Strengthening the Vaccines for Children Program Act of 2021

To amend title XIX of the Social Security Act to ensure adequate access to vaccines under the Medicaid program and the Vaccines for Children program, and for other purposes. 1. Short title This Act may be cited as the Strengthening the Vaccines for Children Program Act of 2021 2. Ensuring adequate access to vaccines under the Medicaid program and the Vaccines for Children program (a) Encouraging involvement of providers Paragraph (3) of section 1928(c) of the Social Security Act ( 42 U.S.C. 1396s(c) (1) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and moving the margins of each such clause, as so redesignated, 2 ems to the right; (2) by striking providers Each program providers.— (A) In general Each program ; and (3) by adding at the end the following: (B) Incentive payments (i) In general The Secretary shall pay to each provider that requests payment under this subparagraph and that is a program-registered provider under this section for the duration of the period beginning on the date of the enactment of this subparagraph, and ending on December 31, 2022— (I) an amount equal to $5,000, to be paid as soon as practicable after the date of the enactment of this subparagraph; (II) an amount equal to $2,500, to be paid as soon as practicable after January 1, 2022; and (III) an amount equal to $2,500, to be paid as soon as practicable after January 1, 2023. (ii) Use of funds Payments made under clause (i) may only be used by a provider for purposes of carrying out the program under this section (including any operational expenses associated with the furnishing of vaccines under such program, as specified by the Secretary). (iii) Recoupment of payments The Secretary may conduct reviews of providers receiving payments under this subparagraph to ensure that such payments are used in accordance with clause (ii) and recoup from such providers any such payments not so used in accordance with such clause. . (b) Expansion of definition of federally vaccine-Eligible child Paragraph (2) of section 1928(b) of the Social Security Act ( 42 U.S.C. 1396s(b) (1) in subparagraph (A)— (A) in clause (iii), by striking A child who A child who is administered a qualified pediatric vaccine and is not insured with respect to such vaccine. (B) by adding at the end the following new clause: (v) A child who is enrolled for child health assistance under a State child health plan approved under title XXI. ; and (2) in subparagraph (B)(ii)(II), by striking for purposes of subparagraph (A)(iii)(II) for purposes of subparagraph (A)(iii) (c) Minimum payment requirement for vaccine administration services (1) In general Section 1902(a)(13) of the Social Security Act ( 42 U.S.C. 1396a(a)(13) (A) in subparagraph (B), by striking and (B) in subparagraph (C), by striking the semicolon and inserting ; and (C) by adding at the end the following new subparagraph: (D) for payment for vaccine administration services (including vaccine counseling and educational services) furnished by a provider during the period beginning on the date of the enactment of this subparagraph, and ending on December 31, 2022 (including, notwithstanding subsection (c)(2)(C)(ii) of section 1928, any such services furnished with respect to a vaccine furnished under the program established by the State pursuant to such section to a medicaid-eligible child (as defined in subsection (b)(2)(B)(i) of such section)), at a rate not less than 100 percent of the payment rate that applies to such services and provider under part B of title XVIII; . (2) Managed care plans Section 1932(f) of the Social Security Act ( 42 U.S.C. 1396u–2(f) (A) in the header, by striking payment for primary care services payments (B) by striking section 1902(a)(13)(C) subparagraph (C) of section 1902(a)(13) and vaccine administration services described in subparagraph (D) of such section (C) by striking such section such subparagraph (C) or (D), respectively (D) by adding at the end the following new sentence: The provisions of the preceding sentence shall apply to contracts entered into with, and payments made by, other specified entities (as defined in section 1903(m)(9)(D)(iii)) in the same manner as such provisions apply with respect to contracts entered into with, and payments made by, medicaid managed care organizations. (3) CHIP Section 2103(c) of the Social Security Act ( 42 U.S.C. 1397cc(c) (11) Vaccine administration services The child health assistance provided to a targeted low-income child shall include payment for vaccine administration services (including vaccine counseling and educational services) furnished by a provider during the period beginning on the date of the enactment of this paragraph, and ending on December 31, 2022 (including, notwithstanding subsection (c)(2)(C)(ii) of section 1928, any such services furnished to such child with respect to a vaccine furnished under the program established by the State pursuant to such section), at a rate not less than 100 percent of the payment rate that applies to such services and provider under part B of title XVIII. . (d) Coverage of vaccine counseling and educational services under Medicaid (1) In general Section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d (A) in paragraph (29), by striking and (B) by redesignating paragraph (30) as paragraph (31); and (C) by inserting after paragraph (29) the following new paragraph: (30) vaccine counseling and educational services furnished to children under the age of 19 on or after the date of the enactment of this paragraph, including any such services furnished as part of a multiple component vaccine (identified as of October 1, 2020, by CPT code 