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‘‘(6) NO APPLICATION OF COST SHARING FOR 
ADULT VACCINES RECOMMENDED BY THE ADVISORY 
COMMITTEE
ON
IMMUNIZATION
PRACTICES.—For 
plan years beginning on or after January 1, 2024, 
there shall be no cost sharing under this section, in-
cluding no annual deductible applicable under this 
section, with respect to an adult vaccine rec-
ommended by the Advisory Committee on Immuniza-
tion Practices (as defined in subparagraph (B) of 
such section).’’. 
(c) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as limiting coverage under part D 
of title XVIII of the Social Security Act for vaccines that 
are not recommended by the Advisory Committee on Im-
munization Practices. 
(d) IMPLEMENTATION
FOR 2024.—The Secretary 
shall implement this section, including the amendments 
made by this section, for 2024 by program instruction or 
otherwise. 
SEC. 
139403. 
PAYMENT 
FOR 
BIOSIMILAR 
BIOLOGICAL 
PRODUCTS DURING INITIAL PERIOD. 
Section 1847A(c)(4) of the Social Security Act (42 
U.S.C. 1395w–3a(c)(4)) is amended— 
(1) in each of subparagraphs (A) and (B), by 
redesignating clauses (i) and (ii) as subclauses (I) 
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and (II), respectively, and moving such subclauses 2 
ems to the right; 
(2) by redesignating subparagraphs (A) and 
(B) as clauses (i) and (ii) and moving such clauses 
2 ems to the right; 
(3) by striking ‘‘UNAVAILABLE.—In the case’’ 
and inserting ‘‘UNAVAILABLE.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), in the case’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(B) LIMITATION
ON
PAYMENT
AMOUNT 
FOR BIOSIMILAR BIOLOGICAL PRODUCTS DUR-
ING
INITIAL
PERIOD.—In the case of a bio-
similar biological product furnished on or after 
July 1, 2023, during the initial period described 
in subparagraph (A) with respect to the bio-
similar biological product, the amount payable 
under this section for the biosimilar biological 
product is the lesser of the following: 
‘‘(i) The amount determined under 
clause (ii) of such subparagraph for the 
biosimilar biological product. 
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‘‘(ii) The amount determined under 
subsection (b)(1)(B) for the reference bio-
logical product.’’. 
SEC. 139404. TEMPORARY INCREASE IN MEDICARE PART B 
PAYMENT FOR CERTAIN BIOSIMILAR BIO-
LOGICAL PRODUCTS. 
Section 1847A(b)(8) of the Social Security Act (42 
U.S.C. 1395w–3a(b)(8)) is amended— 
(1) by redesignating subparagraphs (A) and 
(B) as clauses (i) and (ii), respectively, and moving 
the margin of each such redesignated clause 2 ems 
to the right; 
(2) by striking ‘‘PRODUCT.—The amount’’ and 
inserting the following: ‘‘PRODUCT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the amount’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(B) TEMPORARY PAYMENT INCREASE.— 
‘‘(i) IN GENERAL.—In the case of a 
qualifying biosimilar biological product 
that is furnished during the applicable 5- 
year period for such product, the amount 
specified in this paragraph for such prod-
uct with respect to such period is the sum 
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determined under subparagraph (A), ex-
cept that clause (ii) of such subparagraph 
shall be applied by substituting ‘8 percent’ 
for ‘6 percent’. 
‘‘(ii) APPLICABLE 5-YEAR PERIOD.— 
For purposes of clause (i), the applicable 
5-year period for a qualifying biosimilar bi-
ological product is— 
‘‘(I) in the case of such a product 
for which payment was made under 
this paragraph as of March 31, 2022, 
the 5-year period beginning on April 
1, 2022; and 
‘‘(II) in the case of such a prod-
uct for which payment is first made 
under this paragraph during a cal-
endar quarter during the period be-
ginning April 1, 2022, and ending 
March 31, 2027, the 5-year period be-
ginning on the first day of such cal-
endar quarter during which such pay-
ment is first made. 
