[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1003 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 1003
To increase immunization rates.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 7, 2009
Mr. Reed introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To increase immunization rates.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Immunization
Improvement Act of 2009''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. State authority to purchase recommended vaccines for adults.
Sec. 4. Demonstration program to improve immunization coverage.
Sec. 5. Reauthorization of immunization program.
Sec. 6. Inclusion of recommended immunizations under part B of the
Medicare program with no beneficiary cost-
sharing.
Sec. 7. Medicaid coverage of recommended adult immunizations.
Sec. 8. Vaccine administration fees.
Sec. 9. Health insurance coverage for recommended immunizations.
Sec. 10. Immunization information systems.
Sec. 11. Reports.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Immunizations recommended for routine use have been
proven to be clinically effective in improving health and
preventing the spread of disease. Routine childhood
immunizations prevent over 14,000,000 cases of disease and over
33,500 deaths over the lifetime of children born in any given
year. In addition to protecting individuals from disease,
immunization provides population-based (herd) immunity.
(2) An economic evaluation of the impact of seven vaccines
routinely given as part of the childhood immunization schedule
found that the vaccines are cost-effective. Over the lifetime
of children born in any given year, these immunizations result
in an annual cost savings of $10,000,000,000 in direct medical
costs and over $40,000,000,000 in indirect societal costs.
(3) There are significant and persistent gaps in public and
private health insurance coverage of immunizations. About 11
percent of young children and 21 percent of adolescents are
underinsured for immunizations. Among adults, 59 percent are
underinsured and 17 percent are completely uninsured for
immunizations. According to the Institute of Medicine, even
those with insurance increasingly have to pay higher
deductibles and copayments for immunizations.
(4) Each year, vaccine-preventable diseases cause the
deaths of more than 42,000 people and hundreds of thousands
cases of illness.
(5) In 2003, the Institute of Medicine's Committee on the
Evaluation of Vaccine Purchase Financing made the following
conclusions:
(A) Current public and private financing strategies
for immunization have had substantial success,
especially in improving immunization rates for young
children. However, significant disparities remain in
assuring access to recommended vaccines across
geographic and demographic populations.
(B) Many young children, adolescents, and high-risk
adults have no or limited insurance for recommended
vaccines. Gaps and fragmentation in insurance benefits
create barriers for both vulnerable populations and
clinicians that can contribute to lower immunization
rates.
SEC. 3. STATE AUTHORITY TO PURCHASE RECOMMENDED VACCINES FOR ADULTS.
Section 317 of the Public Health Service Act (42 U.S.C. 247b) is
amended by adding at the end the following:
``(l) Authority To Purchase Recommended Vaccines for Adults.--
``(1) In general.--The Secretary may negotiate and enter
into contracts with manufacturers of vaccines for the purchase
and delivery of vaccines for adults otherwise provided vaccines
under grants under this section.
``(2) State purchase.--A State may obtain adult vaccines
(subject to amounts specified to the Secretary by the State in
advance of negotiations) through the purchase of vaccines from
manufacturers at the applicable price negotiated by the
Secretary under this subsection.''.
SEC. 4. DEMONSTRATION PROGRAM TO IMPROVE IMMUNIZATION COVERAGE.
Section 317 of the Public Health Service Act (42 U.S.C. 247b), as
amended by section 3, is further amended by adding at the end the
following:
``(m) Demonstration Program To Improve Immunization Coverage.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall establish a demonstration program to award grants to
States to improve the provision of recommended immunizations
for children, adolescents, and adults through the use of
evidence-based, population-based interventions for high-risk
populations.
``(2) State plan.--To be eligible for a grant under
paragraph (1), a State shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require, including a State
plan that describes the interventions to be implemented under
the grant and how such interventions match with local needs and
capabilities, as determined through consultation with local
authorities.
