[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4297 Introduced in House (IH)]
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115th CONGRESS
1st Session
H. R. 4297
To amend title XVIII of the Social Security Act to provide information
regarding vaccines for seniors as part of the Medicare & You handbook
and to ensure that the treatment of cost sharing for vaccines under
Medicare part D is consistent with the treatment of vaccines under
Medicare part B, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 8, 2017
Mr. Bucshon (for himself and Mr. Gene Green of Texas) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, 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 title XVIII of the Social Security Act to provide information
regarding vaccines for seniors as part of the Medicare & You handbook
and to ensure that the treatment of cost sharing for vaccines under
Medicare part D is consistent with the treatment of vaccines under
Medicare part B, 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 ``Protecting Seniors Through
Immunization Act of 2017''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Herpes zoster, also known as shingles, is caused by the
reactivation of the varicella-zoster virus that causes
chickenpox in childhood. The virus can reactivate later in
life, resulting in a painful, itchy rash that can persist for
weeks, months, or years. Not only does the risk of herpes
zoster itself increase with age, but, among individuals who
experience herpes zoster, older individuals are much more
likely to experience postherpetic neuralgia non-pain
complications, hospitalizations, and interference with
activities of daily living, such as eating, dressing, and
bathing.
(2) Postherpetic neuralgia, a complication of shingles,
occurs rarely among individuals under age 40 but can occur in
up to \1/3\ of untreated individuals age 60 and older.
(3) The Food and Drug Administration approved the herpes
zoster vaccine for individuals age 50 and older. The Advisory
Committee on Immunization Practices presently recommends the
herpes zoster vaccine for all individuals age 60 and older.
(4) The Healthy People 2020 target baseline for the herpes
zoster vaccine is 30 percent coverage for individuals age 60
and over. This benchmark is unfortunately low compared to that
of other adult vaccines such as influenza (70 percent) and
pneumococcal disease (60 percent). Even at such a low target,
the coverage rate is not being met. The Centers for Disease
Control and Prevention reported that in 2014, only 28 percent
of adults age 60 and older reported receiving the herpes zoster
vaccine.
(5) According to the 2014 National Health Interview Survey
of the Centers for Disease Control and Prevention, vaccination
rates for adults are 20 percent for Tetanus, Diphtheria, and
Pertussis, 28 percent for shingles, 24 percent for Hepatitis B,
and 61 percent for pneumonia. There are also disparities across
adult vaccination rates. Adult immunization rates are generally
lower among Hispanics, African Americans, and Asians.
(6) Medicare coverage for the herpes zoster vaccine under
the Prescription Drug Program under part D of title XVIII of
the Social Security Act has resulted in many barriers to
optimal and consistent uptake to prevent shingles and its
costly and painful complications.
(7) Lack of awareness and logistical and financial
challenges are the most often cited reasons for Medicare
beneficiaries not being immunized against the varicella-zoster
virus.
(8) Herpes zoster is estimated to account for more than
87,000 emergency room visits and 28,000 inpatient admissions
each year. Average costs across the episode of care were $1,835
and $14,428 per patient in the outpatient and inpatient
settings, respectively.
SEC. 3. PROVISION OF INFORMATION REGARDING VACCINES FOR SENIORS AS PART
OF MEDICARE & YOU HANDBOOK AND COVERAGE OF THE SHINGLES
VACCINE UNDER MEDICARE PART D.
(a) Provision of Information Regarding Vaccines for Seniors as Part
of Medicare & You Handbook.--
(1) In general.--Section 1804 of the Social Security Act
(42 U.S.C. 1395b-2) is amended--
(A) in subsection (a)(1), by inserting ``,
including information with respect to coverage of
vaccines for seniors described in subsection (d)''
before the comma at the end; and
(B) by adding at the end the following new
subsection:
``(d) The notice provided under subsection (a) shall include
information with respect to vaccines for seniors, including information
with respect to coverage of the shingles vaccine under part D for
individuals enrolled in a prescription drug plan under such part.''.
(2) Effective date.--The amendments made by this subsection
shall apply to notices distributed prior to each Medicare open
enrollment period beginning after the date of implementation of
section 1860D-2(b)(8), as added by subsection (b)(2).
