‘‘(B) an amount equal to the number of
children in the United States who are 5 years
of age or younger (as determined by the sum of
the respective amounts determined under sub-
paragraph (A)).
‘‘(j) LIST OF PEDIATRIC VACCINES; SCHEDULE FOR
ADMINISTRATION.—
‘‘(1) RECOMMENDED
PEDIATRIC
VACCINES.—
The Secretary shall establish a list of the vaccines
that the Secretary recommends for administration to
all children for the purpose of immunizing the chil-
dren, subject to such contraindications for particular
medical categories of children as the Secretary may
establish under paragraph (2)(A)(iv). The Secretary
shall periodically review the list, and shall revise the
list as appropriate.
‘‘(2) RECOMMENDED SCHEDULE FOR ADMINIS-
TRATION.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), in the case of a pediatric vaccine,
the Secretary shall establish (and periodically
review and as appropriate revise) a schedule of
nonbinding recommendations for the following:
‘‘(i) The number of immunizations
with the vaccine that children should re-
ceive.
‘‘(ii) The ages at which children
should receive the immunizations.
‘‘(iii) The dosage of vaccine that
should be administered in the immuniza-
tions.
‘‘(iv) Any contraindications regarding
administration of the vaccine to particular
medical categories of children.
‘‘(v) Such other guidelines as the Sec-
retary determines to be appropriate with
respect to administering the vaccine to
children.
‘‘(B) VARIATIONS
IN
MEDICAL
PRAC-
TICE.—In establishing and revising a schedule
under subparagraph (A), the Secretary shall en-
sure that, in the case of the pediatric vaccine
involved, the schedule provides for the full
range of variations in medical judgment regard-
ing the administration of the vaccine, subject to
remaining within medical norms.
‘‘(3) RULES OF CONSTRUCTION.—
‘‘(A) IN
GENERAL.—The list established
under paragraph (1) and the schedules estab-
lished under paragraph (2) do not constitute
guidelines, standards, performance measures, or
review criteria for purposes of the program car-
ried out by the Administrator for Health Care
Policy and Research under part B of title IX or
under section 1142 of the Social Security Act.
‘‘(B) STATE LAWS.—This section does not
supersede any State law on requirements with
respect to receiving immunizations (including
any such law relating to religious exemptions or
medical exemptions).
‘‘(4) ISSUANCE OF LIST AND SCHEDULES.—Not
later than 180 days after the date of the enactment
of this section, the Secretary shall establish the ini-
tial list required in paragraph (1) and the schedule
required in paragraph (2).
‘‘(k) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘immunization’ means an immu-
nization against a vaccine-preventable disease.
‘‘(2) The term ‘pediatric vaccine’ means a vac-
cine included on the list established under subsection
(j)(1).
‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $100,000,000 for each of the fiscal
years 1994 through 1996.’’.
TITLE V—MONITORING SYSTEM
WITH RESPECT TO IMMUNIZA-
TION OF CERTAIN CHILDREN
SEC. 501. ESTABLISHMENT OF PROGRAM OF FORMULA
GRANTS TO STATES.
Title III of the Public Health Service Act (42 U.S.C.
241 et seq.), as amended by section 401 of this Act, is
amended by inserting after section 317A the following
section:
‘‘MONITORING SYSTEM REGARDING IMMUNIZATION
STATUS OF CERTAIN CHILDREN
‘‘SEC. 317B. (a) FORMULA GRANTS TO STATES.—
For the purpose described in subsection (b), the Secretary,
acting through the Director of the Centers for Disease
Control and Prevention, shall make an allotment each fis-
cal year for each State in an amount determined in ac-
cordance with subsection (j). The Secretary shall make a
grant to the State of the allotment made for the State
for the fiscal year if the State submits to the Secretary
an application in accordance with subsection (h).
