,,ii #aafth ,,congress #ast ,session ,s4 #ahgb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #ac1 #bjai ,ms4 ,hirono 7for herself1 ,mrs4 ,capito1 and ,mr4 ,whitehouse7 introduced the following bill2 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 ,b1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,protecting ,seniors ,through ,immunization ,act of #bjai4 #b4 ,findings ,congress makes the following findings3 7#a7 ,the immune system deteriorates with age1 leaving older adults more susceptible to many vaccine-preventable diseases that could result in hospitalizations and other costly medical interventions4 7#b7 ,vaccines play an essential role in preventing disease1 thereby helping to keep older adults active and independent4 7#c7 ,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 ,prevention1 including-- 7,a7 influenza2 7,b7 tetanus1 diphtheria1 pertussis 7,tdap72 7,c7 measles1 mumps1 rubella 7,,mmr72 7,d7 herpes zoster 7shingles72 7,e7 human papillomavirus 7,,hpv72 7,f7 pneumococcal2 7,g7 hepatitis ,a2 7,h7 hepatitis ,b2 and 7,i7 meningococcal4 7#d7 ,through new research and technology1 additional vaccines may be approved for older adults4 7#e7 ,although immunizations are lifesaving and cost-effective interventions1 adult vaccination rates in the ,united ,states remain below ,federal ,healthy ,people benchmarks4 7#f7 ,there are disparities in adult vaccination rates across different races and ethnicities with rates generally lower among ,hispanics1 ,african ,americans1 and ,asian ,americans4 7#g7 ,important vaccines1 including those for shingles and ,tdap1 are covered under the ,medicare ,prescription ,drug ,program under part ,d of title ,,xviii of the ,social ,security ,act4 ,coverage under the ,medicare part ,d has resulted in barriers to optimal and consistent uptake1 including lack of patient and provider awareness1 beneficiary cost sharing1 and low provider reimbursement1 as well as geographic1 cultural1 and linguistic challenges4 7#h7 ,the ,advisory ,committee on ,immunization ,practices of the ,centers for ,disease ,control and ,prevention recommends the ,tdap vaccine should be administered every #aj years for all ages4 ,according to the ,centers for ,disease ,control and ,prevention ,surveillance of ,vaccination ,coverage ,among ,adults in the ,united ,states1 ,national ,health ,interview ,survey1 #bjaf1 vaccination rates remain low for tetanus and diphtheria 7,td7 and tetanus and diphtheria with acellular pertussis 7,tdap7 for adults age #fe and older1 at #eh percent and #bj percent respectively4 7#i7 ,being up-to-date with ,tdap is especially important for adults who are around babies1 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 life4 7#aj7 ,the ,advisory ,committee on ,immunization ,practices of the ,centers for ,disease ,control and ,prevention recommends the shingles vaccine for individuals aged #ej and older4 ,while vaccine coverage for shingles has increased each year since licensure1 in #bjaf1 only #cc percent of adults over #fj years reported receiving the vaccine4 7#aa7 ,almost #a out of every #c people in the ,united ,states will develop shingles in their lifetime4 ,the risk increases with age1 and older individuals are much more likely to experience postherpetic neuralgia non-pain complications1 hospitalizations1 and interference with activities of daily living1 such as eating1 dressing1 and bathing4 7#ab7 ,a #bjah 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 claims1 suggesting vaccination was abandoned4 ,in this study1 cost sharing of #ea or greater was associated with a #b to #b4g-times greater rate of cancelled vaccination claims compared with #j cost sharing4 7#ac7 ,there is an opportunity to improve education around adult immunization1 including the risks and consequences of vaccine-preventable disease1 and which vaccines are recommended for older adults4 #c4 ,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 7a7 ,provision of information regarding vaccines for seniors as part of ,medicare ,you handbook 7#a7 ,in general ,section #ahjd of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is amended-- 7,a7 in subsection 7a77#a71 by inserting 1 including information with respect to coverage of vaccines for seniors described in subsection 7e7 before the comma at the end2 and 7,b7 by adding at the end the following new subsection3 7e7 ,the notice provided under subsection 7a7 shall include information with respect to vaccines for seniors1 including information with respect to coverage of adult vaccines recommended by the ,advisory ,committee on ,immunization ,practices 7as defined in section #ahfj;,d-#b7;b77#h77;,b77 under part ,d for individuals enrolled in a prescription drug plan under such part4 4 7#b7 ,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 #ahfj;,d-#b7;b77#h71 as added by subsection 7b77#b74 7b7 ,coverage of adult vaccines recommended by the ,advisory ,committee on ,immunization ,practices under ,medicare part ,d 7#a7 ,provision of educational materials regarding the availability of adult vaccines recommended by the ,advisory ,committee on ,immunization ,practices with no cost sharing ,section #ahfj;,d-#d7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;a77#a77;,b77 is amended by adding at the end the following new clause3 7vii7 ,for plan years beginning on or after ,january #a of the first year beginning more than #fj days after the date of the enactment of this clause1 information regarding access to adult vaccines recommended by the ,advisory ,committee on ,immunization ,practices 7as defined in section #ahfj;,d-#b7;b77#h77;,b774 4 7#b7 ,ensuring treatment of cost sharing is consistent with treatment of vaccines under medicare part b ,section #ahfj;,d-#b7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;b77 is amended-- 7,a7 in paragraph 7#a77;,a71 by striking the coverage and inserting ,subject to paragraph 7#h71 the coverage2 7,b7 in paragraph 7#b77;,a71 by striking and 7,d7 and inserting and 7,d7 and paragraph 7#h72 7,c7 in paragraph 7#c77;,a71 by striking and 7#d7 and inserting 7#d71 and 7#h72 7,d7 in paragraph 7#d77;,a77i71 by striking ,the coverage and inserting ,subject to paragraph 7#h71 the coverage2 and 7,e7 by adding at the end the following new paragraph3 7#h7 ,treatment of cost sharing for adult vaccines recommended by the ,advisory ,committee on ,immunization ,practices consistent with treatment of vaccines under part b 7,a7 ,in general ,for plan years beginning on or after ,january #a of the first year beginning more than #fj days after the date of the enactment of this paragraph1 the following shall apply with respect to an adult vaccine recommended by the ,advisory ,committee on ,immunization ,practices 7as defined in subparagraph 7,b773 7i7 ,no application of deductible ,the deductible under paragraph 7#a7 shall not apply with respect to such vaccine4 7ii7 ,no application of coinsurance ,there shall be no coinsurance under paragraph 7#b7 with respect to such vaccine4 7iii7 ,no application of initial coverage limit ,the initial coverage limit under paragraph 7#c7 shall not apply with respect to such vaccine4 7iv7 ,no cost sharing above annual out-of-pocket threshold ,there shall be no cost sharing under paragraph 7#d7 with respect to such vaccine4 7,b7 ,adult vaccines recommended by the advisory committee on immunization practices ,for purposes of this paragraph1 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 ,prevention4 4 7#c7 ,conforming amendments to cost sharing for low-income individuals ,section #ahfj;,d-#ad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is amended-- 7,a7 in paragraph 7#a77;,d71 in each of clauses 7ii7 and 7iii71 by striking ,in the case and inserting ,subject to paragraph 7#f71 in the case2 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,d71 by striking ,the substitution and inserting ,subject to paragraph 7#f71 the substitution2 and 7ii7 in subparagraph 7,e71 by striking subsection 7c7 and inserting paragraph 7#f7 and subsection 7c72 and 7,c7 by adding at the end the following new paragraph3 7#f7 ,no application of cost sharing for adult vaccines recommended by the advisory committee on immunization practices ,consistent with section #ahfj;,d-#b7;b77#h71 for plan years beginning on or after ,january #a of the first year beginning more than #fj days after the date of the enactment of this paragraph1 there shall be no cost sharing under this section with respect to an adult vaccine recommended by the ,advisory ,committee on ,immunization ,practices 7as defined in subparagraph 7,b7 of such section74 4 7c7 ,study and report 7#a7 ,study ,the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary71 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 and in collaboration with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall conduct a study on the uptake of vaccines among the ,medicare beneficiary population1 including the herpes zoster vaccine and the tetanus1 diphtheria1 and pertussis vaccine1 and anticipated vaccines against such diseases as respiratory syncytial virus1 clostridium difficile1 and others4 ,such study shall include an analysis of ways to-- 7,a7 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 #bjbj goals2 7,b7 ensure that baseline targets focus on reducing racial and socioeconomic disparities in the vaccine coverage rates for all adult vaccines2 7,c7 help facilitate immunization of ,medicare beneficiaries1 by developing and evaluating a specific set of actions that will address physician and health care provider administrative challenges1 such as difficulty verifying beneficiary coverage and complexity of physician office billing of vaccines covered under ,medicare part ,d1 that impact access for beneficiaries2 7,d7 support adoption of the ,,hedis adult immunization status composite measure 7,tdap1 pneumococcal1 influenza1 and zoster7 in order to close gaps in adult immunization performance measurement and incentivize vaccination through adoption of evidence-based measures2 and 7,e7 strengthen immunization information systems to allow all ,states to have electronic databases for immunization records4 7#b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report containing the results of the study under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4