I

103D CONGRESS

1ST SESSION H. R. 2432

To provide financial incentives to encourage parents receiving public assistance

to have their children appropriately immunized against disease.

IN THE HOUSE OF REPRESENTATIVES

JUNE 16, 1993

Mr. CAMP (for himself, Mr. KLUG, Mr. GREENWOOD, Mr. EMERSON, Mr.

GUNDERSON, Mr. SANTORUM, Mr. GINGRICH, and Ms. MOLINARI) introduced the following bill; which was referred jointly to the Committees on

Energy and Commerce, Ways and Means, and Agriculture

A BILL

To provide financial incentives to encourage parents receiving

public assistance to have their children appropriately immunized against disease.

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 ‘‘Responsible Parent

5 Immunization Plan Act of 1993’’.
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1 TITLE I—IMMUNIZATION OF

2 CHILDREN RECEIVING AFDC

3 SEC. 101. IMMUNIZATION OF CHILDREN RECEIVING AFDC.

4 (a) STATE PLAN REQUIREMENTS.—Section 402(a)

5 of the Social Security Act (42 U.S.C. 602(a)) is amend6 ed—

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

8 (44);

9 (2) by striking the period at the end of para10 graph (45) and inserting ‘‘; and’’; and

11 (3) by inserting after paragraph (45) the fol12 lowing:

13 ‘‘(46)(A) require any parent or caretaker rel14 ative applying for or receiving aid under the State

15 plan to ensure that each dependent child of the par16 ent or such relative has received immunizations as

17 recommended for the same kind of child under sec18 tion 317A(j) of the Public Health Service Act;

19 ‘‘(B) provide for monitoring compliance with

20 subparagraph (A); and

21 ‘‘(C) at the option of the State, provide that the

22 aid otherwise payable to any family under the State

23 plan will be—

24 ‘‘(i) if the parent or caretaker relative of

25 the family complies with subparagraph (A), in-
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1 creased by not more than $75 per month for

2 not more than 3 months;

3 ‘‘(ii) if the parent or caretaker relative of

4 the family fails to comply with subparagraph

5 (A), decreased by not more than $75 per month

6 until the first month of such compliance or for

7 such number of months as the State may pre8 scribe, whichever ends earlier; or

9 ‘‘(iii) increased in accordance with clause

10 (i) and decreased in accordance with clause

11 (ii).’’.

12 (b) NO REIMBURSEMENT OF CERTAIN STATE EX13 PENSES.—Section 403(a)(3) of such Act (42 U.S.C.

14 603(a)(3)) is amended by inserting ‘‘, or in connection

15 with carrying out subparagraph (A), or (if the State has

16 not exhausted any grant received under section 317B of

17 the Public Health Service Act) individual monitoring

18 under subparagraph (B), of section 402(a)(46)’’ before

19 the semicolon.

20 (c) EFFECTIVE DATE.—The amendments made by

21 this section shall take effect on October 1, 1994.
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1 TITLE II—IMMUNIZATION OF

2 CHILDREN RECEIVING FOOD

3 STAMPS BENEFITS

4 SEC. 201. AMENDMENT TO THE FOOD STAMP ACT OF 1977.

5 (a) AMENDMENT.—Section 8 of the Food Stamp Act

6 of 1977 (7 U.S.C. 2017) is amended by adding at the end

7 the following:

8 ‘‘(f)(1) At the option of the State agency, the value

9 of allotments determined under this section without regard

10 to this subsection for all households that include a child

11 less that 5 years of age may be—

12 ‘‘(A) reduced by not more than $75 per

13 month—

14 ‘‘(i) for each month until the first month

15 beginning after all such children in the particu16 lar household have received the age-appropriate

17 immunizations recommended under section

18 317A(j) of the Public Health Service Act; or

19 ‘‘(ii) for such number of months as the

20 State agency may prescribe;

21 whichever period is shorter, if 1 or more of such

22 children have not received such immunizations;

23 ‘‘(B) increased by not more than $75 per

24 month for not more than 3 months if all of such

25 children have received such immunizations; or
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1 ‘‘(C) reduced in accordance with subparagraph

2 (A) and increased in accordance with subparagraph

3 (B).

