[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.
                                 <all>