I

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.

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 ‘‘Immunization Now

5 Act of 1993’’.
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1 SEC. 2. FINDINGS.

2 The Congress finds, with respect to immunizations

3 against vaccine-preventable diseases, the following:

4 (1) Childhood illnesses that can be prevented by

5 timely application of commonly available vaccina6 tions, through a program of Federal and local co7 operation, are rising at an alarming rate.

8 (2) The incidence of measles increased 336 per9 cent in 1989, increasing to eighteen thousand one

10 hundred ninety three cases from three thousand

11 three hundred ninety six in 1988.

12 (3) The cost of appropriate immunizations is

13 minimal. One estimate places that cost at $130 per

14 child.

15 (4) The typical price per dose of a measles,

16 mumps, rubella vaccine is approximately $24 to the

17 practitioner and the average cost of hospitalization

18 for a child with measles is approximately $5,000–

19 $6,000.

20 (5) A child who was not immunized from mea21 sles died in a California hospital after $800,000 was

22 spent in an effort to treat the child’s measles com23 plications.

24 (6) In November 1990 the measles rate for the

25 year had already surpassed the rates of other full

26 years since 1978 and deaths from measles are the
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1 highest since 1971. Measles caused more than sixty

2 deaths in 1990, the largest annual number of re3 ported cases due to measles in almost two decades.

4 (7) Fifty four percent of measles cases occur

5 among vaccine-eligible infants and preschool children

6 who have not been vaccinated.

7 (8) One-third to one-half of children up to age

8 two who live in poor, inner-city areas are not prop9 erly immunized.

10 (9) Preschool children in other Western, indus11 trialized nations have significantly higher immuniza12 tion rates than United States children of the same

13 age group.

14 (10) There are seven to nine million uninsured

15 children in the United States.

16 (11) While programs to immunize school-aged

17 children have been very successful, preschoolers as a

18 group now make up 47 percent of measles cases, up

19 from 25 percent in 1988.

20 (12) Computerized systems of tracking immuni21 zation status and utilization from birth have been

22 operationalized in several countries, including Great

23 Britain and the Netherlands. Such systems can aid

24 in surveillance of immunization status, provision of

25 reminders to parents when vaccines are due, and
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1 monitoring the distribution of vaccines through pub2 lic and private providers.

3 SEC. 3. ESTABLISHMENT OF ENTITLEMENT PROGRAM RE4 GARDING IMMUNIZATION OF INFANTS

5 AGAINST VACCINE-PREVENTABLE DISEASES.

6 (a) IN GENERAL.—Each infant in the United

7 States—

8 (1) who has not reached the infant’s second

9 birthday,

10 (2) who is a citizen or national of the United

11 States, an alien lawfully admitted for permanent res12 idence, or other alien permanently in the United

13 States under color of law, and

14 (3) who is not entitled under a health insurance

15 policy or other health benefit plan to receive (or have

16 any payment made for the expenses of) any immuni17 zation specified under section 7, is entitled to receive

18 without charge, in accordance with this Act, immu19 nizations against vaccine-preventable diseases.

20 (b) IMPLEMENTATION THROUGH SYSTEM OF VOUCH21 ERS.—The entitlement established in subsection (a) shall

22 be implemented through the use of vouchers issued under

23 section 5. Such vouchers represent the obligation of the

24 Federal Government to pay, subject to section 6, the costs
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1 of providing the immunizations specified under section 7

2 for the infants for whom the vouchers are issued.

3 SEC. 4. OBLIGATION TO PROVIDE IMMUNIZATIONS.

4 (a) IN GENERAL.—Any licensed health care profes5 sional or provider who or which is authorized by law to

6 provide immunizations specified under section 7 and who

7 or which is engaged in the public or private practice of

8 pediatrics or family medicine shall provide the immuniza9 tions specified under section 7 that are appropriate for

10 the age of the infant involved if a voucher issued under

11 section 5 for the infant is presented to the professional

12 or provider.

13 (b) APPLICABILITY.—The requirement established in

14 subsection (a) shall apply to a professional or provider

15 without regard to whether the professional or provider

16 provides health services as a participant in the program

17 established in title XVIII of the Social Security Act or

18 the program established in title XIX of such Act, and

19 without regard to whether the professional or provider oth20 erwise receives Federal payments or Federal financial as21 sistance for any purpose.