4 ‘‘(2) The State agency, in consultation with the Sec5 retary, shall develop procedures to determine whether

6 household members are children less than 5 years of age

7 who have received such immunizations. Such procedures

8 may not require any household member to appear at any

9 office operated by the State agency.

10 ‘‘(3) If insufficient funds are made available under

11 section 317B(l) of the Public Health Service Act to carry

12 out 317B of such Act with respect to household members

13 who are children less than 5 years of age, then from funds

14 appropriated to carry out this Act the Secretary shall

15 make available to the Secretary of Health and Human

16 Services such funds as may be necessary to pay 50 percent

17 of such costs.’’.

18 (b) EFFECTIVE DATE AND APPLICATION OF AMEND19 MENT.—

20 (1) EFFECTIVE DATE.—Except as provided in

21 paragraph (2), the amendment made by subsection

22 (a) shall take effect on October 1, 1994.

23 (2) APPLICATION OF AMENDMENT.—The

24 amendment made by subsection (a) shall not apply
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1 with respect to certification periods beginning before

2 October 1, 1994.

3 TITLE III—CURRENT PROGRAM

4 REGARDING IMMUNIZATIONS

5 SEC. 301. EXTENSION OF CURRENT PROGRAM OF DISCRE6 TIONARY STATE GRANTS.

7 Section 317(j)(1) of the Public Health Service Act

8 (42 U.S.C. 247b(j)(1)) is amended in the first sentence—

9 (1) by striking ‘‘and’’ after ‘‘1991,’’; and

10 (2) by striking ‘‘1995’’ and inserting ‘‘1993’’;

11 and

12 (3) by inserting before the period the following:

13 ‘‘, and $290,000,000 for each of the fiscal years

14 1994 through 1996’’.

15 TITLE IV—IMMUNIZATIONS FOR

16 UNINSURED CHILDREN

17 SEC. 401. ESTABLISHMENT OF PROGRAM OF FORMULA

18 GRANTS TO STATES.

19 Title III of the Public Health Service Act (42 U.S.C.

20 241 et seq.), as amended by sections 303, 306, and 308

21 of Public Law 102–531, is amended—

22 (1) by redesignating sections 317A through

23 317D as sections 317D through 317G, respectively;

24 and
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1 (2) by inserting after section 317 the following

2 section:

3 ‘‘FORMULA GRANTS TO STATES REGARDING

4 IMMUNIZATIONS FOR UNINSURED CHILDREN

5 ‘‘SEC. 317A. (a) IN GENERAL.—For the purpose de6 scribed in subsection (b), the Secretary, acting through

7 the Director of the Centers for Disease Control and Pre8 vention, shall make an allotment each fiscal year for each

9 State in an amount determined in accordance with sub10 section (i). The Secretary shall make a grant to the State

11 of the allotment made for the State for the fiscal year if

12 the State submits to the Secretary an application in ac13 cordance with subsection (g).

14 ‘‘(b) PURPOSE OF GRANTS.—The Secretary may

15 make a grant under subsection (a) only if the State in16 volved agrees that the grant will be expended only for the

17 purpose of—

18 ‘‘(1) purchasing pediatric vaccines; and

19 ‘‘(2) utilizing the vaccines to provide immuniza20 tions to uninsured children without charge for the

21 cost of the vaccine.

22 ‘‘(c) UNINSURED CHILDREN.—For purposes of this

23 section, the term ‘uninsured child’ means an individual 18

24 years of age or younger who is uninsured with respect to

25 health insurance policies or plans (including group health

26 plans or prepaid health plans).
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1 ‘‘(d) ARRANGEMENTS WITH PROVIDERS.—

2 ‘‘(1) IN GENERAL.—The Secretary may make a

3 grant under subsection (a) only if the State involved

4 agrees that the State will enter into arrangements

5 with public and private health care providers to

6 carry out the purpose described in subsection (b)(2).

