US Codex
Bill
Notes

Title II — Medicare, Medicaid, and other provisions

H.R. 786 · 114th Congress · Feb 5, 2015 · Lineage

II Medicare, Medicaid, and other provisions

Sec. 201 Requiring prompt updates to Medicare program upon issuance of ACIP recommendations

In the case that the advisory committee on immunization practices established by the Secretary of Health and Human Services pursuant to section 222 of the Public Health Service Act (42 U.S.C. 217a) issues a recommendation for a vaccine or an update to a recommendation for a vaccine that the Secretary is using under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) with respect to coverage of vaccines or immunizations under such title, the Secretary shall determine whether or not to update policies under such title with respect to such coverage on a date that is not later than 60 business days after the date on which such advisory committee issues such recommendation or update.

Sec. 202 GAO study and report on Medicare and Medicaid beneficiary access for vaccines

(a)
Study— The Comptroller General of the United States (in this section referred to as the “Comptroller General”) shall conduct a study on the impact of reimbursement rates under the Medicare program under parts B, C, and D of title XVIII of the Social Security Act and under the Medicaid program under title XIX of such Act on access by targeted individuals to vaccines recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. Such study shall include an analysis and determination of—
(1)
the reimbursement rates for vaccines under such parts of the Medicare program and under the Medicaid program, including those rates paid by a PDP sponsor under part D of title XVIII of such Act, Medicare Advantage organizations under part C of such title, and Medicaid managed care organizations (as defined in section 1903(m)(1)(A) of the Social Security Act (42 U.S.C. 1396b(m)(1)(A));
(2)
the number of targeted individuals during the 3-year period prior to the study who were eligible for a vaccination recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;
(3)
the number of such targeted individuals who actually received a vaccination described in paragraph (2), with a particular breakdown of adults, the elderly, and populations located in rural or underserved communities; and
(4)
the extent to which the reimbursement rates under such parts of the Medicare program and under the Medicaid program for vaccinations described in paragraph (2) affect their use by physicians or access for such targeted individuals.
(b)
Targeted individuals— For purposes of subsection (a), the term “targeted individual” means and individual who is—
(1)
(A)
entitled to benefits under part A of title XVIII of the Social Security Act or enrolled in part B of such Act; or
(B)
eligible for medical assistance under title XIX of such Act; and
(2)
within a vulnerable population.
(c)
Report— Not later than 2 years after the date of enactment of this Act, the Comptroller General shall submit to the appropriate committees of the Congress a report containing the results of the study conducted under subsection (a), including—
(1)
a summary of the findings of the study; and
(2)
recommendations based on the results of the study, including recommendations for such legislative and administrative action as the Comptroller General determines appropriate.

Sec. 203 Encouraging health plans to establish programs to increase adult immunization

(a)
Private health plans— Section 2718 of the Public Health Service Act (42 U.S.C. 300gg–18) is amended by adding at the end the following new subsection:

“(f) Programs to increase adult immunization

“(1) In general—For purposes of this section, for plan years beginning on or after the date of enactment of the Vaccine Access, Certainty, and Innovation Act of 2015, activities that improve health care quality described in subsection (a)(2) shall include programs to increase adult immunization.

“(2) Administration—Not later than December 31, 2016, the Secretary shall establish standardized methodologies, including definitions, for which activities, and in what regard such activities, constitute programs to increase adult immunization in accordance with this subsection. The Secretary shall consult with relevant stakeholders in establishing such methodologies.”

(b)
Medicare Advantage and part D plans— Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph:

“(5) Inclusion of expenditures on programs to increase adult immunization in minimum medical loss ratio calculation—For purposes of calculating the minimum medical loss ratio under paragraph (4), for plan years beginning at least 12 months after the date of enactment of this Act, the numerator shall include any expenditures on programs to increase adult immunization.”