90461) and including any such services furnished under the program established by the State pursuant to section 1928 to a medicaid-eligible child (as defined in subsection (b) of such section), . (2) Mandatory benefit Section 1902(a)(10)(A) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(A) and (29) (29), and (30) (e) Clarification of coverage of pediatric vaccines and vaccine counseling and educational services under the Vaccines for Children program Section 1928(c)(2)(C)(ii) of the Social Security Act ( 42 U.S.C. 1396s(c)(2)(C)(ii) (ii) The provider may impose— (I) in the case of a qualified pediatric vaccine not described in subclause (II), a fee for the administration of and counseling for such vaccine so long as the fee in the case of a federally vaccine-eligible child does not exceed the costs of such administration and counseling (as determined by the Secretary based on actual regional costs for such administration and counseling); and (II) in the case of a qualified pediatric vaccine that is a multiple component vaccine, a separate charge for the administration of and counseling for each component of such vaccine so long as the charge in the case of a federally vaccine-eligible child does not exceed— (aa) with respect to the first component of such vaccine, the costs of such administration and counseling for such component (as determined by the Secretary based on actual regional costs for such administration and counseling for such first component); and (bb) with respect to a subsequent component of such vaccine, the payment rate that applies to such administration and counseling for such component and provider under part B of title XVIII. . (f) Increase in Federal medical assistance percentage (1) In general Subject to paragraph (2), for each calendar quarter occurring during the period beginning on January 1, 2021, and ending on December 31, 2022, the Federal medical assistance percentage determined for each State, including the District of Columbia, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, Puerto Rico, and the United States Virgin Islands, under section 1905(b) of the Social Security Act ( 42 U.S.C. 1396d(b) Public Law 116–127 (2) Requirements (A) In general A State described in paragraph (1) may not receive the increase described in such paragraph in the Federal medical assistance percentage for such State, with respect to a quarter, if such State does not ensure culturally competent and effective messages for vaccination outreach to child populations, which may include the dissemination of information highlighting— (i) advancements in research and vaccine development that have saved millions of individuals from death and disability from now-preventable diseases; (ii) information on how individuals across the lifespan benefit from immunizations, including those who cannot be vaccinated and rely on community immunity; (iii) information on the dangers of not being vaccinated, including the potential for infectious disease outbreaks within communities; and (iv) information on vaccine safety and the systems in place to monitor vaccine safety. (B) Requirement for certain States Section 1905(cc) of the Social Security Act ( 42 U.S.C. 1396d(cc) (i) by inserting and section 2(e) of the Strengthening the Vaccines for Children Program Act of 2021 , except that in applying (ii) by inserting , and in applying such treatments to the increases in the Federal medical assistance percentage under section 2(e) of the Strengthening the Vaccines for Children Program Act of 2021, the reference to December 31, 2009 December 31, 2020 (g) Tribal epidemiology center data access With respect to data access for tribal epidemiology centers established under section 214 of the Indian Health Care Improvement Act ( 25 U.S.C. 1621m (h) Reports (1) In general For each of fiscal years 2021 and 2022, the Director of the Centers for Disease Control and Prevention, in coordination with each State that has established a pediatric vaccine distribution program under section 1928 of the Social Security Act ( 42 U.S.C. 1396s (2) Effects on vaccination rates and program participation Not later than 2 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report containing an analysis of the effects of the provisions of, and the amendments made by, this Act on— (A) vaccination rates under the pediatric vaccine distribution program under section 1928 of the Social Security Act ( 42 U.S.C. 1396s (B) provider participation in such program.

Summary: Strengthening the Vaccines for Children Program Act of 2021 This bill modifies vaccination programs and coverage for children under Medicaid and the Children's Health Insurance Program (CHIP). Specifically, the bill expands and otherwise modifies the Vaccines for Children Program, which provides free vaccinations to individuals 18 years of age or younger who are uninsured or underinsured (i.e., with limited or no insurance for vaccines), are eligible for Medicaid, or are American Indians or Alaskan Natives. The bill expands the program to include children enrolled in CHIP and temporarily provides for additional payments to incentivize provider participation. The Government Accountability Office must report on the related effects of the bill's changes. The bill also expands coverage under Medicaid and CHIP to include vaccine counseling and educational services for children and temporarily requires payments to be made at a rate that is no less than the rate under Medicare for equivalent services. It also temporarily increases the Federal Medical Assistance Percentage (i.e., federal matching rate) for states that conduct culturally appropriate outreach regarding the benefits of vaccinations for children.