7 ‘‘(2) REQUEST FOR ARRANGEMENTS.—The Sec8 retary may make a grant under subsection (a) only

9 if the State involved agrees that pediatric vaccines

10 obtained pursuant to such subsection will not be dis11 tributed to a health care provider unless—

12 ‘‘(A) the provider submits to the State a

13 written request to participate in the program

14 established by the State pursuant to such sub15 section;

16 ‘‘(B) the request is in such form and is

17 made in such manner as the Secretary may re18 quire; and

19 ‘‘(C) the provider makes the agreements

20 described in this subsection.

21 ‘‘(3) DETERMINATIONS REGARDING CHIL22 DREN.—

23 ‘‘(A) IN GENERAL.—An agreement for a

24 health care provider under paragraph (2) is

25 that the provider—
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1 ‘‘(i) before administering a pediatric

2 vaccine to a child, will ask a parent of the

3 child such questions as are necessary to

4 determine whether the child is an unin5 sured child;

6 ‘‘(ii) will, for a period of time speci7 fied by the Secretary, maintain records of

8 responses made to the questions; and

9 ‘‘(iii) will, upon request, make such

10 records available to the State involved and

11 to the Secretary, subject to subparagraph

12 (B).

13 ‘‘(B) RESTRICTION ON USE OF INFORMA14 TION.—Records provided to a State or to the

15 Secretary under subparagraph (A)(iii) may be

16 used only for purposes of audit of the program

17 carried out pursuant to subsection (a) by the

18 State.

19 ‘‘(4) CHARGES FOR VACCINES.—

20 ‘‘(A) VACCINES PER SE.—An agreement

21 for a health care provider under paragraph (1)

22 is that, in administering a pediatric vaccine to

23 an uninsured child pursuant to subsection (a),

24 the provider will not impose a charge for the

25 cost of the vaccine.
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1 ‘‘(B) ADMINISTRATION OF VACCINES.—

2 With respect to compliance with an agreement

3 under subparagraph (A), a health care provider

4 may impose a charge for the administration of

5 a pediatric vaccine pursuant to subsection (a),

6 subject to an agreement by the provider that

7 the provider will not impose such charge with

8 respect to an uninsured child if a parent of the

9 child certifies to the provider that the parent is

10 unable to pay the charge.

11 ‘‘(5) RULES OF CONSTRUCTION.—

12 ‘‘(A) EXTENT OF PARTICIPATION.—With

13 respect to a health care provider that enters

14 into an arrangement under paragraph (2), this

15 subsection may not be construed as requiring

16 that the provider administer a pediatric vaccine

17 pursuant to subsection (a) to each uninsured

18 child for whom an immunization with the vac19 cine is sought from the provider.

20 ‘‘(B) VERIFICATION OF INFORMATION.—

21 With respect to compliance with agreements

22 under paragraphs (3) and (4), such agreements

23 may not be construed as requiring a health care

24 provider to verify independently the information
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1 provided to the provider by a parent pursuant

2 to such paragraphs.

3 ‘‘(e) FEDERAL CRITERIA REGARDING VACCINES.—

4 ‘‘(1) ISSUANCE OF CRITERIA.—Not later than

5 180 days after the date of the enactment of this sec6 tion, the Secretary shall, through publication in the

7 Federal Register, establish criteria for the purchase

8 and delivery of pediatric vaccines pursuant to sub9 section (a).

10 ‘‘(2) VACCINES IN LIEU OF GRANT FUNDS.— In

11 establishing criteria under paragraph (1), the Sec12 retary may provide that part or all of a grant under

13 subsection (a) to a State will be in the form of pedi14 atric vaccines or related services rather than cash.

15 ‘‘(3) COMPLIANCE BY STATES.—The Secretary

16 may make a grant under subsection (a) only if the

17 State involved agrees to maintain compliance with

18 the criteria established under paragraph (1).

19 ‘‘(f) COORDINATION BY STATES OF IMMUNIZATION

20 ACTIVITIES.—The Secretary may make a grant under

21 subsection (a) only if the State involved agrees to ensure

22 that all activities carried out by the State with respect to

23 the immunization of children are coordinated by a single

24 agency of the State, including coordination regarding—

25 ‘‘(1) activities carried out under this section;
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1 ‘‘(2) activities under section 317, section 317B,

2 and part A of title XIX; and

3 ‘‘(3) activities under part A of title IV of the

4 Social Security Act and under the Food Stamp Act

5 of 1977.

