I 
109TH CONGRESS 
1ST SESSION H. R. 3598 
To amend the Public Health Service Act to provide for increased funding 
for the Centers for Disease Control and Prevention to carry out activities 
toward increasing the number of medically underserved, at-risk adults 
who are immunized against vaccine-preventable diseases, to require a 
study regarding standards for the measurement of use by beneficiaries 
under the Medicare and Medicaid Programs of adult immunizations 
for influenza, to amend title 5, United States Code, with respect to 
the Federal Employees Health Benefits Program and certain immuniza-
tion services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 28, 2005 
Ms. ROYBAL-ALLARD (for herself, Mr. WICKER, Mr. WAXMAN, Mr. GRIJALVA, 
Mrs. DAVIS of California, Ms. WOOLSEY, Mr. FARR, Ms. SOLIS, Mr. 
CARDOZA, Ms. ZOE LOFGREN of California, Ms. MATSUI, Mrs. CAPPS, 
Ms. ESHOO, Mr. HONDA, Mr. COSTA, Mr. ROYCE, Mr. INSLEE, Mr. PAS-
TOR, Mr. SALAZAR, Mr. MENENDEZ, Mr. BACA, Mr. BECERRA, Mrs. 
NAPOLITANO, Mr. GUTIERREZ, Ms. LINDA T. SA´NCHEZ of California, 
Mr. SERRANO, Ms. VELA´ZQUEZ, Mr. REYES, Mr. LEACH, Mr. ENGLISH 
of Pennsylvania, Mr. WALSH, Mr. BONNER, Mr. CASTLE, Mrs. JOHNSON 
of Connecticut, Mr. CRENSHAW, Ms. JACKSON-LEE of Texas, Mr. GON-
ZALEZ, and Ms. LORETTA SANCHEZ of California) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means and Gov-
ernment Reform, 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 the Public Health Service Act to provide for 
increased funding for the Centers for Disease Control 
and Prevention to carry out activities toward increasing
the number of medically underserved, at-risk adults who 
are immunized against vaccine-preventable diseases, to 
require a study regarding standards for the measurement 
of use by beneficiaries under the Medicare and Medicaid 
Programs of adult immunizations for influenza, to amend 
title 5, United States Code, with respect to the Federal 
Employees Health Benefits Program and certain immu-
nization services, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Total Health Requires 
Improved Vaccination Efforts Act of 2005’’ or the 
‘‘THRIVE Act of 2005’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows: 
(1) Since the 1990s, the United States has 
achieved and maintained high levels of childhood im-
munization, yet certain problems persist within the 
national immunization system. Data from the Cen-
ters for Disease Control indicate the following: 
(A) Immunization coverage rates among 
adults are well below those achieved among chil-
dren. 
(B) Significant racial and ethnic dispari-
ties exist between coverage rates among adults.
(C) Many at-risk adults are not getting the 
vaccines they need to prevent diseases such as 
influenza, pneumococcal pneumonia and hepa-
titis B. 
(2) Vaccine-preventable diseases in adults cause 
a staggering number of deaths and illnesses each 
year. Research shows that the following applies each 
year in the United States: 
(A) 200,000 individuals are hospitalized 
due to influenza complications and approxi-
mately 36,000 will die. 
(B) 33,000 people suffer from invasive 
pneumococcal disease and 5,000 will die. 
(C) 80,000 individuals become newly in-
fected with hepatitis B, and of these 5,000 will 
die. 
(D) Pneumonia and influenza together are 
the sixth leading cause of death among older 
adults. 
(3) The Centers for Disease Control and Pre-
vention (‘‘CDC’’) estimates that the overall cost to 
the Nation from these vaccine-preventable diseases 
of adults exceeds $10 billion per year. 
(4) Recommended adult immunizations are cost 
effective and would produce significant savings for
the health care system of the United States. Accord-
ing to current research and CDC statistics: 
(A) Influenza vaccine saves $14.71 per 
person vaccinated between the ages of 18 and 
63. 
(B) Influenza vaccine saves $182 in med-
ical costs for each person vaccinated aged 65 or 
over. 
(C) Pneumococcal vaccine saves $8.87 in 
medical costs per person vaccinated aged 65 or 
over. 
(D) Hepatitis B vaccine saves $100 million 
in medical costs for every 1 million high-risk 
adults vaccinated. 
