,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #ghf  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,febru>y #e1 #bjae    
,mrs4 ,ellm]s 7= h]self & ,mr4          
,butt]field7 introduc$ ! foll[+ bill2   
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to improve access1 
c]ta9ty1 & innovation ) respect to      
vacc9es4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,vacc9e ,access1 ,c]ta9ty1 &
 ,innovation ,act ( #bjae4  #b4 ,table (
 cont5ts ,! table ( cont5ts = ?is ,act  
is z foll[s3  ,sec4 #a4 ,%ort title4    
,sec4 #b4 ,table ( cont5ts4 ,title      
,i--,developm5t1 ,lic5sure1 &           
,recomm5dations ,sec4 #aja4 ,review (   
transp>5cy & consi/5cy ( ,,acip         
recomm5dation process4 ,sec4 #ajb4      
,guidance on vacc9e developm5t4 ,sec4   
#ajc4 ,meet+s betwe5 ,,cdc & vacc9e     

develop]s4 ,sec4 #ajd4 ,modifications to
 priority review v\*] program = tropical
 diseases4 ,sec4 #aje4 ,guidance on     
*anges to an approv$ application =      
biological products4 ,sec4 #ajf4        
,exp$it+ ! process = export             
c]tifications = vacc9es4 ,sec4 #ajg4    
,,nih vacc9e rese>*4 ,title             
,,ii--,m$ic>e1 ,m$icaid1 & o!r          
provisions ,sec4 #bja4 ,requir+ prompt  
updates to ,m$ic>e program ^u issuance (
 ,,acip recomm5dations4 ,sec4 #bjb4     
,,gao /udy & report on ,m$ic>e &        
,m$icaid b5efici>y access = vacc9es4    
,sec4 #bjc4 ,enc\rag+ heal? plans to    
e/abli% programs to increase adult      
immunization4  ,i ,developm5t1          
,lic5sure1 & ,recomm5dations  #aja4     
,review ( transp>5cy & consi/5cy (      
,,acip recomm5dation process  7a7       
,review ,! ,director ( ! ,c5t]s =       
,disease ,control & ,prev5tion %all     
conduct a review ( ! transp>5cy &       
consi/5cy ( ! process us$ by ! ,advisory
 ,committee on ,immunization ,practices 

9 =mulat+ & issu+ recomm5dations p]ta9+ 
to vacc9es4  7b7 ,consid]ations ,!      
review "u subsection 7a7 %all include   
assessm5t (--  7#a7 ! crit]ia us$ to    
evaluate new & exi/+ vacc9es2  7#b7 !   
,grad+ ( ,recomm5dations1 ,assessm5t1   
,developm5t1 & ,evaluation 7,,grade7    
approa* to ! review & analysis (        
sci5tific & economic data1 includ+ !    
sci5tific basis = su* approa*2 &  7#c7 !
 ext5t to :i* ! processes us$ by ! work+
 gr\ps ( ! ,advisory ,committee on      
,immunization ,practices are transp>5t &
 consi/5t4  7c7 ,/akehold]s ,9 c>ry+ out
 ! review "u subsection 7a71 ! ,director
 ( ! ,c5t]s = ,disease ,control &       
,prev5tion %all solicit input f vacc9e  
/akehold]s4  7d7 ,report ,n lat] ?an #a 
ye> aft] ! date ( enactm5t ( ?is ,act1 !
 ,director ( ! ,c5t]s = ,disease        
,control & ,prev5tion %all submit to !  
appropriate committees ( ! ,congress &  
make publicly available a report on !   
results ( ! review "u subsection 7a71   
includ+ recomm5dations on improv+ !     

