```

[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 940 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 940

   To establish an entitlement program regarding the immunization of 
             infants against vaccine-preventable diseases.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           February 17, 1993

  Mrs. Byrne (for herself, Mr. Evans, Mr. Rahall, Mr. Jefferson, Mr. 
   Wheat, Mrs. Morella, Mr. Peterson of Minnesota, and Mr. Brown of 
 California) introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

                              May 13, 1993

 Additional sponsors: Mr. Berman, Mr. Moran, Ms. Norton, Mr. Payne of 
 Virginia, Mr. Gonzalez, Mr. Valentine, Mr. Watt, Mr. Blackwell, Mrs. 
 Meek, Ms. Eddie Bernice Johnson of Texas, Mr. Rangel, Mr. Kildee, Mr. 
  Underwood, Mr. Martinez, Mr. Smith of New Jersey, Mr. Hinchey, Mr. 
 Towns, Mr. Boucher, Mr. Parker, Mr. Bonior, Mr. Kopetski, Ms. Furse, 
                Ms. DeLauro, Mr. Hastings, and Mr. Wynn

_______________________________________________________________________

                                 A BILL

 
   To establish an entitlement program regarding the immunization of 
             infants against vaccine-preventable diseases.

    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 ``Immunization Now Act of 1993''.

SEC. 2. FINDINGS.

    The Congress finds, with respect to immunizations against vaccine-
preventable diseases, the following:
            (1) Childhood illnesses that can be prevented by timely 
        application of commonly available vaccinations, through a 
        program of Federal and local cooperation, are rising at an 
        alarming rate.
            (2) The incidence of measles increased 336 percent in 1989, 
        increasing to eighteen thousand one hundred ninety three cases 
        from three thousand three hundred ninety six in 1988.
            (3) The cost of appropriate immunizations is minimal. One 
        estimate places that cost at $130 per child.
            (4) The typical price per dose of a measles, mumps, rubella 
        vaccine is approximately $24 to the practitioner and the 
        average cost of hospitalization for a child with measles is 
        approximately $5,000-$6,000.
            (5) A child who was not immunized from measles died in a 
        California hospital after $800,000 was spent in an effort to 
        treat the child's measles complications.
            (6) In November 1990 the measles rate for the year had 
        already surpassed the rates of other full years since 1978 and 
        deaths from measles are the highest since 1971. Measles caused 
        more than sixty deaths in 1990, the largest annual number of 
        reported cases due to measles in almost two decades.
            (7) Fifty four percent of measles cases occur among 
        vaccine-eligible infants and preschool children who have not 
        been vaccinated.
            (8) One-third to one-half of children up to age two who 
        live in poor, inner-city areas are not properly immunized.
            (9) Preschool children in other Western, industrialized 
        nations have significantly higher immunization rates than 
        United States children of the same age group.
            (10) There are seven to nine million uninsured children in 
        the United States.
            (11) While programs to immunize school-aged children have 
        been very successful, preschoolers as a group now make up 47 
        percent of measles cases, up from 25 percent in 1988.
            (12) Computerized systems of tracking immunization status 
        and utilization from birth have been operationalized in several 
        countries, including Great Britain and the Netherlands. Such 
        systems can aid in surveillance of immunization status, 
        provision of reminders to parents when vaccines are due, and 
        monitoring the distribution of vaccines through public and 
        private providers.

SEC. 3. ESTABLISHMENT OF ENTITLEMENT PROGRAM REGARDING IMMUNIZATION OF 
              INFANTS AGAINST VACCINE-PREVENTABLE DISEASES.

    (a) In General.--Each infant in the United States--
            (1) who has not reached the infant's second birthday,
            (2) who is a citizen or national of the United States, an 
        alien lawfully admitted for permanent residence, or other alien 
        permanently in the United States under color of law, and
            (3) who is not entitled under a health insurance policy or 
        other health benefit plan to receive (or have any payment made 
        for the expenses of) any immunization specified under section 
        7, is entitled to receive without charge, in accordance with 
        this Act, immunizations against vaccine-preventable diseases.
    (b) Implementation Through System of Vouchers.--The entitlement 
established in subsection (a) shall be implemented through the use of 
vouchers issued under section 5. Such vouchers represent the obligation 
of the Federal Government to pay, subject to section 6, the costs of 
providing the immunizations specified under section 7 for the infants 
for whom the vouchers are issued.

