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) intro-
duced 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 im-
munized against disease.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Responsible Parent
Immunization Plan Act of 1993’’.
TITLE I—IMMUNIZATION OF
CHILDREN RECEIVING AFDC
SEC. 101. IMMUNIZATION OF CHILDREN RECEIVING AFDC.
(a) STATE PLAN REQUIREMENTS.—Section 402(a)
of the Social Security Act (42 U.S.C. 602(a)) is amend-
ed—
(1) by striking ‘‘and’’ at the end of paragraph
(44);
(2) by striking the period at the end of para-
graph (45) and inserting ‘‘; and’’; and
(3) by inserting after paragraph (45) the fol-
lowing:
‘‘(46)(A) require any parent or caretaker rel-
ative applying for or receiving aid under the State
plan to ensure that each dependent child of the par-
ent or such relative has received immunizations as
recommended for the same kind of child under sec-
tion 317A(j) of the Public Health Service Act;
‘‘(B) provide for monitoring compliance with
subparagraph (A); and
‘‘(C) at the option of the State, provide that the
aid otherwise payable to any family under the State
plan will be—
‘‘(i) if the parent or caretaker relative of
the family complies with subparagraph (A), in-
creased by not more than $75 per month for
not more than 3 months;
‘‘(ii) if the parent or caretaker relative of
the family fails to comply with subparagraph
(A), decreased by not more than $75 per month
until the first month of such compliance or for
such number of months as the State may pre-
scribe, whichever ends earlier; or
‘‘(iii) increased in accordance with clause
(i) and decreased in accordance with clause
(ii).’’.
(b) NO REIMBURSEMENT OF CERTAIN STATE EX-
PENSES.—Section 403(a)(3) of such Act (42 U.S.C.
603(a)(3)) is amended by inserting ‘‘, or in connection
with carrying out subparagraph (A), or (if the State has
not exhausted any grant received under section 317B of
the Public Health Service Act) individual monitoring
under subparagraph (B), of section 402(a)(46)’’ before
the semicolon.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect on October 1, 1994.
TITLE 
II—IMMUNIZATION 
OF
CHILDREN RECEIVING FOOD
STAMPS BENEFITS
SEC. 201. AMENDMENT TO THE FOOD STAMP ACT OF 1977.
(a) AMENDMENT.—Section 8 of the Food Stamp Act
of 1977 (7 U.S.C. 2017) is amended by adding at the end
the following:
‘‘(f)(1) At the option of the State agency, the value
of allotments determined under this section without regard
to this subsection for all households that include a child
less that 5 years of age may be—
‘‘(A) reduced by not more than $75 per
month—
‘‘(i) for each month until the first month
beginning after all such children in the particu-
lar household have received the age-appropriate
immunizations 
recommended 
under 
section
317A(j) of the Public Health Service Act; or
‘‘(ii) for such number of months as the
State agency may prescribe;
whichever period is shorter, if 1 or more of such
children have not received such immunizations;
‘‘(B) increased by not more than $75 per
month for not more than 3 months if all of such
children have received such immunizations; or
‘‘(C) reduced in accordance with subparagraph
(A) and increased in accordance with subparagraph
(B).
‘‘(2) The State agency, in consultation with the Sec-
retary, shall develop procedures to determine whether
household members are children less than 5 years of age
who have received such immunizations. Such procedures
may not require any household member to appear at any
office operated by the State agency.
‘‘(3) If insufficient funds are made available under
section 317B(l) of the Public Health Service Act to carry
out 317B of such Act with respect to household members
who are children less than 5 years of age, then from funds
appropriated to carry out this Act the Secretary shall
make available to the Secretary of Health and Human
Services such funds as may be necessary to pay 50 percent
of such costs.’’.
(b) EFFECTIVE DATE AND APPLICATION OF AMEND-
MENT.—
(1) EFFECTIVE DATE.—Except as provided in
paragraph (2), the amendment made by subsection
(a) shall take effect on October 1, 1994.
(2) 
APPLICATION
OF
AMENDMENT.—The
amendment made by subsection (a) shall not apply
with respect to certification periods beginning before
October 1, 1994.
TITLE III—CURRENT PROGRAM
REGARDING IMMUNIZATIONS
SEC. 301. EXTENSION OF CURRENT PROGRAM OF DISCRE-
TIONARY STATE GRANTS.
Section 317(j)(1) of the Public Health Service Act
(42 U.S.C. 247b(j)(1)) is amended in the first sentence—
(1) by striking ‘‘and’’ after ‘‘1991,’’; and
(2) by striking ‘‘1995’’ and inserting ‘‘1993’’;
and
(3) by inserting before the period the following:
‘‘, and $290,000,000 for each of the fiscal years
1994 through 1996’’.
TITLE IV—IMMUNIZATIONS FOR
UNINSURED CHILDREN
SEC. 401. 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 sections 303, 306, and 308
of Public Law 102–531, is amended—
(1) by redesignating sections 317A through
317D as sections 317D through 317G, respectively;
and
(2) by inserting after section 317 the following
section:
‘‘FORMULA GRANTS TO STATES REGARDING
IMMUNIZATIONS FOR UNINSURED CHILDREN
‘‘SEC. 317A. (a) IN GENERAL.—For the purpose de-
scribed in subsection (b), the Secretary, acting through
the Director of the Centers for Disease Control and Pre-
vention, shall make an allotment each fiscal year for each
State in an amount determined in accordance with sub-
section (i). 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 ac-
cordance with subsection (g).
