I
103D CONGRESS
1ST SESSION
H. R. 1640
To provide for the immunization of all children in the United States against
vaccine preventable diseases, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
APRIL 1, 1993
Mr. WAXMAN (for himself, Mr. DINGELL, Ms. SLAUGHTER, Mrs. CLAYTON,
Mr. SYNAR, Mr. RICHARDSON, Mr. ROWLAND, Mr. SLATTERY, Mr.
WASHINGTON, Mr. BROWN of Ohio, Mr. KREIDLER, Ms. PELOSI, Mr.
MCDERMOTT, and Mr. WYDEN) introduced the following bill; which was
referred jointly to the Committees on Energy and Commerce and Ways
and Means
MAY 13, 1993
Additional sponsors: Mr. KLEIN, Mr. STUDDS, Mr. SWIFT, and Mr. RANGEL
OCTOBER 21, 1993
Additional sponsors: Mr. GUTIERREZ, Mr. BERMAN, and Mr. BISHOP
A BILL
To provide for the immunization of all children in the United
States against vaccine preventable diseases, and for other
purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE AND REFERENCES IN THE ACT.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Comprehensive Child Immunization Act of 1993’’.
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(b) REFERENCES IN ACT.—The amendments in this
Act apply to the Public Health Service Act unless other-
wise specifically stated.
SEC. 2. PURPOSE OF THE ACT.
The purpose of this Act is to ensure that all children
in the United States are protected against vaccine prevent-
able infectious diseases at the earliest appropriate age; to
establish a program to purchase vaccines and to distribute
them to all willing health care providers; to establish a
tracking program to monitor which children need to be
immunized and the results of immunizing children; and
to extend the National Childhood Vaccine Injury Com-
pensation Program.
SEC. 3. FINDINGS OF THE CONGRESS.
(a) 
CURRENT
CIRCUMSTANCES.—The 
Congress
makes the following findings as to current circumstances:
(1) Immunizations are among the most cost-ef-
fective means of preventing disease.
(2) Although Federal support for childhood im-
munizations has been in existence since 1962, the
full potential of immunizations remains to be
achieved. Enactment and enforcement of school im-
munization requirements have resulted in excellent
immunization levels (96 percent or greater) in school
children. However, approximately 80 percent of vac-
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cine doses should be received before the second
birthday in order to protect children during their
most vulnerable periods. Many children do not re-
ceive their basic immunizations by that time, and in
some inner cities as few as 10 percent of 2-year olds
have received a complete series. This low level of im-
munizations has been reflected in recent years by
outbreaks of measles among inadequately immunized
pre-school children.
(3) The ‘‘infrastructure’’ to immunize children
is both public and private. There is considerable evi-
dence to suggest that the ‘‘private’’ infrastructure
has been damaged over the past decade as a result
of the significantly increased cost of privately pur-
chased vaccine.
(4) In some cases costs have risen over a ten-
year period by nearly 1400 percent, with private
rates exceeding the rates paid for like vaccines in
some other industrialized nations by over 2500 per-
cent.
(5) High costs, coupled with the growing num-
ber of uninsured and underinsured families, mean
that private physicians are increasingly referring
their private patients to overburdened public clinics
for vaccinations.
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(6) Eleven States now have programs that pro-
vide vaccines without charge to both public and pri-
vate health care providers. Some of these programs
have been in place for more than 20 years, with vir-
tually no burden or controversy. Other States that
have sought to establish such programs have been
denied additional discounted vaccines by manufac-
turers.
(7) There is no evidence to suggest that a nego-
tiated price that takes into account the reasonable
cost of production, marketing, research and develop-
ment, and distribution will not fairly compensate
vaccine manufacturers. Indeed, a recent report by
the Congressional Office of Technology Assessment
supports the proposition that negotiated rates can
assure fair compensation while holding down costs.
(8) The Secretary of Health and Human Serv-
ices has experience negotiating vaccine purchase
through the Federal contract system.
(9) The National Vaccine Injury Compensation
Program is an essential element in a comprehensive
immunization program and should be strengthened
and applied to additional vaccines recommended for
universal use in children.
