Strengthening the Vaccines for Children Program Act of 2021
This bill modifies vaccination programs and coverage for children under Medicaid and the Children's Health Insurance Program (CHIP).
Specifically, the bill expands and otherwise modifies the Vaccines for Children Program, which provides free vaccinations to individuals 18 years of age or younger who are uninsured or underinsured (i.e., with limited or no insurance for vaccines), are eligible for Medicaid, or are American Indians or Alaskan Natives. The bill expands the program to include children enrolled in CHIP and temporarily provides for additional payments to incentivize provider participation. The Government Accountability Office must report on the related effects of the bill's changes.
The bill also expands coverage under Medicaid and CHIP to include vaccine counseling and educational services for children and temporarily requires payments to be made at a rate that is no less than the rate under Medicare for equivalent services. It also temporarily increases the Federal Medical Assistance Percentage (i.e., federal matching rate) for states that conduct culturally appropriate outreach regarding the benefits of vaccinations for children.
To amend title XIX of the Social Security Act to ensure adequate access 
 to vaccines under the Medicaid program and the Vaccines for Children 
                    program, 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 ``Strengthening the Vaccines for 
Children Program Act of 2021''.

SEC. 2. ENSURING ADEQUATE ACCESS TO VACCINES UNDER THE MEDICAID PROGRAM 
              AND THE VACCINES FOR CHILDREN PROGRAM.

    (a) Encouraging Involvement of Providers.--Paragraph (3) of section 
1928(c) of the Social Security Act (42 U.S.C. 1396s(c)) is amended--
            (1) by redesignating subparagraphs (A) and (B) as clauses 
        (i) and (ii), respectively, and moving the margins of each such 
        clause, as so redesignated, 2 ems to the right;
            (2) by striking ``providers'' and all that follows through 
        ``Each program'' and inserting ``providers.--
                    ``(A) In general.--Each program''; and
            (3) by adding at the end the following:
                    ``(B) Incentive payments.--
                            ``(i) In general.--The Secretary shall pay 
                        to each provider that requests payment under 
                        this subparagraph and that is a program-
                        registered provider under this section for the 
                        duration of the period beginning on the date of 
                        the enactment of this subparagraph, and ending 
                        on December 31, 2022--
                                    ``(I) an amount equal to $5,000, to 
                                be paid as soon as practicable after 
                                the date of the enactment of this 
                                subparagraph;
                                    ``(II) an amount equal to $2,500, 
                                to be paid as soon as practicable after 
                                January 1, 2022; and
                                    ``(III) an amount equal to $2,500, 
                                to be paid as soon as practicable after 
                                January 1, 2023.
                            ``(ii) Use of funds.--Payments made under 
                        clause (i) may only be used by a provider for 
                        purposes of carrying out the program under this 
                        section (including any operational expenses 
                        associated with the furnishing of vaccines 
                        under such program, as specified by the 
                        Secretary).
                            ``(iii) Recoupment of payments.--The 
                        Secretary may conduct reviews of providers 
                        receiving payments under this subparagraph to 
                        ensure that such payments are used in 
                        accordance with clause (ii) and recoup from 
                        such providers any such payments not so used in 
                        accordance with such clause.''.
    (b) Expansion of Definition of Federally Vaccine-Eligible Child.--
Paragraph (2) of section 1928(b) of the Social Security Act (42 U.S.C. 
1396s(b)) is amended--
            (1) in subparagraph (A)--
                    (A) in clause (iii), by striking ``A child who'' 
                and all that follows through the period at the end and 
                inserting ``A child who is administered a qualified 
                pediatric vaccine and is not insured with respect to 
                such vaccine.''; and
                    (B) by adding at the end the following new clause:
                            ``(v) A child who is enrolled for child 
                        health assistance under a State child health 
                        plan approved under title XXI.''; and
            (2) in subparagraph (B)(ii)(II), by striking ``for purposes 
        of subparagraph (A)(iii)(II)'' and inserting ``for purposes of 
        subparagraph (A)(iii)''.
