Total Health Requires Improved Vaccination Efforts Act of 2005 or the THRIVE Act of 2005 - Amends the Public Health Service Act to expand the Center for Disease Control's adult immunization program by: (1) authorizing additional appropriations for activities to increase immunizations rates for adults; and (2) making grants to states for demonstrations projects to provide influenza immunizations to uninsured adults at high risk for influenza.
Requires the Secretary of Health and Human Services to: (1) develop and disseminate guidelines to ensure that immunizations are routinely offered to adults by health care providers; and (2) provide for an educational campaign on the importance of adult immunizations.
Requires the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, to: (1) establish standards for adult influenza immunizations under the Medicare and Medicaid programs; (2) determine the feasibility and advisability of including such immunizations as a performance measure under program quality initiatives; and (3) establish standards for immunizations for influenza of health care workers.
Requires the Secretary, acting through the Agency for Healthcare Research and Quality (AHRQ), to study the best practices of health insurers and managed care organizations to encourage the use of adult immunizations for influenza by enrollees.
Requires the Secretary to determine the feasibility and advisability of requiring compliance with recommendations for immunizations for all health care workers for provider accreditation.
Prohibits a contract or plan under the federal employees health benefit program from being made or approved which does not offer and waive the deductible for pneumococcal and influenza immunization services to high risk adult enrollees.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3598 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 3598
To amend the Public Health Service Act to provide for increased funding
for the Centers for Disease Control and Prevention to carry out
activities toward increasing the number of medically underserved, at-
risk adults who are immunized against vaccine-preventable diseases, to
require a study regarding standards for the measurement of use by
beneficiaries under the Medicare and Medicaid Programs of adult
immunizations for influenza, to amend title 5, United States Code, with
respect to the Federal Employees Health Benefits Program and certain
immunization services, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 28, 2005
Ms. Roybal-Allard (for herself, Mr. Wicker, Mr. Waxman, Mr. Grijalva,
Mrs. Davis of California, Ms. Woolsey, Mr. Farr, Ms. Solis, Mr.
Cardoza, Ms. Zoe Lofgren of California, Ms. Matsui, Mrs. Capps, Ms.
Eshoo, Mr. Honda, Mr. Costa, Mr. Royce, Mr. Inslee, Mr. Pastor, Mr.
Salazar, Mr. Menendez, Mr. Baca, Mr. Becerra, Mrs. Napolitano, Mr.
Gutierrez, Ms. Linda T. Sanchez of California, Mr. Serrano, Ms.
Velazquez, Mr. Reyes, Mr. Leach, Mr. English of Pennsylvania, Mr.
Walsh, Mr. Bonner, Mr. Castle, Mrs. Johnson of Connecticut, Mr.
Crenshaw, Ms. Jackson-Lee of Texas, Mr. Gonzalez, and Ms. Loretta
Sanchez of California) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Ways and Means and Government Reform, for a period to
be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to provide for increased funding
for the Centers for Disease Control and Prevention to carry out
activities toward increasing the number of medically underserved, at-
risk adults who are immunized against vaccine-preventable diseases, to
require a study regarding standards for the measurement of use by
beneficiaries under the Medicare and Medicaid Programs of adult
immunizations for influenza, to amend title 5, United States Code, with
respect to the Federal Employees Health Benefits Program and certain
immunization services, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Total Health Requires Improved
Vaccination Efforts Act of 2005'' or the ``THRIVE Act of 2005''.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) Since the 1990s, the United States has achieved and
maintained high levels of childhood immunization, yet certain
problems persist within the national immunization system. Data
from the Centers for Disease Control indicate the following:
(A) Immunization coverage rates among adults are
well below those achieved among children.
(B) Significant racial and ethnic disparities exist
between coverage rates among adults.
(C) Many at-risk adults are not getting the
vaccines they need to prevent diseases such as
influenza, pneumococcal pneumonia and hepatitis B.
(2) Vaccine-preventable diseases in adults cause a
staggering number of deaths and illnesses each year. Research
shows that the following applies each year in the United
States:
(A) 200,000 individuals are hospitalized due to
influenza complications and approximately 36,000 will
die.