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(b) NEEDED ACTIONS.—The Congress makes the fol-
lowing findings as to actions needed to ensure the full im-
munization of children at the earliest appropriate age:
(1) The Federal Government should purchase
and provide free of charge to health care providers
vaccines recommended for universal use in children.
This action will not only remove financial barriers to
immunization that impede children from being vac-
cinated at the appropriate time, but will also facili-
tate development of an immunization tracking sys-
tem.
(2) The Federal Government and the States
should develop linked registries to track the immuni-
zation status of the Nation’s children. The registries
should have the capability to notify parents of inad-
equately immunized children of the need to protect
their children with specific vaccines.
(2) The coordinated national information and
education outreach initiative inaugurated by the De-
partment of Health and Human Services in 1993
should be continued. This program brings needed in-
formation to parents and health care providers and
focuses their attention on the importance of achiev-
ing the full immunization of children at the earliest
appropriate age.
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(4) Private and public health insurers should be
encouraged to provide adequate reimbursement for
the administration of childhood vaccines.
(5) Volunteer community activities to promote
the full immunization of children at the earliest ap-
propriate age should be encouraged.
(6) The National Vaccine Injury Compensation
Program should be extended and improved. Vaccine
information materials should be simplified to ensure
that parents can understand the benefits and risks
of vaccines.
SEC. 4. FEDERAL PURCHASE AND TRACKING OF CHILD-
HOOD VACCINES.
(a) IN GENERAL.—Title XXI of the Public Health
Service Act is amended by adding at the end a new Sub-
title 3 as follows:
‘‘Subtitle 3—Federal Purchase and Tracking of
Childhood Vaccines.
‘‘SEC. 2141. PURCHASE BY THE SECRETARY.
‘‘(a) RECOMMENDED CHILDHOOD VACCINES.—The
Secretary shall promulgate not later than October 1, 1994
(and periodically thereafter as the Secretary determines
appropriate in view of advances in scientific understanding
in the areas of immunization and disease control), a list
of vaccines that provide immunization against naturally
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occurring infectious diseases and are recommended for
universal use in children. The Secretary shall concurrently
promulgate recommendations regarding the appropriate
dosage for each vaccine and the age or ages of children
at which each vaccine should be administered.
‘‘(b) CONSULTATION.—The Secretary shall, in order
to determine the amounts of vaccines to be purchased
under subsection (c), consult with Federal agencies in-
volved in research regarding, or the regulation, procure-
ment, or distribution of, recommended childhood vaccines.
The consultation may be effected through the establish-
ment of a Vaccine Requirements Panel, composed entirely
of representatives of the relevant Federal agencies, or
through such other means as the Secretary finds appro-
priate.
‘‘(c) PURCHASE OF VACCINE.—
‘‘(1) IN GENERAL.—The Secretary shall peri-
odically purchase recommended childhood vaccines in
amounts necessary for—
‘‘(A) distribution under section 2142 to
meet anticipated needs for the routine and
catch-up immunization of children in the Unit-
ed States in accordance with the recommenda-
tions promulgated under subsection (a) and
foreseeable outbreak control activities, and
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‘‘(B) maintenance of a reserve supply suf-
ficient for a six-month period.
The Secretary shall negotiate a reasonable price for
such vaccine that takes fairly into account the var-
ious costs described in paragraph (3).
‘‘(2) PRE-PROCUREMENT
CONSULTATIONS.—
The Secretary may consult with representatives of
State governments, experts in vaccine delivery,
health care providers, and others with expertise in
purchasing and pricing pharmaceutical products
prior to soliciting bids or offers for recommended
childhood vaccines under this subtitle.