transp>5cy & consi/5cy ( ! process      
describ$ 9 su* subsection4  7e7         
,def9ition ,9 ?is section1 ! t]m        
,advisory ,committee on ,immunization   
,practices means ! advisory committee on
 immunization practices e/abli%$ by !   
,secret>y ( ,heal? & ,human ,s]vices    
pursuant to section #bbb ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bag;a71 act+ ?r\gh ! ,director ( !     
,c5t]s = ,disease ,control & ,prev5tion4
  #ajb4 ,guidance on vacc9e developm5t  
7a7 ,issuance ,n lat] ?an #b ye>s aft] !
 date ( enactm5t ( ?is ,act1 ! ,secret>y
 ( ,heal? & ,human ,s]vices %all issue  
f9al guidance to facilitate ! use (     
accel]at$ & exp$it$ pa?ways = !         
developm5t & lic5sure ( vacc9es to      
prev5t-- 7#a7 em]g+1 re-em]g+1 or r>e   
infecti\s diseases ) respect to :i* ! l[
 preval5ce or nature ( ! disease may    
r5d] ! exi/5ce or collection ( cl9ical  
outcome data unlikely or impractical2 & 
7#b7 infecti\s diseases ) respect to :i*
 curr5tly available vacc9es are n       

address+ ! full scope ( public heal?    
ne$s4  7b7 ,consid]ations ,9 develop+ ! 
guidance requir$ by ?is section1 !      
,secret>y ( ,heal? & ,human ,s]vices    
%all consid] issues relat+ to cl9ical   
developm5t /rategies = diseases describ$
 9 subsection 7a71 includ+ ! developm5t 
& acceptability ( novel cl9ical &       
surrogate endpo9ts1 ! use ( novel or    
accel]at$ /udy designs1 ! use (         
obs]vational real-_w data1 ! use ( novel
 adjuvants1 ! use ( new te*nologies or  
approa*es to collect+ & monitor+        
pati5t-level data1 & ! demon/ration (   
efficacy ?r\gh /udies 9 heal?y volunte]s
 = ! purpose ( lic5sure4  #ajc4 ,meet+s 
betwe5 ,,cdc & vacc9e develop]s ,section
 #caj ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #bdbo7 is am5d$ by add+  
at ! end ! foll[+3  7c7 7#a7 ,9 ?is     
subsection1 ! t]m vacc9e develop] means 
a nongov]nm5tal entity engag$ 9--  7,a7 
! developm5t or production ( a vacc9e2 &
  7,b7 vacc9e rese>*4  7#b7  7,a7 ,^u ! 
submission ( a writt5 reque/ by a vacc9e

 develop]1 ! ,secret>y1 act+ ?r\gh !    
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion1 %all conv5e a meet+ (    
repres5tatives ( ! vacc9e develop] &    
exp]ts 9 immunization programs1         
epidemiology1 & o!r relevant areas1     
includ+ su* exp]ts f ! ,food & ,drug    
,adm9i/ration & ! ,national ,vacc9e     
,program1 at :i* ! ,director 7or !      
,director's designee71 = ! purpose (    
in=m+ ! vacc9e develop]'s und]/&+ (     
public heal? ne$s & priorities1 %all    
provide ! p]spectives ( ! ,c5t]s =      
,disease ,control & ,prev5tion & o!r    
relevant ,f$]al ag5cies reg>d+-- 7i7    
public heal? ne$s1 epidemiology1 &      
implem5tation consid]ations ) reg>d to a
 vacc9e develop]'s pot5tial vacc9e      
pr(ile2 &  7ii7 pot5tial implications ( 
su* p]spectives = ! vacc9e develop]'s   
vacc9e rese>* & developm5t plann+4  7,b7
 ,! ,director ( ! ,c5t]s = ,disease     
,control & ,prev5tion 7or ! ,director's 
designee7 %all conv5e a meet+ reque/$ "u
 subp>agraph 7,a7 n lat] ?an #ij bus9ess

