II 

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. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Immunization Improvements Act of 2012’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 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. 

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1 SEC. 2. DEMONSTRATION PROJECT TO IMPROVE VACCINA2 TION RATES AMONG MEDICARE BENE3 FICIARIES. 

4 (a) AUTHORITY TO CONDUCT DEMONSTRATION

5 PROJECT.—The Secretary of Health and Human Services 

6 (in this section referred to as the ‘‘Secretary’’) shall estab7 lish a demonstration project under title XVIII of the So8 cial Security Act to evaluate the ability of State and local 

9 health departments to act as providers in the purchase and 

10 reimbursement of influenza and pneumococcal vaccina11 tions for Medicare beneficiaries. 

12 (b) CONDUCT.— 

13 (1) DURATION.—The demonstration project 

14 under this section shall be conducted for a 3-year 

15 period. 

16 (2) SCOPE.—The demonstration project shall be 

17 conducted in up to 5 States, as determined by the 

18 Secretary, based on consideration of the potential to 

19 result in the highest percentage increase in influenza 

20 and pneumococcal vaccination rates among Medicare 

21 beneficiaries in the State. 

22 (3) CONSIDERATION OF ONGOING PROJECTS.— 

23 In establishing and conducting the demonstration 

24 project under this section, the Secretary shall take 

25 into consideration any States or local entities that 

26 have an ongoing demonstration or memorandum of 

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1 understanding with the Secretary to be reimbursed 

2 as a Medicare provider for the cost of an influenza 

3 and pneumococcal vaccination administered to a 

4 Medicare beneficiary. 

5 (4) REQUIREMENTS FOR PARTICIPATING

6 STATES.—Under the demonstration project, each 

7 participating State (or local government entity par8 ticipating in the demonstration project) shall meet 

9 the following requirements: 

10 (A) Contract with multiple sources for the 

11 purchase of the influenza and pneumococcal 

12 vaccine for purposes of the demonstration 

13 project based on population. 

14 (B) Purchase influenza and pneumococcal 

15 vaccines using the authority provided under sec16 tion 317 of the Public Health Service Act (42 

17 U.S.C. 247b). 

18 (C) Distribute the influenza and pneumo19 coccal vaccine to participating physicians for 

20 furnishing to Medicare beneficiaries at no cost 

21 to the physician or beneficiary. 

22 (D) Be a qualified Medicare provider eligi23 ble for reimbursement under title XVIII of the 

24 Social Security Act (42 U.S.C. 1395 et seq.). 

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1 (E) Establish a formal agreement with 

2 other appropriate Medicare providers of services 

3 and suppliers to participate in the demonstra4 tion project. 

5 (F) Collect such information as the Sec6 retary shall require on Medicare beneficiaries 

7 vaccinated under the demonstration project in 

8 order to determine accurate reimbursement for 

9 such vaccinations. 

10 (c) ADMINISTRATION FEES.—Nothing in this section 

11 shall prevent a provider of services or supplier under the 

12 Medicare program under title XVIII of the Social Security 

13 Act who is participating in the demonstration project 

14 under this section from receiving reimbursement under 

15 such program for the administration of an influenza or 

16 pneumococcal vaccination. 

17 (d) NO REQUIREMENT TO PARTICIPATE.—No pro18 vider in a participating State shall be required to partici19 pate in the demonstration project under this section. 

20 (e) FUNDING FOR EDUCATION AND OUTREACH AND

21 VACCINE DISTRIBUTION.—The Secretary shall provide for 

22 the transfer, out of amounts appropriated under section 

23 1115A(f) of the Social Security Act (42 U.S.C. 1315A(f)), 

24 of— 

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1 (1) $5,000,000, to the Centers for Medicare & 

2 Medicaid Services Program Management Account 

3 for purposes of distributing grants to States (or 

4 local government entities) participating in the dem5 onstration project under this section to promote the 

6 annual vaccination of seniors against influenza and 

7 pneumococcal; and 

8 (2) such sums as may be necessary to carry out 

9 the activity described in subsection (b)(4)(C). 