‘‘(3) COST OR PRICING DATA.—A manufacturer
of recommended childhood vaccine shall provide cost
or pricing data in support of its proposed price at
the time it responds to a procurement instituted by
the Secretary under this section. A manufacturer
shall also provide such data upon the request of the
Secretary whenever the Secretary determines that
contract modifications are necessary. This informa-
tion shall include data related to the research and
development costs of the vaccine, production costs,
handling, shipping, and other costs associated with
delivering vaccine to health care providers and
States in accordance with the distribution plan of
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the Secretary (or a State, as the case may be) under
section 2142, marketing costs, profit levels sufficient
to encourage future investments in research and de-
velopment of new or improved vaccines, the cost of
maintaining adequate capacity for outbreak control,
and any other data the Secretary determines are
relevant.
‘‘(4)(A) CONFIDENTIALITY OF DATA.—Informa-
tion provided to the Secretary under paragraph (3)
shall be treated as trade secret or confidential infor-
mation subject to section 552(b)(4) of title 5, United
States Code and section 1905 of title 18, United
States Code and shall not be revealed to any person
other than those authorized by the Secretary in con-
nection with carrying out official duties under this
section.
‘‘(B) Subparagraph (A) does not authorize the
withholding of information provided under para-
graph (3) from any duly authorized subcommittee or
committee of the Congress. If the Secretary provides
such information to any subcommittee or committee,
the Secretary shall give written notice of this fact to
the manufacturer that provided the information.
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‘‘(C) The Secretary shall establish written pro-
cedures to ensure the confidentiality of information
provided under paragraph (3).
‘‘(5) PROHIBITION
ON
ADDITIONAL
SHIPPING
OR
HANDLING
CHARGES.—Each contract for the
purchase of recommended childhood vaccine under
this section shall contain a provision by which the
manufacturer agrees to ship or otherwise arrange
for the delivery of such vaccine in accordance with
the distribution plan of the Secretary (or a State, as
the case may be) without imposing any additional
charge for shipping, handling, or any other cost on
the health care provider or State to which the
vaccine is shipped or delivered.
‘‘(6) MULTIPLE SUPPLIERS.—To ensure a reli-
able and adequate supply of vaccine, the Secretary
may enter into contracts with multiple manufactur-
ers of the same recommended childhood vaccine,
under such terms and conditions and utilizing such
procurement processes as the Secretary deems ap-
propriate.
‘‘(7) REPORTING REQUIREMENTS.—Each con-
tract for the purchase of recommended childhood
vaccine under this section shall require the manufac-
turer to report to the Secretary or the Secretary’s
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designee, at intervals determined by the Secretary,
data regarding the destination of vaccine by lot
number, and any other information the Secretary
may require.
‘‘SEC. 2142. DISTRIBUTION OF VACCINES.
‘‘(a) IN GENERAL.—The Secretary shall provide for
the distribution without charge of recommended childhood
vaccines purchased under this subtitle to health care pro-
viders who serve children and who (1) are members of a
uniformed service, or are officers or employees of the Unit-
ed States, (2) are health centers (as defined in section
2144(2)), (3) provide services under section 503 of the
Indian Health Care Improvement Act or pursuant to a
contract under section 102 of the Indian Self-Determina-
tion Act, or (4) are located in a State receiving a grant
under section 2143(b). The Secretary may provide for
such distribution through any State that receives a grant
under section 2143(b).
‘‘(b) DUTIES OF HEALTH CARE PROVIDERS.—
‘‘(1) FREE PROVISION TO CHILDREN.—A health
care provider receiving vaccine under this section
may use such vaccine only for administration to chil-
dren and may not impose a charge for such vaccine.
A provider may impose a fee for the administration
of such vaccine, except that a provider may not deny
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a child a vaccination due to inability of the child’s
parent or guardian to pay an administration fee.
‘‘(2) REPORTING
REQUIREMENTS.—A health
care provider receiving vaccine under this section
shall report to the applicable State registry operated
pursuant to a grant under section 2143(b) (or to the
Secretary if there is no such State registry) the data
described in section 2143(b)(1) for each dose of vac-
cine administered to a child. The provider shall addi-
tionally report to such State registry any occurrence
reported to the Secretary pursuant to section
2125(b). The provider shall also provide periodic es-
timates of the provider’s future dosage needs for rec-
ommended childhood vaccine distributed under this
section. All reports shall be made with such fre-
quency and in such detail as the Secretary may
prescribe.