6 ‘‘(g) APPLICATION FOR GRANT.—An application by

7 a State for a grant under subsection (a) is in accordance

8 with this subsection if the application—

9 ‘‘(1) is submitted not later than the date speci10 fied by the Secretary;

11 ‘‘(2) contains each agreement required in this

12 section; and

13 ‘‘(3) is in such form, is made in such manner,

14 and contains such agreements, assurances, and in15 formation as the Secretary determines to be nec16 essary to carry out this section.

17 ‘‘(h) CONTRACTS WITH MANUFACTURERS OF VAC18 CINES.—

19 ‘‘(1) IN GENERAL.—Subject to the provisions of

20 this subsection, the Secretary shall periodically issue

21 requests for proposals from manufacturers of pedi22 atric vaccines for the purpose of maintaining con23 tracts under which the Secretary, for purposes of

24 grants under subsection (a), provides for the pur25 chase and delivery of pediatric vaccines.
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1 ‘‘(2) CHARGES FOR SHIPPING AND HAN2 DLING.—The Secretary may enter into a contract

3 under paragraph (1) only if the manufacturer in4 volved agrees that the manufacturer will provide for

5 delivering pediatric vaccines on behalf of the States

6 in accordance with the criteria established by the

7 Secretary under subsection (e), and will not impose

8 any charges for the costs of such delivery (except to

9 the extent such costs are provided for in the price

10 of the vaccines under the contract).

11 ‘‘(3) QUANTITY OF VACCINES.—The Secretary

12 may enter into a contract under paragraph (1) only

13 if the contract provides for maintaining a supply of

14 vaccines sufficient to meet the obligation of the Fed15 eral Government under subsection (a) for a period of

16 six months. In carrying out the preceding sentence,

17 the Secretary shall consider the potential for out18 breaks of the diseases with respect to which the vac19 cines have been developed.

20 ‘‘(4) AUTHORITY OF SECRETARY REGARDING

21 CONTRACTS.—In carrying out paragraph (1), the

22 Secretary, to the extent determined by the Secretary

23 to be appropriate, may enter into contracts described

24 in such paragraph, may decline to enter into such

25 contracts, and with the consent of the manufactur-
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1 ers involved, may modify such agreements and may

2 extend such agreements.

3 ‘‘(5) DURATION OF CONTRACTS.—A contract

4 entered into by the Secretary subsection under para5 graph (1) is effective for such period as the Sec6 retary and the manufacturer involved may agree in

7 the contract.

8 ‘‘(6) RULE OF CONSTRUCTION REGARDING

9 MULTIPLE SUPPLIERS.—With respect to a pediatric

10 vaccine, this subsection may not be construed as

11 prohibiting the Secretary from entering into con12 tracts under paragraph (1) with more than one man13 ufacturer of the vaccine, or from having in effect dif14 ferent prices under each of such contracts.

15 ‘‘(i) DETERMINATION OF AMOUNT OF ALLOT16 MENT.—The allotment under subsection (a) for a State

17 for a fiscal year shall be an amount equal to the product

18 of—

19 ‘‘(1) an amount equal to the amount appro20 priated under subsection (l) for grants under sub21 section (a) for the fiscal year; and

22 ‘‘(2) the percentage equal to the quotient of—

23 ‘‘(A) an amount equal to the number of

24 children in the State who are 5 years of age or

25 younger; divided by
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1 ‘‘(B) an amount equal to the number of

2 children in the United States who are 5 years

3 of age or younger (as determined by the sum of

4 the respective amounts determined under sub5 paragraph (A)).

