Title: Protecting Seniors Through Immunization Act of 2019
Policy area: Health

Summary:
Protecting Seniors Through Immunization Act of 2019
This bill specifies that certain deductible, coinsurance, initial coverage limit, and cost-sharing requirements that apply under the Medicare prescription drug benefit shall not apply with respect to vaccines that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
The Centers for Medicare & Medicaid Services must provide to Medicare beneficiaries specified information regarding (1) coverage of vaccines for seniors, and (2) access to recommended vaccines without cost-sharing.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5076 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 5076

To amend title XVIII of the Social Security Act to provide information 
 regarding vaccines for seniors as part of the Medicare & You handbook 
  and to ensure that the treatment of cost sharing for vaccines under 
  Medicare part D is consistent with the treatment of vaccines under 
                Medicare part B, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 13, 2019

Ms. Shalala (for herself, Mr. Bucshon, Ms. Kuster of New Hampshire, and 
Mr. David P. Roe of Tennessee) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
   the Committee on Ways and Means, 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 title XVIII of the Social Security Act to provide information 
 regarding vaccines for seniors as part of the Medicare & You handbook 
  and to ensure that the treatment of cost sharing for vaccines under 
  Medicare part D is consistent with the treatment of vaccines under 
                Medicare part B, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Seniors Through 
Immunization Act of 2019''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The immune system deteriorates with age, leaving older 
        adults more susceptible to many vaccine-preventable diseases 
        that could result in hospitalizations and other costly medical 
        interventions.
            (2) Vaccines play an essential role in preventing disease, 
        thereby helping to keep older adults active and independent.
            (3) There are more than a dozen immunizations recommended 
        for adult populations by the Advisory Committee on Immunization 
        Practices of the Centers for Disease Control and Prevention, 
        including--
                    (A) influenza;
                    (B) tetanus, diphtheria, pertussis (Tdap);
                    (C) measles, mumps, rubella (MMR);
                    (D) herpes zoster (shingles);
                    (E) human papillomavirus (HPV);
                    (F) pneumococcal;
                    (G) hepatitis A;
                    (H) hepatitis B; and
                    (I) meningococcal.
            (4) Through new research and technology, additional 
        vaccines may be approved for older adults.
            (5) Although immunizations are lifesaving and cost-
        effective interventions, adult vaccination rates in the United 
        States remain below Federal Healthy People benchmarks.
            (6) There are disparities in adult vaccination rates across 
        different races and ethnicities with rates generally lower 
        among Hispanics, African Americans, and Asian Americans.
            (7) Important vaccines, including those for shingles and 
        Tdap, are covered under the Medicare Prescription Drug Program 
        under part D of title XVIII of the Social Security Act. 
        Coverage under the Medicare part D has resulted in barriers to 
        optimal and consistent uptake, including lack of patient and 
        provider awareness, beneficiary cost sharing, and low provider 
        reimbursement, as well as geographic, cultural, and linguistic 
        challenges.
            (8) The Advisory Committee on Immunization Practices of the 
        Centers for Disease Control and Prevention recommends the Tdap 
        vaccine should be administered every 10 years for all ages. 
        According to the Centers for Disease Control and Prevention 
        Surveillance of Vaccination Coverage Among Adults in the United 
        States, National Health Interview Survey, 2016, vaccination 
        rates remain low for tetanus and diphtheria (Td) and tetanus 
        and diphtheria with acellular pertussis (Tdap) for adults age 
        65 and older, at 58 percent and 20 percent respectively.
            (9) Being up-to-date with Tdap is especially important for 
        adults who are around babies, because they are not only 
        protecting their own health but helping to form a ``cocoon'' of 
        disease protection around the baby during the first few months 
        of life.
            (10) The Advisory Committee on Immunization Practices of 
        the Centers for Disease Control and Prevention recommends the 
        shingles vaccine for individuals aged 50 and older. While 
        vaccine coverage for shingles has increased each year since 
        licensure, in 2016, only 33 percent of adults over 60 years 
        reported receiving the vaccine.
            (11) Almost 1 out of every 3 people in the United States 
        will develop shingles in their lifetime. The risk increases 
        with age, and older individuals are much more likely to 
        experience postherpetic neuralgia non-pain complications, 
        hospitalizations, and interference with activities of daily 
        living, such as eating, dressing, and bathing.
            (12) A 2018 study of Tdap and shingles vaccine claims in 
        Medicare part D demonstrated that higher out-of-pocket cost 
        sharing was associated with higher rates of cancelled 
        vaccination claims, suggesting vaccination was abandoned. In 
        this study, cost sharing of $51 or greater was associated with 
        a 2 to 2.7-times greater rate of cancelled vaccination claims 
        compared with $0 cost sharing.
            (13) There is an opportunity to improve education around 
        adult immunization, including the risks and consequences of 
        vaccine-preventable disease, and which vaccines are recommended 
        for older adults.