``(3) Use of funds.--Funds received under a grant under
this subsection shall be used to implement interventions that
are recommended by the Task Force on Community Preventive
Services (as established by the Secretary, acting through the
Director of the Centers for Disease Control and Prevention) or
other evidence-based interventions, including--
``(A) providing immunization reminders or recalls
for target populations of clients, patients, and
consumers;
``(B) educating targeted populations and health
care providers concerning immunizations in combination
with one or more other interventions;
``(C) reducing out-of-pocket costs for families for
vaccines and their administration;
``(D) carrying out immunization-promoting
strategies for participants or clients of public
programs, including assessments of immunization status,
referrals to health care providers, education,
provision of on-site immunizations, or incentives for
immunization;
``(E) providing for home visits that promote
immunization through education, assessments of need,
referrals, provision of immunizations, or other
services;
``(F) providing reminders or recalls for
immunization providers;
``(G) conducting assessments of, and providing
feedback to, immunization providers; or
``(H) any combination of one or more interventions
described in this paragraph.
``(4) Consideration.--In awarding grants under this
subsection, the Secretary shall consider any reviews or
recommendations of the Task Force on Community Preventive
Services.
``(5) Evaluation.--Not later than 3 years after the date on
which a State receives a grant under this subsection, the State
shall submit to the Secretary an evaluation of progress made
toward improving immunization coverage rates among high-risk
populations within the State.
``(6) Report to congress.--Not later than 4 years after the
date of enactment of the Immunization Improvement Act of 2009,
the Secretary shall submit to Congress a report concerning the
effectiveness of the demonstration program established under
this subsection together with recommendations on whether to
continue and expand such program.
``(7) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection, such sums as
may be necessary for each of fiscal years 2010 through 2014.''.
SEC. 5. REAUTHORIZATION OF IMMUNIZATION PROGRAM.
Section 317(j) of the Public Health Service Act (42 U.S.C. 247b(j))
is amended--
(1) in paragraph (1), by striking ``for each of the fiscal
years 1998 through 2005''; and
(2) in paragraph (2), by striking ``after October 1,
1997,''.
SEC. 6. INCLUSION OF RECOMMENDED IMMUNIZATIONS UNDER PART B OF THE
MEDICARE PROGRAM WITH NO BENEFICIARY COST-SHARING.
(a) In General.--Paragraph (10) of section 1861(s) of the Social
Security Act (42 U.S.C. 1395x(s)) is amended to read as follows:
``(10) vaccines recommended for routine use by the Advisory
Committee on Immunization Practices (an advisory committee
established by the Secretary, acting through the Director of
the Centers for Disease Control and Prevention) and their
administration;''.
(b) Conforming Amendments.--
(1) Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended, in each of subsections (a)(1)(B), (a)(2)(G),
(a)(3)(A), (b)(1), by striking ``1861(s)(10)(A)'' or
``1861(s)(10)(B)'' and inserting ``1861(s)(10)'' each place it
appears.
(2) Section 1842(o)(1)(A)(iv) of the Social Security Act
(42 U.S.C. 1395u(o)(1)(A)(iv)) is amended by striking
``subparagraph (A) or (B) of''.
(3) Section 1847A(c)(6) of the Social Security Act (42
U.S.C. 1395w-3a(c)(6)) is amended by striking subparagraph (G).
(4) Section 1860D-2(e)(1) of the Social Security Act (42
U.S.C. 1395w-102(e)(1)) is amended by striking ``a vaccine''
and all that follows through ``its administration) and''.
(5) Section 1861(ww)(2)(A) of the Social Security Act (42
U.S.C. 1395x(ww)(2)(A)) is amended by striking ``Pneumococcal,
influenza, and hepatitis B'' and inserting ``Any''.
(6) Section 1866(a)(2)(A) of the Social Security Act (42
U.S.C. 1395cc(a)(2)(A)) is amended by striking
``1861(s)(10)(A)'' and inserting ``1861(s)(10)''.
(c) Effective Date.--The amendments made by this section shall
apply to vaccines administered on or after January 1, 2010.
SEC. 7. MEDICAID COVERAGE OF RECOMMENDED ADULT IMMUNIZATIONS.