‘‘(b) PURPOSE
OF GRANTS.—The Secretary may
make a grant under subsection (a) only if the State in-
volved agrees that the grant will be expended only for the
purpose of—
‘‘(1) purchasing pediatric vaccines; and
‘‘(2) utilizing the vaccines to provide immuniza-
tions to uninsured children without charge for the
cost of the vaccine.
‘‘(c) UNINSURED CHILDREN.—For purposes of this
section, the term ‘uninsured child’ means an individual 18
years of age or younger who is uninsured with respect to
health insurance policies or plans (including group health
plans or prepaid health plans).
‘‘(d) ARRANGEMENTS WITH PROVIDERS.—
‘‘(1) IN GENERAL.—The Secretary may make a
grant under subsection (a) only if the State involved
agrees that the State will enter into arrangements
with public and private health care providers to
carry out the purpose described in subsection (b)(2).
‘‘(2) REQUEST FOR ARRANGEMENTS.—The Sec-
retary may make a grant under subsection (a) only
if the State involved agrees that pediatric vaccines
obtained pursuant to such subsection will not be dis-
tributed to a health care provider unless—
‘‘(A) the provider submits to the State a
written request to participate in the program
established by the State pursuant to such sub-
section;
‘‘(B) the request is in such form and is
made in such manner as the Secretary may re-
quire; and
‘‘(C) the provider makes the agreements
described in this subsection.
‘‘(3) 
DETERMINATIONS
REGARDING
CHIL-
DREN.—
‘‘(A) IN GENERAL.—An agreement for a
health care provider under paragraph (2) is
that the provider—
‘‘(i) before administering a pediatric
vaccine to a child, will ask a parent of the
child such questions as are necessary to
determine whether the child is an unin-
sured child;
‘‘(ii) will, for a period of time speci-
fied by the Secretary, maintain records of
responses made to the questions; and
‘‘(iii) will, upon request, make such
records available to the State involved and
to the Secretary, subject to subparagraph
(B).
‘‘(B) RESTRICTION ON USE OF INFORMA-
TION.—Records provided to a State or to the
Secretary under subparagraph (A)(iii) may be
used only for purposes of audit of the program
carried out pursuant to subsection (a) by the
State.
‘‘(4) CHARGES FOR VACCINES.—
‘‘(A) VACCINES
PER
SE.—An agreement
for a health care provider under paragraph (1)
is that, in administering a pediatric vaccine to
an uninsured child pursuant to subsection (a),
the provider will not impose a charge for the
cost of the vaccine.
‘‘(B) ADMINISTRATION
OF
VACCINES.—
With respect to compliance with an agreement
under subparagraph (A), a health care provider
may impose a charge for the administration of
a pediatric vaccine pursuant to subsection (a),
subject to an agreement by the provider that
the provider will not impose such charge with
respect to an uninsured child if a parent of the
child certifies to the provider that the parent is
unable to pay the charge.
‘‘(5) RULES OF CONSTRUCTION.—
‘‘(A) EXTENT
OF
PARTICIPATION.—With
respect to a health care provider that enters
into an arrangement under paragraph (2), this
subsection may not be construed as requiring
that the provider administer a pediatric vaccine
pursuant to subsection (a) to each uninsured
child for whom an immunization with the vac-
cine is sought from the provider.
‘‘(B) VERIFICATION
OF
INFORMATION.—
With respect to compliance with agreements
under paragraphs (3) and (4), such agreements
may not be construed as requiring a health care
provider to verify independently the information
provided to the provider by a parent pursuant
to such paragraphs.
‘‘(e) FEDERAL CRITERIA REGARDING VACCINES.—
‘‘(1) ISSUANCE OF CRITERIA.—Not later than
180 days after the date of the enactment of this sec-
tion, the Secretary shall, through publication in the
Federal Register, establish criteria for the purchase
and delivery of pediatric vaccines pursuant to sub-
section (a).
‘‘(2) VACCINES IN LIEU OF GRANT FUNDS.— In
establishing criteria under paragraph (1), the Sec-
retary may provide that part or all of a grant under
subsection (a) to a State will be in the form of pedi-
atric vaccines or related services rather than cash.
‘‘(3) COMPLIANCE BY STATES.—The Secretary
may make a grant under subsection (a) only if the
State involved agrees to maintain compliance with
the criteria established 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) activities carried out under this section;
‘‘(3) with respect to the State involved—
‘‘(A) is entitled to medical assistance under
the plan approved for the State under title XIX
of the Social Security Act (including a State op-
erating under a statewide waiver under section
1115 of such Act);
‘‘(B) is receiving assistance under the plan
approved for the State under part A of title IV
of the Social Security Act; or
‘‘(C) is receiving services under the special
supplemental food program for women, infants,
and children under section 17 of the Child Nu-
trition Act of 1966.
‘‘(d) REQUIREMENT REGARDING STATE LAWS.—
‘‘(1) IN GENERAL.—The Secretary may make a
grant under subsection (a) only if the State in-
volved—
‘‘(A) provides assurances satisfactory to
the Secretary that, not later than October 1,
1996, the State will be operating a registry in
accordance with this section, including having
in effect such laws and regulations as may be
necessary to so operate such a registry; and
‘‘(B) agrees that, prior to such date, the
State will make such efforts to operate a reg-