 days aft] receipt ( ! reque/ = ! meet+4
  7#c7  7,a7 ,^u ! submission ( a writt5
 reque/ by a vacc9e develop]1 !         
,secret>y1 act+ ?r\gh ! ,director ( !   
,c5t]s = ,disease ,control & ,prev5tion1
 %all provide to ! vacc9e develop] any  
age-bas$ disease epidemiological        
analyses or data t-- 7i7 are specifi$ 9 
! reque/2  7ii7 h be5 publi%$2  7iii7 h 
be5 p]=m$ by or are 9 ! possession ( !  
,c5t]s2 &  7iv7 are n a trade secret or 
o!rwise confid5tial in=mation subject to
 section #eeb7;b77#d7 ( title #e1 ,unit$
 ,/ates ,code1 or section #aije ( title 
#ah1 ,unit$ ,/ates ,code4  7,b7 ,!      
,secret>y %all provide analyses reque/$ 
by a vacc9e manufactur] "u subp>agraph  
7,a7 n lat] ?an #ij bus9ess days aft]   
receipt ( ! reque/ = ! analyses4  7#d7  
,! ,secret>y %all promptly notify a     
vacc9e develop] if-- 7,a7 ! ,secret>y   
becomes aw>e ( any *ange to in=mation t 
0--  7i7 %>$ by ! ,secret>y ) ! vacc9e  
develop] dur+ a meet+ "u p>agraph 7#b72 
or  7ii7 provid$ by ! ,secret>y to !    

vacc9e develop] 9 "o or m analyses "u   
p>agraph 7#c72 &  7,b7 ! *ange may h    
implications = ! vacc9e develop]'s      
vacc9e rese>* & developm5t4  4  #ajd4   
,modifications to priority review v\*]  
program = tropical diseases ,section    
#ebd ( ! ,f$]al ,food1 ,drug1 &         
,cosmetic ,act 7#ba ,u4,s4,c4 #cfjn7 is 
am5d$--  7#a7 9 subsection 7a7-- 7,a7 9 
p>agraph 7#c7--  7i7 9 ! matt] be=e     
subp>agraph 7,a71 by /rik+ ,?is t]m &   
ins]t+ ,9 ?is section1 ?is t]m2 &  7ii7 
9 subp>agraph 7,r71 by /rik+ designat$  
by ord] ( ! ,secret>y & ins]t+ designat$
 by ! ,secret>y pursuant to p>agraph    
7#d72  7,b7 by r$esignat+ p>agraph 7#d7 
z p>agraph 7#e72 &  7,c7 by ins]t+ aft] 
p>agraph 7#c7 ! foll[+3  7#d7           
,designation ( o!r infecti\s diseases z 
tropical diseases  7,a7 ,9 g5]al ,!     
,secret>y %all e/abli% a process "u :i* 
! ,secret>y-- 7i7 us+ a me?odology t is 
made available to ! public on ! ,int]net
 site ( ! ,food & ,drug ,adm9i/ration1  
designates infecti\s diseases o!r ?an ! 

diseases specifi$ 9 subp>agraphs 7,a7   
?r\gh 7,q7 ( p>agraph 7#c7 to be        
tropical diseases = purposes ( ?is      
section2 &  7ii7 publi%es on su*        
,int]net site a complete1 updat$ li/ ( !
 diseases t are tropical diseases =     
purposes ( ?is section4  7,b7           
,consid]ations ,9 designat+ an infecti\s
 disease z a tropical disease "u        
subp>agraph 7,a71 ! ,secret>y %all--    
7i7 consid] ! pot5tial impact ( !       
disease on ! public heal? due to-- 7,i7 
! pot5tial rate ( spread ( ! disease2 & 
7,,ii7 ! pot5tial sev]ity ( ! disease 9 
t]ms ( human morbidity & mortality2 &   
7ii7 consult ) exp]ts 9 tropical        
infecti\s diseases1 includ+ ! ,c5t]s =  
,disease ,control & ,prev5tion1 ! ,food 
& ,drug ,adm9i/ration1 m$ical           
pr(essionals1 ! cl9ical rese>*          
community1 & ! ,_w ,heal? ,organization4
  7,c7 ,review ,e #e ye>s1 or m         
frequ5tly z det]m9$ necess>y by !       
,secret>y1 ! ,secret>y %all review1     
provide modifications to1 & re-publi% ! 

