Protecting Seniors Through Immunization Act of 2021

I 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 subse- quently 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 Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1978 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Protecting Seniors 2 Through Immunization Act of 2021’’. 3 SEC. 2. FINDINGS. 4 Congress makes the following findings: 5 (1) The immune system deteriorates with age, 6 leaving older adults more susceptible to many vac- 7 cine-preventable diseases that could result in hos- 8 pitalizations and other costly medical interventions. 9 (2) Vaccines play an essential role in preventing 10 disease, thereby helping to keep older adults active 11 and independent. 12 (3) There are more than a dozen immunizations 13 recommended for adult populations by the Advisory 14 Committee on Immunization Practices of the Cen- 15 ters for Disease Control and Prevention, including— 16 (A) influenza; 17 (B) tetanus, diphtheria, pertussis (Tdap); 18 (C) measles, mumps, rubella (MMR); 19 (D) herpes zoster (shingles); 20 (E) human papillomavirus (HPV); 21 (F) pneumococcal; 22 (G) hepatitis A; 23 (H) hepatitis B; and 24 (I) meningococcal. 25 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1978 IH (4) Through new research and technology, addi- 1 tional vaccines may be approved for older adults. 2 (5) Although immunizations are lifesaving and 3 cost-effective interventions, adult vaccination rates 4 in the United States remain below Federal Healthy 5 People benchmarks. 6 (6) There are disparities in adult vaccination 7 rates across different races and ethnicities with rates 8 generally lower among Hispanics, African Ameri- 9 cans, and Asian Americans. 10 (7) Important vaccines, including those for 11 shingles and Tdap, are covered under the Medicare 12 Prescription Drug Program under part D of title 13 XVIII of the Social Security Act. Coverage under 14 the Medicare part D has resulted in barriers to opti- 15 mal and consistent uptake, including lack of patient 16 and provider awareness, beneficiary cost sharing, 17 and low provider reimbursement, as well as geo- 18 graphic, cultural, and linguistic challenges. 19 (8) The Advisory Committee on Immunization 20 Practices of the Centers for Disease Control and 21 Prevention recommends the Tdap vaccine should be 22 administered every 10 years for all ages. According 23 to the Centers for Disease Control and Prevention 24 Surveillance of Vaccination Coverage Among Adults 25 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1978 IH in the United States, National Health Interview Sur- 1 vey, 2016, vaccination rates remain low for tetanus 2 and diphtheria (Td) and tetanus and diphtheria with 3 acellular pertussis (Tdap) for adults age 65 and 4 older, at 58 percent and 20 percent respectively. 5 (9) Being up-to-date with Tdap is especially im- 6 portant for adults who are around babies, because 7 they are not only protecting their own health but 8 helping to form a ‘‘cocoon’’ of disease protection 9 around the baby during the first few months of life. 10 (10) The Advisory Committee on Immunization 11 Practices of the Centers for Disease Control and 12 Prevention recommends the shingles vaccine for indi- 13 viduals aged 50 and older. While vaccine coverage 14 for shingles has increased each year since licensure, 15 in 2016, only 33 percent of adults over 60 years re- 16 ported receiving the vaccine. 17 (11) Almost 1 out of every 3 people in the 18 United States will develop shingles in their lifetime. 19 The risk increases with age, and older individuals 20 are much more likely to experience postherpetic neu- 21 ralgia non-pain complications, hospitalizations, and 22 interference with activities of daily living, such as 23 eating, dressing, and bathing. 24 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 1978 IH (12) A 2018 study of Tdap and shingles vaccine 1 claims in Medicare part D demonstrated that higher 2 out-of-pocket cost sharing was associated with high- 3 er rates of cancelled vaccination claims, suggesting 4 vaccination was abandoned. In this study, cost shar- 5 ing of $51 or greater was associated with a 2 to 2.7- 6 times greater rate of cancelled vaccination claims 7 compared with $0 cost sharing. 