,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #ahgb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #ac1 #bjai ,ms4  
,hirono 7= h]self1 ,mrs4 ,capito1 & ,mr4
 ,:iteh\se7 introduc$ ! foll[+ bill2 :i*
 0 read twice & ref]r$ to ! ,committee  
on ,f9ance  ,a ,,bill  ,to am5d title   
,,xviii ( ! ,social ,security ,act to   
provide in=mation reg>d+ vacc9es =      
s5iors z "p ( ! ,m$ic>e  ,y h&book & to 
ensure t ! treatm5t ( co/ %>+ = vacc9es 
"u ,m$ic>e "p ,d is consi/5t ) !        
treatm5t ( vacc9es "u ,m$ic>e "p ,b1 & =
 o!r purposes4  #a4 ,%ort title  ,?is   
,act may be cit$ z ! ,protect+ ,s5iors  
,?r\gh ,immunization ,act ( #bjai4  #b4 
,f9d+s ,congress makes ! foll[+ f9d+s3  
7#a7 ,! immune sy/em det]iorates ) age1 
leav+ old] adults m susceptible to _m   
vacc9e-prev5table diseases t c\ld result
 9 hospitalizations & o!r co/ly m$ical  
int]v5tions4  7#b7 ,vacc9es play an     
ess5tial role 9 prev5t+ disease1 !reby  
help+ to keep old] adults active &      
indep5d5t4  7#c7 ,!re are m ?an a doz5  

immunizations recomm5d$ = adult         
populations by ! ,advisory ,committee on
 ,immunization ,practices ( ! ,c5t]s =  
,disease ,control & ,prev5tion1         
includ+--  7,a7 influ5za2  7,b7 tetanus1
 diph!ria1 p]tussis 7,tdap72  7,c7      
measles1 mumps1 rubella 7,,mmr72  7,d7  
h]pes zo/] 7%+les72  7,e7 human         
papillomavirus 7,,hpv72  7,f7           
pneumococcal2  7,g7 hepatitis ,a2  7,h7 
hepatitis ,b2 &  7,i7 m5+ococcal4  7#d7 
,?r\gh new rese>* & te*nology1          
additional vacc9es may be approv$ = old]
 adults4  7#e7 ,al?\gh immunizations are
 lifesav+ & co/-effective int]v5tions1  
adult vacc9ation rates 9 ! ,unit$ ,/ates
 rema9 bel[ ,f$]al ,heal?y ,p b5*m>ks4  
7#f7 ,!re are disp>ities 9 adult        
vacc9ation rates across diff]5t races & 
e?nicities ) rates g5]ally l[] among    
,hispanics1 ,african ,am]icans1 & ,asian
 ,am]icans4  7#g7 ,important vacc9es1   
includ+ ^? = %+les & ,tdap1 are cov]$ "u
 ! ,m$ic>e ,prescription ,drug ,program 
"u "p ,d ( title ,,xviii ( ! ,social    

,security ,act4 ,cov]age "u ! ,m$ic>e "p
 ,d has result$ 9 b>ri]s to optimal &   
consi/5t uptake1 includ+ lack ( pati5t &
 provid] aw>5ess1 b5efici>y co/ %>+1 &  
l[ provid] reimbursem5t1 z well z       
geographic1 cultural1 & l+ui/ic         
*all5ges4  7#h7 ,! ,advisory ,committee 
on ,immunization ,practices ( ! ,c5t]s =
 ,disease ,control & ,prev5tion         
recomm5ds ! ,tdap vacc9e %\ld be        
adm9i/]$ e #aj ye>s = all ages4 ,accord+
 to ! ,c5t]s = ,disease ,control &      
,prev5tion ,surveillance ( ,vacc9ation  
,cov]age ,among ,adults 9 ! ,unit$      
,/ates1 ,national ,heal? ,int]view      
,survey1 #bjaf1 vacc9ation rates rema9  
l[ = tetanus & diph!ria 7,td7 & tetanus 
& diph!ria ) acellul> p]tussis 7,tdap7 =
 adults age #fe & old]1 at #eh p]c5t &  
#bj p]c5t respectively4  7#i7 ,be+      
up-to-date ) ,tdap is especially        
important = adults :o are ar\nd babies1 
because !y are n only protect+ _! own   
heal? b help+ to =m a cocoon ( disease  
protection ar\nd ! baby dur+ ! fir/ few 