10 (f) PROHIBITION ON USE OF FUNDS FOR VACCINE

11 PURCHASE.—Amounts appropriated under section 317 of 

12 the Public Health Service Act (42 U.S.C. 247b) may not 

13 be used by a State (or local government entity) partici14 pating in the demonstration project under this section to 

15 purchase influenza and pneumococcal vaccines under sub16 section (b)(4)(B). 

17 (g) DEFINITION OF MEDICARE BENEFICIARY.—For 

18 purposes of the demonstration project under this section, 

19 the term ‘‘Medicare beneficiary’’ means an individual enti20 tled to, or enrolled for, benefits under part A of title XVIII 

21 of the Social Security Act (42 U.S.C. 1395 et seq.) and 

22 enrolled for benefits under part B of such title, except 

23 such term does not include an individual enrolled in a 

24 Medicare Advantage plan under part C of such title (42 

25 U.S.C. 1395w–21 et seq.). 

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1 (h) WAIVER.—The Secretary may waive such provi2 sions of titles XI and XVIII of the Social Security Act 

3 as are necessary to carry out the demonstration project 

4 under this section. 

5 (i) REPORT.—Not later than 12 months after the 

6 completion of the demonstration project under this sec7 tion, the Secretary shall submit to Congress a report on 

8 the demonstration project. Such report shall contain the 

9 following information: 

10 (1) The percentage of Medicare beneficiaries 

11 vaccinated against influenza and pneumococcal by 

12 providers participating in the demonstration project 

13 in each year in each participating State. 

14 (2) The estimated cost of the vaccinations (to 

15 the State and to the Medicare beneficiary) if they 

16 had not been furnished under the demonstration 

17 project. 

18 (3) The estimated actual cost of the vaccina19 tions (to the State and to the Medicare beneficiary) 

20 furnished under the demonstration project. 

21 (4) The difference (if any) between the costs 

22 described in paragraphs (2) and (3). 

23 (5) Recommendations for such legislation and 

24 administrative action as the Secretary determines 

25 appropriate. 

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1 SEC. 3. INCLUSION OF RECOMMENDED IMMUNIZATIONS 

2 UNDER PART B OF THE MEDICARE PROGRAM 

3 WITH NO BENEFICIARY COST-SHARING. 

4 (a) IN GENERAL.—Paragraph (10) of section 

5 1861(s) of the Social Security Act (42 U.S.C. 1395x(s)) 

6 is amended to read as follows: 

7 ‘‘(10) vaccines recommended for routine use by 

8 the Advisory Committee on Immunization Practices 

9 (an advisory committee established by the Secretary, 

10 acting through the Director of the Centers for Dis11 ease Control and Prevention) and their administra12 tion;’’. 

13 (b) CONFORMING AMENDMENTS.— 

14 (1) Section 1833 of the Social Security Act (42 

15 U.S.C. 1395l) is amended, in each of subsections 

16 (a)(1)(B), (a)(2)(G), (a)(3)(A), and (k), by striking 

17 ‘‘1861(s)(10)(A)’’ or ‘‘1861(s)(10)(B)’’ and insert18 ing ‘‘1861(s)(10)’’ each place it appears. 

19 (2) Section 1842(o)(1)(A)(iv) of the Social Se20 curity Act (42 U.S.C. 1395u(o)(1)(A)(iv)) is amend21 ed by striking ‘‘subparagraph (A) or (B) of’’. 

22 (3) Section 1847A(c)(6) of the Social Security 

23 Act (42 U.S.C. 1395w–3a(c)(6)) is amended by 

24 striking subparagraph (G). 

25 (4) Section 1860D–2(e)(1) of the Social Secu26 rity Act (42 U.S.C. 1395w–102(e)(1)) is amended 

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1 by striking ‘‘a vaccine’’ and all that follows through 

2 ‘‘its administration) and’’. 

