[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1978 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 1978
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
March 17, 2021
Ms. Kuster (for herself and Mr. Bucshon) 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 2021''.
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.
<all>