‘‘SEC. 2143. TRACKING OF CHILDHOOD IMMUNIZATIONS.
‘‘(a) NATIONAL TRACKING SYSTEM.—The Secretary
shall establish a national system to track the immuniza-
tion status of children. The system shall be designed to
obtain timely information about the immunization status
of individual children and to monitor immunization rates
at the State and local levels. In addition, the system shall
be designed to monitor the safety and efficacy of vaccines,
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and to provide for the coordination of vaccine administra-
tion information with the information on adverse events
reported under section 2125(b). In addition, the Secretary
is authorized, in the case of inadequately immunized chil-
dren in States not receiving grants under subsection (b),
to notify the parents or guardians of those children of the
need to protect their children with specific vaccine.
‘‘(b) STATE REGISTRY GRANTS.—
‘‘(1) IN GENERAL.—The Secretary may make
grants to States to establish and operate State im-
munization tracking registries. A State receiving a
grant under this section shall maintain a registry
that includes the following information for each child
living within the State:
‘‘(A) type and lot number of each rec-
ommended childhood vaccine administered after
September 30, 1996,
‘‘(B) identification of the health care pro-
vider administering such vaccine,
‘‘(C) address and other demographic data
needed to find the child,
‘‘(D) notations of any adverse events asso-
ciated with each immunization, and
‘‘(E) such other information as the Sec-
retary may prescribe.
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‘‘(2) GRANT CONDITIONS.—A State, as a condi-
tion of receiving a grant under this subsection, shall
comply with the following requirements:
‘‘(A) The State registry shall provide for
entry of the birth of each infant within the
State within six weeks following the birth, and
for timely entry thereafter of all information re-
ceived from health care providers pursuant to
section 2142(b)(2).
‘‘(B) The State shall provide for the shar-
ing of appropriate information from the State’s
registry, including immunization status and re-
ports of adverse reactions, with health care pro-
viders who offer immunizations, for the purpose
of achieving the full immunization of all chil-
dren in accordance with the recommendations
of the Secretary under section 2141(a).
‘‘(C) The State shall provide for notifica-
tion to the parents or guardian of an inad-
equately immunized child of the need to protect
the child with specific vaccine.
‘‘(D) The State shall provide for the co-
ordination and exchange of information with
other State registries to allow the tracking of
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the immunization status of children changing
state of residence.
‘‘(E) The State shall periodically furnish to
the Secretary, at such times and in such form
as the Secretary may prescribe, information
contained in the State registry.
‘‘(F) In designing its registry, the State
shall adhere to tracking models and systems
specifications prescribed by the Secretary for
the purpose of ensuring the mutual compatibil-
ity of the data systems and electronic informa-
tion technology utilized by the Secretary and
the various States in carrying out activities
under this subtitle.
‘‘(G) The State shall monitor and enforce
compliance by health care providers with the re-
quirements of section 2142(b). The State shall
establishes procedures satisfactory to the Sec-
retary for terminating from participation in the
recommended childhood vaccine distribution
program any health care provider who fails to
comply with the requirements of section
2142(b), and for reinstating such provider to
program participation upon receiving from such
provider (i) the reports necessary to make cur-
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rent and complete the information that would
have been furnished to the State registry be-
tween the dates of the provider’s termination
and reinstatement, and (ii) satisfactory assur-
ances regarding the provider’s future compli-
ance.
‘‘(H) If a State distributes recommended
childhood vaccines within the State on behalf of
the Secretary pursuant to section 2142(a), the
State shall compile data, including lot numbers,
on the vaccines distributed to each health care
provider, and shall furnish such data to the
Secretary in such form and at such intervals as
the Secretary may prescribe.
‘‘(3) APPLICATIONS.—A State shall submit an
application for a grant under subsection (b) in such
form and containing such information as the Sec-
retary may prescribe. The application shall include a
description of the methods by which the State will
comply with the requirements of paragraph (2). The
application shall also include the assurances required
by paragraph (4) and a description of the expenses
that the State will incur in carrying out its respon-
sibilities under the grant.