mon?s ( life4  7#aj7 ,! ,advisory       
,committee on ,immunization ,practices (
 ! ,c5t]s = ,disease ,control &         
,prev5tion recomm5ds ! %+les vacc9e =   
individuals ag$ #ej & old]4 ,:ile vacc9e
 cov]age = %+les has increas$ ea* ye>   
s9ce lic5sure1 9 #bjaf1 only #cc p]c5t (
 adults ov] #fj ye>s report$ receiv+ !  
vacc9e4  7#aa7 ,almo/ #a out ( e #c p 9 
! ,unit$ ,/ates w develop %+les 9 _!    
lifetime4 ,! risk increases ) age1 &    
old] individuals are mu* m likely to    
exp]i5ce po/h]petic neuralgia non-pa9   
complications1 hospitalizations1 &      
int]f]5ce ) activities ( daily liv+1 su*
 z eat+1 dress+1 & ba?+4  7#ab7 ,a #bjah
 /udy ( ,tdap & %+les vacc9e claims 9   
,m$ic>e "p ,d demon/rat$ t high]        
out-(-pocket co/ %>+ 0 associat$ ) high]
 rates ( cancell$ vacc9ation claims1    
sugge/+ vacc9ation 0 ab&on$4 ,9 ?is     
/udy1 co/ %>+ ( #ea or great] 0         
associat$ ) a #b to #b4g-times great]   
rate ( cancell$ vacc9ation claims comp>$
 ) #j co/ %>+4  7#ac7 ,!re is an        

opportunity to improve education ar\nd  
adult immunization1 includ+ ! risks &   
consequ5ces ( vacc9e-prev5table disease1
 & :i* vacc9es are recomm5d$ = old]     
adults4  #c4 ,provision ( in=mation     
reg>d+ vacc9es = s5iors z "p ( ,m$ic>e  
,y h&book & cov]age ( adult vacc9es     
recomm5d$ by ! ,advisory ,committee on  
,immunization ,practices "u ,m$ic>e "p  
,d  7a7 ,provision ( in=mation reg>d+   
vacc9es = s5iors z "p ( ,m$ic>e  ,y     
h&book  7#a7 ,9 g5]al ,section #ahjd ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;b-#b7 is am5d$-- 7,a7 9 subsection
 7a77#a71 by ins]t+ 1 includ+ in=mation 
) respect to cov]age ( vacc9es = s5iors 
describ$ 9 subsection 7e7 be=e ! comma  
at ! end2 &  7,b7 by add+ at ! end !    
foll[+ new subsection3  7e7 ,! notice   
provid$ "u subsection 7a7 %all include  
in=mation ) respect to vacc9es = s5iors1
 includ+ in=mation ) respect to cov]age 
( adult vacc9es recomm5d$ by ! ,advisory
 ,committee on ,immunization ,practices 
7z def9$ 9 section                      