SEC. 3. PROVISION OF INFORMATION REGARDING VACCINES FOR SENIORS AS PART 
              OF MEDICARE & YOU HANDBOOK AND COVERAGE OF ADULT VACCINES 
              RECOMMENDED BY THE ADVISORY COMMITTEE ON IMMUNIZATION 
              PRACTICES UNDER MEDICARE PART D.

    (a) Provision of Information Regarding Vaccines for Seniors as Part 
of Medicare & You Handbook.--
            (1) In general.--Section 1804 of the Social Security Act 
        (42 U.S.C. 1395b-2) is amended--
                    (A) in subsection (a)(1), by inserting ``, 
                including information with respect to coverage of 
                vaccines for seniors described in subsection (e)'' 
                before the comma at the end; and
                    (B) by adding at the end the following new 
                subsection:
    ``(e) The notice provided under subsection (a) shall include 
information with respect to vaccines for seniors, including information 
with respect to coverage of adult vaccines recommended by the Advisory 
Committee on Immunization Practices (as defined in section 1860D-
2(b)(8)(B)) under part D for individuals enrolled in a prescription 
drug plan under such part.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to notices distributed prior to each Medicare open 
        enrollment period beginning after the date of implementation of 
        section 1860D-2(b)(8), as added by subsection (b)(2).
    (b) Coverage of Adult Vaccines Recommended by the Advisory 
Committee on Immunization Practices Under Medicare Part D.--
            (1) Provision of educational materials regarding the 
        availability of adult vaccines recommended by the advisory 
        committee on immunization practices with no cost sharing.--
        Section 1860D-4(a)(1)(B) of the Social Security Act (42 U.S.C. 
        1395w-104(a)(1)(B)) is amended by adding at the end the 
        following new clause:
                            ``(vii) For plan years beginning on or 
                        after January 1 of the first year beginning 
                        more than 60 days after the date of the 
                        enactment of this clause, information regarding 
                        access to adult vaccines recommended by the 
                        Advisory Committee on Immunization Practices 
                        (as defined in section 1860D-2(b)(8)(B)).''.
            (2) Ensuring treatment of cost sharing is consistent with 
        treatment of vaccines under medicare part b.--Section 1860D-
        2(b) of the Social Security Act (42 U.S.C. 1395w-102(b)) is 
        amended--
                    (A) in paragraph (1)(A), by striking ``the 
                coverage'' and inserting ``Subject to paragraph (8), 
                the coverage'';
                    (B) in paragraph (2)(A), by striking ``and (D)'' 
                and inserting ``and (D) and paragraph (8)'';
                    (C) in paragraph (3)(A), by striking ``and (4)'' 
                and inserting ``(4), and (8)'';
                    (D) in paragraph (4)(A)(i), by striking ``The 
                coverage'' and inserting ``Subject to paragraph (8), 
                the coverage''; and
                    (E) by adding at the end the following new 
                paragraph:
            ``(8) Treatment of cost sharing for adult vaccines 
        recommended by the advisory committee on immunization practices 
        consistent with treatment of vaccines under part b.--
                    ``(A) In general.--For plan years beginning on or 
                after January 1 of the first year beginning more than 
                60 days after the date of the enactment of this 
                paragraph, the following shall apply with respect to an 
                adult vaccine recommended by the Advisory Committee on 
                Immunization Practices (as defined in subparagraph 
                (B)):
                            ``(i) No application of deductible.--The 
                        deductible under paragraph (1) shall not apply 
                        with respect to such vaccine.
                            ``(ii) No application of coinsurance.--
                        There shall be no coinsurance under paragraph 
                        (2) with respect to such vaccine.
                            ``(iii) No application of initial coverage 
                        limit.--The initial coverage limit under 
                        paragraph (3) shall not apply with respect to 
                        such vaccine.
                            ``(iv) No cost sharing above annual out-of-
                        pocket threshold.--There shall be no cost 