22 SEC. 5. ISSUANCE OF VOUCHERS.

23 (a) IN GENERAL.—The Secretary of Health and

24 Human Services shall provide for the issuance of vouchers

25 for purposes of section 3(b). Each such voucher shall—
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1 (1) bear a seal for purposes of indicating that

2 the voucher has been issued for purposes of the enti3 tlement established in section 3(a);

4 (2) contain the name of the infant for whom

5 the voucher is issued and the name and address of

6 not less than one parent of the infant;

7 (3) in summary form state the principal legal

8 rights and obligations arising with respect to the

9 voucher; and

10 (4) contain a simple explanation of what immu11 nizations are needed and why.

12 (b) ELIGIBILITY.—A voucher shall not be issued

13 under this section with respect to an infant unless the in14 fant is described in section 3(a) and an application for

15 the voucher has been made and signed by a parent of the

16 infant.

17 (c) APPLICATION FOR ISSUANCE.—

18 (1) HOSPITALS.—The Secretary shall provide

19 for a process by which a hospital, in which an infant

20 eligible for a voucher is born, issues the voucher to

21 the parent of the infant at the time of birth if the

22 hospital determines, based on information supplied

23 by the parent, that the infant is described in section

24 3(a). Under the process, the hospital shall complete

25 the application for the voucher on behalf of the in-
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1 fant, obtain the signature of a parent as to the accu2 racy of the information supplied, and forward the

3 application to the Secretary.

4 (2) COMMUNITY HEALTH CENTERS.—The Sec5 retary shall provide for a process by which a commu6 nity health center issues a voucher to the parent of

7 an infant if—

8 (A) based upon information supplied by

9 the parent to the center, the center determines

10 that the infant is described in section 3(a) and

11 a voucher has not been previously issued with

12 respect to the infant, and

13 (B) the infant is a patient at the center.

14 Under the process, the center shall complete the ap15 plication for the voucher on behalf of the infant, ob16 tain the signature of a parent as to the accuracy of

17 the information supplied, and forward the applica18 tion to the Secretary.

19 (3) SECRETARY.—In cases not described in

20 paragraph (1) or (2), the Secretary shall provide for

21 direct issuance of a voucher to a parent of an infant

22 described in section 3(a) upon application by the

23 parent.
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1 SEC. 6. REIMBURSEMENT FOR PROVISION OF IMMUNIZA2 TIONS.

3 (a) IN GENERAL.—In the case of a professional or

4 provider providing immunizations pursuant to the presen5 tation of vouchers issued under section 5, the Secretary

6 shall make a single payment to the professional or pro7 vider each quarter of the fiscal year as reimbursement for

8 the costs of immunizations provided in the preceding quar9 ter if—

10 (1) the professional or provider submits to the

11 Secretary the vouchers involved;

12 (2) the Secretary determines that the vouchers

13 were obtained, and the immunizations involved were

14 provided, in accordance with this Act; and

15 (3) the vouchers are submitted to the Secretary

16 in accordance with such procedures and meet such

17 requirements as the Secretary determines to be nec18 essary to carry out paragraph (2).

19 (b) AMOUNT OF REIMBURSEMENT.—The Secretary

20 shall establish amounts of reimbursement that will be pro21 vided for types of immunizations specified under section

22 7. Each such reimbursement shall include reimbursement

23 both for the vaccine and for the professional service of pro24 viding the immunization.
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1 SEC. 7. SPECIFICATION OF IMMUNIZATIONS.

2 The immunizations specified in this section are such

3 immunizations as may be established by the Secretary

4 based on the recommendations of the Advisory Committee

5 on Immunization Practice of the Centers for Disease

6 Control.

7 SEC. 8. GENERAL PROVISIONS.

8 (a) PROVISION OF INFORMATION REGARDING PRO9 GRAM.—The Secretary shall carry out activities—

10 (1) to inform the public of the entitlement es11 tablished in section 3(a), including the manner in

12 which an application under section 5(c) may be ob13 tained; and

14 (2) to inform professionals and providers of

15 their legal rights and obligations regarding vouchers

16 issued under section 5.

17 (b) REGULATIONS.—The Secretary shall by regula18 tion issue criteria for carrying out sections 3 through 7.

19 For purposes of the preceding sentence, the final rule shall

20 be issued not later than ninety days after the date of the

21 enactment of this Act.