#ahfj;,d-#b7;b77#h77;,b77 "u "p ,d =    
individuals enroll$ 9 a prescription    
drug plan "u su* "p4  4  7#b7 ,effective
 date ,! am5dm5ts made by ?is subsection
 %all apply to notices di/ribut$ prior  
to ea* ,m$ic>e op5 enrollm5t p]iod      
beg9n+ aft] ! date ( implem5tation (    
section #ahfj;,d-#b7;b77#h71 z add$ by  
subsection 7b77#b74  7b7 ,cov]age (     
adult vacc9es recomm5d$ by ! ,advisory  
,committee on ,immunization ,practices  
"u ,m$ic>e "p ,d  7#a7 ,provision (     
educational mat]ials reg>d+ !           
availability ( adult vacc9es recomm5d$  
by ! ,advisory ,committee on            
,immunization ,practices ) no co/ %>+   
,section #ahfj;,d-#d7;a77#a77;,b7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajd7;a77#a77;,b77 is am5d$ by   
add+ at ! end ! foll[+ new clause3      
7vii7 ,= plan ye>s beg9n+ on or aft]    
,janu>y #a ( ! fir/ ye> beg9n+ m ?an #fj
 days aft] ! date ( ! enactm5t ( ?is    
clause1 in=mation reg>d+ access to adult
 vacc9es recomm5d$ by ! ,advisory       

,committee on ,immunization ,practices  
7z def9$ 9 section                      
#ahfj;,d-#b7;b77#h77;,b774  4  7#b7     
,ensur+ treatm5t ( co/ %>+ is consi/5t )
 treatm5t ( vacc9es "u m$ic>e "p b      
,section #ahfj;,d-#b7;b7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;b77 is am5d$-- 7,a7 9      
p>agraph 7#a77;,a71 by /rik+ ! cov]age &
 ins]t+ ,subject to p>agraph 7#h71 !    
cov]age2  7,b7 9 p>agraph 7#b77;,a71 by 
/rik+ & 7,d7 & ins]t+ & 7,d7 & p>agraph 
7#h72  7,c7 9 p>agraph 7#c77;,a71 by    
/rik+ & 7#d7 & ins]t+ 7#d71 & 7#h72     
7,d7 9 p>agraph 7#d77;,a77i71 by /rik+  
,! cov]age & ins]t+ ,subject to p>agraph
 7#h71 ! cov]age2 &  7,e7 by add+ at !  
end ! foll[+ new p>agraph3  7#h7        
,treatm5t ( co/ %>+ = adult vacc9es     
recomm5d$ by ! ,advisory ,committee on  
,immunization ,practices consi/5t )     
treatm5t ( vacc9es "u "p b  7,a7 ,9     
g5]al ,= plan ye>s beg9n+ on or aft]    
,janu>y #a ( ! fir/ ye> beg9n+ m ?an #fj
 days aft] ! date ( ! enactm5t ( ?is    

p>agraph1 ! foll[+ %all apply ) respect 
to an adult vacc9e recomm5d$ by !       
,advisory ,committee on ,immunization   
,practices 7z def9$ 9 subp>agraph 7,b773
  7i7 ,no application ( d$uctible ,!    
d$uctible "u p>agraph 7#a7 %all n apply 
) respect to su* vacc9e4  7ii7 ,no      
application ( co9surance ,!re %all be no
 co9surance "u p>agraph 7#b7 ) respect  
to su* vacc9e4  7iii7 ,no application ( 
initial cov]age limit ,! initial cov]age
 limit "u p>agraph 7#c7 %all n apply )  
respect to su* vacc9e4  7iv7 ,no co/ %>+
 above annual out-(-pocket ?re%old ,!re 
%all be no co/ %>+ "u p>agraph 7#d7 )   
respect to su* vacc9e4  7,b7 ,adult     
vacc9es recomm5d$ by ! advisory         
committee on immunization practices ,=  
purposes ( ?is p>agraph1 ! t]m adult    
vacc9e recomm5d$ by ! ,advisory         
,committee on ,immunization ,practices  
means a vacc9e approv$ = use by adult   
populations & 9 accordance )            
recomm5dations ( ! ,advisory ,committee 
on ,immunization ,practices ( ! ,c5t]s =