(B) 33,000 people suffer from invasive pneumococcal
disease and 5,000 will die.
(C) 80,000 individuals become newly infected with
hepatitis B, and of these 5,000 will die.
(D) Pneumonia and influenza together are the sixth
leading cause of death among older adults.
(3) The Centers for Disease Control and Prevention
(``CDC'') estimates that the overall cost to the Nation from
these vaccine-preventable diseases of adults exceeds $10
billion per year.
(4) Recommended adult immunizations are cost effective and
would produce significant savings for the health care system of
the United States. According to current research and CDC
statistics:
(A) Influenza vaccine saves $14.71 per person
vaccinated between the ages of 18 and 63.
(B) Influenza vaccine saves $182 in medical costs
for each person vaccinated aged 65 or over.
(C) Pneumococcal vaccine saves $8.87 in medical
costs per person vaccinated aged 65 or over.
(D) Hepatitis B vaccine saves $100 million in
medical costs for every 1 million high-risk adults
vaccinated.
(5) The shortage of influenza vaccine for the 2004-2005
season revealed a number of weaknesses in the adult
immunization infrastructure in the United States: insufficient
vaccine to meet demand; uneven distribution of vaccine; and
impaired abilities to administer vaccine to those in greatest
need. Such problems undermine public health and confidence in
the public health system, create confusion and uncertainty, and
destabilize the vaccine market place.
(6) These deficiencies in adult immunization in the United
States are further exacerbated by decreasing Federal and State
resources for immunizations:
(A) The Federal budget for immunizations has
decreased over the last five years, shifting more of
the immunization infrastructural costs to states
already facing budget shortfalls.
(B) With most currently available State and Federal
immunization resources directed toward childhood
immunization, adult immunization policies and programs
are increasingly at risk.
(C) The diminishing resource base compromises the
abilities of State health departments to collect data
about adult immunization, assess immunization rates and
conduct and implement strategic planning to protect
adults from vaccine-preventable diseases.
(7) There is, therefore, a vital need to enhance the
Nation's efforts to protect adults against vaccine-preventable
diseases. Establishing a strong and effective adult
immunization infrastructure in the Unites States makes good
sense:
(A) From a public health perspective it will better
prepare the health care system for an anticipated
influenza pandemic.
(B) From a homeland security preparedness stance it
will enable the public health community to respond more
quickly and effectively to biological threats.
(C) From a biomedical standpoint it will encourage
American adults to capitalize on newly developed
vaccines for other diseases such as cervical cancer and
shingles.
(8) There are proven ways to bolster the adult immunization
system:
(A) Rigorous studies have shown that removing
financial barriers increases vaccination rates among
adults.
(B) Measuring how well providers deliver
immunizations increases vaccination rates.
(C) Existing performance measurement systems are
excellent incentives to ensure that health care workers
are immunized against infectious diseases that could
potentially spread to vulnerable patients.
(D) Health education campaigns are proven ways to
positively impact immunization behaviors.
SEC. 3. CENTERS FOR DISEASE CONTROL AND PREVENTION; PROGRAM FOR
INCREASING IMMUNIZATION RATES FOR ADULTS.
(a) Activities of Centers for Disease Control and Prevention.--
Section 317(j) of the Public Health Service Act (42 U.S.C. 247b(j)) is
amended by adding at the end the following paragraphs:
``(3)(A) For the purpose of carrying out activities toward
increasing immunization rates for adults through the immunization
program under this subsection, and for the purpose of carrying out
subsection (k)(2), there are authorized to be appropriated $75,000,000
for fiscal year 2006, and such sums as may be necessary for each of the
fiscal years 2007 through 2010. Such authorization is in addition to
amounts available under paragraphs (1) and (2) for such purposes.
``(B) In expending amounts appropriated under subparagraph (A), the
Secretary shall give priority to adults who are medically underserved
and are at risk for vaccine-preventable diseases.
``(C) The purposes for which amounts appropriated under
subparagraph (A) are available include (with respect to immunizations
for adults) payment of the costs of storing vaccines, outreach
activities to inform individuals of the availability of the
immunizations, and other program expenses necessary for the
establishment or operation of immunization programs carried out or
supported by States or other public entities pursuant to this
subsection.