(a) Mandatory Coverage of Recommended Immunizations for Adults.--
Section 1905(a)(4) of the Social Security Act (42 U.S.C. 1396d(a)(4))
is amended--
(1) by striking ``and'' before ``(C)''; and
(2) by inserting after the semicolon the following: ``and
(D) with respect to an adult individual, vaccines recommended
for routine use by the Advisory Committee on Immunization
Practices (an advisory committee established by the Secretary,
acting through the Director of the Centers for Disease Control
and Prevention) and their administration;''.
(b) Prohibition on Cost-Sharing.--
(1) In general.--Section 1916 of the Social Security Act
(42 U.S.C. 1396o), as amended by section 5006(a)(1)(A) of
division B of Public Law 111-5, is amended--
(A) in subsection (a), by striking ``and (j)'' and
inserting ``, (j), and (k)''; and
(B) by adding at the end the following:
``(k) The State plan shall require that no provider participating
under the State plan may impose a copayment, cost-sharing charge, or
similar charge for vaccines or their administration that the State is
required to provide under sections 1902(a)(10)(A) and 1905(a)(4)(D).''.
(2) Technical and conforming amendment.--The second
sentence of section 1916A(a)(1) of such Act (42 U.S.C. 1396o-
1(a)(1)) is amended by striking ``or (i)'' and inserting ``(i),
(j), or (k)''.
(c) Allowing for Medicaid Rebates.--Section 1927(k)(2)(B) of such
Act (42 U.S.C. 1396r-8(k)(2)(B)) is amended by striking ``, other than
a vaccine'' and inserting ``(including vaccines described in section
1905(a)(4)(D) but excluding qualified pediatric vaccines under section
1928)''.
(d) Effective Date.--
(1) In general.--Except as provided in paragraphs (2) and
(3), the amendments made by this section take effect on October
1, 2010.
(2) Extension of effective date for state law amendment.--
In the case of a State plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) which the Secretary of
Health and Human Services determines requires State legislation
in order for the plan to meet the additional requirements
imposed by the amendments made by this section, the State plan
shall not be regarded as failing to comply with the
requirements of such title solely on the basis of its failure
to meet these additional requirements before the first day of
the first calendar quarter beginning after the close of the
first regular session of the State legislature that begins
after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session is considered to
be a separate regular session of the State legislature.
(3) Medicaid rebates.--The amendment made by subsection (c)
takes effect on October 1, 2010, and applies to rebate
agreements entered into under section 1927 of the Social
Security Act (42 U.S.C. 1396r-8) on or after that date.
SEC. 8. VACCINE ADMINISTRATION FEES.
(a) Review of Federally Established Maximum Allowable
Administrative Fees.--Not later than October 1, 2010, the Administrator
of the Centers for Medicare & Medicaid Services and the Director of the
Centers for Disease Control and Prevention, jointly shall--
(1) review the regional maximum charge for vaccine
administration for each State established under the Vaccines
for Children program under section 1928 of the Social Security
Act (42 U.S.C. 1396s) to determine the appropriateness and
adequacy of such rates; and
(2) update such rates, as appropriate, based on the results
of such review and taking into account all appropriate costs
related to the administration of vaccines under that program.
(b) Federal Reimbursement for Vaccine Administration for Non-
Medicaid Vaccine-Eligible Children.--
(1) In general.--Section 1928 of the Social Security Act
(42 U.S.C. 1396s) is amended--
(A) in subsection (a)(1)(B), by inserting ``and is
entitled to receive reimbursement for any fee imposed
by the provider for the administration of such vaccine
consistent with subsection (c)(2)(C) (not to exceed the
amount applicable under clause (iv) of such subsection)
to a federally vaccine-eligible child who is described
in clause (ii), (iii), or (iv) of subsection (b)(2),''
after ``delivery to the provider,'';
(B) in subsection (a)(2), by adding at the end the
following new subparagraph:
``(D) Reimbursement for vaccine
administration for non-medicaid eligible
children.--The Secretary shall pay each State
such amounts as are necessary for the State to
reimburse each program-registered provider in
the State for an administration fee imposed
consistent with subsection (c)(2)(C) (not to
exceed the amount applicable under clause (iv)
of such subsection) for the administration of a
qualified pediatric vaccine to a federally
vaccine-eligible child who is described in
clause (ii), (iii), or (iv) of subsection
(b)(2).'';
(C) in subsection (c)(2)(C), by adding at the end
the following new clause:
``(IV) In the case of a federally vaccine-
eligible child who is described in clause (ii),
(iii), or (iv) of subsection (b)(2), the State
shall pay the provider an amount equal to the
administration fee established under the State
plan approved under this title for the
administration of a qualified pediatric vaccine
to a medicaid-eligible child.''; and
(D) by striking subsection (g).