                        sharing under paragraph (4) with respect to 
                        such vaccine.
                    ``(B) Adult vaccines recommended by the advisory 
                committee on immunization practices.--For purposes of 
                this paragraph, the term `adult vaccine recommended by 
                the Advisory Committee on Immunization Practices' means 
                a vaccine approved for use by adult populations and in 
                accordance with recommendations of the Advisory 
                Committee on Immunization Practices of the Centers for 
                Disease Control and Prevention.''.
            (3) Conforming amendments to cost sharing for low-income 
        individuals.--Section 1860D-14(a) of the Social Security Act 
        (42 U.S.C. 1395w-114(a)) is amended--
                    (A) in paragraph (1)(D), in each of clauses (ii) 
                and (iii), by striking ``In the case'' and inserting 
                ``Subject to paragraph (6), in the case'';
                    (B) in paragraph (2)--
                            (i) in subparagraph (D), by striking ``The 
                        substitution'' and inserting ``Subject to 
                        paragraph (6), the substitution''; and
                            (ii) in subparagraph (E), by striking 
                        ``subsection (c)'' and inserting ``paragraph 
                        (6) and subsection (c)''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(6) No application of cost sharing for adult vaccines 
        recommended by the advisory committee on immunization 
        practices.--Consistent with section 1860D-2(b)(8), for plan 
        years beginning on or after January 1 of the first year 
        beginning more than 60 days after the date of the enactment of 
        this paragraph, there shall be no cost sharing under this 
        section with respect to an adult vaccine recommended by the 
        Advisory Committee on Immunization Practices (as defined in 
        subparagraph (B) of such section).''.
    (c) Study and Report.--
            (1) Study.--The Secretary of Health and Human Services 
        (referred to in this subsection as the ``Secretary''), acting 
        through the Director of the Centers for Disease Control and 
        Prevention, and in collaboration with the Administrator of the 
        Centers for Medicare & Medicaid Services, shall conduct a study 
        on the uptake of vaccines among the Medicare beneficiary 
        population, including the herpes zoster vaccine and the 
        tetanus, diphtheria, and pertussis vaccine, and anticipated 
        vaccines against such diseases as respiratory syncytial virus, 
        clostridium difficile, and others. Such study shall include an 
        analysis of ways to--
                    (A) increase the baseline target rate of coverage 
                for vaccines recommended by the Advisory Committee on 
                Immunization Practices of the Centers for Disease 
                Control and Prevention in the Healthy People 2020 
                goals;
                    (B) ensure that baseline targets focus on reducing 
                racial and socioeconomic disparities in the vaccine 
                coverage rates for all adult vaccines;
                    (C) help facilitate immunization of Medicare 
                beneficiaries, by developing and evaluating a specific 
                set of actions that will address physician and health 
                care provider administrative challenges, such as 
                difficulty verifying beneficiary coverage and 
                complexity of physician office billing of vaccines 
                covered under Medicare part D, that impact access for 
                beneficiaries;
                    (D) support adoption of the HEDIS adult 
                immunization status composite measure (Tdap, 
                pneumococcal, influenza, and zoster) in order to close 
                gaps in adult immunization performance measurement and 
                incentivize vaccination through adoption of evidence-
                based measures; and
                    (E) strengthen immunization information systems to 
                allow all States to have electronic databases for 
                immunization records.
            (2) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall submit to Congress a 
        report containing the results of the study under paragraph (1), 
        together with recommendations for such legislation and 
        administrative action as the Secretary determines appropriate.
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