[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 3344 Introduced in Senate (IS)]

112th CONGRESS
  2d Session
                                S. 3344

                    To increase immunization rates.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 27, 2012

  Mr. Reed (for himself, Mr. Durbin, Mr. Johnson of South Dakota, Mr. 
 Whitehouse, and Mr. Blumenthal) introduced the following bill; which 
        was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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 
Improvements Act of 2012''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Demonstration project to improve vaccination rates among 
                            Medicare beneficiaries.
Sec. 3. Inclusion of recommended immunizations under part B of the 
                            Medicare program with no beneficiary cost-
                            sharing.
Sec. 4. Vaccine administration fees.
Sec. 5. Improving vaccination rates among health care workers.

SEC. 2. DEMONSTRATION PROJECT TO IMPROVE VACCINATION RATES AMONG 
              MEDICARE BENEFICIARIES.

    (a) Authority To Conduct Demonstration Project.--The Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') shall establish a demonstration project under title 
XVIII of the Social Security Act to evaluate the ability of State and 
local health departments to act as providers in the purchase and 
reimbursement of influenza and pneumococcal vaccinations for Medicare 
beneficiaries.
    (b) Conduct.--
            (1) Duration.--The demonstration project under this section 
        shall be conducted for a 3-year period.
            (2) Scope.--The demonstration project shall be conducted in 
        up to 5 States, as determined by the Secretary, based on 
        consideration of the potential to result in the highest 
        percentage increase in influenza and pneumococcal vaccination 
        rates among Medicare beneficiaries in the State.
            (3) Consideration of ongoing projects.--In establishing and 
        conducting the demonstration project under this section, the 
        Secretary shall take into consideration any States or local 
        entities that have an ongoing demonstration or memorandum of 
        understanding with the Secretary to be reimbursed as a Medicare 
        provider for the cost of an influenza and pneumococcal 
        vaccination administered to a Medicare beneficiary.
            (4) Requirements for participating states.--Under the 
        demonstration project, each participating State (or local 
        government entity participating in the demonstration project) 
        shall meet the following requirements:
                    (A) Contract with multiple sources for the purchase 
                of the influenza and pneumococcal vaccine for purposes 
                of the demonstration project based on population.
                    (B) Purchase influenza and pneumococcal vaccines 
                using the authority provided under section 317 of the 
                Public Health Service Act (42 U.S.C. 247b).
                    (C) Distribute the influenza and pneumococcal 
                vaccine to participating physicians for furnishing to 
                Medicare beneficiaries at no cost to the physician or 
                beneficiary.
                    (D) Be a qualified Medicare provider eligible for 
                reimbursement under title XVIII of the Social Security 
                Act (42 U.S.C. 1395 et seq.).
                    (E) Establish a formal agreement with other 
                appropriate Medicare providers of services and 
                suppliers to participate in the demonstration project.
                    (F) Collect such information as the Secretary shall 
                require on Medicare beneficiaries vaccinated under the 
                demonstration project in order to determine accurate 
                reimbursement for such vaccinations.
    (c) Administration Fees.--Nothing in this section shall prevent a 
provider of services or supplier under the Medicare program under title 
XVIII of the Social Security Act who is participating in the 
demonstration project under this section from receiving reimbursement 
under such program for the administration of an influenza or 
pneumococcal vaccination.
    (d) No Requirement To Participate.--No provider in a participating 
State shall be required to participate in the demonstration project 
under this section.
    (e) Funding for Education and Outreach and Vaccine Distribution.--
The Secretary shall provide for the transfer, out of amounts 
appropriated under section 1115A(f) of the Social Security Act (42 
U.S.C. 1315A(f)), of--
            (1) $5,000,000, to the Centers for Medicare & Medicaid 
        Services Program Management Account for purposes of 
        distributing grants to States (or local government entities) 
        participating in the demonstration project under this section 
        to promote the annual vaccination of seniors against influenza 
        and pneumococcal; and
            (2) such sums as may be necessary to carry out the activity 
        described in subsection (b)(4)(C).
    (f) Prohibition on Use of Funds for Vaccine Purchase.--Amounts 
appropriated under section 317 of the Public Health Service Act (42 
U.S.C. 247b) may not be used by a State (or local government entity) 
participating in the demonstration project under this section to 
purchase influenza and pneumococcal vaccines under subsection 
(b)(4)(B).
    (g) Definition of Medicare Beneficiary.--For purposes of the 
demonstration project under this section, the term ``Medicare 
beneficiary'' means an individual entitled to, or enrolled for, 
benefits under part A of title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) and enrolled for benefits under part B of such 
title, except such term does not include an individual enrolled in a 
Medicare Advantage plan under part C of such title (42 U.S.C. 1395w-21 
et seq.).
    (h) Waiver.--The Secretary may waive such provisions of titles XI 
and XVIII of the Social Security Act as are necessary to carry out the 
demonstration project under this section.
    (i) Report.--Not later than 12 months after the completion of the 
demonstration project under this section, the Secretary shall submit to 
Congress a report on the demonstration project. Such report shall 
contain the following information:
            (1) The percentage of Medicare beneficiaries vaccinated 
        against influenza and pneumococcal by providers participating 
        in the demonstration project in each year in each participating 
        State.
            (2) The estimated cost of the vaccinations (to the State 
        and to the Medicare beneficiary) if they had not been furnished 
        under the demonstration project.
            (3) The estimated actual cost of the vaccinations (to the 
        State and to the Medicare beneficiary) furnished under the 
        demonstration project.
            (4) The difference (if any) between the costs described in 
        paragraphs (2) and (3).
            (5) Recommendations for such legislation and administrative 
        action as the Secretary determines appropriate.

