[Congressional Record Volume 155, Number 70 (Thursday, May 7, 2009)]
[Senate]
[Pages S5287-S5290]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. REED:
  S. 1003. A bill to increase immunization rates; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. REED. Mr. President, today I introduce the Immunization 
Improvement Act of 2009. The recent outbreak of H1N1 influenza makes 
this legislation timelier than ever before. While a vaccine has not yet 
been developed to protect us against this flu strain, one is currently 
in the works. This outbreak is a reminder of the important role that 
immunizations provide in protecting us against harmful or even deadly 
viruses, like the measles, polio, and seasonal human influenza.
  Vaccinations have been proven to be clinically effective in improving 
health, and providing population-based immunity. Routine childhood 
immunizations, for example, prevent over 14 million individual cases of 
disease and over 33,500 deaths over the lifetime of children born in 
any given year.
  However, significant and persistent gaps in public and private health 
insurance coverage of immunizations remain. Approximately 11 percent of 
young children and 21 percent of adolescents are underinsured for 
immunizations. Nearly 2/3 of adults are underinsured for 
immunizations--17 percent are uninsured. Each year, vaccine-preventable 
diseases cause the deaths of more than 42,000 people and hundreds of 
thousands of cases of illness.
  Congress will soon embark upon meaningful health care reform. This 
debate will provide the opportunity for us to eliminate the obstacles--
lack of insurance and high cost-sharing--to accessing routine 
immunizations. We must shift to a system that will make routine 
preventive care, like immunizations, affordable.
  In fact, it is in the best interest of Government and society to 
ensure coverage of routine vaccinations, as these preventive 
vaccinations currently result in an annual cost savings of $10 billion 
in direct medical costs and over $40 billion in indirect societal 
costs.

[[Page S5288]]

Expanding immunization coverage will enhance these savings over the 
long term.
  The Immunization Improvement Act would remove barriers to 
immunization. First, it would enable states to access routine 
vaccinations for adults at a discount negotiated by the Federal 
Government. Currently, 36 States and New York City are able to buy 
vaccines using the Federal discount, but these contracts are about to 
expire. The Immunization Improvement Act would ensure that states can 
continue to purchase adult vaccines under CDC contracts. It would also 
provide for Medicaid coverage of adult immunizations that are 
recommended for routine use and prohibit any cost-sharing for them.
  There are a host of routinely recommended vaccinations for the 
Medicare population, as well. Unfortunately, Medicare Part B only 
covers influenza, pneumonia, and hepatitis B vaccines. Medicare 
beneficiaries are eligible for additional vaccines that are covered by 
Part D, but few of these vaccines are covered by prescription drug 
plans. Moreover, physicians have difficulties billing plans for the 
incurred costs. As such, the Medicare Payment Advisory Commission, 
MedPAC, has recommended that all immunizations recommended for routine 
use among the Medicare population be covered under Part B. The 
Immunization Improvement Act would codify that recommendation.
  Inadequate reimbursement for administering immunizations also 
prevents children, adolescents, and adults from receiving necessary 
vaccinations. According to the National Vaccine Advisory Committee, the 
Centers for Medicare and Medicaid Services, CMS, and CDC should review 
and update the maximum allowable fees for administering routine 
vaccinations, and publish and update the actual fees for vaccination 
administration paid by each State--in an effort to encourage 
consistency across state lines. This legislation would also reimburse 
providers for administering vaccines to children who are eligible for 
vaccination through the Vaccines for Children program, but not 
Medicaid. This would enable both uninsured and underinsured children to 
become vaccinated in an effort to get all children vaccinated.
  Finally, as we look to reform our health care system, we must also 
hold private health insurers accountable for covering vaccinations 
recommended for routine use--without any cost-sharing. The Immunization 
Improvement Act would require this coverage upon the enactment of 
health reform.
  Given the current circumstances, it is evident that vaccinations can 
and truly do eradicate the spread of preventable diseases. However, we 
must do more to ensure comprehensive coverage of immunizations. It is 
my hope that my colleagues will join me in supporting this legislation.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1003

       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.

[[Page S5289]]

       ``(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,

[[Page S5290]]

     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.
                                 ______