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than a loan described in subclause (I);’’;
and
(C) by adding at the end the following new
paragraph:
‘‘(5) DIRECT LOANS.—In the event that a bor-
rower is unable to obtain a consolidation loan from
a lender with an agreement under subsection (a)(1),
the Secretary shall offer any such borrower who ap-
plies for it, a direct consolidation loan to be repaid
pursuant to income contingent repayment under part
D of this title or pursuant to any other repayment
provision under this section, except that the Secretary
shall not offer such loans if, in the Secretary’s judg-
ment, the Department of Education does not have the
necessary origination and servicing arrangements in
place for such loans.’’; and
(3) in subsection (c)—
(A) in paragraph (2)—
(i) in subparagraph (A)—
(I) in the matter preceding clause
(i), by striking ‘‘income sensitive re-
payment schedules. Such repayment
terms’’ and inserting ‘‘income sensitive
repayment schedules, established by the
lender in accordance with the regula-
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tions of the Secretary. Except as re-
quired by such income sensitive repay-
ment schedules, or by the terms of re-
payment pursuant to income contin-
gent repayment offered by the Sec-
retary under subsection (b)(5), such re-
payment terms’’;
(II) by redesignating clauses (i),
(ii), (iii), (iv), and (v) as clauses (ii),
(iii), (iv), (v), and (vi), respectively;
and
(III) by inserting before clause
(ii) (as redesignated by subclause (II))
the following new clause:
‘‘(i) is less than $7,500, then such con-
solidation loan shall be repaid in not more
than 10 years;’’;
(ii) by striking subparagraph (B); and
(iii) by redesignating subparagraph
(C) as subparagraph (B); and
(B) in paragraph (3)(A), by inserting ‘‘ex-
cept as required by the terms of repayment pur-
suant to income contingent repayment offered by
the Secretary under subsection (b)(5),’’ before
‘‘the lender’’.
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(b) EFFECTIVE DATE.—The amendments made by this
section shall be effective for loans made on or after July
1, 1994.
SEC. 12047. AUTHORITY TO USE OPTICALLY IMAGED DOCU-
MENTS.
(a) GENERAL AUTHORITY.—Section 484A of the Act
(20 U.S.C. 1091a) is amended—
(1) in the section heading, by inserting ‘‘; OPTI-
CALLY
IMAGED
DOCUMENTS’’ after ‘‘LIMITA-
TIONS’’; and
(2) by adding at the end the following new sub-
section:
‘‘(c) OPTICALLY IMAGED DOCUMENTS.—
‘‘(1) PURPOSE.—It is the purpose of this sub-
section to—
‘‘(A) allow the Secretary to use optical im-
aging technology to store and retrieve documents
and records, including promissory notes and re-
payment agreements, required for the adminis-
tration of the programs authorized under part D
of this title, or for the administration of loans
made under part B of this title that have been
assigned to the Secretary;
‘‘(B) permit the Secretary to destroy origi-
nals of such documents and records, including
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promissory notes and repayment agreements,
after such documents and records have been opti-
cally imaged, thereby achieving significant sav-
ings in storage and retrieval costs; and
‘‘(C) ensure that the Secretary may intro-
duce as evidence in any proceeding with respect
to the programs or loans described in subpara-
graph (A) optically imaged documents and
records, including promissory notes and repay-
ment agreements.
‘‘(2) EVIDENCE.—Notwithstanding any other
provision of law, an optically imaged copy of any
document or record, including a promissory note or
repayment agreement, may be introduced as evidence
in any proceeding with respect to the programs or
loans described in paragraph (1)(A) in any Federal
or State court, or other tribunal, and such optically
imaged copy shall be admissible in any court or tri-
bunal of the United States or any State as if such
copy were the original document or record and have
the same force and effect as the original.
‘‘(3) CONSTRUCTION.—(A) Nothing in this sub-
section shall be interpreted to preclude the admissibil-
ity of a duplicate of a document or record required
for the administration of the programs or loans de-
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scribed in paragraph (1)(A) made by a technology
other than optical imaging consistent with the Fed-
eral Rules of Evidence and section 1732 of title 28,
United States Code, or applicable State law.
‘‘(B) Nothing in this subsection shall be inter-
preted to preclude the admissibility of an optically
imaged copy of any document or record in a proceed-
ing outside the scope of this subsection consistent with
the Federal Rules of Evidence and section 1732 of
title 28 of the United States Code, or applicable State
law.’’.