3 (5) Section 1861(ww)(2)(A) of the Social Secu4 rity Act (42 U.S.C. 1395x(ww)(2)(A)) is amended 

5 by striking ‘‘Pneumococcal, influenza, and hepatitis 

6 B’’ and inserting ‘‘Any’’. 

7 (6) Section 1866(a)(2)(A) of the Social Security 

8 Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by 

9 striking ‘‘1861(s)(10)(A)’’ and inserting 

10 ‘‘1861(s)(10)’’. 

11 (c) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply to vaccines administered on or 

13 after January 1, 2013. 

14 SEC. 4. VACCINE ADMINISTRATION FEES. 

15 (a) REVIEW OF FEDERALLY ESTABLISHED MAX16 IMUM ALLOWABLE ADMINISTRATIVE FEES.—Not later 

17 than 160 days after the date of enactment of this Act, 

18 the Administrator of the Centers for Medicare & Medicaid 

19 Services and the Director of the Centers for Disease Con20 trol and Prevention, jointly shall— 

21 (1) review the regional maximum charge for 

22 vaccine administration for each State established 

23 under the Vaccines for Children program under sec24 tion 1928 of the Social Security Act (42 U.S.C. 

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1 1396s) to determine the appropriateness and ade2 quacy of such rates; 

3 (2) update such rates, as appropriate, based on 

4 the results of such review and taking into account 

5 all appropriate costs related to the administration of 

6 vaccines under that program; and 

7 (3) establish the regional minimum charge for 

8 vaccine administration for each State pursuant to 

9 section 1928(c)(2)(C)(iv) of such Act. 

10 (b) ESTABLISHMENT OF REGIONAL MINIMUM

11 CHARGE FOR VACCINE ADMINISTRATION.— 

12 (1) IN GENERAL.—Section 1928(c)(2)(C) of the 

13 Social Security Act (42 U.S.C. 1396s(c)(2)(C)) is 

14 amended— 

15 (A) in clause (ii), by striking ‘‘The pro16 vider may’’ and inserting ‘‘Subject to clause 

17 (iv), the provider may’’; and 

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

19 clause: 

20 ‘‘(iv) For purposes of a provider who imposes a 

21 fee for the administration of a qualified pediatric 

22 vaccine, the State shall pay such provider an amount 

23 equal to the administrative fee established under the 

24 State plan, which shall not be less than the regional 

25 minimum charge for vaccine administration for such 

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1 State, as established by the Secretary (in conjunc2 tion with the Director of the Centers for Disease 

3 Control and Prevention) and updated, as appro4 priate, based on appropriate costs related to admin5 istration of pediatric vaccines under this program.’’. 

6 (c) FEDERAL REIMBURSEMENT FOR VACCINE AD7 MINISTRATION FOR NON-MEDICAID VACCINE-ELIGIBLE

8 CHILDREN.— 

9 (1) IN GENERAL.—Section 1928 of the Social 

10 Security Act (42 U.S.C. 1396s), as amended by sub11 section (b), is further amended— 

12 (A) in subsection (a)(1)(B), by inserting 

13 ‘‘and is entitled to receive reimbursement for 

14 any fee imposed by the provider for the admin15 istration of such vaccine consistent with sub16 section (c)(2)(C) to a federally vaccine-eligible 

17 child who is described in clause (ii), (iii), or (iv) 

18 of subsection (b)(2),’’ after ‘‘delivery to the pro19 vider,’’; 

20 (B) in subsection (a)(2), by adding at the 

21 end the following new subparagraph: 

22 ‘‘(D) REIMBURSEMENT FOR VACCINE AD23 MINISTRATION FOR NON-MEDICAID ELIGIBLE

24 CHILDREN.—The Secretary shall pay each 

25 State such amounts as are necessary for the 

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1 State to reimburse each program-registered 