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‘‘(4) A State submitting an application for a
grant under this section shall provide assurances
satisfactory to the Secretary that—
‘‘(A) the State’s tracking registry will be
fully operational not later than October 1,
1996;
‘‘(B) the State’s tracking registry will ad-
here to any tracking models and systems speci-
fications prescribed by the Secretary pursuant
to paragraph (2)(F); and
‘‘(C) as appropriate, the State is making
satisfactory and timely progress toward achiev-
ing the conditions described in subparagraphs
(A) and (B).
‘‘(5) ALLOWABLE USES OF GRANT FUNDS.—A
State may use funds from a grant awarded under
this subsection for reasonable costs associated with
the development and operation of its registry, includ-
ing computer needs, technical assistance and train-
ing, education of health care providers, personnel
costs, travel expenses, and other appropriate activi-
ties.
‘‘(6) STATE REPORTS TO THE SECRETARY.—A
State shall submit periodic reports to the Secretary
on the operation of the State’s registry and other ac-
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tivities under this subtitle. The reports shall be in
such form, contain such information, and be submit-
ted at such intervals as the Secretary may prescribe.
‘‘(c) USE AND DISCLOSURE OF PERSONAL INFORMA-
TION.—
‘‘(1) Notwithstanding any other provision of
this subtitle, no personally-identifiable information
relating to a child who receives recommended child-
hood vaccine under this subtitle or to the parent or
guardian of such a child that is collected or main-
tained by the National Tracking System established
under subsection (a), or a State immunization track-
ing registry established under subsection (b), may be
used or disclosed by any holder of such information
except as permitted by this subsection.
‘‘(2) Information described in paragraph (1)
may be used or disclosed, without the consent of the
individual to whom it refers, or of the parent or
guardian of such individual, for—
‘‘(A) the tracking of children’s immuniza-
tion status, and other purposes directly related
to the health of the children being tracked and
of their families;
‘‘(B) oversight, audit, and evaluation of
the immunization delivery and tracking activi-
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ties, and the enforcement of the provisions of
this subtitle;
‘‘(C) activities relating to establishing and
maintaining a safe and effective supply of rec-
ommended childhood vaccine (including activi-
ties to carry out part C of subtitle 2);
‘‘(D) processing of insurance claims for
payment for vaccine administration (but only to
the extent necessary to process a claim);
‘‘(E) administration of the National Vac-
cine Injury Compensation Program under sub-
title 2; or
‘‘(F) health research, including research on
the delivery and financing of health services.
‘‘(3) Information described in paragraph (1)
may be used or disclosed with the written authoriza-
tion of the individual to whom it refers, or the par-
ent or guardian of such individual, and must, upon
the request of such individual, or parent or guard-
ian, be provided in writing to the individual.
‘‘(4) The Secretary is authorized to issue regu-
lations governing the use, maintenance, and disclo-
sure, by any holder of information described in para-
graph (1), including appropriate administrative,
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technical and physical safeguards to ensure that only
authorized persons have access to the information.
‘‘(5) ANY PERSON WHO KNOWINGLY—
‘‘(A) uses or discloses information in viola-
tion of this subsection, or
‘‘(B) requests or obtains any information
in violation of this subsection, and offers or
provides anything of value in exchange for the
provision of the information,
shall be fined as prescribed by title 18, United
States Code, or imprisoned not more than 3 years,
or both.’’
‘‘(d) AUTHORITY TO USE SOCIAL SECURITY NUM-
BERS.—
‘‘(1) IN
GENERAL.—Notwithstanding section
205 of the Social Security Act or any other provision
of law, the Secretary and States receiving grants
under subsection (b) may utilize the social security
number of a child or of a parent or guardian of the
child for purposes of identification of a child in any
registry established under this section, and may re-
quire a child’s parent or guardian to furnish such
number (in any case where such a number has been
assigned by the Social Security Administration) as a
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condition of the child receiving recommended child-
hood vaccine under this subtitle.