(b) OPTICALLY IMAGED DOCUMENTS.—Section 432 of
the Act (20 U.S.C. 1082) is amended by adding at the end
the following new subsection:
‘‘(q) 
OPTICALLY
IMAGED
DOCUMENTS.—Records
maintained in accordance with section 484A(c) may be
used in any proceeding, as permitted by section 484A(c),
with respect to a loan that was made under this part and
has been assigned to the Secretary.’’.
(c) CONFORMING AMENDMENT.—Section 487 of the Act
(20 U.S.C. 1094) is amended by adding at the end the fol-
lowing new subsection:
‘‘(f) USE OF OPTICALLY IMAGED DOCUMENTS.—In
any proceeding with respect to a program or activity under
part D of this title, or with respect to a loan made under
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part B of this title that has been assigned to the Secretary,
records maintained in accordance with section 484A may
be used as provided in that section.’’.
SEC. 12048. CONSOLIDATION OF PROGRAMS.
(a) IN GENERAL.—Section 428H of the Act (20 U.S.C.
1078–9) is amended—
(1) in the matter preceding paragraph (1) of
subsection (b), by inserting ‘‘(including graduate and
professional students as defined in regulations pro-
mulgated by the Secretary)’’ after ‘‘484’’;
(2) in subsection (d), by inserting ‘‘, except
that—
‘‘(1) the maximum annual amount of loans
under this section an independent student (or a stu-
dent whose parents are unable to borrow under the
Federal Direct PLUS Loan Program) may borrow in
any academic year or its equivalent or in any period
of 7 consecutive months, whichever is longer, shall be
as follows:
‘‘(A) In the case of such a student attending
an eligible institution who has not completed
such student’s first 2 years of undergraduate
study, the amount determined in accordance
with section 428(b)(1), plus—
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‘‘(i) $4,000, if such student is enrolled
in a program whose length is at least one
academic year in length (as determined
under section 481);
‘‘(ii) $2,500, if such student is enrolled
in a program whose length is less than one
academic year, but at least 2⁄3 of such an
academic year; and
‘‘(iii) $1,500, if such student is en-
rolled in a program whose length is less
than 2⁄3, but at least 1⁄3, of such an aca-
demic year.
‘‘(B) In the case of such a student attending
an eligible institution who has completed the
first 2 years of undergraduate study but who has
not completed the remainder of a program of un-
dergraduate study, the amount determined in ac-
cordance with section 428(b)(1), plus—
‘‘(i) $5,000, if such student is enrolled
in a program whose length is at least one
academic year in length (as determined
under section 481);
‘‘(ii) $3,325, if such student is enrolled
in a program whose length is less than one
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academic year, but at least 2⁄3 of such an
academic year; and
‘‘(iii) $1,675, if such student is en-
rolled in a program whose length is less
than 2⁄3, but at least 1⁄3, of such an aca-
demic year.
‘‘(C) In the case of such a student who is
a graduate or professional student attending an
eligible institution, the amount determined in
accordance with section 428(b)(1), plus $10,000;
and
‘‘(2) the maximum aggregate amount of such
loans such student may borrow shall be adjusted to
reflect the increased annual limits described in para-
graph (1)’’ before the period;
(3) in subsection (e), by adding at the end the
following new paragraphs:
‘‘(5) AMORTIZATION.—The amount of the peri-
odic payment and the repayment schedule for any
loan made pursuant to this section shall be estab-
lished by assuming an interest rate equal to the ap-
plicable rate of interest at the time the repayment of
the principal amount of the loan commences. At the
option of the lender, the note or other written evidence
of the loan may require that—
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‘‘(A) the amount of the periodic payment
will be adjusted annually; or
‘‘(B) the period of repayment of principal
will be lengthened or shortened,
in order to reflect adjustments in interest rates occur-
ring as a consequence of section 427A(c)(4).