(5) The shortage of influenza vaccine for the 
2004–2005 season revealed a number of weaknesses 
in the adult immunization infrastructure in the 
United States: insufficient vaccine to meet demand; 
uneven distribution of vaccine; and impaired abilities 
to administer vaccine to those in greatest need. Such 
problems undermine public health and confidence in 
the public health system, create confusion and un-
certainty, and destabilize the vaccine market place. 
(6) These deficiencies in adult immunization in 
the United States are further exacerbated by de-
creasing Federal and State resources for immuniza-
tions: 
(A) The Federal budget for immunizations 
has decreased over the last five years, shifting 
more of the immunization infrastructural costs 
to states already facing budget shortfalls. 
(B) With most currently available State 
and Federal immunization resources directed 
toward childhood immunization, adult immuni-
zation policies and programs are increasingly at 
risk. 
(C) The diminishing resource base com-
promises the abilities of State health depart-
ments to collect data about adult immunization, 
assess immunization rates and conduct and im-
plement strategic planning to protect adults 
from vaccine-preventable diseases. 
(7) There is, therefore, a vital need to enhance 
the Nation’s efforts to protect adults against vac-
cine-preventable diseases. Establishing a strong and 
effective adult immunization infrastructure in the 
Unites States makes good sense: 
(A) From a public health perspective it will 
better prepare the health care system for an an-
ticipated influenza pandemic.
(B) From a homeland security prepared-
ness stance it will enable the public health com-
munity to respond more quickly and effectively 
to biological threats. 
(C) From a biomedical standpoint it will 
encourage American adults to capitalize on 
newly developed vaccines for other diseases such 
as cervical cancer and shingles. 
(8) There are proven ways to bolster the adult 
immunization system: 
(A) Rigorous studies have shown that re-
moving financial barriers increases vaccination 
rates among adults. 
(B) Measuring how well providers deliver 
immunizations increases vaccination rates. 
(C) Existing performance measurement 
systems are excellent incentives to ensure that 
health care workers are immunized against in-
fectious diseases that could potentially spread 
to vulnerable patients. 
(D) Health education campaigns are prov-
en ways to positively impact immunization be-
haviors.
SEC. 3. CENTERS FOR DISEASE CONTROL AND PREVEN-
TION; PROGRAM FOR INCREASING IMMUNI-
ZATION RATES FOR ADULTS. 
(a) ACTIVITIES OF CENTERS FOR DISEASE CONTROL 
AND PREVENTION.—Section 317(j) of the Public Health 
Service Act (42 U.S.C. 247b(j)) is amended by adding at 
the end the following paragraphs: 
‘‘(3)(A) For the purpose of carrying out activities to-
ward increasing immunization rates for adults through the 
immunization program under this subsection, and for the 
purpose of carrying out subsection (k)(2), there are au-
thorized to be appropriated $75,000,000 for fiscal year 
2006, and such sums as may be necessary for each of the 
fiscal years 2007 through 2010. Such authorization is in 
addition to amounts available under paragraphs (1) and 
(2) for such purposes. 
‘‘(B) In expending amounts appropriated under sub-
paragraph (A), the Secretary shall give priority to adults 
who are medically underserved and are at risk for vaccine- 
preventable diseases. 
‘‘(C) The purposes for which amounts appropriated 
under subparagraph (A) are available include (with re-
spect to immunizations for adults) payment of the costs 
of storing vaccines, outreach activities to inform individ-
uals of the availability of the immunizations, and other 
program expenses necessary for the establishment or oper-
ation of immunization programs carried out or supported 
by States or other public entities pursuant to this sub-
section. 
‘‘(D)(i) Of the amounts appropriated under subpara-
graph (A), the Secretary may, for three consecutive fiscal 
years during the fiscal years 2006 through 2010, reserve 
in the aggregate for such three years not more than 
$25,000,000 to make grants to not more than four States 
for the purpose of carrying out demonstration projects to 
provide immunizations against influenza to individuals 
who are in the age group 19 through 64, are uninsured 
with respect to such vaccine, and are at high risk with 
respect to influenza. 