6 ‘‘(j) LIST OF PEDIATRIC VACCINES; SCHEDULE FOR

7 ADMINISTRATION.—

8 ‘‘(1) RECOMMENDED PEDIATRIC VACCINES.—

9 The Secretary shall establish a list of the vaccines

10 that the Secretary recommends for administration to

11 all children for the purpose of immunizing the chil12 dren, subject to such contraindications for particular

13 medical categories of children as the Secretary may

14 establish under paragraph (2)(A)(iv). The Secretary

15 shall periodically review the list, and shall revise the

16 list as appropriate.

17 ‘‘(2) RECOMMENDED SCHEDULE FOR ADMINIS18 TRATION.—

19 ‘‘(A) IN GENERAL.—Subject to subpara20 graph (B), in the case of a pediatric vaccine,

21 the Secretary shall establish (and periodically

22 review and as appropriate revise) a schedule of

23 nonbinding recommendations for the following:
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1 ‘‘(i) The number of immunizations

2 with the vaccine that children should re3 ceive.

4 ‘‘(ii) The ages at which children

5 should receive the immunizations.

6 ‘‘(iii) The dosage of vaccine that

7 should be administered in the immuniza8 tions.

9 ‘‘(iv) Any contraindications regarding

10 administration of the vaccine to particular

11 medical categories of children.

12 ‘‘(v) Such other guidelines as the Sec13 retary determines to be appropriate with

14 respect to administering the vaccine to

15 children.

16 ‘‘(B) VARIATIONS IN MEDICAL PRAC17 TICE.—In establishing and revising a schedule

18 under subparagraph (A), the Secretary shall en19 sure that, in the case of the pediatric vaccine

20 involved, the schedule provides for the full

21 range of variations in medical judgment regard22 ing the administration of the vaccine, subject to

23 remaining within medical norms.

24 ‘‘(3) RULES OF CONSTRUCTION.—
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1 ‘‘(A) IN GENERAL.—The list established

2 under paragraph (1) and the schedules estab3 lished under paragraph (2) do not constitute

4 guidelines, standards, performance measures, or

5 review criteria for purposes of the program car6 ried out by the Administrator for Health Care

7 Policy and Research under part B of title IX or

8 under section 1142 of the Social Security Act.

9 ‘‘(B) STATE LAWS.—This section does not

10 supersede any State law on requirements with

11 respect to receiving immunizations (including

12 any such law relating to religious exemptions or

13 medical exemptions).

14 ‘‘(4) ISSUANCE OF LIST AND SCHEDULES.—Not

15 later than 180 days after the date of the enactment

16 of this section, the Secretary shall establish the ini17 tial list required in paragraph (1) and the schedule

18 required in paragraph (2).

19 ‘‘(k) DEFINITIONS.—For purposes of this section:

20 ‘‘(1) The term ‘immunization’ means an immu21 nization against a vaccine-preventable disease.

22 ‘‘(2) The term ‘pediatric vaccine’ means a vac23 cine included on the list established under subsection

24 (j)(1).
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1 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For the

2 purpose of carrying out this section, there are authorized

3 to be appropriated $100,000,000 for each of the fiscal

4 years 1994 through 1996.’’.

5 TITLE V—MONITORING SYSTEM

6 WITH RESPECT TO IMMUNIZA7 TION OF CERTAIN CHILDREN

8 SEC. 501. ESTABLISHMENT OF PROGRAM OF FORMULA

9 GRANTS TO STATES.

10 Title III of the Public Health Service Act (42 U.S.C.

11 241 et seq.), as amended by section 401 of this Act, is

12 amended by inserting after section 317A the following

13 section:

14 ‘‘MONITORING SYSTEM REGARDING IMMUNIZATION

15 STATUS OF CERTAIN CHILDREN

16 ‘‘SEC. 317B. (a) FORMULA GRANTS TO STATES.—

17 For the purpose described in subsection (b), the Secretary,

18 acting through the Director of the Centers for Disease

19 Control and Prevention, shall make an allotment each fis20 cal year for each State in an amount determined in ac21 cordance with subsection (j). The Secretary shall make a

22 grant to the State of the allotment made for the State

23 for the fiscal year if the State submits to the Secretary

24 an application in accordance with subsection (h).