(2) Conforming amendments.--Section 1928 of such Act (42
U.S.C. 1396s), as amended by paragraph (1), is amended--
(A) by redesignating subsection (h) as subsection
(g);
(B) in subsection (a)(1)(A), by striking ``(h)(8)''
and inserting ``(g)(8)''; and
(C) in subsection (b)(2)(A)(iv), by striking
``(h)(3)'' and inserting ``(g)(3)''.
SEC. 9. HEALTH INSURANCE COVERAGE FOR RECOMMENDED IMMUNIZATIONS.
(a) Amendments to the Public Health Service Act.--
(1) Group health coverage.--Subpart 2 of part A of title
XXVII of the Public Health Service Act (42 U.S.C. 300gg-4 et
seq.) is amended by adding at the end the following:
``SEC. 2708. COVERAGE OF RECOMMENDED IMMUNIZATIONS.
``A group health plan, and a health insurance issuer offering group
health insurance coverage, shall provide for coverage, without the
application of deductibles, coinsurance, or copayments, of vaccines
recommended for routine use by the Advisory Committee on Immunization
Practices (as established by the Secretary, acting through the Director
of the Centers for Disease Control and Prevention) and their
administration.''.
(2) Individual health insurance coverage.--Subpart 2 of
part B of title XXVII of the Public Health Service Act (42
U.S.C. 300gg-51 et seq.) is amended by adding at the end the
following:
``SEC. 2754. COVERAGE OF RECOMMENDED IMMUNIZATIONS.
``The provisions of section 2708 shall apply to health insurance
coverage offered by a health insurance issuer in the individual market
in the same manner as such provisions apply to health insurance
coverage offered by a health insurance issuer in connection with a
group health plan in the small or large group market.''.
(b) Amendments to ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 is
amended by adding at the end the following:
``SEC. 715. COVERAGE OF RECOMMENDED IMMUNIZATIONS.
``A group health plan, and a health insurance issuer offering group
health insurance coverage, shall provide for coverage, without the
application of deductibles, coinsurance, or copayments, of vaccines
recommended for routine use by the Advisory Committee on Immunization
Practices (as established by the Secretary, acting through the Director
of the Centers for Disease Control and Prevention) and their
administration.''.
(2) Technical amendments.--
(A) Section 732(a) of such Act (29 U.S.C. 1191a(a))
is amended by striking ``section 711'' and inserting
``sections 711 and 715''.
(B) The table of contents in section 1 of such Act
is amended by inserting after the item relating to
section 713 the following new item:
``Sec. 715. Coverage of recommended immunizations.''.
(c) Internal Revenue Code Amendments.--
(1) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended--
(A) in the table of sections, by inserting after
the item relating to section 9813 the following new
item:
``Sec. 9814. Coverage of recommended immunizations.'';
and
(B) by inserting after section 9813 the following:
``SEC. 9814. COVERAGE OF RECOMMENDED IMMUNIZATIONS.
``A group health plan, and a health insurance issuer offering group
health insurance coverage, shall provide for coverage, without the
application of deductibles, coinsurance, or copayments, of vaccines
recommended for routine use by the Advisory Committee on Immunization
Practices (as established by the Secretary, acting through the Director
of the Centers for Disease Control and Prevention) and their
administration.''.