‘‘(6) REPAYMENT PERIOD.—For purposes of cal-
culating the 10-year repayment period under section
428(b)(1)(D), such period shall commence at the time
the first payment of principal is due from the bor-
rower.’’; and
(4) by adding at the end the following new sub-
section:
‘‘(h) REFINANCING.—
‘‘(1) REFINANCING TO SECURE COMBINED PAY-
MENT.—An eligible lender may at any time consoli-
date loans held by such lender which are made under
this section to a borrower, including loans which were
made under sections 428A and 428B as such sections
were in effect prior to the date of enactment of the
Higher Education Amendments of 1986, under a sin-
gle repayment schedule which provides for a single
principal payment and a single payment of interest,
and shall calculate the repayment period for each in-
cluded loan from the date of the commencement of re-
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payment of the most recent included loan. Unless the
consolidated loan is obtained by a borrower who is
electing to obtain variable interest under paragraph
(2) or (3), such consolidated loan shall bear interest
at the weighted average of the rates of all included
loans rounded to the nearest whole percent. The exten-
sion of any repayment period of an included loan
pursuant to this paragraph shall be reported (if re-
quired by such loan) to the Secretary or guaranty
agency insuring the loan, as the case may be, but no
additional insurance premiums shall be payable with
respect to any such extension. The extension of the re-
payment period of any included loan shall not re-
quire the formal extension of the promissory note evi-
dencing the included loan or the execution of a new
promissory note, but shall be treated as an adminis-
trative forbearance of the repayment terms of the in-
cluded loan.
‘‘(2) REFINANCING TO SECURE VARIABLE INTER-
EST RATE.—An eligible lender may reissue a loan
which was made under this section before July 1,
1987, or under sections 428A and 428B as such sec-
tions were in effect prior to the date of enactment of
the Higher Education Amendments of 1986 in order
to permit the borrower to obtain the interest rate pro-
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vided under section 427A(c)(4). A lender offering to
reissue a loan or loans for such purpose may charge
a borrower an amount not to exceed $100 to cover the
administrative costs of reissuing such loan or loans,
not more than one-half of which shall be paid to the
guarantor of the loan being reissued to recover costs
of reissuance. Reissuance of a loan under this para-
graph shall not affect any insurance applicable with
respect to the loan, and no additional insurance fee
may be charged to the borrower with respect to the
loan.
‘‘(3) REFINANCING BY DISCHARGE OF PREVIOUS
LOAN.—A borrower who has applied to an original
lender for reissuance of a loan under paragraph (2)
and who is denied such reissuance may obtain a loan
from another lender for the purpose of discharging the
loan from such original lender. A loan made for such
purpose—
‘‘(A) shall bear interest at the applicable
rate 
of 
interest 
provided 
under 
section
427A(c)(4);
‘‘(B) shall not result in the extension of the
duration of the note (other than as permitted
under subsection (e)(5)(B));
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‘‘(C) may be subject to an additional insur-
ance fee but shall not be subject to the adminis-
trative cost charge permitted by paragraph (2) of
this subsection; and
‘‘(D) shall be applied to discharge the bor-
rower from any remaining obligation to the
original lender with respect to the original loan.
‘‘(4) CERTIFICATION
IN
LIEU
OF
PROMISSORY
NOTE PRESENTATION.—Each new lender may accept
certification from the original lender of the borrower’s
original loan in lieu of presentation of the original
promissory note.
‘‘(5) NOTIFICATION TO BORROWERS OF AVAIL-
ABILITY OF REFINANCING OPTIONS.—Each holder of a
loan made under this section or under section 428B
as in effect prior to the date of enactment of this Act
shall, not later than October 1, 1993, in the case of
loans made before the date of enactment of this para-
graph, notify the borrower of such loan—
‘‘(A) of the refinancing options for which
the borrower is eligible under this subsection;
‘‘(B) of those options which will be made
available by the holder and of the practical con-
sequences of such options in terms of interest
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rates and monthly and total payments for a set
of loan examples; and
‘‘(C) that, with respect to any option that
the holder will not make available, the holder
will, to the extent practicable, refer the borrower
to an eligible lender offering such option.’’.
(b) REPEAL.—
(1) REPEALER.—Section 428A of the Act is re-
pealed.
(2) EFFECTIVE DATE.—The amendment made by
paragraph (1) shall be effective on July 1, 1994.
(c) TERMS, CONDITIONS
AND BENEFITS.—Notwith-
standing the amendments made by this section, with respect
to loans provided under sections 428A and 428H of the
Higher Education Act of 1965 (as such sections existed on
the date preceding the date of enactment of this Act) the
terms, conditions and benefits applicable to such loans
under such sections shall continue to apply to such loans
after the date of enactment of this Act.
SEC. 12049. ORIGINATION FEE; INSURANCE PREMIUM.