22 (c) APPLICABILITY.—The entitlement established in

23 section 3(a) shall apply upon the expiration of the forty24 five day period beginning on the date on which the final

25 rule referred to in subsection (b) is required under such

26 subsection to be issued.
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1 (d) DEFINITIONS.—For purposes of this Act:

2 (1) The term ‘‘Secretary’’ means the Secretary

3 of Health and Human Services.

4 (2) The term ‘‘parent’’ means any parent, step5 parent, grandparent, or duly appointed guardian.

6 (3) The term ‘‘United States’’ includes Puerto

7 Rico, Guam, the Virgin Islands, American Samoa,

8 and the Northern Mariana Islands.

9 (e) AUTHORIZATION OF APPROPRIATIONS.—For the

10 purpose of carrying out this Act, there are authorized to

11 be appropriated such sums as may be necessary for fiscal

12 year 1994 and each subsequent fiscal year.

13 SEC. 9. NATIONAL IMMUNIZATION REGISTRY SYSTEM.

14 (a) IN GENERAL.—The Secretary, acting through the

15 Director of the Centers for Disease Control, shall establish

16 a national immunization registry system (in this section

17 referred to as the ‘‘registry’’). The purpose of the system

18 is to provide for national surveillance of childhood immuni19 zation status through age six.

20 (b) 2-YEAR RESEARCH AND DEMONSTRATION

21 PHASE.—

22 (1) IN GENERAL.—The Secretary shall make

23 grants to public and nonprofit private entities to

24 conduct research and demonstration projects aimed
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1 at identifying mechanisms and structures to develop

2 the registry, including—

3 (A) projects to test methods for collecting

4 birth certificate and immunization information

5 in a large central data system;

6 (B) projects to evaluate the capacity of

7 public health agencies to provide birth certifi8 cate and immunization information in a cost-ef9 fective and efficient manner;

10 (C) projects to assess techniques for track11 ing children in mobile populations across geo12 graphic areas;

13 (D) projects to explore the feasibility of a

14 registry which requires the participation by pri15 vate providers of immunization services; and

16 (E) projects to demonstrate the efficient

17 use of registry information in providing immu18 nization status.

19 (2) AUTHORIZATION OF APPROPRIATIONS.—

20 There are authorized to be appropriated to carry out

21 this subsection $7,000,000 in fiscal year 1994 and

22 $12,000,000 in fiscal year 1995.

23 (c) ENHANCEMENT OF INFORMATION SYSTEMS.—

24 (1) IN GENERAL.—The Secretary, based on

25 projects conducted under subsection (b), shall ex-
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1 pand the registry to cover the entire Nation. In

2 doing this, the Secretary shall—

3 (A) develop the capacity to link and proc4 ess all birth certificate records through a

5 central registry;

6 (B) enhance State and local technical ca7 pacity to provide information through use of re8 sources (such as new computer hardware and

9 software or technical assistance);

10 (C) promote participation by private pro11 viders who administer childhood vaccines; and

12 (D) develop mechanisms to collect informa13 tion on all doses of vaccine administered to pre14 school age children in both the public and pri15 vate sectors.

16 (2) AUTHORIZATION OF APPROPRIATIONS.—

17 There are authorized to be appropriated to carry out

18 this subsection $50,000,000 in fiscal year 1996.

19 (d) FULL IMPLEMENTATION.—

20 (1) IN GENERAL.—Beginning with fiscal year

21 1997, the Secretary shall provide for full implemen22 tation of the registry. In implementing such registry,

23 the Secretary shall provide that—

24 (A) all infants born in the United States

25 are registered through birth certificate informa-
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1 tion that relates to immunization tracking and

2 vaccine administration;

3 (B) information on doses of vaccines ad4 ministered to all children under six years of age

5 is collected;

6 (C) appropriate notices are provided to

7 parents regarding overdue vaccinations; and

8 (D) appropriate records are provided to

9 parents for their children entering schools or

10 day care programs.

11 The Secretary shall include information on the oper12 ation of the registry with annual reports submitted

13 to Congress on the operation of the vaccine system

14 provided under the other provisions of this Act.

15 (2) AUTHORIZATION OF APPROPRIATIONS.—

16 There are authorized to be appropriated to carry out

17 this subsection $50,000,000 in each fiscal year, be18 ginning with fiscal year 1997.

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