‘‘(iii) QUALIFYING
BIOSIMILAR
BIO-
LOGICAL
PRODUCT
DEFINED.—For pur-
poses of this subparagraph, the term 
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‘qualifying biosimilar biological product’ 
means a biosimilar biological product de-
scribed in paragraph (1)(C) with respect to 
which— 
‘‘(I) in the case of a product de-
scribed in clause (ii)(I), the average 
sales price under paragraph (8)(A)(i) 
for a calendar quarter during the 5- 
year period described in such clause is 
not more than the average sales price 
under paragraph (4)(A) for such 
quarter for the reference biological 
product; and 
‘‘(II) in the case of a product de-
scribed in clause (ii)(II), the average 
sales price under paragraph (8)(A)(i) 
for a calendar quarter during the 5- 
year period described in such clause is 
not more than the average sales price 
under paragraph (4)(A) for such 
quarter for the reference biological 
product.’’. 
SEC. 139405. IMPROVING ACCESS TO ADULT VACCINES 
UNDER MEDICAID AND CHIP. 
(a) MEDICAID.— 
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(1) REQUIRING COVERAGE OF ADULT VACCINA-
TIONS.— 
(A) IN GENERAL.—Section 1902(a)(10)(A) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)) is amended in the matter pre-
ceding clause (i) by inserting ‘‘(13)(B),’’ after 
‘‘(5),’’. 
(B) 
MEDICALLY
NEEDY.— 
Section 
1902(a)(10)(C)(iv) of such Act (42 U.S.C. 
1396a(a)(10)(C)(iv)) is amended by inserting ‘‘, 
(13)(B),’’ after ‘‘(5)’’. 
(2) NO COST SHARING FOR VACCINATIONS.— 
(A) 
GENERAL
COST-SHARING
LIMITA-
TIONS.—Section 1916 of the Social Security 
Act (42 U.S.C. 1396o) is amended— 
(i) in subsection (a)(2)— 
(I) in subparagraph (G), by in-
serting a comma after ‘‘State plan’’; 
(II) in subparagraph (H), by 
striking ‘‘; or’’ and inserting a 
comma; 
(III) in subparagraph (I), by 
striking ‘‘; and’’ and inserting ‘‘, or’’; 
and 
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(IV) by adding at the end the fol-
lowing new subparagraph: 
‘‘(J) 
vaccines 
described 
in 
section 
1905(a)(13)(B) and the administration of such 
vaccines; and’’; and 
(ii) in subsection (b)(2)— 
(I) in subparagraph (G), by in-
serting a comma after ‘‘State plan’’; 
(II) in subparagraph (H), by 
striking ‘‘; or’’ and inserting a 
comma; 
(III) in subparagraph (I), by 
striking ‘‘; and’’ and inserting ‘‘, or’’; 
and 
(IV) by adding at the end the fol-
lowing new subparagraph: 
‘‘(J) 
vaccines 
described 
in 
section 
1905(a)(13)(B) and the administration of such 
vaccines; and’’. 
(B) APPLICATION TO ALTERNATIVE COST 
SHARING.—Section 1916A(b)(3)(B) of the So-
cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 
is amended by adding at the end the following 
new clause: 
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‘‘(xiv) Vaccines described in section 
1905(a)(13)(B) and the administration of 
such vaccines.’’. 
(3) INCREASED FMAP FOR ADULT VACCINES.— 
Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended— 
(A) by striking ‘‘and (5)’’ and inserting 
‘‘(5)’’; 
(B) by striking ‘‘services and vaccines de-
scribed in subparagraphs (A) and (B) of sub-
section (a)(13), and prohibits cost-sharing for 
such services and vaccines’’ and inserting ‘‘serv-
ices described in subsection (a)(13)(A), and 
prohibits cost-sharing for such services’’; 
(C) by striking ‘‘medical assistance for 
such services and vaccines’’ and inserting ‘‘med-
ical assistance for such services’’; and 
(D) by inserting ‘‘, and (6) during the first 
8 fiscal quarters beginning on or after the effec-
tive date of this clause, in the case of a State 
which, as of the date of enactment of the Act 
titled ‘An Act to provide for reconciliation pur-
suant to title II of S. Con. Res. 14’, provides 
medical assistance for vaccines described in 
subsection (a)(13)(B) and their administration 
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and prohibits cost-sharing for such vaccines, the 
Federal medical assistance percentage, as deter-
mined under this subsection and subsection (y), 
shall be increased by 1 percentage point with 
respect to medical assistance for such vaccines’’ 
before the first period. 