Section 428H of the Act (20 U.S.C. 1078–8) is amend-
ed—
(1) in subsection (f)—
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(A) in the subsection heading, by striking
‘‘INSURANCE PREMIUM’’ and inserting ‘‘ORIGI-
NATION FEE’’;
(B) in the heading of paragraph (1), by
striking ‘‘/INSURANCE PREMIUM’’;
(C) in paragraph (1)—
(i) by striking ‘‘a combined origination
fee and insurance premium in the amount
of 6.5 percent’’ and inserting ‘‘an origina-
tion fee in the amount of 3.0 percent’’; and
(ii) by striking the second sentence;
(D) in paragraph (2), by striking ‘‘com-
bined fee and premium’’ and inserting ‘‘origina-
tion fee’’;
(E) in paragraph (3), by striking ‘‘com-
bined origination fee and insurance premium’’
and inserting ‘‘origination fee’’;
(F) in paragraph (4)—
(i) in the heading, by striking ‘‘INSUR-
ANCE PREMIUM’’ and inserting ‘‘ORIGINA-
TION FEE’’;
(ii) by striking ‘‘combined origination
fee and insurance premiums’’ and inserting
‘‘origination fees’’; and
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(iii) by striking ‘‘and premiums to
pay’’ and inserting ‘‘to pay’’; and
(G) in paragraph (5)—
(i) in the heading, by inserting ‘‘ORIGI-
NATION FEE AND’’ before ‘‘INSURANCE’’; and
(ii) in the second sentence—
(I) by striking ‘‘6.5 percent insur-
ance premium’’ and inserting ‘‘com-
bined origination fee under this sub-
section and the insurance premium
under subsection (h)’’; and
(II) by inserting ‘‘origination fee
and’’ before ‘‘insurance’’; and
(2) by adding at the end the following new sub-
section:
‘‘(h) INSURANCE PREMIUM.—Each State or nonprofit
private institution or organization having an agreement
with the Secretary under section 428(b)(1) may charge a
borrower under this section an insurance premium equal
to not more than 1 percent of the principal amount of the
loan, if such premium will not be used for incentive pay-
ments to lenders.’’
SEC. 12050. DISBURSEMENTS FOR FIRST YEAR STUDENTS.
Section 428(G) of the Act (20 U.S.C. 1078–7) is
amended—
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(1) in the heading for subsection (b), by striking
‘‘AND ENDORSEMENT’’; and
(2) in subsection (b)—
(A) by striking paragraph (1);
(B) in paragraph (2)—
(i) by striking ‘‘other than a student
described in paragraph (1)’’; and
(ii) by striking ‘‘(2) OTHER
STU-
DENTS.—’’.
Subchapter B—Amendments to Other Laws
SEC. 12055. DISCLOSURE OF TAX RETURN INFORMATION.
(a) RETURNS AND RETURN INFORMATION.—Section
6103(a)(3) of the Internal Revenue Code of 1986 (hereafter
referred to in this part as ‘‘the Code’’) is amended by strik-
ing ‘‘(l)(12)’’ and inserting ‘‘(l)(10), (12), or (13)’’.
(b) INCOME CONTINGENT REPAYMENT OF STUDENT
LOANS.—Section 6103(l) of the Code is amended—
(1) in paragraph (10)(B), by striking ‘‘officers
and employees of an agency receiving return informa-
tion under subparagraph (A) shall use such informa-
tion’’ and inserting ‘‘return information disclosed
under subparagraph (A) may be used by officers and
employees of an agency, and by officers, employees,
and agents of the Department of Education,’’; and
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(2) at the end, by adding a new paragraph to
read as follows:
‘‘(13) DISCLOSURE OF RETURN INFORMATION TO
CARRY OUT INCOME CONTINGENT REPAYMENT OF STU-
DENT LOANS.—
‘‘(A) IN
GENERAL.—The Secretary may,
upon written request from the Secretary of Edu-
cation, disclose to officers and employees of the
Department of Education return information
with respect to a taxpayer who has received a
Federal loan under a student loan program and
whose loan repayment amounts are based in
whole or in part on the taxpayer’s income. Such
return information shall be limited to—
‘‘(i) taxpayer identity information
with respect to such taxpayer;
‘‘(ii) the filing status of such taxpayer;
and
‘‘(iii) the adjusted gross income of such
taxpayer (as defined in section 62).