SEC. 4. OBLIGATION TO PROVIDE IMMUNIZATIONS.

    (a) In General.--Any licensed health care professional or provider 
who or which is authorized by law to provide immunizations specified 
under section 7 and who or which is engaged in the public or private 
practice of pediatrics or family medicine shall provide the 
immunizations specified under section 7 that are appropriate for the 
age of the infant involved if a voucher issued under section 5 for the 
infant is presented to the professional or provider.
    (b) Applicability.--The requirement established in subsection (a) 
shall apply to a professional or provider without regard to whether the 
professional or provider provides health services as a participant in 
the program established in title XVIII of the Social Security Act or 
the program established in title XIX of such Act, and without regard to 
whether the professional or provider otherwise receives Federal 
payments or Federal financial assistance for any purpose.

SEC. 5. ISSUANCE OF VOUCHERS.

    (a) In General.--The Secretary of Health and Human Services shall 
provide for the issuance of vouchers for purposes of section 3(b). Each 
such voucher shall--
            (1) bear a seal for purposes of indicating that the voucher 
        has been issued for purposes of the entitlement established in 
        section 3(a);
            (2) contain the name of the infant for whom the voucher is 
        issued and the name and address of not less than one parent of 
        the infant;
            (3) in summary form state the principal legal rights and 
        obligations arising with respect to the voucher; and
            (4) contain a simple explanation of what immunizations are 
        needed and why.
    (b) Eligibility.--A voucher shall not be issued under this section 
with respect to an infant unless the infant is described in section 
3(a) and an application for the voucher has been made and signed by a 
parent of the infant.
    (c) Application for Issuance.--
            (1) Hospitals.--The Secretary shall provide for a process 
        by which a hospital, in which an infant eligible for a voucher 
        is born, issues the voucher to the parent of the infant at the 
        time of birth if the hospital determines, based on information 
        supplied by the parent, that the infant is described in section 
        3(a). Under the process, the hospital shall complete the 
        application for the voucher on behalf of the infant, obtain the 
        signature of a parent as to the accuracy of the information 
        supplied, and forward the application to the Secretary.
            (2) Community health centers.--The Secretary shall provide 
        for a process by which a community health center issues a 
        voucher to the parent of an infant if--
                    (A) based upon information supplied by the parent 
                to the center, the center determines that the infant is 
                described in section 3(a) and a voucher has not been 
                previously issued with respect to the infant, and
                    (B) the infant is a patient at the center.
        Under the process, the center shall complete the application 
        for the voucher on behalf of the infant, obtain the signature 
        of a parent as to the accuracy of the information supplied, and 
        forward the application to the Secretary.
            (3) Secretary.--In cases not described in paragraph (1) or 
        (2), the Secretary shall provide for direct issuance of a 
        voucher to a parent of an infant described in section 3(a) upon 
        application by the parent.

SEC. 6. REIMBURSEMENT FOR PROVISION OF IMMUNIZATIONS.

    (a) In General.--In the case of a professional or provider 
providing immunizations pursuant to the presentation of vouchers issued 
under section 5, the Secretary shall make a single payment to the 
professional or provider each quarter of the fiscal year as 
reimbursement for the costs of immunizations provided in the preceding 
quarter if--
            (1) the professional or provider submits to the Secretary 
        the vouchers involved;
            (2) the Secretary determines that the vouchers were 
        obtained, and the immunizations involved were provided, in 
        accordance with this Act; and
            (3) the vouchers are submitted to the Secretary in 
        accordance with such procedures and meet such requirements as 
        the Secretary determines to be necessary to carry out paragraph 
        (2).
    (b) Amount of Reimbursement.--The Secretary shall establish amounts 
of reimbursement that will be provided for types of immunizations 
specified under section 7. Each such reimbursement shall include 
reimbursement both for the vaccine and for the professional service of 
providing the immunization.

SEC. 7. SPECIFICATION OF IMMUNIZATIONS.

    The immunizations specified in this section are such immunizations 
as may be established by the Secretary based on the recommendations of 
the Advisory Committee on Immunization Practice of the Centers for 
Disease 
Control.

SEC. 8. GENERAL PROVISIONS.