``(D)(i) Of the amounts appropriated under subparagraph (A), the
Secretary may, for three consecutive fiscal years during the fiscal
years 2006 through 2010, reserve in the aggregate for such three years
not more than $25,000,000 to make grants to not more than four States
for the purpose of carrying out demonstration projects to provide
immunizations against influenza to individuals who are in the age group
19 through 64, are uninsured with respect to such vaccine, and are at
high risk with respect to influenza.
``(ii) In making grants pursuant to clause (i), the Secretary shall
give preference to any State that--
``(I) has a low rate of adult immunizations for influenza
and pneumococcus among populations that are at high risk with
respect to such diseases; or
``(II) has a racial or ethnic minority group for which
there is a significant disparity in the rate of adult
immunizations for influenza and pneumococcus as compared to the
general population of the State.
``(iii) A grant may be made pursuant to clause (i) only if the
State involved agrees that, before the demonstration project under such
clause begins providing immunizations, the State will, for purposes of
determining the effects of the project, make an estimate of the rate of
immunizations with influenza vaccine in the population that will be
served by the project.
``(iv) Upon the request of a State that will carry out a
demonstration project under clause (i), the Secretary shall provide
technical assistance to the State with respect to making the estimate
described in clause (iii) and with respect to identifying intervention
and comparison sites for the project.
``(v) For purposes of this subparagraph:
``(I) An individual shall be considered to be uninsured
with respect to influenza vaccine if the individual does not
have benefits with respect to the cost of such vaccine under a
health insurance policy or plan (including a group health plan,
a prepaid health plan, or an employee welfare benefit plan
under the Employee Retirement Income Security Act of 1974).
``(II) With respect to influenza, an individual shall be
considered to be at high risk if the individual meets the high-
risk criteria identified by the Advisory Committee on
Immunization Practices (an advisory committee established by
the Secretary).
``(4)(A) The Secretary shall annually submit to the Congress a
report that--
``(i) evaluates the extent to which the
immunization system in the United States has been
effective in providing for adequate immunization rates
for adults, taking into account the applicable year
2010 health objectives established by the Secretary
regarding the health status of the people of the United
States; and
``(ii) describes any issues identified by the
Secretary that may affect such rates.
``(B) For each fiscal year for which demonstration projects under
paragraph (3)(D) are being carried out, the report under subparagraph
(A) shall include information on--
``(i) the effectiveness of the projects in increasing the
rate of immunizations with influenza vaccine in the populations
involved;
``(ii) demographic information on the individuals to whom
the projects have provided immunizations (including with
respect to race and ethnicity); and
``(iii) the types of health care entities that have been
involved in the projects.
``(5) In carrying out this subsection and paragraphs (1) and (2) of
subsection (k), the Secretary shall consider recommendations regarding
immunizations that are made in reports issued by the Institute of
Medicine.''.
(b) Research, Demonstrations, and Education.--Section 317(k) of the
Public Health Service Act (42 U.S.C. 247b(k)) is amended--
(1) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5), respectively; and
(2) by inserting after paragraph (1) the following
paragraph:
``(2)(A) The Secretary, directly or through grants under paragraph
(1), shall provide for the following:
``(i) The Secretary shall coordinate with public and
private entities (including nonprofit private entities), and
develop and disseminate guidelines, toward the goal of ensuring
that immunizations are routinely offered to adults by public
and private health care providers.
``(ii) The Secretary shall cooperate with public and
private entities to obtain information for the annual
evaluations required in subsection (j)(4)(A)(i).
``(B)(i) The Secretary, directly or through grants under paragraph
(1), shall provide for a campaign of education on the importance of
adults receiving immunizations. Such campaign shall have--
``(I) a component directed toward the general public;
``(II) a component or components directed toward health
professionals, providers of health insurance and plans, and
employers; and
``(III) components directed toward particular populations
for which the rate of immunizations is low relative to the
general population.