‘‘(B) RESTRICTION ON USE OF DISCLOSED
INFORMATION.—Return 
information 
disclosed
under subparagraph (A) may be used by officers,
employees, and agents of the Department of Edu-
cation only for the purposes of, and to the extent
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necessary in, establishing an appropriate income
contingent repayment level under a student loan
program.
‘‘(C) DEFINITIONS.—For purposes of this
paragraph, the term ‘student loan program’
means the program authorized under part D of
title IV of the Higher Education Act of 1965 and
includes loans under parts B and E of title IV
the Higher Education Act of 1965 that are in de-
fault and have been assigned to the Department
of Education.’’.
(c) DISCLOSURE OF TAXPAYER IDENTITY INFORMA-
TION.—Section 6103(m)(4) of the Code is amended—
(1) in the heading, by inserting ‘‘OWE
AN
OVERPAYMENT ON FEDERAL PELL GRANTS OR’’
immediately after ‘‘INDIVIDUALS WHO’’;
(2) in subparagraph (A)—
(A) by redesignating clauses (i) and (ii) as
subclauses (I) and (II); and
(B) by striking ‘‘of any taxpayer who has
defaulted on a loan—’’ and inserting ‘‘of any
taxpayer—
‘‘(i) who owes an overpayment of a
grant awarded to that taxpayer under sub-
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part 1 of part A of title IV of the Higher
Education Act of 1965, or
‘‘(ii) who has defaulted on a loan—’’;
(3) in subparagraph (B)—
(A) in clause (i), by striking ‘‘under part
B’’ and inserting ‘‘under part B or D’’; and
(B) in clause (ii), by striking ‘‘under part
E’’ and inserting ‘‘under subpart 1 of part A,
part D, or part E’’;
(d) 
PROCEDURE
AND
RECORDKEEPING.—Section
6103(p) of the Code is amended—
(1) in paragraph (3)(A), by striking ‘‘(11), or
(12), (m)’’ and inserting ‘‘(11), (12), or (13), (m)’’;
(2) in paragraph (4)—
(A) in the matter preceding subparagraph
(A), by striking ‘‘(10), or (11),’’ and inserting
‘‘(10), (11), or (13),’’;
(B) in subparagraph (F)(ii), by striking
‘‘(11), or (12),’’ and inserting ‘‘(11), (12), or
(13),’’; and
(C) in the flush left material after subpara-
graph 
(F), 
by 
striking 
‘‘under 
subsection
(l)(12)(B)’’ and inserting ‘‘under paragraph
(10), (12)(B), or (13) of subsection (l)’’.
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(e) COLLECTION OF PAYMENTS.—(1) Subchapter A of
chapter 64 of the Code is amended by adding at the end
the following new section:
‘‘SEC. 6306. COLLECTION OF PAYMENTS ON FEDERAL DI-
RECT STUDENT LOANS.
‘‘Upon a determination by the President under section
457(b) of the Higher Education Act of 1965 concerning the
implementation of a plan for the repayment of Federal Di-
rect Stafford Loans through wage withholding or other
means by the Internal Revenue Service, the Secretary of the
Treasury may enter into an agreement with the Secretary
of Education to provide for the collection of payments on
loans made pursuant to part D of title IV of such Act. The
Secretary of the Treasury may assess and collect such pay-
ments as though they were additional income taxes due, and
shall establish such procedures and conventions as are nec-
essary under such agreement, including—
‘‘(1) procedures for the resolution of disputes
through the Secretary of Education;
‘‘(2) an alternate system of fees and penalties,
which system shall not include the seizure of real
property by the Internal Revenue Service, for the
nonpayment of amounts due; and
‘‘(3) provisions related to withholding, payment
of estimated tax and allocation of payments.’’.
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(2) The table of sections for subchapter A of chapter
64 of the Code is amended by adding at the end the follow-
ing new item:
‘‘Sec. 6306. Collection of payments on Federal direct Stafford loans.’’.
(f) UNAUTHORIZED DISCLOSURE.—Section 7213(a)(2)
of the Code is amended by striking ‘‘(10) or (12)’’ and in-
serting ‘‘(10), (12), or (13),’’.
(g) EFFECTIVE DATE.—The amendments made by this
section shall be effective during the period beginning on the
date of enactment of this Act and ending on December 30,
1998.