25 ‘‘(b) AUTHORIZED ACTIVITIES.—With respect to des26 ignated children (as defined in subsection (c)), the Sec-
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1 retary may make a grant under subsection (a) only if the

2 State agrees to expend the grant for the purpose of—

3 ‘‘(1) collecting such data as may be necessary

4 to indicate whether designated children have received

5 immunizations in accordance with the schedule es6 tablished by the Secretary under section 317A(j);

7 ‘‘(2) operating registries to maintain the data

8 (and establishing such registries, in the case of a

9 State that is not operating such a registry);

10 ‘‘(4) notifying parents of designated children if

11 the children have not received immunizations in ac12 cordance with such schedule, and encouraging par13 ents to ensure that the children receive such immu14 nizations; and

15 ‘‘(5) providing to parents of designated children

16 information, education, and outreach with respect to

17 such schedule.

18 ‘‘(c) DESIGNATED CHILDREN.—For purposes of this

19 section, the term ‘designated child’ means an individual

20 18 years of age or younger who—

21 ‘‘(1) is uninsured with respect to health insur22 ance policies or plans (including group health plans

23 or prepaid health plans);

24 ‘‘(2) is a member of a household participating

25 in the Food Stamp Act of 1977; or
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1 ‘‘(3) with respect to the State involved—

2 ‘‘(A) is entitled to medical assistance under

3 the plan approved for the State under title XIX

4 of the Social Security Act (including a State op5 erating under a statewide waiver under section

6 1115 of such Act);

7 ‘‘(B) is receiving assistance under the plan

8 approved for the State under part A of title IV

9 of the Social Security Act; or

10 ‘‘(C) is receiving services under the special

11 supplemental food program for women, infants,

12 and children under section 17 of the Child Nu13 trition Act of 1966.

14 ‘‘(d) REQUIREMENT REGARDING STATE LAWS.—

15 ‘‘(1) IN GENERAL.—The Secretary may make a

16 grant under subsection (a) only if the State in17 volved—

18 ‘‘(A) provides assurances satisfactory to

19 the Secretary that, not later than October 1,

20 1996, the State will be operating a registry in

21 accordance with this section, including having

22 in effect such laws and regulations as may be

23 necessary to so operate such a registry; and

24 ‘‘(B) agrees that, prior to such date, the

25 State will make such efforts to operate a reg-
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1 istry in accordance with this section as may be

2 authorized in the law and regulations of the

3 State.

4 ‘‘(2) RULES OF CONSTRUCTION.—

5 ‘‘(A) With respect to the agreements made

6 by a State under this section, other than para7 graph (1)(B), the Secretary may require com8 pliance with the agreements only to the extent

9 consistent with such paragraph.

10 ‘‘(B) This section does not authorize the

11 Secretary, as a condition of the receipt of a

12 grant under subsection (a) by a State, to pro13 hibit the State from providing any parent, upon

14 the request of the parent, with an exemption

15 from the requirements established by the State

16 pursuant to this section for the collection of

17 data regarding any child of the parent.

18 ‘‘(e) AUTHORITY REGARDING MONITORING METH19 ODOLOGY.—

20 ‘‘(1) REPRESENTATIVE SAMPLING.—With re21 spect to compliance with the agreement under sub22 section (b)(1) to determine the immunization status

23 of designated children, a State may determine such

24 status through representative sampling of the popu25 lation of such children in the State, subject to main-
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1 taining compliance with criteria issued by the Sec2 retary under paragraph (2).

3 ‘‘(2) FEDERAL CRITERIA.—Not later than 180

4 days after the date of the enactment of the Respon5 sible Parent Immunization Plan Act of 1993, the

6 Secretary shall issue criteria for representative sam7 pling under paragraph (1).

8 ‘‘(f) COORDINATION BY STATES OF IMMUNIZATION

9 ACTIVITIES.—The Secretary may make a grant under

10 subsection (a) only if the State involved agrees to ensure

11 that all activities carried out by the State with respect to

12 the immunization of children are coordinated by a single

13 agency of the State, including coordination regarding—

14 ‘‘(1) the reports required in subsection (g);

15 ‘‘(2) other activities carried out under this sec16 tion;

17 ‘‘(3) activities under section 317, section 317A,

18 and part A of title XIX; and

19 ‘‘(4) activities under part A of title IV of the

20 Social Security Act and under the Food Stamp Act

21 of 1977.

