,,ii  #aacth ,,congress  #ast ,session  
,s4 #aafe  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #ac1     
#bjac ,mr4 ,tester 7for himself1 ,mr4   
,pryor1 ,mr4 ,begich1 and ,mr4 ,wyden7  
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,veterans' ,affairs  ,a   
,,bill  ,to amend title #ch1 ,united    
,states ,code1 to provide for certain   
requirements relating to the            
immunization of veterans1 and for other 
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,access to          
,appropriate ,immunizations for         
,veterans ,act of #bjac4  #b4 ,ensuring 
veteran access to appropriate           
immunizations  7a7 ,inclusion of        
recommended adult vaccinations as       
medical services  7#a7 ,covered benefit 
,subparagraph 7,f7 of section #agja7i7  
of title #ch1 ,united ,states ,code1 is 
amended to read as follows3  7,f7       
immunizations against infectious        
diseases1 including each immunization on

 the recommended adult immunization     
schedule at the time such immunization  
is indicated on that schedule2  4  7#b7 
,definition ,section #agja of such title
 is amended by adding after paragraph   
7#i7 the following new paragraph3  7#aj7
 ,the term recommended adult            
immunization schedule means the schedule
 established 7and periodically reviewed 
and1 as appropriate1 revised7 by the    
,advisory ,committee on ,immunization   
,practices established by the ,secretary
 of ,health and ,human ,services and    
delegated to the ,centers for ,disease  
,control and ,prevention4  4  7b7       
,report to ,congress ,section           
#agjd7a77;,a7 of such title is amended--
  7#a7 in clause 7i71 by striking and at
 the end2  7#b7 in clause 7ii71 by      
striking the period at the end and      
inserting 2 and2 and  7#c7 by inserting 
after clause 7ii7 the following new     
clause3  7iii7 to ensure that veterans  
have received each immunization on the  
recommended adult immunization schedule 

at the time such immunization is        
indicated on that schedule4  4  7c7     
,assurance that administration of       
vaccinations constitutes appropriate    
management and cost-,effective delivery 
of health care services  7#a7 ,in       
general ,section #agjf7;a7 of such title
 is amended--  7,a7 by striking ,in     
managing the provision and inserting    
7#a7 ,in managing the provision2 and    
7,b7 by adding at the end the following 
new paragraph3  7#b7 7,a7 ,in managing  
the provision of medical services under 
such section1 the ,secretary shall      
develop and implement quality measures  
and metrics to ensure that veterans     
receiving medical services under this   
title receive each immunization on the  
recommended adult immunization schedule 
at the time such immunization is        
indicated on that schedule4  7,b7       
,quality measures and metrics developed 
and implemented under subparagraph 7,a7 
shall include targets for compliance4   
7,c7 ,the ,secretary shall1 to the      

maximum extent feasible1 develop and    
implement measures and metrics required 
by subparagraph 7,a7 concurrently and   
consistently with the metrics in place1 
as of the date of the enactment of this 
paragraph1 with respect to influenza and
 pneumococcal vaccinations4  4  7#b7    
,report to ,congress ,section #agjd7a7  
of such title is amended by adding at   
the end the following new subparagraph3 
7,h7 ,statistics related to the quality 
measures and metrics developed and      
implemented under section #agjf7;a77#b7 
of this title4  4  7#c7 ,effective dates
  7,a7 ,development of initial schedule 
,the ,secretary shall establish the     
quality measures and metrics described  
in paragraph 7#b7 of section #agjf7;a7  
of such title1 as added by paragraph    
7#a71 through notice and comment        
rulemaking4 ,the ,secretary shall       
publish in the ,federal ,register       
proposed measures and metrics by no     
later than ,july #a1 #bjac1 and shall   
finalize such measures and metrics by no

 later than ,december #ca1 #bjac4  7,b7 
,implementation of measures and metrics 
,the ,secretary shall implement         
paragraph 7#b7 of such section on       
,january #a1 #bjad4  7,c7 ,report to    
,congress ,subparagraph 7,h7 of         
paragraph 7#a7 of section #agjd of such 
title1 as added by paragraph 7#b71 shall
 apply with respect to the first report 
submitted under such section after      
,january #a1 #bjad4