‘‘(2) AUTHORITY
TO
REDISCLOSE.—Notwith-
standing section 205(c)(2)(C)(vii)(I) of the Social
Security Act, a social security number obtained in
connection with activities under this subtitle may be
redisclosed if such redisclosure is otherwise in ac-
cordance with subsection (c) of this section.
‘‘(e) REPORTS BY SECRETARY TO THE CONGRESS.—
The Secretary shall submit a report to Congress not later
than January 1, 1996, and biennially thereafter on the
operation of the national tracking system and the State
registries.
‘‘SEC. 2144. DEFINITIONS.
‘‘For purposes of this subtitle—
‘‘(1) The term ‘recommended childhood vaccine’
is a vaccine on the list promulgated by the Secretary
pursuant to section 2141(a).
‘‘(2) The term ‘health center’ means—
‘‘(A) a federally qualified health center, as
defined in section 1905(l)(2) of the Social Secu-
rity Act; or
‘‘(B) a public or nonprofit private entity
receiving Federal funds under—
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‘‘(i) section 340A (relating to grants
for health services for residents of public
housing), or
‘‘(ii) section 501(a)(2) of the Social
Security Act (relating to special projects of
regional and national significance).
‘‘SEC. 2145. APPROPRIATIONS AND AUTHORIZATION.
‘‘(a) VACCINE PURCHASES.—There shall be made
available for expenditure by the Secretary, out of the Com-
prehensive Child Immunization Account in the Treasury
established pursuant to section 6 of the Comprehensive
Child Immunization Act of 1993, such amounts as are re-
quired to carry out subsections (b) and (c) of section 2141
for fiscal year 1995 and for each fiscal year thereafter
during which such subsections remain in effect.
‘‘(b) OTHER ACTIVITIES.—For carrying out this sub-
title other than subsections (b) and (c) of section 2141,
there are authorized to be appropriated $152,000,000 for
fiscal year 1995, $125,000,000 for fiscal year 1996, and
$35,000,000 for each of fiscal years 1997, 1998, and
1999.
‘‘(c) In addition to other amounts available for carry-
ing out title III and subtitle 1 of title XXI, there are au-
thorized to be appropriated for fiscal years 1993 and 1994
such additional sums as may be necessary for activities
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related to and preparatory to implementation of this sub-
title, including infrastructure improvements, information
and education, surveillance and response, and vaccine
safety.’’.
(b) REQUIREMENTS CONCERNING IMMUNIZATIONS
OF CHILDREN UNDER STATE MEDICAID PROGRAMS.—
(1) Coverage of immunizations under early and
periodic 
screening, 
diagnosis, 
and 
testing
(EPSDT).—Section 1905(r)(1)(B)(iii) of the Social
Security Act is amended to read as follows:
‘‘(iii) appropriate immunizations ac-
cording to the recommendations of the
Secretary 
promulgated 
under 
section
2141(a) of the Public Health Service Act,
taking into account the health history of
the individual,’’.
(2) REIMBURSEMENT
RATES
FOR
IMMUNIZA-
TIONS
WITH
RECOMMENDED
CHILDHOOD
VAC-
CINES.—Section 1902(a)(13) of the Social Security
Act is amended—
(A) by striking ‘‘and’’ and the end of sub-
paragraph (E),
(B) by inserting ‘‘and’’ at the end of sub-
paragraph (F), and
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(C) by adding at the end the following new
subparagraph:
‘‘(G) that payments to providers shall in-
clude amounts, as appropriate, as reimburse-
ment for administration of recommended child-
hood vaccines (as defined in section 2144 of the
Public Health Service Act) in accordance with
section 1905(r)(i)(B)(iii);’’.
(3) EFFECTIVE DATE.—(A) IN GENERAL.—Ex-
cept as provided in subparagraph (B), the amend-
ments made by this subsection shall be effective with
respect to calendar quarters beginning on or after
October 1, 1994.
