I 

116TH CONGRESS 

1ST SESSION H. R. 5076 

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 13, 2019 

Ms. SHALALA (for herself, Mr. BUCSHON, Ms. KUSTER of New Hampshire, 

and Mr. DAVID P. ROE of Tennessee) 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Protecting Seniors 

3 Through Immunization Act of 2019’’. 

4 SEC. 2. FINDINGS. 

5 Congress makes the following findings: 

6 (1) The immune system deteriorates with age, 

7 leaving older adults more susceptible to many vac8 cine-preventable diseases that could result in hos9 pitalizations and other costly medical interventions. 

10 (2) Vaccines play an essential role in preventing 

11 disease, thereby helping to keep older adults active 

12 and independent. 

13 (3) There are more than a dozen immunizations 

14 recommended for adult populations by the Advisory 

15 Committee on Immunization Practices of the Cen16 ters for Disease Control and Prevention, including— 

17 (A) influenza; 

18 (B) tetanus, diphtheria, pertussis (Tdap); 

19 (C) measles, mumps, rubella (MMR); 

20 (D) herpes zoster (shingles); 

21 (E) human papillomavirus (HPV); 

22 (F) pneumococcal; 

23 (G) hepatitis A; 

24 (H) hepatitis B; and 

25 (I) meningococcal. 


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1 (4) Through new research and technology, addi2 tional vaccines may be approved for older adults. 

3 (5) Although immunizations are lifesaving and 

4 cost-effective interventions, adult vaccination rates 

5 in the United States remain below Federal Healthy 

6 People benchmarks. 

7 (6) There are disparities in adult vaccination 

8 rates across different races and ethnicities with rates 

9 generally lower among Hispanics, African Ameri10 cans, and Asian Americans. 

11 (7) Important vaccines, including those for 

12 shingles and Tdap, are covered under the Medicare 

13 Prescription Drug Program under part D of title 

14 XVIII of the Social Security Act. Coverage under 

15 the Medicare part D has resulted in barriers to opti16 mal and consistent uptake, including lack of patient 

17 and provider awareness, beneficiary cost sharing, 

18 and low provider reimbursement, as well as geo19 graphic, cultural, and linguistic challenges. 

20 (8) The Advisory Committee on Immunization 

21 Practices of the Centers for Disease Control and 

22 Prevention recommends the Tdap vaccine should be 

23 administered every 10 years for all ages. According 

24 to the Centers for Disease Control and Prevention 

25 Surveillance of Vaccination Coverage Among Adults 


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1 in the United States, National Health Interview Sur2 vey, 2016, vaccination rates remain low for tetanus 

3 and diphtheria (Td) and tetanus and diphtheria with 

4 acellular pertussis (Tdap) for adults age 65 and 

5 older, at 58 percent and 20 percent respectively. 

6 (9) Being up-to-date with Tdap is especially im7 portant for adults who are around babies, because 

8 they are not only protecting their own health but 

9 helping to form a ‘‘cocoon’’ of disease protection 

10 around the baby during the first few months of life. 

11 (10) The Advisory Committee on Immunization 

12 Practices of the Centers for Disease Control and 

13 Prevention recommends the shingles vaccine for indi14 viduals aged 50 and older. While vaccine coverage 

15 for shingles has increased each year since licensure, 

16 in 2016, only 33 percent of adults over 60 years re17 ported receiving the vaccine. 

18 (11) Almost 1 out of every 3 people in the 

19 United States will develop shingles in their lifetime. 

20 The risk increases with age, and older individuals 

21 are much more likely to experience postherpetic neu22 ralgia non-pain complications, hospitalizations, and 

23 interference with activities of daily living, such as 

24 eating, dressing, and bathing. 


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1 (12) A 2018 study of Tdap and shingles vaccine 

2 claims in Medicare part D demonstrated that higher 

3 out-of-pocket cost sharing was associated with high4 er rates of cancelled vaccination claims, suggesting 

5 vaccination was abandoned. In this study, cost shar6 ing of $51 or greater was associated with a 2 to 2.7- 

7 times greater rate of cancelled vaccination claims 

8 compared with $0 cost sharing. 

9 (13) There is an opportunity to improve edu10 cation around adult immunization, including the 

11 risks and consequences of vaccine-preventable dis12 ease, and which vaccines are recommended for older 

13 adults. 