‘‘(b) AUTHORIZED ACTIVITIES.—With respect to des-
ignated children (as defined in subsection (c)), the Sec-
retary may make a grant under subsection (a) only if the
State agrees to expend the grant for the purpose of—
‘‘(1) collecting such data as may be necessary
to indicate whether designated children have received
immunizations in accordance with the schedule es-
tablished by the Secretary under section 317A(j);
‘‘(2) operating registries to maintain the data
(and establishing such registries, in the case of a
State that is not operating such a registry);
‘‘(4) notifying parents of designated children if
the children have not received immunizations in ac-
cordance with such schedule, and encouraging par-
ents to ensure that the children receive such immu-
nizations; and
‘‘(5) providing to parents of designated children
information, education, and outreach with respect to
such schedule.
‘‘(c) DESIGNATED CHILDREN.—For purposes of this
section, the term ‘designated child’ means an individual
18 years of age or younger who—
‘‘(1) is uninsured with respect to health insur-
ance policies or plans (including group health plans
or prepaid health plans);
‘‘(2) is a member of a household participating
in the Food Stamp Act of 1977; or
taining compliance with criteria issued by the Sec-
retary under paragraph (2).
‘‘(2) FEDERAL CRITERIA.—Not later than 180
days after the date of the enactment of the Respon-
sible Parent Immunization Plan Act of 1993, the
Secretary shall issue criteria for representative sam-
pling under paragraph (1).
‘‘(f) COORDINATION BY STATES OF IMMUNIZATION
ACTIVITIES.—The Secretary may make a grant under
subsection (a) only if the State involved agrees to ensure
that all activities carried out by the State with respect to
the immunization of children are coordinated by a single
agency of the State, including coordination regarding—
‘‘(1) the reports required in subsection (g);
‘‘(2) other activities carried out under this sec-
tion;
‘‘(3) activities under section 317, section 317A,
and part A of title XIX; and
‘‘(4) activities under part A of title IV of the
Social Security Act and under the Food Stamp Act
of 1977.
‘‘(g) REPORTS TO SECRETARY.—The Secretary may
make a grant under subsection (a) only if the State in-
volved agrees that, not later than February 1 of the fiscal
year following the fiscal year for which the grant is made,
the State will submit to the Secretary a report on the im-
munization status of designated children in the State.
‘‘(h) APPLICATION FOR GRANT.—An application by
a State for a grant under subsection (a) is in accordance
with this subsection if the application—
‘‘(1) is submitted not later than the date speci-
fied by the Secretary;
‘‘(2) contains each agreement required in this
section;
‘‘(3) provides assurances satisfactory to the
Secretary that the State is operating a registry pur-
suant to subsection (a), in the case of fiscal year
1996 and subsequent fiscal years; and
‘‘(4) is in such form, is made in such manner,
and contains such agreements, assurances, and in-
formation as the Secretary determines to be nec-
essary to carry out this section.
‘‘(i) USE
OF SOCIAL SECURITY ACCOUNT NUM-
BERS.—Subject to the provisions of the Social Security
Act (or other applicable Federal law), the Secretary may
authorize grantees under subsection (a) to utilize social
security account numbers in carrying out the purpose de-
scribed in subsection (b).
‘‘(j) DETERMINATION
OF
AMOUNT
OF
ALLOT-
MENT.—The allotment under subsection (a) for a State
for a fiscal year shall be an amount equal to the product
of—
‘‘(1) an amount equal to the amount appro-
priated under subsection (l) for grants under sub-
section (a) for the fiscal year; and
‘‘(2) the percentage equal to the quotient of—
‘‘(A) an amount equal to the number of
children in the State who are 5 years of age or
younger; divided by
‘‘(B) an amount equal to the number of
children in the United States who are 5 years
of age or younger (as determined by the sum of
the respective amounts determined under sub-
paragraph (A)).
‘‘(k) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘designated child’ has the mean-
ing given such term in subsection (c).
‘‘(2) The term ‘immunization’ means an immu-
nization against a vaccine-preventable disease.
‘‘(3) The term ‘immunization schedule’ means
the schedule established by the Secretary under sec-
tion 317A(j).
