I

104TH CONGRESS

1ST SESSION H. R. 191

To amend part A of title IV of the Social Security Act to deny benefits

under the program of aid to families with dependent children with respect

to any child who has not received preventive health care or been immunized in accordance with recommendations issued by the Surgeon General

of the Public Health Service, and to amend the Child Care and Development Block Grant Act to require that child care providers that receive

assistance, directly or indirectly, under such Act require all children

to be immunized in accordance with such recommendations.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 4, 1995

Mrs. ROUKEMA introduced the following bill; which was referred to the Committee on Ways and Means and, in addition, to the Committee on Commerce, 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 part A of title IV of the Social Security Act

to deny benefits under the program of aid to families

with dependent children with respect to any child who

has not received preventive health care or been immunized in accordance with recommendations issued by the

Surgeon General of the Public Health Service, and to

amend the Child Care and Development Block Grant

Act to require that child care providers that receive assistance, directly or indirectly, under such Act require
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all children to be immunized in accordance with such

recommendations.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Child Immunization

5 Incentive Act of 1995’’.

6 SEC. 2. AFDC BENEFITS DENIED FOR CHILDREN WHO HAVE

7 NOT RECEIVED PREVENTIVE HEALTH CARE

8 OR IMMUNIZATIONS.

9 Section 402(a) of the Social Security Act (42 U.S.C.

10 602(a)) is amended—

11 (1) by striking ‘‘and’’ at the end of paragraph

12 (44);

13 (2) by striking the period at the end of para14 graph (45) and inserting ‘‘; and’’; and

15 (3) by inserting after paragraph (45) the fol16 lowing:

17 ‘‘(46) provide that—

18 ‘‘(A) aid under the plan shall not be pay19 able with respect to any child who has not at20 tained the age of 6 years, unless the State

21 agency has received from 1 or more physicians

22 written verification (on a form prescribed by the

23 State)—
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1 ‘‘(i) that the child has been examined

2 by a physician not less frequently than—

3 ‘‘(I) in the case of a child who

4 has not attained the age of 19

5 months, every 6 months since the

6 child was born; and

7 ‘‘(II) in the case of any other

8 child, every 6 months until the child

9 attained the age of 19 months, and

10 every year thereafter;

11 ‘‘(ii) that the child has been immu12 nized in accordance with recommendations

13 issued by the Surgeon General of the Pub14 lic Health Service; and

15 ‘‘(iii) of any contraindication which

16 exempts the child from receiving an immu17 nization;

18 ‘‘(B) the State will conduct appropriate

19 education and outreach activities designed to—

20 ‘‘(i) increase public awareness of the

21 importance of preventive health care and

22 immunizations for pre-school children; and

23 ‘‘(ii) inform the public about—
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1 ‘‘(I) the availability of preventive

2 health care and immunization services

3 for pre-school children;

4 ‘‘(II) any transportation, child

5 care, or other support services that

6 may be available to assist parents in

7 obtaining such services for their chil8 dren; and

9 ‘‘(III) the clinics at which any

10 child may receive immunizations free

11 or at a reduced charge.’’.

12 SEC. 3. AMENDMENTS TO THE CHILD CARE AND DEVELOP13 MENT BLOCK GRANT.

14 Section 658E(2) of the Child Care and Development

15 Block Grant Act (42 U.S.C. 9858c(2)) is amended—

16 (1) in subparagraph (F)—

17 (A) in clause (ii) by striking ‘‘and’’ at the

18 end,

19 (B) in clause (iii) by striking the period at

20 the end and inserting ‘‘; and’’,

21 (C) by inserting after subclause (III), as so

22 redesignated, the following:

23 ‘‘(iv) a requirement that such provid24 ers require with respect to each child who

25 receives child care services from any of
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1 such providers that certificates signed by a

2 physician who verifies that such child has

3 been immunized in accordance with rec4 ommendations issued by the Surgeon Gen5 eral of the Public Health Service be sub6 mitted, at required intervals and in accord7 ance with rules issued by the Secretary, to

8 the child care provider involved.’’, and

9 (D) by striking the last sentence, and

10 (2) in subparagraph (G)—

11 (i) by inserting ‘‘(i)’’ before ‘‘Provide’’, and

12 (ii) by adding at the end the following:

13 ‘‘(ii) For the purpose of enforcing the re14 quirement described in subparagraph (F)(iv),

15 such procedures shall ensure that each of such

16 providers gives to parents of each child who re17 ceives child care services from the provider in18 volved written notice of—

19 ‘‘(I) each immunization requirement

20 applicable to such child;

21 ‘‘(II) an opportunity of not less than

22 30 days, and not more than 45 days, to

23 correct the failure to satisfy such require24 ment; and
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1 ‘‘(III) the fact that child care services

2 for such child will be terminated for failure

3 to satisfy such requirement before the expi4 ration of the 45-day period beginning on

5 the date such notice is received.’’.

6 SEC. 4. ISSUANCE OF IMMUNIZATION RECOMMENDATIONS

7 BY THE SURGEON GENERAL OF THE PUBLIC

8 HEALTH SERVICE.

9 After taking into consideration the then most recent

10 report of the Committee on Infectious Diseases of the

11 American Academy of Pediatrics, the Surgeon General of

12 the Public Health Service shall issue, and revise from time

13 to time, recommendations for the immunization of chil14 dren under 6 years of age. With respect to each rec15 ommended immunization, such recommendation shall in16 clude—

17 (1) contraindications (if any) that should be

18 identified to exempt a child from receiving such im19 munization, and

20 (2) remedial action that may be taken to mini21 mize the adverse effect of failure to administer such

22 immunization to a child at the recommended age.

23 SEC. 5. EFFECTIVE DATES; APPLICATION OF AMENDMENTS.

24 (a) EFFECTIVE DATE.—Except as provided in sub25 sections (b) and (c), this Act and the amendments made
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1 by this Act shall take effect on the date of the enactment

2 of this Act.

3 (b) APPLICATION OF SECTION 2 AMENDMENTS.—

4 The amendments made by section 2 shall apply, without

5 regard to whether regulations to implement the amend6 ments have been promulgated, to—

7 (1) payments to individuals under State plan

8 approved under part A of title IV of the Social Secu9 rity Act, for months ending after the 120-day period

10 that begins with the date of the enactment of this

11 Act; and

12 (2) payments to States under such part for cal13 endar quarters ending after such 120-day period.

14 (c) APPLICATION OF SECTION 3 AMENDMENTS.—

15 The amendments made by section 3 shall not apply with

16 respect to fiscal years beginning before the date of the en17 actment of this Act.

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