I
103D CONGRESS
1ST SESSION
H. R. 1840
To amend part A of title IV of the Social Security Act to deny benefits
under the program of aid to families with dependent children with respect
to any child who has not received preventive health care or been immu-
nized in accordance with recommendations issued by the Surgeon General
of the Public Health Service, and to amend the Child Care and Develop-
ment Block Grant Act to require that child care providers that receive
assistance, directly or indirectly, under such Act require all children
to be immunized in accordance with such recommendations.
IN THE HOUSE OF REPRESENTATIVES
APRIL 22, 1993
Mrs. ROUKEMA introduced the following bill; which was referred jointly to the
Committees on Ways and Means and Energy and Commerce
A BILL
To amend part A of title IV of the Social Security Act
to deny benefits under the program of aid to families
with dependent children with respect to any child who
has not received preventive health care or been immu-
nized in accordance with recommendations issued by the
Surgeon General of the Public Health Service, and to
amend the Child Care and Development Block Grant
Act to require that child care providers that receive as-
sistance, directly or indirectly, under such Act require
all children to be immunized in accordance with such
recommendations.
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 ‘‘Child Immunization
Incentive Act of 1993’’.
SEC. 2. AFDC BENEFITS DENIED FOR CHILDREN WHO HAVE
NOT RECEIVED PREVENTIVE HEALTH CARE
OR IMMUNIZATIONS.
Section 402(a) of the Social Security Act (42 U.S.C.
602(a)) is amended—
(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) provide that—
‘‘(A) aid under the plan shall not be pay-
able with respect to any child who has not at-
tained the age of 6 years, unless the State
agency has received from 1 or more physicians
written verification (on a form prescribed by the
State)—
‘‘(i) that the child has been examined
by a physician not less frequently than—
‘‘(I) in the case of a child who
has not attained the age of 19
months, every 6 months since the
child was born; and
‘‘(II) in the case of any other
child, every 6 months until the child
attained the age of 19 months, and
every year thereafter;
‘‘(ii) that the child has been immu-
nized in accordance with recommendations
issued by the Surgeon General of the Pub-
lic Health Service; and
‘‘(iii) of any contraindication which
exempts the child from receiving an immu-
nization;
‘‘(B) the State will conduct appropriate
education and outreach activities designed to—
‘‘(i) increase public awareness of the
importance of preventive health care and
immunizations for pre-school children; and
‘‘(ii) inform the public about—
‘‘(I) the availability of preventive
health care and immunization services
for pre-school children;
‘‘(II) any transportation, child
care, or other support services that
may be available to assist parents in
obtaining such services for their chil-
dren; and
‘‘(III) the clinics at which any
child may receive immunizations free
or at a reduced charge.’’.
SEC. 3. AMENDMENTS TO THE CHILD CARE AND DEVELOP-
MENT BLOCK GRANT.
Section 658E(2) of the Child Care and Development
Block Grant Act (42 U.S.C. 9858c(2)) is amended—
(1) in subparagraph (F)—
(A) in clause (ii) by striking ‘‘and’’ at the
end,
(B) in clause (iii) by striking the period at
the end and inserting ‘‘; and’’,
(C) by inserting after subclause (III), as so
redesignated, the following:
‘‘(iv) a requirement that such provid-
ers require with respect to each child who
receives child care services from any of
such providers that certificates signed by a
physician who verifies that such child has
been immunized in accordance with rec-
ommendations issued by the Surgeon Gen-
eral of the Public Health Service be sub-
mitted, at required intervals and in accord-
ance with rules issued by the Secretary, to
the child care provider involved.’’, and
(D) by striking the last sentence, and
(2) in subparagraph (G)—
(i) by inserting ‘‘(i)’’ before ‘‘Provide’’, and
(ii) by adding at the end the following:
‘‘(ii) For the purpose of enforcing the re-
quirement described in subparagraph (F)(iv),
such procedures shall ensure that each of such
providers gives to parents of each child who re-
ceives child care services from the provider in-
volved written notice of—
‘‘(I) each immunization requirement
applicable to such child;
‘‘(II) an opportunity of not less than
30 days, and not more than 45 days, to
correct the failure to satisfy such require-
ment; and
‘‘(III) the fact that child care services
for such child will be terminated for failure
to satisfy such requirement before the expi-
ration of the 45-day period beginning on
the date such notice is received.’’.
SEC. 4. ISSUANCE OF IMMUNIZATION RECOMMENDATIONS
BY THE SURGEON GENERAL OF THE PUBLIC
HEALTH SERVICE.
After taking into consideration the then most recent
report of the Committee on Infectious Diseases of the
American Academy of Pediatrics, the Surgeon General of
the Public Health Service shall issue, and revise from time
to time, recommendations for the immunization of chil-
dren under 6 years of age. With respect to each rec-
ommended immunization, such recommendation shall in-
clude—
(1) contraindications (if any) that should be
identified to exempt a child from receiving such im-
munization, and
(2) remedial action that may be taken to mini-
mize the adverse effect of failure to administer such
immunization to a child at the recommended age.
SEC. 5. EFFECTIVE DATES; APPLICATION OF AMENDMENTS.
(a) EFFECTIVE DATE.—Except as provided in sub-
sections (b) and (c), this Act and the amendments made
by this Act shall take effect on the date of the enactment
of this Act.
(b) APPLICATION OF SECTION 2 AMENDMENTS.—
The amendments made by section 2 shall apply, without
regard to whether regulations to implement the amend-
ments have been promulgated, to—
(1) payments to individuals under State plan
approved under part A of title IV of the Social Secu-
rity Act, for months ending after the 120-day period
that begins with the date of the enactment of this
Act; and
(2) payments to States under such part for cal-
endar quarters ending after such 120-day period.
(c) APPLICATION OF SECTION 3 AMENDMENTS.—
The amendments made by section 3 shall not apply with
respect to fiscal years beginning before the date of the en-
actment of this Act.
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