I 
110TH CONGRESS 
2D SESSION 
H. R. 4993 
To amend the Public Health Service Act to increase the availability of 
vaccines, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 16, 2008 
Mr. WAXMAN (for himself and Ms. ROYBAL-ALLARD) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committees on Education and Labor, Ways and Means, 
and Oversight and Government Reform, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Public Health Service Act to increase the 
availability of vaccines, 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 ‘‘Vaccines for the Unin-
sured Adult Act of 2008’’. 
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SEC. 2. CERTAIN AUTHORITIES REGARDING ADULT IMMU-
NIZATIONS. 
(a) IN GENERAL.—Part B of title III of the Public 
Health Service Act (42 U.S.C. 243 et seq.) is amended— 
(1) by redesignating section 317A as section 
317A–1; and 
(2) by inserting after section 317 the following 
section: 
‘‘SEC. 317A. CERTAIN AUTHORITIES REGARDING ADULT IM-
MUNIZATIONS. 
‘‘(a) 
IMMUNIZATION
PROGRAM
FOR
ELIGIBLE 
ADULTS.— 
‘‘(1) IN GENERAL.—The Secretary shall by reg-
ulation establish a program for the distribution of 
qualified adult vaccines through States with ap-
proved applications under paragraph (4)(C) and the 
payment of a fee for the administration of such vac-
cines, under which program— 
‘‘(A) each vaccine-eligible adult, in receiv-
ing an immunization with a qualified adult vac-
cine from a program-registered provider on or 
after October 1, 2009, is entitled to receive the 
immunization without charge for the cost of 
such vaccine; and 
‘‘(B)(i) each program-registered provider 
who administers such a vaccine to a vaccine-eli-
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‘‘(I) is administered a qualified 
adult vaccine while incarcerated in a 
Federal, State, or local penal or cor-
rectional 
institution, 
including 
an 
adult who is held pending judicial or 
administrative proceedings; and 
‘‘(II) is not insured with respect 
to the vaccine. 
‘‘(C) STATE VACCINE-ELIGIBLE ADULT.— 
For purposes of this subsection, the term ‘State 
vaccine-eligible adult’ means, with respect to a 
State and a qualified adult vaccine, an adult 
who is within a class of adults for which the 
State is purchasing the vaccine pursuant to 
provisions that apply pursuant to paragraph 
(2). 
‘‘(4) PARTICIPATION OF STATES.— 
‘‘(A) IN GENERAL.—In the case or each 
State with an approved application under sub-
paragraph (C), the Secretary shall provide, in 
accordance with provisions that apply pursuant 
to paragraph (2), for the purchase and delivery 
on behalf of the State, without charge to the 
State, of such quantities of qualified adult vac-
cines as may be necessary for the administra-
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tion of such vaccines to all vaccine-eligible 
adults in the State on or after October 1, 2009. 
‘‘(B) PROGRAM CRITERIA.—The Secretary, 
in accordance with provisions that apply pursu-
ant to paragraph (2), shall establish criteria for 
State programs under paragraph (1). 
‘‘(C) STATE APPLICATION.—A State may 
participate in the program under paragraph (1) 
only if the State submits to the Secretary an 
application for such participation. The Sec-
retary shall approve any such application 
that— 
‘‘(i) is submitted in such form and 
such manner as the Secretary may require; 
and 
‘‘(ii) demonstrates that the State is in 
compliance with criteria under subpara-
graph (B) and the requirement of subpara-
graph (D). 
‘‘(D) REQUIREMENT
OF
STATE
MAINTE-
NANCE OF IMMUNIZATION LAWS.—In the case 
of a State that had in effect as of July 1, 2008, 
a law that requires some or all health insurance 
policies or plans to provide some coverage with 
respect to an adult vaccine, the Secretary may 
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not approve the State’s application under sub-
paragraph (C) unless the State certifies to the 
Secretary that the State has not modified or re-
pealed such law in a manner that reduces the 
amount of coverage so required. 
‘‘(5) ADDITIONAL DEFINITIONS.—For purposes 
of this subsection: 
‘‘(A) The term ‘adult’ means an individual 
who is not a child as defined in section 1928 of 
the Social Security Act. 
‘‘(B) The term ‘adult vaccine’ means a fed-
erally recommended vaccine for adults. 
‘‘(C)(i) The term ‘insured’, with respect to 
an adult, means that the adult is enrolled 
under, and entitled to benefits under, a health 
insurance policy or plan, including a group 
health plan, a prepaid health plan, or an em-
ployee welfare benefit plan under the Employee 
Retirement Income Security Act of 1974. 
‘‘(ii) An adult is not insured with respect 
to a qualified adult vaccine if the adult is enti-
tled to benefits under such a health insurance 
policy or plan, but such benefits are not avail-
able with respect to the cost of such vaccine. 
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‘‘(D) The term ‘qualified adult vaccine’ 
means an adult vaccine with respect to which a 
contract is in effect pursuant to provisions that 
apply pursuant to paragraph (2). 
‘‘(6) PAYMENT
FOR
VACCINE
ADMINISTRA-
TION.— 
‘‘(A) IN GENERAL.—The amount of pay-
ment for vaccine administration under the pro-
gram under this section shall be the same as 
the amount established under the physician fee 
schedule under section 1848 of the Social Secu-
rity Act for payment for administration of a 
vaccine under part B of title XVIII of such Act. 
‘‘(B) ADMINISTRATIVE
CONTRACTS.—The 
Secretary shall enter into such contracts or 
agreements with qualified carriers or inter-
mediaries as may be necessary for the proc-
essing of claims for payment for vaccine admin-
istration under this section. 
‘‘(7) DIRECT
SPENDING.—The requirement 
under paragraph (1) that the Secretary carry out a 
program constitutes budget authority in advance of 
appropriations Acts, and represents the obligation of 
the Federal Government to make outlays to provide 
for immunizations of vaccine-eligible adults in ac-
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cordance with this subsection, including with respect 
to program-registered providers and with respect to 
the purchase and delivery of qualified adult vaccines 
on behalf of States and with respect to the payment 
for vaccine administration. 
‘‘(b) EMERGENCY
RESPONSE
PLAN
REGARDING 
SHORTAGES.— 
‘‘(1) DEVELOPMENT OF PLAN.—The Secretary 
shall develop and maintain a plan for the response 
of the Secretary to potential shortages in supplies of 
vaccines that would constitute public health emer-
gencies. The plan shall include provisions with re-
spect to— 
‘‘(A) communication among the relevant 
entities; 
‘‘(B) distribution of available supplies of 
the vaccine involved; 
‘‘(C) the designation of populations to be 
given priority for immunizations; 
‘‘(D) interactions with State and local gov-
ernments; 
‘‘(E) the use of the vaccine stockpile; and 
‘‘(F) special considerations for specific vac-
cines. 
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