    (c) Minimum Payment Requirement for Vaccine Administration 
Services.--
            (1) In general.--Section 1902(a)(13) of the Social Security 
        Act (42 U.S.C. 1396a(a)(13)) is amended--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) in subparagraph (C), by striking the semicolon 
                and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) for payment for vaccine administration 
                services (including vaccine counseling and educational 
                services) furnished by a provider during the period 
                beginning on the date of the enactment of this 
                subparagraph, and ending on December 31, 2022 
                (including, notwithstanding subsection (c)(2)(C)(ii) of 
                section 1928, any such services furnished with respect 
                to a vaccine furnished under the program established by 
                the State pursuant to such section to a medicaid-
                eligible child (as defined in subsection (b)(2)(B)(i) 
                of such section)), at a rate not less than 100 percent 
                of the payment rate that applies to such services and 
                provider under part B of title XVIII;''.
            (2) Managed care plans.--Section 1932(f) of the Social 
        Security Act (42 U.S.C. 1396u-2(f)) is amended--
                    (A) in the header, by striking ``Payment for 
                Primary Care Services'' and inserting ``Payments'';
                    (B) by striking ``section 1902(a)(13)(C)'' and 
                inserting ``subparagraph (C) of section 1902(a)(13) and 
                vaccine administration services described in 
                subparagraph (D) of such section'';
                    (C) by striking ``such section'' and inserting 
                ``such subparagraph (C) or (D), respectively''; and
                    (D) by adding at the end the following new 
                sentence: ``The provisions of the preceding sentence 
                shall apply to contracts entered into with, and 
                payments made by, other specified entities (as defined 
                in section 1903(m)(9)(D)(iii)) in the same manner as 
                such provisions apply with respect to contracts entered 
                into with, and payments made by, medicaid managed care 
                organizations.''.
            (3) CHIP.--Section 2103(c) of the Social Security Act (42 
        U.S.C. 1397cc(c)) is amended by adding at the end the following 
        new paragraph:
            ``(11) Vaccine administration services.--The child health 
        assistance provided to a targeted low-income child shall 
        include payment for vaccine administration services (including 
        vaccine counseling and educational services) furnished by a 
        provider during the period beginning on the date of the 
        enactment of this paragraph, and ending on December 31, 2022 
        (including, notwithstanding subsection (c)(2)(C)(ii) of section 
        1928, any such services furnished to such child with respect to 
        a vaccine furnished under the program established by the State 
        pursuant to such section), at a rate not less than 100 percent 
        of the payment rate that applies to such services and provider 
        under part B of title XVIII.''.
    (d) Coverage of Vaccine Counseling and Educational Services Under 
Medicaid.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in paragraph (29), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (30) as paragraph 
                (31); and
                    (C) by inserting after paragraph (29) the following 
                new paragraph:
            ``(30) vaccine counseling and educational services 
        furnished to children under the age of 19 on or after the date 
        of the enactment of this paragraph, including any such services 
        furnished as part of a multiple component vaccine (identified 
        as of October 1, 2020, by CPT code 90461) and including any 
        such services furnished under the program established by the 
        State pursuant to section 1928 to a medicaid-eligible child (as 
        defined in subsection (b) of such section),''.
            (2) Mandatory benefit.--Section 1902(a)(10)(A) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by 
        striking ``and (29)'' and inserting ``(29), and (30)''.
    (e) Clarification of Coverage of Pediatric Vaccines and Vaccine 
Counseling and Educational Services Under the Vaccines for Children 
Program.--Section 1928(c)(2)(C)(ii) of the Social Security Act (42 
U.S.C. 1396s(c)(2)(C)(ii)) is amended to read as follows:
                    ``(ii) The provider may impose--
                            ``(I) in the case of a qualified pediatric 
                        vaccine not described in subclause (II), a fee 
                        for the administration of and counseling for 
                        such vaccine so long as the fee in the case of 
                        a federally vaccine-eligible child does not 
                        exceed the costs of such administration and 
                        counseling (as determined by the Secretary 
                        based on actual regional costs for such 
                        administration and counseling); and
                            ``(II) in the case of a qualified pediatric 
                        vaccine that is a multiple component vaccine, a 
                        separate charge for the administration of and 
                        counseling for each component of such vaccine 
                        so long as the charge in the case of a 
                        federally vaccine-eligible child does not 
                        exceed--
                                    ``(aa) with respect to the first 
                                component of such vaccine, the costs of 
                                such administration and counseling for 
                                such component (as determined by the 
                                Secretary based on actual regional 
                                costs for such administration and 
                                counseling for such first component); 
                                and
                                    ``(bb) with respect to a subsequent 
                                component of such vaccine, the payment 
                                rate that applies to such 
                                administration and counseling for such 
                                component and provider under part B of 
                                title XVIII.''.
