
                and
            ``(B) the term `eligible enrollee', as used with respect to 
        a health benefits plan, means an individual enrolled in such 
        plan under this chapter who is 18 years of age or older and who 
        is at high risk of contracting pneumonia or influenza, as 
        determined under criteria of the Advisory Committee on 
        Immunization Practices or another similar body (as identified 
        by the Office).''.
    (b) Effective Date.--The amendment made by this section shall apply 
to services provided under any contract entered into or renewed for any 
contract year beginning later than 9 months after the date of the 
enactment of this Act.
                                 <all>