CHAPTER 4—COST SHARING BY STATES
SEC. 12061. COST SHARING BY STATES.
(a) AMENDMENT.—Section 428 of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1078) is amended by adding
at the end the following new subsection:
‘‘(n) STATE SHARE OF DEFAULT COSTS.—
‘‘(1) IN GENERAL.—In the case of any State in
which there are located any institutions of higher edu-
cation with cohort default rates that exceed 20 per-
cent, such State shall pay to the Secretary an amount
equal to—
‘‘(A) the new loan volume attributable to all
institutions in the State for the current fiscal
year; multiplied by
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‘‘(B) the percentage specified in paragraph
(2); multiplied by
‘‘(C) the quotient of—
‘‘(i) the sum of the amounts calculated
under paragraph (3) for each such institu-
tion in the State; divided by
‘‘(ii) the total amount of loan volume
attributable to current and former students
of institutions located in that State entering
repayment in the period used to calculate
the cohort default rate.
‘‘(2) PERCENTAGE.—For purposes of paragraph
(1)(B), the percentage used shall be—
‘‘(A) 12.5 percent for fiscal year 1995;
‘‘(B) 20 percent for fiscal year 1996; and
‘‘(C) 50 percent for fiscal year 1997 and
succeeding fiscal years.
‘‘(3) CALCULATION.—For purposes of paragraph
(1)(C)(i), the amount shall be determined by calculat-
ing for each institution the amount by which—
‘‘(A) the amount of the loans received for at-
tendance by such institution’s current and
former students who (i) enter repayment during
the fiscal year used for the calculation of the co-
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hort default rate, and (ii) default before the end
of the following fiscal year; exceeds
‘‘(B) 20 percent of the loans received for at-
tendance by all the current and former students
who enter repayment during the fiscal year used
for the calculation of the cohort default rate.
‘‘(4) FEE.—A State shall charge a fee to an in-
stitution of higher education that participates in the
program under this part and is located in that State
according to a fee structure, approved by the Sec-
retary, that is based on the institution’s cohort default
rate and the State’s risk of loss under this subsection.
Such fee structure shall include a process by which an
institution with a high cohort default rate is exempt
from any fees under this paragraph if such institu-
tion demonstrates to the satisfaction of the State that
exceptional mitigating circumstances, as determined
by the State and approved by the Secretary, contrib-
uted to its cohort default rate.’’.
(b) EFFECTIVE DATE.—The amendment made by this
section shall be effective on October 1, 1994.
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CHAPTER 5—GENERAL EFFECTIVE DATE
SEC. 12071. GENERAL EFFECTIVE DATE.
Except as otherwise provided in this subtitle, this sub-
title and the amendments made by this subtitle shall be ef-
fective on October 1, 1993.
Subtitle B—Public Health Service
Act Provisions
SEC. 12101. HEALTH COVERAGE CLEARINGHOUSE.
(a) IN GENERAL.—The Public Health Service Act is
amended—
(1) by redesignating title XXVII (42 U.S.C.
300cc et seq.) as title XXVIII; and
(2) by inserting after title XXVI the following
new title:
‘‘TITLE XXVII—HEALTH
COVERAGE CLEARINGHOUSE
‘‘SEC. 2701. ESTABLISHMENT OF CLEARINGHOUSE.
‘‘(a) IN GENERAL.—The Secretary shall establish and
operate a Health Coverage Clearinghouse (in this title re-
ferred to as the ‘Clearinghouse’) for the purpose of identify-
ing, for beneficiaries under a covered health program (as
defined in subsection (c)), third parties (which may include
a covered health program) which may be liable for payment
for health care items and services furnished to such bene-
ficiaries under such program.
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‘‘(b) DIRECTOR.—The Clearinghouse shall be headed
by a Director (in this title referred to as the ‘Director’) ap-
pointed by the Secretary.