(b) CHIP.— 
(1) REQUIRING COVERAGE OF ADULT VACCINA-
TIONS.—Section 2103(c) of the Social Security Act 
(42 U.S.C. 1397cc(c)) is amended by adding at the 
end the following paragraph: 
‘‘(12) REQUIRED
COVERAGE
OF
APPROVED, 
RECOMMENDED ADULT VACCINES AND THEIR AD-
MINISTRATION.—Regardless of the type of coverage 
elected by a State under subsection (a), if the State 
child health plan or a waiver of such plan provides 
child health assistance or pregnancy-related assist-
ance (as defined in section 2112) to an individual 
who is 19 years of age or older, such assistance shall 
include coverage of vaccines described in section 
1905(a)(13)(B) and their administration.’’. 
(2) NO
COST-SHARING
FOR
VACCINATIONS.— 
Section 
2103(e)(2) 
of 
such 
Act 
(42 
U.S.C. 
1397cc(e)(2)) is amended by inserting ‘‘vaccines de-
scribed in subsection (c)(12) (and the administration 
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of such vaccines),’’ after ‘‘in vitro diagnostic prod-
ucts described in subsection (c)(10) (and administra-
tion of such products),’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on the 1st day of the 1st fiscal 
quarter that begins on or after the date that is 1 year 
after the date of enactment of this Act and shall apply 
to expenditures made under a State plan or waiver of such 
plan under title XIX of the Social Security Act (42 U.S.C. 
1396 through 1396w-6) or under a State child health plan 
or waiver of such plan under title XXI of such Act (42 
U.S.C. 1397aa through 1397mm) on or after such effec-
tive date. 
Subtitle J—Supplemental Security 
Income for the Territories 
SEC. 131001. EXTENSION OF THE SUPPLEMENTAL SECU-
RITY INCOME PROGRAM TO PUERTO RICO, 
THE UNITED STATES VIRGIN ISLANDS, GUAM, 
AND AMERICAN SAMOA. 
(a) IN GENERAL.—Section 303 of the Social Security 
Amendments of 1972 (86 Stat. 1484) is amended by strik-
ing subsection (b). 
(b) CONFORMING AMENDMENTS.— 
(1) 
DEFINITION
OF
STATE.—Section 
1101(a)(1) of the Social Security Act (42 U.S.C. 
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1301(a)(1)) is amended by striking the 5th sentence 
and inserting the following: ‘‘Such term when used 
in title XVI includes Puerto Rico, the United States 
Virgin Islands, Guam, and American Samoa.’’. 
(2) EXEMPTION OF SSI PAYMENTS FROM LIMIT 
ON TOTAL PAYMENTS TO THE TERRITORIES.—Sec-
tion 1108(a)(1) of such Act (42 U.S.C. 1308(a)(1)) 
is amended by striking ‘‘under titles I, X, XIV, and 
XVI’’. 
(3) UNITED STATES NATIONALS TREATED THE 
SAME AS CITIZENS.—Section 1614(a)(1)(B) of such 
Act (42 U.S.C. 1382c(a)(1)(B)) is amended— 
(A) in clause (i)(I), by inserting ‘‘or na-
tional of the United States,’’ after ‘‘citizen’’; 
(B) in clause (i)(II), by adding ‘‘; or’’ at 
the end; and 
(C) in clause (ii), by inserting ‘‘or na-
tional’’ after ‘‘citizen’’. 
(4) TERRITORIES
INCLUDED
IN
GEOGRAPHIC 
MEANING OF UNITED STATES.—Section 1614(e) of 
such Act (42 U.S.C. 1382c(e)) is amended by strik-
ing ‘‘and the District of Columbia’’ and inserting ‘‘, 
the District of Columbia, Puerto Rico, the United 
States 
Virgin 
Islands, 
Guam, 
and 
American 
Samoa’’. 
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(c) WAIVER AUTHORITY.—The Commissioner of So-
cial Security may waive or modify any statutory require-
ment relating to the provision of benefits under the Sup-
plemental Security Income Program under title XVI of the 
Social Security Act in Puerto Rico, the United States Vir-
gin Islands, Guam, or American Samoa, to the extent that 
the Commissioner deems it necessary in order to adapt 
the program to the needs of the territory involved. 
(d) EFFECTIVE DATE.—This section and the amend-
ments made by this section shall take effect on January 
1, 2024. 
Passed the House of Representatives November 19, 
2021. 
Attest: 
CHERYL L. JOHNSON, 
Clerk. 
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