(d) Exception for Collective Bargaining Agreements.--Nothing in
this section shall be construed to preempt any provision of a
collective bargaining agreement that is in effect on the date of
enactment of this section.
(e) Effective Date.--The amendments made by this section shall
apply to plan years beginning with the first plan year during which the
Congressional Budget Office determines that any health reform
legislation enacted by Congress will provide health insurance coverage
to 95 percent or more of the population of the United States.
SEC. 10. IMMUNIZATION INFORMATION SYSTEMS.
(a) Health Information Technology Infrastructure.--Section 3011(a)
of the Public Health Service Act (as added by section 13301 of the
American Recovery and Reinvestment Act of 2009) is amended by adding at
the end the following:
``(8) Improvement and expansion of immunization information
systems (as defined in section 3000), including activities to--
``(A) support the integration and linkage of such
systems with electronic birth records, health care
providers, other preventive health services information
systems, and health information exchanges;
``(B) support interstate data exchange;
``(C) ensure that such systems are interoperable
with electronic health record systems;
``(D) provide technical support, such as training,
data reporting, data quality and completeness review,
and decision support, to immunization providers to
integrate the use of such systems;
``(E) develop, in consultation with manufacturers,
vendors, and specialty professional organizations,
continuing education materials relating to the use of
such systems;
``(F) ensure that such systems can provide complete
and accurate data to monitor immunization coverage,
uptake, and the impact of shortages in the population
served within their jurisdiction; and
``(G) ensure the privacy, confidentiality, and
security of all data and data exchanges with such
systems.''.
(b) State Grants.--Section 3013(d) of the Public Health Service Act
(as added by section 13301 of the American Recovery and Reinvestment
Act of 2009) is amended--
(1) in paragraph (9), by striking ``and'' at the end;
(2) by redesignating paragraph (10) as paragraph (11); and
(3) by inserting after paragraph (9), the following:
``(10) improving and expanding immunization information
systems (as defined in section 3000); and''.
(c) Definition.--Section 3000 of the Public Health Service Act (as
added by section 13301 of the American Recovery and Reinvestment Act of
2009) is amended--
(1) by redesignating paragraphs (9) through (14) as
paragraphs (10) through (15), respectively; and
(2) by inserting after paragraph (8), the following:
``(9) Immunization information system.--The term
`immunization information system' means an immunization
registry or a confidential, population-based, computerized
information system that collects vaccination data within a
geographic area, consolidates vaccination records from multiple
health care providers, generates reminder and recall
notifications, and is capable of exchanging immunization
information with health care providers.''.
SEC. 11. REPORTS.
(a) Costs of Public and Private Vaccine Administration.--Not later
than 5 years after the date of enactment of this Act, and every 5 years
thereafter, the Director of the Centers for Disease Control and
Prevention jointly with the Administrator of the Centers for Medicare &
Medicaid Services shall collect and publish data relating to the costs
associated with public and private vaccine administration, including
the costs associated with the delivery of vaccines, activities such as
reporting data to immunization registries, and maintenance of
appropriate storage requirements for vaccines.
(b) Section 317 Immunization Program.--Not later than February 1,
2010, and each February 1 thereafter, the Director of the Centers for
Disease Control and Prevention shall submit to Congress a report
concerning the size and scope of the appropriations needed for each
fiscal year for vaccine purchases, vaccination infrastructure, vaccine
administration, and vaccine safety under section 317 of the Public
Health Service Act (42 U.S.C. 247b).
(c) Annual Publication of State-Established Administrative Fees
Under Medicaid.--Beginning October 1, 2009, and annually thereafter,
the Administrator of the Centers for Medicare & Medicaid Services and
the Director of the Centers for Disease Control and Prevention jointly
shall make publicly available the administrative fee established under
each State Medicaid program for administering a qualified pediatric
vaccine to a vaccine-eligible child under the Vaccines for Children
program under section 1928 of the Social Security Act (42 U.S.C. 1396s)
with the State and Federal contribution for such fee separately
identified.
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