 ,disease ,control & ,prev5tion4  4     
7#c7 ,con=m+ am5dm5ts to co/ %>+ =      
l[-income individuals ,section          
#ahfj;,d-#ad7;a7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is 
am5d$-- 7,a7 9 p>agraph 7#a77;,d71 9 ea*
 ( clauses 7ii7 & 7iii71 by /rik+ ,9 !  
case & ins]t+ ,subject to p>agraph 7#f71
 9 ! case2  7,b7 9 p>agraph 7#b7-- 7i7 9
 subp>agraph 7,d71 by /rik+ ,!          
sub/itution & ins]t+ ,subject to        
p>agraph 7#f71 ! sub/itution2 &  7ii7 9 
subp>agraph 7,e71 by /rik+ subsection   
7c7 & ins]t+ p>agraph 7#f7 & subsection 
7c72 &  7,c7 by add+ at ! end ! foll[+  
new p>agraph3  7#f7 ,no application (   
co/ %>+ = adult vacc9es recomm5d$ by !  
advisory committee on immunization      
practices ,consi/5t ) section           
#ahfj;,d-#b7;b77#h71 = plan ye>s beg9n+ 
on or aft] ,janu>y #a ( ! fir/ ye>      
beg9n+ m ?an #fj days aft] ! date ( !   
enactm5t ( ?is p>agraph1 !re %all be no 
co/ %>+ "u ?is section ) respect to an  
adult vacc9e recomm5d$ by ! ,advisory   

,committee on ,immunization ,practices  
7z def9$ 9 subp>agraph 7,b7 ( su*       
section74  4  7c7 ,/udy & report  7#a7  
,/udy ,! ,secret>y ( ,heal? & ,human    
,s]vices 7ref]r$ to 9 ?is subsection z !
 ,secret>y71 act+ ?r\gh ! ,director ( ! 
,c5t]s = ,disease ,control & ,prev5tion1
 & 9 collaboration ) ! ,adm9i/rator ( ! 
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1    
%all conduct a /udy on ! uptake (       
vacc9es among ! ,m$ic>e b5efici>y       
population1 includ+ ! h]pes zo/] vacc9e 
& ! tetanus1 diph!ria1 & p]tussis       
vacc9e1 & anticipat$ vacc9es aga9/ su*  
diseases z respiratory syncytial virus1 
clo/ridium difficile1 & o!rs4 ,su* /udy 
%all include an analysis ( ways to--    
7,a7 increase ! basel9e t>get rate (    
cov]age = vacc9es recomm5d$ by !        
,advisory ,committee on ,immunization   
,practices ( ! ,c5t]s = ,disease        
,control & ,prev5tion 9 ! ,heal?y ,p    
#bjbj goals2  7,b7 ensure t basel9e     
t>gets focus on r$uc+ racial &          
socioeconomic disp>ities 9 ! vacc9e     

cov]age rates = all adult vacc9es2  7,c7
 help facilitate immunization ( ,m$ic>e 
b5efici>ies1 by develop+ & evaluat+ a   
specific set ( actions t w address      
physician & heal? c>e provid]           
adm9i/rative *all5ges1 su* z difficulty 
v]ify+ b5efici>y cov]age & complexity ( 
physician (fice bill+ ( vacc9es cov]$ "u
 ,m$ic>e "p ,d1 t impact access =       
b5efici>ies2  7,d7 support adoption ( ! 
,,h$is adult immunization /atus         
composite measure 7,tdap1 pneumococcal1 
influ5za1 & zo/]7 9 ord] to close gaps 9
 adult immunization p]=mance measurem5t 
& inc5tivize vacc9ation ?r\gh adoption (
 evid5ce-bas$ measures2 &  7,e7 /r5g!n  
immunization in=mation sy/ems to all[   
all ,/ates to h electronic databases =  
immunization records4  7#b7 ,report ,n  
lat] ?an #b ye>s aft] ! date ( enactm5t 
( ?is ,act1 ! ,secret>y %all submit to  
,congress a report conta9+ ! results ( !
 /udy "u p>agraph 7#a71 toge!r )        
recomm5dations = su* legislation &      
adm9i/rative action z ! ,secret>y       

det]m9es appropriate4