2 provider in the State for an administration fee 

3 imposed consistent with subsection (c)(2)(C) for 

4 the administration of a qualified pediatric vac5 cine to a federally vaccine-eligible child who is 

6 described in clause (ii), (iii), or (iv) of sub7 section (b)(2).’’; 

8 (C) in subsection (c)(2)(C) by adding at 

9 the end the following new clause: 

10 ‘‘(v) In the case of a federally vaccine-eligible 

11 child who is described in clause (ii), (iii), or (iv) of 

12 subsection (b)(2), the State shall pay the provider 

13 an amount equal to the administration fee estab14 lished under the State plan approved under this title 

15 for the administration of a qualified pediatric vac16 cine to a Medicaid-eligible child.’’. 

17 (D) by striking subsection (g); and 

18 (E) in subsection (h)(6), by striking ‘‘a 

19 vaccine’’ and inserting ‘‘each vaccine compo20 nent’’. 

21 (2) CONFORMING AMENDMENTS.—Section 1928 

22 of such Act (42 U.S.C. 1396s), as amended by para23 graph (1), is amended— 

24 (A) by redesignating subsection (h) as sub25 section (g); 

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1 (B) in subsection (a)(1)(A), by striking 

2 ‘‘(h)(8)’’ and inserting ‘‘(g)(8)’’; and 

3 (C) in subsection (b)(2)(A)(iv), by striking 

4 ‘‘(h)(3)’’ and inserting ‘‘(g)(3)’’. 

5 SEC. 5. IMPROVING VACCINATION RATES AMONG HEALTH 

6 CARE WORKERS. 

7 (a) HOSPITAL REQUIREMENTS UNDER MEDICARE.— 

8 Section 1861(e) of the Social Security Act (42 U.S.C. 

9 1395x(e)) is amended— 

10 (1) in paragraph (8), by striking ‘‘; and’’ and 

11 inserting a semicolon; 

12 (2) by redesignating paragraph (9) as para13 graph (10); 

14 (3) by inserting after paragraph (8) the fol15 lowing new paragraph: 

16 ‘‘(9) develops an active surveillance program to 

17 track and record disaggregated influenza vaccination 

18 levels among health care workers, including vaccina19 tions obtained outside of the facility, and reports 

20 those levels annually to the Secretary.’’; and 

21 (4) in the eighth sentence, in each of subpara22 graphs (B) and (C), by striking ‘‘paragraph (9)’’ 

23 each place it appears and inserting ‘‘paragraph 

24 (10)’’. 

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1 (b) SKILLED NURSING FACILITY AND NURSING FA2 CILITY REQUIREMENTS.— 

3 (1) SKILLED NURSING FACILITIES.—Section 

4 1819(d)(3) of the Social Security Act (42 U.S.C. 

5 1395i–3(d)(3)) is amended— 

6 (A) in subparagraph (A), by striking ‘‘, 

7 and’’ and inserting a comma; 

8 (B) in subparagraph (B), by striking the 

9 period at the end and inserting ‘‘, and’’; and 

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

11 subparagraph: 

12 ‘‘(C) develop an active surveillance pro13 gram to track and record disaggregated influ14 enza vaccination levels among health care work15 ers, including vaccinations obtained outside of 

16 the facility, and report those levels annually to 

17 the Secretary.’’. 

18 (2) NURSING FACILITIES.—Section 1919(d)(3) 

19 of the Social Security Act (42 U.S.C. 1396r(d)(3)) 

20 is amended— 

21 (A) in subparagraph (A), by striking ‘‘, 

22 and’’ and inserting a comma; 

23 (B) in subparagraph (B), by striking the 

24 period at the end and inserting ‘‘, and’’; and 

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

2 subparagraph: 

3 ‘‘(C) develop an active surveillance pro4 gram to track and record disaggregated influ5 enza vaccination levels among health care work6 ers, including vaccinations obtained outside of 

7 the facility, and report those levels annually to 

8 the Secretary.’’. 

Æ 

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