‘‘(c) COVERED HEALTH PROGRAM DEFINED.—As used
in this title, the term ‘covered health program’ means any
of the following under which health care items or services
are furnished to a beneficiary—
‘‘(1) a migrant health center receiving assistance
under section 329;
‘‘(2) a community health center receiving assist-
ance under section 330;
‘‘(3) an entity receiving assistance under section
340;
‘‘(4) an alcohol or drug treatment entity or men-
tal health entity receiving assistance under title V or
title XIX;
‘‘(5) a family planning project described in sec-
tion 1001;
‘‘(6) an entity receiving assistance under title
XXVI;
‘‘(7) a black lung clinic authorized under this
Act;
‘‘(8) a clinic that treats sexually transmitted dis-
eases and is authorized under section 318;
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‘‘(9) an entity receiving funds to provide pri-
mary health services to residents of public housing
under section 340A;
‘‘(10) a non-Federal entity authorized under the
Indian Self-Determination Act;
‘‘(11) a tuberculosis clinic receiving assistance
under section 317(j)(2) or 317(k)(2); or
‘‘(12) any other Federally funded program that
provides payments for medical services provided to an
individual which are or may be covered under a pri-
vate health insurance policy.
‘‘(d) OTHER DEFINITIONS.—As used in this title:
‘‘(1) ADMINISTRATOR.—The term ‘administrator’
means, with respect to a covered health program de-
scribed in paragraphs (1) through (12) of subsection
(c), the individual responsible for the overall adminis-
tration of the program under which an entity de-
scribed in such paragraphs receives Federal funds.
‘‘(2) GROUP HEALTH PLAN.—The term ‘group
health plan’ has the same meaning given the term
‘employee welfare benefit plan’ in section 3(1) of the
Employee Retirement Income Security Act of 1974
(29 U.S.C. 1002(1)).
‘‘(3) QUALIFIED EMPLOYER.—The term ‘quali-
fied employer’ has the same meaning given the term
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‘employer’ in section 3(5) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1002(1)).
‘‘SEC. 2702. PROVISION OF INFORMATION
‘‘(a) REQUEST FOR INFORMATION.—An administrator
of a covered health program may request from the Director
information concerning the employment and group health
coverage of a program beneficiary, the beneficiary’s spouse,
and (if the beneficiary is a dependent child) the bene-
ficiary’s parents. The Director shall provide such informa-
tion if the request—
‘‘(1) is in such form and manner and at such a
time as the Director may require, and
‘‘(2) specifies the name and tax identification
number of the beneficiary.
‘‘(b) DATA MATCHING PROGRAM.—
‘‘(1) REQUEST
BY
DIRECTOR.—The Director
shall, at such intervals as the Director finds appro-
priate, transmit to the Secretary of the Treasury the
names and tax identification numbers of beneficiaries
with respect to whom a request has been made pursu-
ant to subsection (a), and request that such Secretary
disclose to the Secretary of Health and Human Serv-
ices the following information:
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‘‘(A) Whether the beneficiary is married
and, if so, the name of the spouse and such
spouse’s tax identification number.
‘‘(B) If the beneficiary is a dependent child,
the name of and tax identification numbers of
the beneficiary’s parents.
‘‘(2) INFORMATION FROM SECRETARY.—The Sec-
retary shall, upon written request from the Director,
disclose to the Director, the following information:
‘‘(A) For each individual who is identified
as having received wages (as defined in section
3401(a) of the Internal Revenue Code of 1986)
from an employer in a previous year—
‘‘(i) the name and taxpayer identifica-
tion number of the individual; and
‘‘(ii) the name, address, and taxpayer
identification number of the employer, and
whether such employer is a qualified em-
ployer.
‘‘(B) For each individual who is identified
as married and whose spouse is identified as
having received wages (as defined in section
3401(a) of the Internal Revenue Code of 1986)
from an employer in a previous year—
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‘‘(i) the name and taxpayer identifica-
tion number of the individual and of the in-
dividual’s spouse; and
‘‘(ii) the name, address, and taxpayer
identification number of the spouse’s em-
ployer, and whether such employer is a
qualified employer.
‘‘(C) For each individual who is identified
as a dependent child and whose parent is identi-
fied as having received wages (as defined in sec-
tion 3401(a) of the Internal Revenue Code of
1986) from an employer in a previous year—
‘‘(i) the name and taxpayer identifica-
tion number of the individual and of the in-
dividual’s parent; and
‘‘(ii) the name, address, and taxpayer
identification number of the parent’s em-
ployer, and whether such employer is a
qualified employer.
‘‘(3) INFORMATION FROM EMPLOYERS.—The Di-
rector shall—
‘‘(A) request, from the employer of each in-
dividual (including each spouse) with respect to
whom information was received from the Sec-
retary pursuant to paragraph (2), information
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concerning coverage of such individual (and of
the individual’s spouse and dependent children)
under the employer’s group health plan, specifi-
cally the period and nature of the coverage, and
the name, address, and identifying number of the
plan, and
‘‘(B) furnish the information received in re-
sponse to such request with respect to an individ-
ual (or such individual’s spouse or dependent
children) to the administrator requesting such
information pursuant to subsection (a).