8 (13) There is an opportunity to improve edu- 9 cation around adult immunization, including the 10 risks and consequences of vaccine-preventable dis- 11 ease, and which vaccines are recommended for older 12 adults. 13 SEC. 3. PROVISION OF INFORMATION REGARDING VAC- 14 CINES FOR SENIORS AS PART OF MEDICARE 15 & YOU HANDBOOK AND COVERAGE OF ADULT 16 VACCINES RECOMMENDED BY THE ADVISORY 17 COMMITTEE ON IMMUNIZATION PRACTICES 18 UNDER MEDICARE PART D. 19 (a) PROVISION OF INFORMATION REGARDING VAC- 20 CINES FOR SENIORS AS PART OF MEDICARE & YOU 21 HANDBOOK.— 22 (1) IN GENERAL.—Section 1804 of the Social 23 Security Act (42 U.S.C. 1395b–2) is amended— 24 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 1978 IH (A) in subsection (a)(1), by inserting ‘‘, in- 1 cluding information with respect to coverage of 2 vaccines for seniors described in subsection (e)’’ 3 before the comma at the end; and 4 (B) by adding at the end the following new 5 subsection: 6 ‘‘(e) The notice provided under subsection (a) shall 7 include information with respect to vaccines for seniors, 8 including information with respect to coverage of adult 9 vaccines recommended by the Advisory Committee on Im- 10 munization Practices (as defined in section 1860D– 11 2(b)(8)(B)) under part D for individuals enrolled in a pre- 12 scription drug plan under such part.’’. 13 (2) EFFECTIVE DATE.—The amendments made 14 by this subsection shall apply to notices distributed 15 prior to each Medicare open enrollment period begin- 16 ning after the date of implementation of section 17 1860D–2(b)(8), as added by subsection (b)(2). 18 (b) COVERAGE OF ADULT VACCINES RECOMMENDED 19 BY THE ADVISORY COMMITTEE ON IMMUNIZATION PRAC- 20 TICES UNDER MEDICARE PART D.— 21 (1) PROVISION OF EDUCATIONAL MATERIALS 22 REGARDING THE AVAILABILITY OF ADULT VACCINES 23 RECOMMENDED BY THE ADVISORY COMMITTEE ON 24 IMMUNIZATION PRACTICES WITH NO COST SHAR- 25 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 1978 IH ING.—Section 1860D–4(a)(1)(B) of the Social Secu- 1 rity Act (42 U.S.C. 1395w–104(a)(1)(B)) is amend- 2 ed by adding at the end the following new clause: 3 ‘‘(vii) For plan years beginning on or 4 after January 1 of the first year beginning 5 more than 60 days after the date of the 6 enactment of this clause, information re- 7 garding access to adult vaccines rec- 8 ommended by the Advisory Committee on 9 Immunization Practices (as defined in sec- 10 tion 1860D–2(b)(8)(B)).’’. 11 (2) ENSURING TREATMENT OF COST SHARING 12 IS CONSISTENT WITH TREATMENT OF VACCINES 13 UNDER MEDICARE PART B.—Section 1860D–2(b) of 14 the Social Security Act (42 U.S.C. 1395w–102(b)) is 15 amended— 16 (A) in paragraph (1)(A), by striking ‘‘the 17 coverage’’ and inserting ‘‘Subject to paragraph 18 (8), the coverage’’; 19 (B) in paragraph (2)(A), by striking ‘‘and 20 (D)’’ and inserting ‘‘and (D) and paragraph 21 (8)’’; 22 (C) in paragraph (3)(A), by striking ‘‘and 23 (4)’’ and inserting ‘‘(4), and (8)’’; 24 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 1978 IH (D) in paragraph (4)(A)(i), by striking 1 ‘‘The coverage’’ and inserting ‘‘Subject to para- 2 graph (8), the coverage’’; and 3 (E) by adding at the end the following new 4 paragraph: 5 ‘‘(8) TREATMENT OF COST SHARING FOR 6 ADULT VACCINES RECOMMENDED BY THE ADVISORY 7 COMMITTEE ON IMMUNIZATION PRACTICES CON- 8 SISTENT WITH TREATMENT OF VACCINES UNDER 9 PART B.— 10 ‘‘(A) IN GENERAL.—For plan years begin- 11 ning on or after January 1 of the first year be- 12 ginning more than 60 days after the date of the 13 enactment of this paragraph, the following shall 14 apply with respect to an adult vaccine rec- 15 ommended by the Advisory Committee on Im- 16 munization Practices (as defined in subpara- 17 graph (B)): 18 ‘‘(i) NO APPLICATION OF DEDUCT- 19 IBLE.—The deductible under paragraph 20 (1) shall not apply with respect to such 21 vaccine. 22 ‘‘(ii) NO APPLICATION OF COINSUR- 23 ANCE.—There shall be no coinsurance 24 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 1978 IH under paragraph (2) with respect to such 1 vaccine. 2 ‘‘(iii) NO APPLICATION OF INITIAL 3 COVERAGE LIMIT.—The initial coverage 4 limit under paragraph (3) shall not apply 5 with respect to such vaccine. 6 ‘‘(iv) NO COST SHARING ABOVE AN- 7 NUAL OUT-OF-POCKET THRESHOLD.— 8 There shall be no cost sharing under para- 9 graph (4) with respect to such vaccine. 10 ‘‘(B) ADULT VACCINES RECOMMENDED BY 11 THE ADVISORY COMMITTEE ON IMMUNIZATION 12 PRACTICES.—For purposes of this paragraph, 13 the term ‘adult vaccine recommended by the 14 Advisory Committee on Immunization Prac- 15 tices’ means a vaccine approved for use by 16 adult populations and in accordance with rec- 17 ommendations of the Advisory Committee on 18 Immunization Practices of the Centers for Dis- 19 ease Control and Prevention.’’. 20 (3) CONFORMING AMENDMENTS TO COST SHAR- 21 ING FOR LOW-INCOME INDIVIDUALS.—Section 22 1860D–14(a) of the Social Security Act (42 U.S.C. 23 1395w–114(a)) is amended— 24 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 1978 IH (A) in paragraph (1)(D), in each of clauses 1 (ii) and (iii), by striking ‘‘In the case’’ and in- 2 serting ‘‘Subject to paragraph (6), in the case’’; 3 (B) in paragraph (2)— 4 (i) in subparagraph (D), by striking 5 ‘‘The substitution’’ and inserting ‘‘Subject 6 to paragraph (6), the substitution’’; and 7 (ii) in subparagraph (E), by striking 8 ‘‘subsection (c)’’ and inserting ‘‘paragraph 9 (6) and subsection (c)’’; and 10 (C) by adding at the end the following new 11 paragraph: 12 ‘‘(6) NO APPLICATION OF COST SHARING FOR 13 ADULT VACCINES RECOMMENDED BY THE ADVISORY 14 COMMITTEE ON IMMUNIZATION PRACTICES.—Con- 15 sistent with section 1860D–2(b)(8), for plan years 16 beginning on or after January 1 of the first year be- 17 ginning more than 60 days after the date of the en- 18 actment of this paragraph, there shall be no cost 19 sharing under this section with respect to an adult 20 vaccine recommended by the Advisory Committee on 21 Immunization Practices (as defined in subparagraph 22 (B) of such section).’’. 23 (c) STUDY AND REPORT.— 24 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 1978 IH (1) STUDY.—The Secretary of Health and 1 Human Services (referred to in this subsection as 2 the ‘‘Secretary’’), acting through the Director of the 3 Centers for Disease Control and Prevention, and in 4 collaboration with the Administrator of the Centers 5 for Medicare & Medicaid Services, shall conduct a 6 study on the uptake of vaccines among the Medicare 7 beneficiary population, including the herpes zoster 8 vaccine and the tetanus, diphtheria, and pertussis 9 vaccine, and anticipated vaccines against such dis- 10 eases as respiratory syncytial virus, clostridium 11 difficile, and others. Such study shall include an 12 analysis of ways to— 13 (A) increase the baseline target rate of 14 coverage for vaccines recommended by the Advi- 15 sory Committee on Immunization Practices of 16 the Centers for Disease Control and Prevention 17 in the Healthy People 2020 goals; 18 (B) ensure that baseline targets focus on 19 reducing racial and socioeconomic disparities in 20 the vaccine coverage rates for all adult vaccines; 21 (C) help facilitate immunization of Medi- 22 care beneficiaries, by developing and evaluating 23 a specific set of actions that will address physi- 24 cian and health care provider administrative 25 VerDate Sep 11 2014 21:45 May 12, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1978.IH H1978 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 1978 IH challenges, such as difficulty verifying bene- 1 ficiary coverage and complexity of physician of- 2 fice billing of vaccines covered under Medicare 3 part D, that impact access for beneficiaries; 4 (D) support adoption of the HEDIS adult 5 immunization status composite measure (Tdap, 6 pneumococcal, influenza, and zoster) in order to 7 close gaps in adult immunization performance 8 measurement and incentivize vaccination 9 through adoption of evidence-based measures; 10 and 11 (E) strengthen immunization information 12 systems to allow all States to have electronic 13 databases for immunization records. 14 (2) REPORT.—Not later than 2 years after the 15 date of enactment of this Act, the Secretary shall 16 submit to Congress a report containing the results 17 of the study under paragraph (1), together with [Text truncated for display. 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