‘‘(ii) In making grants pursuant to clause (i), the 
Secretary shall give preference to any State that— 
‘‘(I) has a low rate of adult immunizations for 
influenza and pneumococcus among populations that 
are at high risk with respect to such diseases; or 
‘‘(II) has a racial or ethnic minority group for 
which there is a significant disparity in the rate of 
adult immunizations for influenza and pneumococcus 
as compared to the general population of the State. 
‘‘(iii) A grant may be made pursuant to clause (i) 
only if the State involved agrees that, before the dem-
onstration project under such clause begins providing im-
munizations, the State will, for purposes of determining 
the effects of the project, make an estimate of the rate 
of immunizations with influenza vaccine in the population 
that will be served by the project. 
‘‘(iv) Upon the request of a State that will carry out 
a demonstration project under clause (i), the Secretary 
shall provide technical assistance to the State with respect 
to making the estimate described in clause (iii) and with 
respect to identifying intervention and comparison sites 
for the project. 
‘‘(v) For purposes of this subparagraph: 
‘‘(I) An individual shall be considered to be un-
insured with respect to influenza vaccine if the indi-
vidual does not have benefits with respect to the cost 
of such vaccine under a health insurance policy or 
plan (including a group health plan, a prepaid health 
plan, or an employee welfare benefit plan under the 
Employee Retirement Income Security Act of 1974). 
‘‘(II) With respect to influenza, an individual 
shall be considered to be at high risk if the indi-
vidual meets the high-risk criteria identified by the 
Advisory Committee on Immunization Practices (an 
advisory committee established by the Secretary). 
‘‘(4)(A) The Secretary shall annually submit to the 
Congress a report that—
‘‘(i) evaluates the extent to which the im-
munization system in the United States has 
been effective in providing for adequate immu-
nization rates for adults, taking into account 
the applicable year 2010 health objectives es-
tablished by the Secretary regarding the health 
status of the people of the United States; and 
‘‘(ii) describes any issues identified by the 
Secretary that may affect such rates. 
‘‘(B) For each fiscal year for which demonstration 
projects under paragraph (3)(D) are being carried out, the 
report under subparagraph (A) shall include information 
on— 
‘‘(i) the effectiveness of the projects in increas-
ing the rate of immunizations with influenza vaccine 
in the populations involved; 
‘‘(ii) demographic information on the individ-
uals to whom the projects have provided immuniza-
tions (including with respect to race and ethnicity); 
and 
‘‘(iii) the types of health care entities that have 
been involved in the projects. 
‘‘(5) In carrying out this subsection and paragraphs 
(1) and (2) of subsection (k), the Secretary shall consider
recommendations regarding immunizations that are made 
in reports issued by the Institute of Medicine.’’. 
(b) RESEARCH, DEMONSTRATIONS, 
AND
EDU-
CATION.—Section 317(k) of the Public Health Service Act 
(42 U.S.C. 247b(k)) is amended— 
(1) by redesignating paragraphs (2) through 
(4) as paragraphs (3) through (5), respectively; and 
(2) by inserting after paragraph (1) the fol-
lowing paragraph: 
‘‘(2)(A) The Secretary, directly or through grants 
under paragraph (1), shall provide for the following: 
‘‘(i) The Secretary shall coordinate with public 
and private entities (including nonprofit private enti-
ties), and develop and disseminate guidelines, toward 
the goal of ensuring that immunizations are rou-
tinely offered to adults by public and private health 
care providers. 
‘‘(ii) The Secretary shall cooperate with public 
and private entities to obtain information for the an-
nual evaluations required in subsection (j)(4)(A)(i). 
‘‘(B)(i) The Secretary, directly or through grants 
under paragraph (1), shall provide for a campaign of edu-
cation on the importance of adults receiving immuniza-
tions. Such campaign shall have—
‘‘(I) a component directed toward the general 
public; 
‘‘(II) a component or components directed to-
ward health professionals, providers of health insur-
ance and plans, and employers; and 
‘‘(III) components directed toward particular 
populations for which the rate of immunizations is 
low relative to the general population. 
‘‘(ii) In carrying out the campaign under clause (i), 
the Secretary shall seek to use innovative educational 
methods, and shall seek to meet the following goals: 
‘‘(I) Increase the demand for immunizations. 
‘‘(II) Correct misconceptions and unjustified 
concerns about the safety of vaccines. 