li/ publi%$ "u subp>agraph 7,a7 & any   
revisions made to ! me?odology =        
designation ( diseases "u su*           
subp>agraph4  2  7#b7 9 subsection 7b7--
  7,a7 9 p>agraph 7#b71 by /rik+ ,!     
sponsor ( a tropical disease & ins]t+3  
7,a7 ,9 g5]al ,! sponsor ( a tropical   
disease  2  7,b7 by ins]t+ aft] su*     
p>agraph 7#b77;,a7 ! foll[+3  7,b7      
,notification ( transf] ,ea* p]son to   
:om a priority review v\*] is transf]r$ 
%all notify ! ,secret>y ( su* *ange 9   
own]%ip ( ! v\*] n lat] ?an #cj bus9ess 
days aft] su* transf]4  2  7,c7 9       
p>agraph 7#d71 by /rik+ ,! sponsor ( a  
human drug application & ins]t+3  7,a7  
,9 g5]al ,! sponsor ( a human drug      
application  2 &  7,d7 by ins]t+ aft]   
p>agraph 7#d77;,a71 z designat$ by      
subp>agraph 7,d71 ! foll[+3  7,b7       
,transf] aft] notice ,! sponsor ( a     
human drug application t provides       
notification ( int5t "u subp>agraph 7,a7
 may transf] ! v\*] aft] su*            
notification is provid$1 if su* sponsor 

has n yet submitt$ ! human drug         
application describ$ 9 ! notification4  
,^u su* a transf]1 not)/&+ subp>agraph  
7,a71 su* sponsor %all n rema9 legally  
committ$ to pay a us] fee because ( !   
sponsor's notification ( int5t "u su*   
subp>agraph4  2 &  7#c7 9 subsection    
7c71 by am5d+ p>agraph 7#b7 to read z   
foll[s3  7#b7 ,fee am\nt ,! am\nt ( !   
priority review us] fee %all be det]m9$ 
ea* fiscal ye> by ! ,secret>y bas$ on ! 
diff]5ce betwe5--  7,a7 ! av]age co/    
incurr$ by ! ag5cy 9 ! review ( a human 
drug application subject to priority    
review 9 ! previ\s fiscal ye>2 &  7,b7 !
 av]age co/ incurr$ by ! ,food & ,drug  
,adm9i/ration 9 ! review ( a human drug 
application t is n subject to priority  
review 9 ! previ\s fiscal ye>4  4  #aje4
 ,guidance on *anges to an approv$      
application = biological products ,n    
lat] ?an #b ye>s aft] ! date ( enactm5t 
( ?is ,act1 ! ,secret>y ( ,heal? &      
,human ,s]vices %all issue f9al guidance
 t-- 7#a7 addresses *anges 9 a lic5s$   

biological product or ! label+1         
production process1 quality controls1   
equipm5t1 facilities1 or responsible    
p]sonnel = su* a product e/abli%$ 9 !   
application = ! product t 0 approv$ "u  
section #cea ( ! ,public ,heal? ,s]vice 
,act 7#db ,u4,s4,c4 #bfb72  7#b7 does n 
address su* *anges = specifi$           
biote*nology or specifi$ syn!tic        
biological products li/$ 9 section      
#fja4b7;c7 ( title #ba ( ! ,code (      
,f$]al ,regulation2 &  7#c7 updates &   
sup]s$es ! guidance entitl$ ,*anges to  
an ,approv$ ,application3 ,biological   
,products1 t 0 issu$ by ! ,food & ,drug 
,adm9i/ration 9 ,july1 #aiig4  #ajf4    
,exp$it+ ! process = export             
c]tifications = vacc9es ,section        
#hja7;e77#d7 ( ! ,f$]al ,food1 ,drug1 & 
,cosmetic ,act 7#ba ,u4,s4,c4           
#cha7;e77#d77 is am5d$-- 7#a7 9 ! matt] 
foll[+ clause 7ii7 9 subp>agraph 7,a71  
by /rik+ )9 #bj days ( ! receipt ( a    
reque/ = su* c]tification & ins]t+ )9   
#bj bus9ess days ( ! receipt ( a reque/ 