SEC. 3. 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), and (k), 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, 2013.

SEC. 4. VACCINE ADMINISTRATION FEES.

    (a) Review of Federally Established Maximum Allowable 
Administrative Fees.--Not later than 160 days after the date of 
enactment of this Act, 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;
            (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; 
        and
            (3) establish the regional minimum charge for vaccine 
        administration for each State pursuant to section 
        1928(c)(2)(C)(iv) of such Act.
    (b) Establishment of Regional Minimum Charge for Vaccine 
Administration.--
            (1) In general.--Section 1928(c)(2)(C) of the Social 
        Security Act (42 U.S.C. 1396s(c)(2)(C)) is amended--
                    (A) in clause (ii), by striking ``The provider 
                may'' and inserting ``Subject to clause (iv), the 
                provider may''; and
                    (B) by adding at the end the following new clause:
            ``(iv) For purposes of a provider who imposes a fee for the 
        administration of a qualified pediatric vaccine, the State 
        shall pay such provider an amount equal to the administrative 
        fee established under the State plan, which shall not be less 
        than the regional minimum charge for vaccine administration for 
        such State, as established by the Secretary (in conjunction 
        with the Director of the Centers for Disease Control and 
        Prevention) and updated, as appropriate, based on appropriate 
        costs related to administration of pediatric vaccines under 
        this program.''.
    (c) 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), as amended by subsection (b), is further 
        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) 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) 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:
            ``(v) 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.''.
                    (D) by striking subsection (g); and
                    (E) in subsection (h)(6), by striking ``a vaccine'' 
                and inserting ``each vaccine component''.
            (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. 5. IMPROVING VACCINATION RATES AMONG HEALTH CARE WORKERS.

    (a) Hospital Requirements Under Medicare.--Section 1861(e) of the 
Social Security Act (42 U.S.C. 1395x(e)) is amended--
            (1) in paragraph (8), by striking ``; and'' and inserting a 
        semicolon;
            (2) by redesignating paragraph (9) as paragraph (10);
            (3) by inserting after paragraph (8) the following new 
        paragraph:
            ``(9) develops an active surveillance program to track and 
        record disaggregated influenza vaccination levels among health 
        care workers, including vaccinations obtained outside of the 
        facility, and reports those levels annually to the 
        Secretary.''; and
            (4) in the eighth sentence, in each of subparagraphs (B) 
        and (C), by striking ``paragraph (9)'' each place it appears 
        and inserting ``paragraph (10)''.
    (b) Skilled Nursing Facility and Nursing Facility Requirements.--
            (1) Skilled nursing facilities.--Section 1819(d)(3) of the 
        Social Security Act (42 U.S.C. 1395i-3(d)(3)) is amended--
                    (A) in subparagraph (A), by striking ``, and'' and 
                inserting a comma;
                    (B) in subparagraph (B), by striking the period at 
                the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(C) develop an active surveillance program to 
                track and record disaggregated influenza vaccination 
                levels among health care workers, including 
                vaccinations obtained outside of the facility, and 
                report those levels annually to the Secretary.''.
            (2) Nursing facilities.--Section 1919(d)(3) of the Social 
        Security Act (42 U.S.C. 1396r(d)(3)) is amended--
                    (A) in subparagraph (A), by striking ``, and'' and 
                inserting a comma;
                    (B) in subparagraph (B), by striking the period at 
                the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(C) develop an active surveillance program to 
                track and record disaggregated influenza vaccination 
                levels among health care workers, including 
                vaccinations obtained outside of the facility, and 
                report those levels annually to the Secretary.''.
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