(b) Coverage of the Shingles Vaccine Under Medicare Part D.--
(1) Provision of educational materials regarding the
availability of acip-recommended herpes vaccine with no cost
sharing.--Section 1860D-4(a)(1)(B) of the Social Security Act
(42 U.S.C. 1395w-104(a)(1)(B)) is amended by adding at the end
the following new clause:
``(vi) For plan years beginning on or after
January 1 of the first year beginning more than
60 days after the date of the enactment of this
clause, information regarding access to the
shingles vaccine with no cost sharing under the
plan.''.
(2) Ensuring treatment of cost sharing is consistent with
treatment of vaccines under medicare part b.--Section 1860D-
2(b) of the Social Security Act (42 U.S.C. 1395w-102(b)) is
amended--
(A) in paragraph (1)(A), by striking ``The
coverage'' and inserting ``Subject to paragraph (8),
the coverage'';
(B) in paragraph (2)(A), by striking ``and (D)''
and inserting ``and (D) and paragraph (8)'';
(C) in paragraph (3)(A), by striking ``and (4)''
and inserting ``(4), and (8)'';
(D) in paragraph (4)(A)(i), by striking ``The
coverage'' and inserting ``Subject to paragraph (8),
the coverage''; and
(E) by adding at the end the following new
paragraph:
``(8) Treatment of cost sharing for shingles vaccine
consistent with treatment of vaccines under part b.--For plan
years beginning on or after January 1 of the first year
beginning more than 60 days after the date of the enactment of
this paragraph:
``(A) No application of deductible.--The deductible
under paragraph (1) shall not apply with respect to the
shingles vaccine.
``(B) No application of coinsurance.--There shall
be no coinsurance under paragraph (2) with respect to
the shingles vaccine.
``(C) No application of initial coverage limit.--
The initial coverage limit under paragraph (3) shall
not apply with respect to the shingles vaccine.
``(D) No cost sharing above annual out-of-pocket
threshold.--There shall be no cost sharing under
paragraph (4) with respect to the shingles vaccine.''.
(3) Conforming amendments to cost sharing for low-income
individuals.--Section 1860D-14(a) of the Social Security Act
(42 U.S.C. 1395w-114(a)) is amended--
(A) in paragraph (1)(D), in each of clauses (ii)
and (iii), by striking ``In the case'' and inserting
``Subject to paragraph (6), in the case'';
(B) in paragraph (2)--
(i) in subparagraph (D), by striking ``The
substitution'' and inserting ``Subject to
paragraph (6), the substitution''; and
(ii) in subparagraph (E), by striking
``subsection (c)'' and inserting ``paragraph
(6) and subsection (c)''; and
(C) by adding at the end the following new
paragraph:
``(6) No application of cost sharing for shingles
vaccine.--Consistent with section 1860D-2(b)(8), for plan years
beginning on or after January 1 of the first year beginning
more than 60 days after the date of the enactment of this
paragraph, there shall be no cost sharing under this section
with respect to the shingles vaccine.''.
(c) Study and Report.--
(1) Study.--The Secretary of Health and Human Services
(referred to in this subsection as the ``Secretary''), acting
through the Director of the Centers for Disease Control and
Prevention, in collaboration with the Administrator of the
Centers for Medicare & Medicaid Services, shall conduct a study
on the uptake of vaccines, including the herpes zoster vaccine
and the tetanus, diphtheria, and pertussis vaccine, and
anticipated vaccines against such diseases as respiratory
syncytial virus, clostridium difficile, and others. Such study
shall include an analysis of ways to--
(A) increase the baseline target rate of coverage
for currently recommended vaccines, such as herpes
zoster vaccine coverage in the Healthy People 2030
goals;
(B) ensure that the baseline target focuses on
reducing racial and socio-economic disparities in the
vaccine coverage rates for all adult vaccines,
including the herpes zoster vaccine; and
(C) help facilitate vaccination for Medicare
beneficiaries for vaccines recommended by the Centers
for Disease Control and Prevention both currently and
in the future, by developing and evaluating a specific
set of actions that will address physician and health
care provider administrative challenges, such as
difficulty verifying beneficiary coverage and
complexity of physician office billing of vaccines
covered under Medicare part D, that impact access for
beneficiaries.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall submit to Congress a
report containing the results of the study under paragraph (1),
together with recommendations for such legislation and
administrative action as the Secretary determines appropriate.
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