14 SEC. 3. PROVISION OF INFORMATION REGARDING VAC15 CINES FOR SENIORS AS PART OF MEDICARE 

16 & YOU HANDBOOK AND COVERAGE OF ADULT 

17 VACCINES RECOMMENDED BY THE ADVISORY 

18 COMMITTEE ON IMMUNIZATION PRACTICES 

19 UNDER MEDICARE PART D. 

20 (a) PROVISION OF INFORMATION REGARDING VAC21 CINES FOR SENIORS AS PART OF MEDICARE & YOU

22 HANDBOOK.— 

23 (1) IN GENERAL.—Section 1804 of the Social 

24 Security Act (42 U.S.C. 1395b–2) is amended— 


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1 (A) in subsection (a)(1), by inserting ‘‘, in2 cluding information with respect to coverage of 

3 vaccines for seniors described in subsection (e)’’ 

4 before the comma at the end; and 

5 (B) by adding at the end the following new 

6 subsection: 

7 ‘‘(e) The notice provided under subsection (a) shall 

8 include information with respect to vaccines for seniors, 

9 including information with respect to coverage of adult 

10 vaccines recommended by the Advisory Committee on Im11 munization Practices (as defined in section 1860D– 

12 2(b)(8)(B)) under part D for individuals enrolled in a pre13 scription drug plan under such part.’’. 

14 (2) EFFECTIVE DATE.—The amendments made 

15 by this subsection shall apply to notices distributed 

16 prior to each Medicare open enrollment period begin17 ning after the date of implementation of section 

18 1860D–2(b)(8), as added by subsection (b)(2). 

19 (b) COVERAGE OF ADULT VACCINES RECOMMENDED

20 BY THE ADVISORY COMMITTEE ON IMMUNIZATION PRAC21 TICES UNDER MEDICARE PART D.— 

22 (1) PROVISION OF EDUCATIONAL MATERIALS

23 REGARDING THE AVAILABILITY OF ADULT VACCINES

24 RECOMMENDED BY THE ADVISORY COMMITTEE ON

25 IMMUNIZATION PRACTICES WITH NO COST SHARVerDate Sep 11 2014 01:20 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5076.IH H5076

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1 ING.—Section 1860D–4(a)(1)(B) of the Social Secu2 rity Act (42 U.S.C. 1395w–104(a)(1)(B)) is amend3 ed by adding at the end the following new clause: 

4 ‘‘(vii) For plan years beginning on or 

5 after January 1 of the first year beginning 

6 more than 60 days after the date of the 

7 enactment of this clause, information re8 garding access to adult vaccines rec9 ommended by the Advisory Committee on 

10 Immunization Practices (as defined in sec11 tion 1860D–2(b)(8)(B)).’’. 

12 (2) ENSURING TREATMENT OF COST SHARING

13 IS CONSISTENT WITH TREATMENT OF VACCINES

14 UNDER MEDICARE PART B.—Section 1860D–2(b) of 

15 the Social Security Act (42 U.S.C. 1395w–102(b)) is 

16 amended— 

17 (A) in paragraph (1)(A), by striking ‘‘the 

18 coverage’’ and inserting ‘‘Subject to paragraph 

19 (8), the coverage’’; 

20 (B) in paragraph (2)(A), by striking ‘‘and 

21 (D)’’ and inserting ‘‘and (D) and paragraph 

22 (8)’’; 

23 (C) in paragraph (3)(A), by striking ‘‘and 

24 (4)’’ and inserting ‘‘(4), and (8)’’; 


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1 (D) in paragraph (4)(A)(i), by striking 

2 ‘‘The coverage’’ and inserting ‘‘Subject to para3 graph (8), the coverage’’; and 

4 (E) by adding at the end the following new 

5 paragraph: 

6 ‘‘(8) TREATMENT OF COST SHARING FOR

7 ADULT VACCINES RECOMMENDED BY THE ADVISORY

8 COMMITTEE ON IMMUNIZATION PRACTICES CON9 SISTENT WITH TREATMENT OF VACCINES UNDER

10 PART B.— 

11 ‘‘(A) IN GENERAL.—For plan years begin12 ning on or after January 1 of the first year be13 ginning more than 60 days after the date of the 

14 enactment of this paragraph, the following shall 

15 apply with respect to an adult vaccine rec16 ommended by the Advisory Committee on Im17 munization Practices (as defined in subpara18 graph (B)): 

19 ‘‘(i) NO APPLICATION OF DEDUCT20 IBLE.—The deductible under paragraph 

21 (1) shall not apply with respect to such 

22 vaccine. 

23 ‘‘(ii) NO APPLICATION OF COINSUR24 ANCE.—There shall be no coinsurance 


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1 under paragraph (2) with respect to such 

2 vaccine. 