22 ‘‘(g) REPORTS TO SECRETARY.—The Secretary may

23 make a grant under subsection (a) only if the State in24 volved agrees that, not later than February 1 of the fiscal

25 year following the fiscal year for which the grant is made,
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1 the State will submit to the Secretary a report on the im2 munization status of designated children in the State.

3 ‘‘(h) APPLICATION FOR GRANT.—An application by

4 a State for a grant under subsection (a) is in accordance

5 with this subsection if the application—

6 ‘‘(1) is submitted not later than the date speci7 fied by the Secretary;

8 ‘‘(2) contains each agreement required in this

9 section;

10 ‘‘(3) provides assurances satisfactory to the

11 Secretary that the State is operating a registry pur12 suant to subsection (a), in the case of fiscal year

13 1996 and subsequent fiscal years; and

14 ‘‘(4) is in such form, is made in such manner,

15 and contains such agreements, assurances, and in16 formation as the Secretary determines to be nec17 essary to carry out this section.

18 ‘‘(i) USE OF SOCIAL SECURITY ACCOUNT NUM19 BERS.—Subject to the provisions of the Social Security

20 Act (or other applicable Federal law), the Secretary may

21 authorize grantees under subsection (a) to utilize social

22 security account numbers in carrying out the purpose de23 scribed in subsection (b).

24 ‘‘(j) DETERMINATION OF AMOUNT OF ALLOT25 MENT.—The allotment under subsection (a) for a State
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1 for a fiscal year shall be an amount equal to the product

2 of—

3 ‘‘(1) an amount equal to the amount appro4 priated under subsection (l) for grants under sub5 section (a) for the fiscal year; and

6 ‘‘(2) the percentage equal to the quotient of—

7 ‘‘(A) an amount equal to the number of

8 children in the State who are 5 years of age or

9 younger; divided by

10 ‘‘(B) an amount equal to the number of

11 children in the United States who are 5 years

12 of age or younger (as determined by the sum of

13 the respective amounts determined under sub14 paragraph (A)).

15 ‘‘(k) DEFINITIONS.—For purposes of this section:

16 ‘‘(1) The term ‘designated child’ has the mean17 ing given such term in subsection (c).

18 ‘‘(2) The term ‘immunization’ means an immu19 nization against a vaccine-preventable disease.

20 ‘‘(3) The term ‘immunization schedule’ means

21 the schedule established by the Secretary under sec22 tion 317A(j).

23 ‘‘(4) The term ‘immunization status’, with re24 spect to a child, means the extent to which the child
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1 has been immunized in accordance with the immuni2 zation schedule.

3 ‘‘(5) The term ‘parent’, with respect to a child,

4 means the legal guardian of the child.

5 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For the

6 purpose of carrying out this section, there is authorized

7 to be appropriated $75,000,000 for each of the fiscal years

8 1994 through 1996.’’.

9 TITLE VI—PARENTAL BEHAVIOR

10 WITH RESPECT TO CHILD11 HOOD IMMUNIZATIONS

12 SEC. 601. ESTABLISHMENT OF DEMONSTRATION PROGRAM.

13 Part B of title III of the Public Health Service Act

14 (42 U.S.C. 243 et seq.), as amended by section 501 of

15 this Act, is amended by inserting after section 317B the

16 following section:

17 ‘‘PARENTAL BEHAVIOR WITH RESPECT TO CHILDHOOD

18 IMMUNIZATIONS

19 ‘‘SEC. 317C. (a) GRANTS FOR DEMONSTRATION

20 PROJECTS.—The Secretary may make grants to public

21 and nonprofit private entities to carry out demonstration

22 projects for the purpose of developing innovative methods

23 to encourage parents to ensure that the children of the

24 parents are immunized in accordance with the schedule

25 established by the Secretary under section 317A(j).
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1 ‘‘(b) PARENTAL INCENTIVES.—With respect to meth2 ods to encourage parents for purposes of subsection (a),

3 the Secretary may make a grant under such subsection

4 for any of the following:

5 ‘‘(1) Evaluating the reasons provided by par6 ents in explanation of the failure of the parents to

7 ensure that the children of the parents are immu8 nized in accordance with the immunization schedule.