‘‘(III) Promote the inclusion in health insurance 
and plans of coverage of immunizations for adults. 
‘‘(IV) Promote the use of evidence-based ap-
proaches for improving the rate of immunizations. 
‘‘(iii) The Secretary shall provide for an evaluation, 
including through surveys, of the effects of the campaign 
under clause (i) on the knowledge, attitudes, and practices 
of the populations described in subclauses (I) through 
(III) of such clause.’’.
SEC. 4. MEDICARE AND MEDICAID PROGRAMS; STANDARDS 
TO MEASURE USAGE AND COVERAGE OF 
ADULT IMMUNIZATIONS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Administrator of the 
Centers for Medicare & Medicaid Services, shall establish 
standards for the measurement of use by beneficiaries 
under the medicare and medicaid programs of adult im-
munizations for influenza. 
(b) STUDY FOR USE OF STANDARDS AS A QUALITY 
MEASURE.—The Secretary, acting through the Adminis-
trator of the Centers for Medicare & Medicaid Services, 
shall conduct a study to determine the feasibility and ad-
visability of including adult immunization for influenza by 
medicare and medicaid beneficiaries, as a performance 
measure under quality initiatives conducted by the Sec-
retary under the medicare and medicaid programs. 
(c) MEASUREMENT OF USAGE BY HEALTH CARE 
WORKERS.—The Secretary, acting through the Adminis-
trator of the Centers for Medicare & Medicaid Services, 
shall establish standards for the measurement of use by 
health care workers, as defined by the Secretary for pur-
poses of this section, working in a provider of services (as 
defined in section 1861(u) of the Social Security Act (42 
U.S.C. 1395x(u)) of adult immunizations for influenza.
(d) ASSESSMENT OF BEST PRACTICES TO IMPROVE 
COVERAGE OF ADULT IMMUNIZATIONS.—The Secretary 
of Health and Human Services, acting through the Agency 
for Healthcare Research and Quality, shall conduct a 
study of the best practices of health insurers and managed 
care organizations to encourage the use of adult immuni-
zations for influenza by enrollees of such insurers and or-
ganizations, such as informed refusal and other interven-
tions. 
SEC. 5. STUDY ON ADULT IMMUNIZATION FOR INFLUENZA 
FOR HEALTH CARE WORKERS AS A QUALITY 
INDICATOR FOR PURPOSES OF ACCREDITA-
TION. 
(a) STUDY.—The Secretary of Health and Human 
Services shall conduct a study to determine the feasibility 
and advisability of including as a requirement of accredita-
tion of a provider of services (as defined in section 1861(u) 
of the Social Security Act (42 U.S.C. 1395x(u)) compli-
ance with recommended adult immunizations, including 
influenza, for all health care workers employed by the pro-
vider of services. Any such requirement should include a 
provision for informed refusal by the health care worker 
of the immunization and appropriate documentation of 
usage and refusal of such immunizations.
(b) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report on the study conducted under sub-
section (a), and shall include in that report a description 
of the difficulties of implementing such a requirement as 
well as recommendations for the resolution of those dif-
ficulties. 
SEC. 6. FEHBP COVERAGE OF QUALIFIED IMMUNIZATION 
SERVICES. 
(a) IN GENERAL.—Section 8902 of title 5, United 
States Code, is amended by adding at the end the fol-
lowing: 
‘‘(p)(1) A contract may not be made or a plan ap-
proved which does not (A) offer qualified immunization 
services to eligible enrollees, and (B) provide for the waiv-
er of any deductible that might otherwise apply with re-
spect to any such services provided to any such enrollee. 
‘‘(2) For purposes of this subsection— 
‘‘(A) the term ‘qualified immunization services’ 
means— 
‘‘(i) pneumococcal vaccine and its adminis-
tration; and 
‘‘(ii) influenza vaccine and its administra-
tion; and
‘‘(B) the term ‘eligible enrollee’, as used with 
respect to a health benefits plan, means an indi-
vidual enrolled in such plan under this chapter who 
is 18 years of age or older and who is at high risk 
of contracting pneumonia or influenza, as deter-
mined under criteria of the Advisory Committee on 
Immunization Practices or another similar body (as 
identified by the Office).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to services provided under any con-
tract entered into or renewed for any contract year begin-
ning later than 9 months after the date of the enactment 
of this Act. 
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