(B) EXTENSION
FOR
STATE
LAW
AMEND-
MENT.—In the case of a State plan under title XIX
of the Social Security Act which the Secretary of
Health and Human Services determines requires
State legislation in order for the plan to meet the
additional requirements imposed by the amendments
made by paragraph (2), the State plan shall not be
regarded as failing to comply with the requirements
of such title solely on the basis of its failure to meet
these additional requirements before the first day of
the first calendar quarter beginning after the close
of the first regular session of the State legislature
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that begins after the date of enactment of this Act.
For purposes of the previous sentence, in the case
of a State that has a two-year legislative session,
each year of such session shall be deemed to be a
separate regular session of the State legislature.
(c) TERMINATION OF PURCHASE PROGRAM.—Sub-
sections (b) and (c) of section 2141 of the Public Health
Service Act (as added by subsection (a) of this section)
shall cease to be in effect beginning on such date as may
be prescribed in Federal law providing for immunization
services for all children as part of a broad-based reform
of the national health care system.
SEC. 5. NATIONAL VACCINE INJURY COMPENSATION PRO-
GRAM AMENDMENTS.
(a) USE OF VACCINE INJURY COMPENSATION TRUST
FUND.—
(1) Section 9510(c)(1) of the Internal Revenue
Code of 1986 is amended by striking out ‘‘, and be-
fore October 1, 1992,’’.
(2) Section 6601(r) of the Omnibus Budget
Reconciliation Act of 1989 is amended by striking
out ‘‘$2,500,000 for each of fiscal years 1991 and
1992’’ each place it appears and inserting in lieu
thereof ‘‘$3,000,000 for fiscal year 1994 and each
fiscal year thereafter’’ (in three places).
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(b) PERMANENT EXTENSION OF AUTHORITY TO IM-
POSE TAXES FOR THE VACCINE INJURY COMPENSATION
TRUST FUND.—
(1) PERMANENT EXTENSION OF TAX.—Section
4131(c) of the Internal Revenue Code of 1986 is re-
pealed.
(2) REINSTATEMENT
OF
TAX.—The tax im-
posed by section 4131 of the Internal Revenue Code
of 1986 is hereby reinstated effective April 1, 1993.
(c) AMENDMENT OF VACCINE INJURY TABLE.—(1)
Section 2114 is amended by adding at the end thereof the
following new subsection:
‘‘(f) ADDITION OF VACCINES TO TABLE.—The Vac-
cine Injury Table set out in subsection (a) also includes
any recommended childhood vaccine included in the list
promulgated by the Secretary under section 2141(a). The
Secretary may modify the Table with respect to any vac-
cine added by operation of the preceding sentence only in
accordance with subsection (c). For purposes of section
2116(b), the addition of a vaccine to the Table by oper-
ation of the subsection shall constitute a revision of this
Table.’’.
(2) Section 2116(b) is amended by striking out ‘‘such
person may file’’ and inserting in lieu thereof ‘‘or to sig-
nificantly increase the likelihood of obtaining compensa-
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tion, 
such 
person 
may, 
notwithstanding 
section
2111(b)(2), file’’.
(d) EXTENSION OF TIME FOR DECISION.—Section
2112(d)(3)(D) is amended by striking out ‘‘540 days’’ and
inserting in lieu thereof ‘‘30 months (but for no more than
6 months at a time)’’.
(e) SIMPLIFICATION OF VACCINE INFORMATION MA-
TERIALS.—
(1) Section 2126 (b) is amended—
(A) by striking out ‘‘by rule’’ in the matter
preceding paragraph (1);
(B) by striking out, in paragraph (1), ‘‘,
opportunity for a public hearing, and 90’’ and
inserting in lieu thereof ‘‘and 30’’; and
(C) by striking out, in paragraph (2), ‘‘,
appropriate health care providers and parent
organizations’’.
(2) Section 2126(c) is amended—
(A) by inserting ‘‘shall be based on avail-
able data and information,’’ immediately after
‘‘such materials’’ in the matter preceding para-
graph (1), and
(B) by striking out paragraphs (1) through
(10) and inserting in lieu thereof the following: