Protecting Seniors Through Immunization Act of 2021

II 117TH CONGRESS 1ST SESSION S. 912 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 SENATE OF THE UNITED STATES MARCH 23, 2021 Ms. HIRONO (for herself, Mrs. CAPITO, Mr. WHITEHOUSE, and Mr. SCOTT of South Carolina) introduced the following bill; which was read twice and referred to the Committee on Finance 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Protecting Seniors 4 Through Immunization Act of 2021’’. 5 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 912 IS SEC. 2. FINDINGS. 1 Congress makes the following findings: 2 (1) The immune system deteriorates with age, 3 leaving older adults more susceptible to many vac- 4 cine-preventable diseases that could result in hos- 5 pitalizations and other costly medical interventions. 6 (2) Vaccines play an essential role in preventing 7 disease, thereby helping to keep older adults active 8 and independent. 9 (3) There are more than a dozen immunizations 10 recommended for adult populations by the Advisory 11 Committee on Immunization Practices of the Cen- 12 ters for Disease Control and Prevention, including— 13 (A) influenza; 14 (B) tetanus, diphtheria, pertussis (Tdap); 15 (C) measles, mumps, rubella (MMR); 16 (D) herpes zoster (shingles); 17 (E) human papillomavirus (HPV); 18 (F) pneumococcal; 19 (G) hepatitis A; 20 (H) hepatitis B; and 21 (I) meningococcal. 22 (4) Through new research and technology, addi- 23 tional vaccines may be approved for older adults. 24 (5) Although immunizations are lifesaving and 25 cost-effective interventions, adult vaccination rates 26 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 912 IS in the United States remain below Federal Healthy 1 People benchmarks. 2 (6) There are disparities in adult vaccination 3 rates across different races and ethnicities with rates 4 generally lower among Hispanics, African Ameri- 5 cans, and Asian Americans. 6 (7) Important vaccines, including those for 7 shingles and Tdap, are covered under the Medicare 8 Prescription Drug Program under part D of title 9 XVIII of the Social Security Act. Coverage under 10 the Medicare part D has resulted in barriers to opti- 11 mal and consistent uptake, including lack of patient 12 and provider awareness, beneficiary cost sharing, 13 and low provider reimbursement, as well as geo- 14 graphic, cultural, and linguistic challenges. 15 (8) The Advisory Committee on Immunization 16 Practices of the Centers for Disease Control and 17 Prevention recommends the Tdap vaccine should be 18 administered every 10 years for all ages. According 19 to the Centers for Disease Control and Prevention 20 Surveillance of Vaccination Coverage Among Adults 21 in the United States, National Health Interview Sur- 22 vey, 2016, vaccination rates remain low for tetanus 23 and diphtheria (Td) and tetanus and diphtheria with 24 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 912 IS acellular pertussis (Tdap) for adults age 65 and 1 older, at 58 percent and 20 percent respectively. 2 (9) Being up-to-date with Tdap is especially im- 3 portant for adults who are around babies, because 4 they are not only protecting their own health but 5 helping to form a ‘‘cocoon’’ of disease protection 6 around the baby during the first few months of life. 7 (10) The Advisory Committee on Immunization 8 Practices of the Centers for Disease Control and 9 Prevention recommends the shingles vaccine for indi- 10 viduals aged 50 and older. While vaccine coverage 11 for shingles has increased each year since licensure, 12 in 2016, only 33 percent of adults over 60 years re- 13 ported receiving the vaccine. 14 (11) Almost 1 out of every 3 people in the 15 United States will develop shingles in their lifetime. 16 The risk increases with age, and older individuals 17 are much more likely to experience postherpetic neu- 18 ralgia non-pain complications, hospitalizations, and 19 interference with activities of daily living, such as 20 eating, dressing, and bathing. 21 (12) A 2018 study of Tdap and shingles vaccine 22 claims in Medicare part D demonstrated that higher 23 out-of-pocket cost-sharing was associated with high- 24 er rates of cancelled vaccination claims, suggesting 25 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 912 IS vaccination was abandoned. In this study, cost-shar- 1 ing of $51 or greater was associated with a 2 to 2.7- 2 times greater rate of cancelled vaccination claims 3 compared with $0 cost-sharing. 4 (13) There is an opportunity to improve edu- 5 cation around adult immunization, including the 6 risks and consequences of vaccine-preventable dis- 7 ease, and which vaccines are recommended for older 8 adults. 9 SEC. 3. PROVISION OF INFORMATION REGARDING VAC- 10 CINES FOR SENIORS AS PART OF MEDICARE 11 & YOU HANDBOOK AND COVERAGE OF ADULT 12 VACCINES RECOMMENDED BY THE ADVISORY 13 COMMITTEE ON IMMUNIZATION PRACTICES 14 UNDER MEDICARE PART D. 15 (a) PROVISION OF INFORMATION REGARDING VAC- 16 CINES FOR SENIORS AS PART OF MEDICARE & YOU 17 HANDBOOK.— 18 (1) IN GENERAL.—Section 1804 of the Social 19 Security Act (42 U.S.C. 1395b–2) is amended— 20 (A) in subsection (a)(1), by inserting ‘‘, in- 21 cluding information with respect to coverage of 22 vaccines for seniors described in subsection (e)’’ 23 before the comma at the end; and 24 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 912 IS (B) by adding at the end the following new 1 subsection: 2 ‘‘(e) The notice provided under subsection (a) shall 3 include information with respect to vaccines for seniors, 4 including information with respect to coverage of adult 5 vaccines recommended by the Advisory Committee on Im- 6 munization Practices (as defined in section 1860D– 7 2(b)(8)(B)) under part D for individuals enrolled in a pre- 8 scription drug plan under such part.’’. 9 (2) EFFECTIVE DATE.—The amendments made 10 by this subsection shall apply to notices distributed 11 prior to each Medicare open enrollment period begin- 12 ning after the date of implementation of section 13 1860D–2(b)(8), as added by subsection (b)(2). 14 (b) COVERAGE OF ADULT VACCINES RECOMMENDED 15 BY THE ADVISORY COMMITTEE ON IMMUNIZATION PRAC- 16 TICES UNDER MEDICARE PART D.— 17 (1) PROVISION OF EDUCATIONAL MATERIALS 18 REGARDING THE AVAILABILITY OF ADULT VACCINES 19 RECOMMENDED BY THE ADVISORY COMMITTEE ON 20 IMMUNIZATION PRACTICES WITH NO COST SHAR- 21 ING.—Section 1860D–4(a)(1)(B) of the Social Secu- 22 rity Act (42 U.S.C. 1395w–104(a)(1)(B)) is amend- 23 ed by adding at the end the following new clause: 24 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 912 IS ‘‘(vii) For plan years beginning on or 1 after January 1 of the first year beginning 2 more than 60 days after the date of the 3 enactment of this clause, information re- 4 garding access to adult vaccines rec- 5 ommended by the Advisory Committee on 6 Immunization Practices (as defined in sec- 7 tion 1860D–2(b)(8)(B)).’’. 8 (2) ENSURING TREATMENT OF COST SHARING 9 IS CONSISTENT WITH TREATMENT OF VACCINES 10 UNDER MEDICARE PART B.—Section 1860D–2(b) of 11 the Social Security Act (42 U.S.C. 1395w–102(b)) is 12 amended— 13 (A) in paragraph (1)(A), by striking ‘‘The 14 coverage’’ and inserting ‘‘Subject to paragraph 15 (8), the coverage’’; 16 (B) in paragraph (2)(A), by striking ‘‘and 17 (D)’’ and inserting ‘‘and (D) and paragraph 18 (8)’’; 19 (C) in paragraph (3)(A), by striking ‘‘and 20 (4)’’ and inserting ‘‘(4), and (8)’’; 21 (D) in paragraph (4)(A)(i), by striking 22 ‘‘The coverage’’ and inserting ‘‘Subject to para- 23 graph (8), the coverage’’; and 24 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 912 IS (E) by adding at the end the following new 1 paragraph: 2 ‘‘(8) TREATMENT OF COST SHARING FOR 3 ADULT VACCINES RECOMMENDED BY THE ADVISORY 4 COMMITTEE ON IMMUNIZATION PRACTICES CON- 5 SISTENT WITH TREATMENT OF VACCINES UNDER 6 PART B.— 7 ‘‘(A) IN GENERAL.—For plan years begin- 8 ning on or after January 1 of the first year be- 9 ginning more than 60 days after the date of the 10 enactment of this paragraph, the following shall 11 apply with respect to an adult vaccine rec- 12 ommended by the Advisory Committee on Im- 13 munization Practices (as defined in subpara- 14 graph (B)): 15 ‘‘(i) NO APPLICATION OF DEDUCT- 16 IBLE.—The deductible under paragraph 17 (1) shall not apply with respect to such 18 vaccine. 19 ‘‘(ii) NO APPLICATION OF COINSUR- 20 ANCE.—There shall be no coinsurance 21 under paragraph (2) with respect to such 22 vaccine. 23 ‘‘(iii) NO APPLICATION OF INITIAL 24 COVERAGE LIMIT.—The initial coverage 25 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 912 IS limit under paragraph (3) shall not apply 1 with respect to such vaccine. 2 ‘‘(iv) NO COST SHARING ABOVE AN- 3 NUAL OUT-OF-POCKET THRESHOLD.— 4 There shall be no cost sharing under para- 5 graph (4) with respect to such vaccine. 6 ‘‘(B) ADULT VACCINES RECOMMENDED BY 7 THE ADVISORY COMMITTEE ON IMMUNIZATION 8 PRACTICES.—For purposes of this paragraph, 9 the term ‘adult vaccine recommended by the 10 Advisory Committee on Immunization Prac- 11 tices’ means a vaccine approved for use by 12 adult populations and in accordance with rec- 13 ommendations of the Advisory Committee on 14 Immunization Practices of the Centers for Dis- 15 ease Control and Prevention.’’. 16 (3) CONFORMING AMENDMENTS TO COST SHAR- 17 ING FOR LOW-INCOME INDIVIDUALS.—Section 18 1860D–14(a) of the Social Security Act (42 U.S.C. 19 1395w–114(a)) is amended— 20 (A) in paragraph (1)(D), in each of clauses 21 (ii) and (iii), by striking ‘‘In the case’’ and in- 22 serting ‘‘Subject to paragraph (6), in the case’’; 23 (B) in paragraph (2)— 24 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 912 IS (i) in subparagraph (D), by striking 1 ‘‘The substitution’’ and inserting ‘‘Subject 2 to paragraph (6), the substitution’’; and 3 (ii) in subparagraph (E), by striking 4 ‘‘subsection (c)’’ and inserting ‘‘paragraph 5 (6) and subsection (c)’’; and 6 (C) by adding at the end the following new 7 paragraph: 8 ‘‘(6) NO APPLICATION OF COST SHARING FOR 9 ADULT VACCINES RECOMMENDED BY THE ADVISORY 10 COMMITTEE ON IMMUNIZATION PRACTICES.—Con- 11 sistent with section 1860D–2(b)(8), for plan years 12 beginning on or after January 1 of the first year be- 13 ginning more than 60 days after the date of the en- 14 actment of this paragraph, there shall be no cost 15 sharing under this section with respect to an adult 16 vaccine recommended by the Advisory Committee on 17 Immunization Practices (as defined in subparagraph 18 (B) of such section).’’. 19 (c) STUDY AND REPORT.— 20 (1) STUDY.—The Secretary of Health and 21 Human Services (referred to in this subsection as 22 the ‘‘Secretary’’), acting through the Director of the 23 Centers for Disease Control and Prevention, and in 24 collaboration with the Administrator of the Centers 25 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 912 IS for Medicare & Medicaid Services, shall conduct a 1 study on the uptake of vaccines among the Medicare 2 beneficiary population, including the herpes zoster 3 vaccine and the tetanus, diphtheria, and pertussis 4 vaccine, and anticipated vaccines against such dis- 5 eases as respiratory syncytial virus, clostridium 6 difficile, and others. Such study shall include an 7 analysis of ways to— 8 (A) increase the baseline target rate of 9 coverage for vaccines recommended by the Advi- 10 sory Committee on Immunization Practices of 11 the Centers for Disease Control and Prevention 12 in the Healthy People 2020 goals; 13 (B) ensure that baseline targets focus on 14 reducing racial and socioeconomic disparities in 15 the vaccine coverage rates for all adult vaccines; 16 (C) help facilitate immunization of Medi- 17 care beneficiaries, by developing and evaluating 18 a specific set of actions that will address physi- 19 cian and health care provider administrative 20 challenges, such as difficulty verifying bene- 21 ficiary coverage and complexity of physician of- 22 fice billing of vaccines covered under Medicare 23 part D, that impact access for beneficiaries; 24 VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S912.IS S912 pbinns on DSKJLVW7X2PROD with BILLS 12 •S 912 IS (D) support adoption of the HEDIS adult 1 immunization status composite measure (Tdap, 2 pneumococcal, influenza, and zoster) in order to 3 close gaps in adult immunization performance 4 measurement and incentivize vaccination 5 through adoption of evidence-based measures; 6 and 7 (E) strengthen immunization information 8 systems to allow all States to have electronic 9 databases for immunization records. 10 (2) REPORT.—Not later than 2 years after the 11 date of enactment of this Act, the Secretary shall 12 submit to Congress a report containing the results 13 of the study under paragraph (1), together with rec- 14 ommendations for such legislation and administra- 15 tive action as the Secretary determines appropriate. 16 Æ VerDate Sep 11 2014 23:21 Apr 12, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\S912.IS S912 pbinns on D [Text truncated for display. 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