``(ii) In carrying out the campaign under clause (i), the Secretary
shall seek to use innovative educational methods, and shall seek to
meet the following goals:
``(I) Increase the demand for immunizations.
``(II) Correct misconceptions and unjustified concerns
about the safety of vaccines.
``(III) Promote the inclusion in health insurance and plans
of coverage of immunizations for adults.
``(IV) Promote the use of evidence-based approaches for
improving the rate of immunizations.
``(iii) The Secretary shall provide for an evaluation, including
through surveys, of the effects of the campaign under clause (i) on the
knowledge, attitudes, and practices of the populations described in
subclauses (I) through (III) of such clause.''.
SEC. 4. MEDICARE AND MEDICAID PROGRAMS; STANDARDS TO MEASURE USAGE AND
COVERAGE OF ADULT IMMUNIZATIONS.
(a) In General.--The Secretary of Health and Human Services, acting
through the Administrator of the Centers for Medicare & Medicaid
Services, shall establish standards for the measurement of use by
beneficiaries under the medicare and medicaid programs of adult
immunizations for influenza.
(b) Study for Use of Standards as a Quality Measure.--The
Secretary, acting through the Administrator of the Centers for Medicare
& Medicaid Services, shall conduct a study to determine the feasibility
and advisability of including adult immunization for influenza by
medicare and medicaid beneficiaries, as a performance measure under
quality initiatives conducted by the Secretary under the medicare and
medicaid programs.
(c) Measurement of Usage by Health Care Workers.--The Secretary,
acting through the Administrator of the Centers for Medicare & Medicaid
Services, shall establish standards for the measurement of use by
health care workers, as defined by the Secretary for purposes of this
section, working in a provider of services (as defined in section
1861(u) of the Social Security Act (42 U.S.C. 1395x(u)) of adult
immunizations for influenza.
(d) Assessment of Best Practices to Improve Coverage of Adult
Immunizations.--The Secretary of Health and Human Services, acting
through the Agency for Healthcare Research and Quality, shall conduct a
study of the best practices of health insurers and managed care
organizations to encourage the use of adult immunizations for influenza
by enrollees of such insurers and organizations, such as informed
refusal and other interventions.
SEC. 5. STUDY ON ADULT IMMUNIZATION FOR INFLUENZA FOR HEALTH CARE
WORKERS AS A QUALITY INDICATOR FOR PURPOSES OF
ACCREDITATION.
(a) Study.--The Secretary of Health and Human Services shall
conduct a study to determine the feasibility and advisability of
including as a requirement of accreditation of a provider of services
(as defined in section 1861(u) of the Social Security Act (42 U.S.C.
1395x(u)) compliance with recommended adult immunizations, including
influenza, for all health care workers employed by the provider of
services. Any such requirement should include a provision for informed
refusal by the health care worker of the immunization and appropriate
documentation of usage and refusal of such immunizations.
(b) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to Congress a report
on the study conducted under subsection (a), and shall include in that
report a description of the difficulties of implementing such a
requirement as well as recommendations for the resolution of those
difficulties.
SEC. 6. FEHBP COVERAGE OF QUALIFIED IMMUNIZATION SERVICES.
(a) In General.--Section 8902 of title 5, United States Code, is
amended by adding at the end the following:
``(p)(1) A contract may not be made or a plan approved which does
not (A) offer qualified immunization services to eligible enrollees,
and (B) provide for the waiver of any deductible that might otherwise
apply with respect to any such services provided to any such enrollee.
``(2) For purposes of this subsection--
``(A) the term `qualified immunization services' means--
``(i) pneumococcal vaccine and its administration;
and
``(ii) influenza vaccine and its administration;
and
``(B) the term `eligible enrollee', as used with respect to
a health benefits plan, means an individual enrolled in such
plan under this chapter who is 18 years of age or older and who
is at high risk of contracting pneumonia or influenza, as
determined under criteria of the Advisory Committee on
Immunization Practices or another similar body (as identified
by the Office).''.
(b) Effective Date.--The amendment made by this section shall apply
to services provided under any contract entered into or renewed for any
contract year beginning later than 9 months after the date of the
enactment of this Act.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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