= su* c]tification1 except t 9 ! case ( 
a vacc9e ! ,secret>y %all issue su*     
c]tification )9 #aj bus9ess days ( !    
receipt ( a reque/ = su* c]tification2 &
  7#b7 9 subp>agraph 7,b71 by /rik+ )9 !
 #bj days prescrib$ by subp>agraph 7,a7 
& ins]t+ )9 ! p]iod prescrib$ by        
subp>agraph 7,a74  #ajg4 ,,nih vacc9e   
rese>*  7a7 ,9 g5]al ,subp>t #f ( "p ,c 
( title ,,iv ( ! ,public ,heal? ,s]vice 
,act 7#db ,u4,s4,c4 #bhe;f et seq47 is  
am5d$ by add+ at ! end ! foll[+3        
#ddg;,d4 ,advancem5t ( vacc9e developm5t
 ,9 c>ry+ out ! g5]al purpose describ$ 9
 section #ddf1 ! ,director ( ! ,in/itute
 %all conduct or support translational  
sci5ce1 rese>*1 & rese>* tra9+ to       
advance ! developm5t ( vacc9es = !      
prev5tion ( diseases1 includ+ !         
advancem5t ( vacc9e developm5t programs 
into cl9ical trials4  4  7b7 ,review (  
,,nih vacc9e rese>*  7#a7 ,9 g5]al ,n   
lat] ?an "o ye> aft] ! date ( enactm5t (
 ?is ,act1 ! ,director ( ! ,national    
,in/itutes ( ,heal? %all--  7,a7 conduct

 a review on vacc9e rese>* be+ conduct$ 
or support$ by ! ,in/itutes2 &  7,b7    
publi% a report on ! results ( su*      
review4  7#b7 ,cont5ts ,at a m9imum1 !  
report "u p>agraph 7#a77;,b7 %all-- 7,a7
 describe intramural & extramural vacc9e
 rese>* & developm5t programs t are be+ 
conduct$ or support$ by ! ,national     
,in/itutes ( ,heal?1 includ+ ^? t are   
translational or cl9ical phase /udies2  
7,b7 provide a summ>y ( fund+           
allocations made to conduct or support !
 matt]s describ$ 9 section #ddg;,d ( !  
,public ,heal? ,s]vice ,act1 z add$ by  
subsection 7a71 & id5tify project$ fund+
 ne$s ) reg>d to future rese>* or       
support ) reg>d to ^! matt]s2 &  7,c7   
id5tify fund+ & collaborations ) !      
private sector ?r\gh--  7i7 ! ,small    
,bus9ess ,innovation ,rese>* & ,small   
,bus9ess ,te*nology ,transf] programs2 &
  7ii7 coop]ative rese>* & developm5t   
agreem5ts4  ,,ii ,m$ic>e1 ,m$icaid1 &   
o!r provisions  #bja4 ,requir+ prompt   
updates to ,m$ic>e program ^u issuance (

 ,,acip recomm5dations ,9 ! case t !    
advisory committee on immunization      
practices e/abli%$ by ! ,secret>y (     
,heal? & ,human ,s]vices pursuant to    
section #bbb ( ! ,public ,heal? ,s]vice 
,act 7#db ,u4,s4,c4 #bag;a7 issues a    
recomm5dation = a vacc9e or an update to
 a recomm5dation = a vacc9e t !         
,secret>y is us+ "u title ,,xviii ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 ) respect to cov]age (   
vacc9es or immunizations "u su* title1 !
 ,secret>y %all det]m9e :e!r or n to    
update policies "u su* title ) respect  
to su* cov]age on a date t is n lat] ?an
 #fj bus9ess days aft] ! date on :i* su*
 advisory committee issues su*          
recomm5dation or update4  #bjb4 ,,gao   
/udy & report on ,m$ic>e & ,m$icaid     
b5efici>y access = vacc9es  7a7 ,/udy ,!
 ,comptroll] ,g5]al ( ! ,unit$ ,/ates 79
 ?is section ref]r$ to z ! ,comptroll]  
,g5]al7 %all conduct a /udy on ! impact 
( reimbursem5t rates "u ! ,m$ic>e       
program "u p>ts ,b1 ,c1 & ,d ( title    