    (f) Increase in Federal Medical Assistance Percentage.--
            (1) In general.--Subject to paragraph (2), for each 
        calendar quarter occurring during the period beginning on 
        January 1, 2021, and ending on December 31, 2022, the Federal 
        medical assistance percentage determined for each State, 
        including the District of Columbia, American Samoa, Guam, the 
        Commonwealth of the Northern Mariana Islands, Puerto Rico, and 
        the United States Virgin Islands, under section 1905(b) of the 
        Social Security Act (42 U.S.C. 1396d(b)), after application of 
        section 6008 of the Families First Coronavirus Response Act 
        (Public Law 116-127) (if applicable), shall be increased by 1 
        percentage point.
            (2) Requirements.--
                    (A) In general.--A State described in paragraph (1) 
                may not receive the increase described in such 
                paragraph in the Federal medical assistance percentage 
                for such State, with respect to a quarter, if such 
                State does not ensure culturally competent and 
                effective messages for vaccination outreach to child 
                populations, which may include the dissemination of 
                information highlighting--
                            (i) advancements in research and vaccine 
                        development that have saved millions of 
                        individuals from death and disability from now-
                        preventable diseases;
                            (ii) information on how individuals across 
                        the lifespan benefit from immunizations, 
                        including those who cannot be vaccinated and 
                        rely on community immunity;
                            (iii) information on the dangers of not 
                        being vaccinated, including the potential for 
                        infectious disease outbreaks within 
                        communities; and
                            (iv) information on vaccine safety and the 
                        systems in place to monitor vaccine safety.
                    (B) Requirement for certain states.--Section 
                1905(cc) of the Social Security Act (42 U.S.C. 
                1396d(cc)) is amended--
                            (i) by inserting ``and section 2(e) of the 
                        Strengthening the Vaccines for Children Program 
                        Act of 2021'' before ``, except that in 
                        applying''; and
                            (ii) by inserting ``, and in applying such 
                        treatments to the increases in the Federal 
                        medical assistance percentage under section 
                        2(e) of the Strengthening the Vaccines for 
                        Children Program Act of 2021, the reference to 
                        `December 31, 2009' shall be deemed to be a 
                        reference to `December 31, 2020''' before the 
                        period at the end.
    (g) Tribal Epidemiology Center Data Access.--With respect to data 
access for tribal epidemiology centers established under section 214 of 
the Indian Health Care Improvement Act (25 U.S.C. 1621m), the Director 
of the Centers for Disease control and Prevention may create a data 
sharing strategy that ensures such centers have access to data, data 
sets, monitoring systems, delivery systems, and other protected health 
information with respect to health care and public health surveillance 
systems of child and adolescent health necessary to accomplish such 
centers' public health authority responsibilities described in such 
section or section 164.501 of title 45, Code of Federal Regulations.
    (h) Reports.--
            (1) In general.--For each of fiscal years 2021 and 2022, 
        the Director of the Centers for Disease Control and Prevention, 
        in coordination with each State that has established a 
        pediatric vaccine distribution program under section 1928 of 
        the Social Security Act (42 U.S.C. 1396s), shall publish on the 
        public internet website of the Centers for Disease Control and 
        Prevention, in such manner as determined appropriate by the 
        Director, information on vaccination rates under each such 
        program during such year, including such rates disaggregated by 
        region, age, sex, race, ethnicity, and other demographic 
        factors determined appropriate by the Director.
            (2) Effects on vaccination rates and program 
        participation.--Not later than 2 years after the date of the 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to Congress a report containing an analysis 
        of the effects of the provisions of, and the amendments made 
        by, this Act on--
                    (A) vaccination rates under the pediatric vaccine 
                distribution program under section 1928 of the Social 
                Security Act (42 U.S.C. 1396s); and
                    (B) provider participation in such program.
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Strengthening the Vaccines for Children Program Act of 2021
To amend title XIX of the Social Security Act to ensure adequate access to vaccines under the Medicaid program and the Vaccines for Children program, and for other purposes.
Strengthening the Vaccines for Children Program Act of 2021
Rep. Schrier, Kim