3 ‘‘(iii) NO APPLICATION OF INITIAL

4 COVERAGE LIMIT.—The initial coverage 

5 limit under paragraph (3) shall not apply 

6 with respect to such vaccine. 

7 ‘‘(iv) NO COST SHARING ABOVE AN8 NUAL OUT-OF-POCKET THRESHOLD.— 

9 There shall be no cost sharing under para10 graph (4) with respect to such vaccine. 

11 ‘‘(B) ADULT VACCINES RECOMMENDED BY

12 THE ADVISORY COMMITTEE ON IMMUNIZATION

13 PRACTICES.—For purposes of this paragraph, 

14 the term ‘adult vaccine recommended by the 

15 Advisory Committee on Immunization Prac16 tices’ means a vaccine approved for use by 

17 adult populations and in accordance with rec18 ommendations of the Advisory Committee on 

19 Immunization Practices of the Centers for Dis20 ease Control and Prevention.’’. 

21 (3) CONFORMING AMENDMENTS TO COST SHAR22 ING FOR LOW-INCOME INDIVIDUALS.—Section 

23 1860D–14(a) of the Social Security Act (42 U.S.C. 

24 1395w–114(a)) is amended— 


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1 (A) in paragraph (1)(D), in each of clauses 

2 (ii) and (iii), by striking ‘‘In the case’’ and in3 serting ‘‘Subject to paragraph (6), in the case’’; 

4 (B) in paragraph (2)— 

5 (i) in subparagraph (D), by striking 

6 ‘‘The substitution’’ and inserting ‘‘Subject 

7 to paragraph (6), the substitution’’; and 

8 (ii) in subparagraph (E), by striking 

9 ‘‘subsection (c)’’ and inserting ‘‘paragraph 

10 (6) and subsection (c)’’; and 

11 (C) by adding at the end the following new 

12 paragraph: 

13 ‘‘(6) NO APPLICATION OF COST SHARING FOR

14 ADULT VACCINES RECOMMENDED BY THE ADVISORY

15 COMMITTEE ON IMMUNIZATION PRACTICES.—Con16 sistent with section 1860D–2(b)(8), for plan years 

17 beginning on or after January 1 of the first year be18 ginning more than 60 days after the date of the en19 actment of this paragraph, there shall be no cost 

20 sharing under this section with respect to an adult 

21 vaccine recommended by the Advisory Committee on 

22 Immunization Practices (as defined in subparagraph 

23 (B) of such section).’’. 

24 (c) STUDY AND REPORT.— 


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1 (1) STUDY.—The Secretary of Health and 

2 Human Services (referred to in this subsection as 

3 the ‘‘Secretary’’), acting through the Director of the 

4 Centers for Disease Control and Prevention, and in 

5 collaboration with the Administrator of the Centers 

6 for Medicare & Medicaid Services, shall conduct a 

7 study on the uptake of vaccines among the Medicare 

8 beneficiary population, including the herpes zoster 

9 vaccine and the tetanus, diphtheria, and pertussis 

10 vaccine, and anticipated vaccines against such dis11 eases as respiratory syncytial virus, clostridium 

12 difficile, and others. Such study shall include an 

13 analysis of ways to— 

14 (A) increase the baseline target rate of 

15 coverage for vaccines recommended by the Advi16 sory Committee on Immunization Practices of 

17 the Centers for Disease Control and Prevention 

18 in the Healthy People 2020 goals; 

19 (B) ensure that baseline targets focus on 

20 reducing racial and socioeconomic disparities in 

21 the vaccine coverage rates for all adult vaccines; 

22 (C) help facilitate immunization of Medi23 care beneficiaries, by developing and evaluating 

24 a specific set of actions that will address physi25 cian and health care provider administrative 


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1 challenges, such as difficulty verifying bene2 ficiary coverage and complexity of physician of3 fice billing of vaccines covered under Medicare 

4 part D, that impact access for beneficiaries; 

5 (D) support adoption of the HEDIS adult 

6 immunization status composite measure (Tdap, 

7 pneumococcal, influenza, and zoster) in order to 

8 close gaps in adult immunization performance 

9 measurement and incentivize vaccination 

10 through adoption of evidence-based measures; 

11 and 

12 (E) strengthen immunization information 

13 systems to allow all States to have electronic 

14 databases for immunization records. 

15 (2) REPORT.—Not later than 2 years after the 

16 date of enactment of this Act, the Secretary shall 

17 submit to Congress a report containing the results 

18 of the study under paragraph (1), together with rec19 ommendations for such legislation and administra20 tive action as the Secretary determines appropriate. 

Æ 


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