,,xviii ( ! ,social ,security ,act & "u 
! ,m$icaid program "u title ,,xix ( su* 
,act on access by t>get$ individuals to 
vacc9es recomm5d$ by ! ,advisory        
,committee on ,immunization ,practices (
 ! ,c5t]s = ,disease ,control &         
,prev5tion4 ,su* /udy %all include an   
analysis & det]m9ation (--  7#a7 !      
reimbursem5t rates = vacc9es "u su* p>ts
 ( ! ,m$ic>e program & "u ! ,m$icaid    
program1 includ+ ^? rates paid by a     
,,pdp sponsor "u "p ,d ( title ,,xviii (
 su* ,act1 ,m$ic>e ,advantage           
organizations "u "p ,c ( su* title1 &   
,m$icaid manag$ c>e organizations 7z    
def9$ 9 section #aijc7m77#a77;,a7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7m77#a77;,a772  7#b7 ! numb] (   
t>get$ individuals dur+ ! #c-ye> p]iod  
prior to ! /udy :o 7 eligible = a       
vacc9ation recomm5d$ by ! ,advisory     
,committee on ,immunization ,practices (
 ! ,c5t]s = ,disease ,control &         
,prev5tion2  7#c7 ! numb] ( su* t>get$  
individuals :o actually receiv$ a       

vacc9ation describ$ 9 p>agraph 7#b71 ) a
 p>ticul> breakd[n ( adults1 ! eld]ly1 &
 populations locat$ 9 rural or und]s]v$ 
communities2 &  7#d7 ! ext5t to :i* !   
reimbursem5t rates "u su* p>ts ( !      
,m$ic>e program & "u ! ,m$icaid program 
= vacc9ations describ$ 9 p>agraph 7#b7  
affect _! use by physicians or access = 
su* t>get$ individuals4  7b7 ,t>get$    
individuals ,= purposes ( subsection    
7a71 ! t]m t>get$ individual means &    
individual :o is-- 7#a7 7,a7 entitl$ to 
b5efits "u "p ,a ( title ,,xviii ( !    
,social ,security ,act or enroll$ 9 "p  
,b ( su* ,act2 or  7,b7 eligible =      
m$ical assi/ance "u title ,,xix ( su*   
,act2 &  7#b7 )9 a vuln]able population4
  7c7 ,report ,n lat] ?an #b ye>s aft] !
 date ( enactm5t ( ?is ,act1 !          
,comptroll] ,g5]al %all submit to !     
appropriate committees ( ! ,congress a  
report conta9+ ! results ( ! /udy       
conduct$ "u subsection 7a71 includ+--   
7#a7 a summ>y ( ! f9d+s ( ! /udy2 &     
7#b7 recomm5dations bas$ on ! results ( 

! /udy1 includ+ recomm5dations = su*    
legislative & adm9i/rative action z !   
,comptroll] ,g5]al det]m9es appropriate4
  #bjc4 ,enc\rag+ heal? plans to e/abli%
 programs to increase adult immunization
  7a7 ,private heal? plans ,section     
#bgah ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #cjj;gg-#ah7 is am5d$ by 
add+ at ! end ! foll[+ new subsection3  
7f7 ,programs to increase adult         
immunization  7#a7 ,9 g5]al ,= purposes 
( ?is section1 = plan ye>s beg9n+ on or 
aft] ! date ( enactm5t ( ! ,vacc9e      
,access1 ,c]ta9ty1 & ,innovation ,act ( 
#bjae1 activities t improve heal? c>e   
quality describ$ 9 subsection 7a77#b7   
%all include programs to increase adult 
immunization4  7#b7 ,adm9i/ration ,n    
lat] ?an ,decemb] #ca1 #bjaf1 !         
,secret>y %all e/abli% /&>diz$          
me?odologies1 includ+ def9itions1 = :i* 
activities1 & 9 :at reg>d su*           
activities1 con/itute programs to       
increase adult immunization 9 accordance
 ) ?is subsection4 ,! ,secret>y %all    

consult ) relevant /akehold]s 9 e/abli%+
 su* me?odologies4  4  7b7 ,m$ic>e      
,advantage & "p ,d plans ,section       
#aheg7;e7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciew-#bg7;e77 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#e7 ,inclusion ( exp5ditures on        
programs to increase adult immunization 
9 m9imum m$ical loss ratio calculation  
,= purposes ( calculat+ ! m9imum m$ical 
loss ratio "u p>agraph 7#d71 = plan ye>s
 beg9n+ at lea/ #ab mon?s aft] ! date ( 
enactm5t ( ?is ,act1 ! num]ator %all    
include any exp5ditures on programs to  
increase adult immunization4  4