9 ‘‘(2) With respect to health clinics that provide

10 immunizations:

11 ‘‘(A) Evaluating the reasons provided by

12 the clinics in explanation of such failure of the

13 parents.

14 ‘‘(B) Evaluating activities carried out by

15 clinics to encourage parents to ensure that the

16 children of the parents are immunized in ac17 cordance with the immunization schedule.

18 ‘‘(C) Increasing the number of hours dur19 ing which the clinics provide immunizations.

20 ‘‘(D) Providing transportation to the clin21 ics for parents and the children of the parents.

22 ‘‘(3) Utilizing mobile medical units to provide

23 immunizations.
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1 ‘‘(4) Providing immunizations on the premises

2 of public housing projects or at sites in close proxim3 ity to such projects.

4 ‘‘(5) Subject to applicable law, determining the

5 immunization status of siblings of a child whenever

6 the immunization status of the child is determined

7 pursuant to entering school, pursuant to receiving

8 day-care services, or pursuant to participation in

9 Federal, State, or local programs.

10 ‘‘(6) Subject to applicable law, increasing or de11 creasing benefits of parents and children under Fed12 eral, State, and local programs on the basis of the

13 extent to which the children have been immunized in

14 accordance with the immunization schedule.

15 ‘‘(7) Such other methods as the Secretary de16 termines to be appropriate.

17 ‘‘(c) REQUIREMENT OF APPLICATION.—The Sec18 retary may make a grant under subsection (a) only if an

19 application for the grant is submitted to the Secretary and

20 the application is in such form, is made in such manner,

21 and contains such agreements, assurances, and informa22 tion as the Secretary determines to be necessary to carry

23 out this section.

24 ‘‘(d) DEFINITIONS.—For purposes of this section:
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1 ‘‘(1) The term ‘immunization’ means an immu2 nization against a vaccine-preventable disease.

3 ‘‘(2) The term ‘immunization schedule’ means

4 the schedule established by the Secretary under sec5 tion 317A(j).

6 ‘‘(3) The term ‘immunization status’, with re7 spect to a child, means the extent to which the child

8 has been immunized in accordance with the immuni9 zation schedule.

10 ‘‘(4) The term ‘parent’, with respect to a child,

11 means the legal guardian of the child.

12 ‘‘(e) FUNDING.—

13 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

14 For the purpose of carrying out this section, there

15 are authorized to be appropriated $50,000,000 for

16 fiscal year 1994, and such sums as may be nec17 essary for each of the fiscal years 1995 through

18 1996.

19 ‘‘(2) ALLOCATION.—Of the amounts appro20 priated under paragraph (1) for a fiscal year, the

21 Secretary shall make available not less than an ag22 gregate 20 percent for grants under subsection (a)

23 for the purposes specified in subparagraphs (A) and

24 (B) of paragraph (2) of subsection (b) and in para25 graph (6) of such subsection.’’.
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1 TITLE VII—USE OF MEDICAID

2 FUNDS FOR MONITORING

3 MEDICAID BENEFICIARIES

4 SEC. 701. USE OF MEDICAID FUNDS FOR MONITORING MED5 ICAID BENEFICIARIES.

6 Section 1903 of the Social Security Act (42 U.S.C.

7 1396b) is amended by inserting after subsection (g) the

8 following new subsection:

9 ‘‘(h) For purposes of subsection (a)(7), in determin10 ing the amounts expended by a State during a quarter

11 for the proper and efficient administration of the State

12 plan, the Secretary shall take into account amounts ex13 pended in determining the immunization status of children

14 entitled to medical assistance under the State plan, in ac15 cordance with the program of the State described in sec16 tion 317B of the Public Health Service Act (but only if

17 the State has exhausted any grant received under section

18 317B of such Act).’’.

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