II 112th CONGRESS 2d Session S. 3344 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.

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.

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.

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.

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).

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. .