‘‘(4) The term ‘immunization status’, with re-
spect to a child, means the extent to which the child
has been immunized in accordance with the immuni-
zation schedule.
‘‘(5) The term ‘parent’, with respect to a child,
means the legal guardian of the child.
‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there is authorized
to be appropriated $75,000,000 for each of the fiscal years
1994 through 1996.’’.
TITLE VI—PARENTAL BEHAVIOR
WITH 
RESPECT 
TO 
CHILD-
HOOD IMMUNIZATIONS
SEC. 601. ESTABLISHMENT OF DEMONSTRATION PROGRAM.
Part B of title III of the Public Health Service Act
(42 U.S.C. 243 et seq.), as amended by section 501 of
this Act, is amended by inserting after section 317B the
following section:
‘‘PARENTAL BEHAVIOR WITH RESPECT TO CHILDHOOD
IMMUNIZATIONS
‘‘SEC. 317C. (a) GRANTS
FOR DEMONSTRATION
PROJECTS.—The Secretary may make grants to public
and nonprofit private entities to carry out demonstration
projects for the purpose of developing innovative methods
to encourage parents to ensure that the children of the
parents are immunized in accordance with the schedule
established by the Secretary under section 317A(j).
‘‘(b) PARENTAL INCENTIVES.—With respect to meth-
ods to encourage parents for purposes of subsection (a),
the Secretary may make a grant under such subsection
for any of the following:
‘‘(1) Evaluating the reasons provided by par-
ents in explanation of the failure of the parents to
ensure that the children of the parents are immu-
nized in accordance with the immunization schedule.
‘‘(2) With respect to health clinics that provide
immunizations:
‘‘(A) Evaluating the reasons provided by
the clinics in explanation of such failure of the
parents.
‘‘(B) Evaluating activities carried out by
clinics to encourage parents to ensure that the
children of the parents are immunized in ac-
cordance with the immunization schedule.
‘‘(C) Increasing the number of hours dur-
ing which the clinics provide immunizations.
‘‘(D) Providing transportation to the clin-
ics for parents and the children of the parents.
‘‘(3) Utilizing mobile medical units to provide
immunizations.
‘‘(4) Providing immunizations on the premises
of public housing projects or at sites in close proxim-
ity to such projects.
‘‘(5) Subject to applicable law, determining the
immunization status of siblings of a child whenever
the immunization status of the child is determined
pursuant to entering school, pursuant to receiving
day-care services, or pursuant to participation in
Federal, State, or local programs.
‘‘(6) Subject to applicable law, increasing or de-
creasing benefits of parents and children under Fed-
eral, State, and local programs on the basis of the
extent to which the children have been immunized in
accordance with the immunization schedule.
‘‘(7) Such other methods as the Secretary de-
termines to be appropriate.
‘‘(c) REQUIREMENT
OF APPLICATION.—The Sec-
retary may make a grant under subsection (a) only if an
application for the grant is submitted to the Secretary and
the application is in such form, is made in such manner,
and contains such agreements, assurances, and informa-
tion as the Secretary determines to be necessary to carry
out this section.
‘‘(d) DEFINITIONS.—For purposes of this section:
TITLE VII—USE OF MEDICAID
FUNDS 
FOR 
MONITORING
MEDICAID BENEFICIARIES
SEC. 701. USE OF MEDICAID FUNDS FOR MONITORING MED-
ICAID BENEFICIARIES.
Section 1903 of the Social Security Act (42 U.S.C.
1396b) is amended by inserting after subsection (g) the
following new subsection:
‘‘(h) For purposes of subsection (a)(7), in determin-
ing the amounts expended by a State during a quarter
for the proper and efficient administration of the State
plan, the Secretary shall take into account amounts ex-
pended in determining the immunization status of children
entitled to medical assistance under the State plan, in ac-
cordance with the program of the State described in sec-
tion 317B of the Public Health Service Act (but only if
the State has exhausted any grant received under section
317B of such Act).’’.
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HR 2432 IH——2
HR 2432 IH——3