    (a) Provision of Information Regarding Program.--The Secretary 
shall carry out activities--
            (1) to inform the public of the entitlement established in 
        section 3(a), including the manner in which an application 
        under section 5(c) may be obtained; and
            (2) to inform professionals and providers of their legal 
        rights and obligations regarding vouchers issued under section 
        5.
    (b) Regulations.--The Secretary shall by regulation issue criteria 
for carrying out sections 3 through 7. For purposes of the preceding 
sentence, the final rule shall be issued not later than ninety days 
after the date of the enactment of this Act.
    (c) Applicability.--The entitlement established in section 3(a) 
shall apply upon the expiration of the forty-five day period beginning 
on the date on which the final rule referred to in subsection (b) is 
required under such subsection to be issued.
    (d) Definitions.--For purposes of this Act:
            (1) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (2) The term ``parent'' means any parent, step-parent, 
        grandparent, or duly appointed guardian.
            (3) The term ``United States'' includes Puerto Rico, Guam, 
        the Virgin Islands, American Samoa, and the Northern Mariana 
        Islands.
    (e) Authorization of Appropriations.--For the purpose of carrying 
out this Act, there are authorized to be appropriated such sums as may 
be necessary for fiscal year 1994 and each subsequent fiscal year.

SEC. 9. NATIONAL IMMUNIZATION REGISTRY SYSTEM.

    (a) In General.--The Secretary, acting through the Director of the 
Centers for Disease Control, shall establish a national immunization 
registry system (in this section referred to as the ``registry''). The 
purpose of the system is to provide for national surveillance of 
childhood immunization status through age six.
    (b) 2-Year Research and Demonstration Phase.--
            (1) In general.--The Secretary shall make grants to public 
        and nonprofit private entities to conduct research and 
        demonstration projects aimed at identifying mechanisms and 
        structures to develop the registry, including--
                    (A) projects to test methods for collecting birth 
                certificate and immunization information in a large 
                central data system;
                    (B) projects to evaluate the capacity of public 
                health agencies to provide birth certificate and 
                immunization information in a cost-effective and 
                efficient manner;
                    (C) projects to assess techniques for tracking 
                children in mobile populations across geographic areas;
                    (D) projects to explore the feasibility of a 
                registry which requires the participation by private 
                providers of immunization services; and
                    (E) projects to demonstrate the efficient use of 
                registry information in providing immunization status.
            (2) Authorization of appropriations.--There are authorized 
        to be appropriated to carry out this subsection $7,000,000 in 
        fiscal year 1994 and $12,000,000 in fiscal year 1995.
    (c) Enhancement of Information Systems.--
            (1) In general.--The Secretary, based on projects conducted 
        under subsection (b), shall expand the registry to cover the 
        entire Nation. In doing this, the Secretary shall--
                    (A) develop the capacity to link and process all 
                birth certificate records through a central registry;
                    (B) enhance State and local technical capacity to 
                provide information through use of resources (such as 
                new computer hardware and software or technical 
                assistance);
                    (C) promote participation by private providers who 
                administer childhood vaccines; and
                    (D) develop mechanisms to collect information on 
                all doses of vaccine administered to preschool age 
                children in both the public and private sectors.
            (2) Authorization of appropriations.--There are authorized 
        to be appropriated to carry out this subsection $50,000,000 in 
        fiscal year 1996.
    (d) Full Implementation.--
            (1) In general.--Beginning with fiscal year 1997, the 
        Secretary shall provide for full implementation of the 
        registry. In implementing such registry, the Secretary shall 
        provide that--
                    (A) all infants born in the United States are 
                registered through birth certificate information that 
                relates to immunization tracking and vaccine 
                administration;
                    (B) information on doses of vaccines administered 
                to all children under six years of age is collected;
                    (C) appropriate notices are provided to parents 
                regarding overdue vaccinations; and
                    (D) appropriate records are provided to parents for 
                their children entering schools or day care programs.
        The Secretary shall include information on the operation of the 
        registry with annual reports submitted to Congress on the 
        operation of the vaccine system provided under the other 
        provisions of this Act.
            (2) Authorization of appropriations.--There are authorized 
        to be appropriated to carry out this subsection $50,000,000 in 
        each fiscal year, beginning with fiscal year 1997.

                                 <all>
```