Under no circumstances shall the information re-
quested pertain in any way to the health status of the
individual, spouse or dependent children, to the cost
of such coverage, or to the beneficiary-specific limita-
tions on such coverage.
‘‘SEC. 2703. REQUIREMENT THAT EMPLOYERS FURNISH IN-
FORMATION.
‘‘(a) IN GENERAL.—An employer shall furnish to the
Director the information requested pursuant to section
2702(b)(3) within 90 days after receipt of such a request.
‘‘(b) CIVIL MONEY PENALTY FOR FAILURE TO CO-
OPERATE.—
‘‘(1) IN GENERAL.—An employer (other than a
Federal or other governmental entity) who willfully or
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repeatedly fails to provide timely and accurate re-
sponse to a request for information pursuant to sec-
tion 2702(b)(3) shall be subject, in addition to any
other penalties that may be prescribed by law, to a
civil money penalty of not to exceed $500 for each in-
dividual with respect to whom such a request is made.
‘‘(2) ENFORCEMENT
AUTHORITY.—In cases of
failure to respond to the Director in accordance with
subsection (a) to inquiries relating to requests pursu-
ant to section 2702, the provisions of section
353(h)(3), regarding procedures for the imposition of
civil money penalties developed by the Secretary, shall
apply in the same manner as such provisions apply
to penalties or proceedings under section 353.
‘‘SEC. 2704. DATA BANK.
‘‘(a) MAINTENANCE OF INFORMATION.—The Clearing-
house shall maintain a data bank, containing information
on individuals obtained pursuant to this title. Individual
information in the data bank shall be retained for not less
than one year after the date the information was obtained.
‘‘(b) DISCLOSURE OF INFORMATION IN DATA BANK.—
‘‘(1) IN GENERAL.—The Director is authorized
(subject to paragraph (2)) to disclose any information
in the data bank established pursuant to subsection
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(a) with respect to an individual (or an individual’s
spouse or parent)—
‘‘(A) to the Secretary, administrators, em-
ployers, and insurers, to the extent necessary to
assist such administrators;
‘‘(B) to Federal and State law enforcement
officials responsible for enforcement of civil or
criminal laws, in connection with investigations
or administrative or judicial law enforcement
proceedings relating to a covered health program;
and
‘‘(C) for research or statistical purposes.
‘‘(2) RESTRICTIONS ON DISCLOSURE.—Informa-
tion in the data bank may be disclosed under this
subsection only for purposes of, and to the extent nec-
essary in, determining the extent to which an individ-
ual is covered under any group health plan.
‘‘(c) USE OF CONTRACTORS.—The responsibilities of
the Clearinghouse under this section may be carried out by
contract.
‘‘(d) FEES.—The Clearinghouse shall—
‘‘(1) establish fees for services under this section
designed to cover the full costs to the Clearinghouse of
providing such services, and
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‘‘(2) require the payment of such fees to provide
such services.’’.
(b) CONFORMING AMENDMENTS.—
(1) Sections 2701 through 2714 of the Public
Health Service Act (42 U.S.C. 300cc through 300cc–
15) are redesignated as sections 2801 through 2814,
respectively.
(2) Sections 465(f) and 497 of such Act (42
U.S.C. 286(f) and 289(f)) are amended by striking
out ‘‘2701’’ each place that such appears and insert-
ing in lieu thereof ‘‘2801’’.
(c) ERISA AMENDMENT.—Section 101 of the Em-
ployee Retirement Income Security Act of 1974 (29 U.S.C.
1021) is amended by adding at the end thereof the following
new subsection:
‘‘(g) COMPLIANCE WITH HEALTH COVERAGE CLEAR-
INGHOUSE REQUIREMENTS.—In addition to providing the
information required under this section, the administrator
of each employee benefit plan shall comply with the require-
ments of section 2703(a) of the Public Health Service Act.
The enforcement provisions of this Act shall apply to an
administrator that fails to comply with this subsection in
the same manner as such provisions otherwise apply to such
administrators under this section.’’.
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(d) EFFECTIVE DATE.—The amendments made by
subsections (a), (b), and (c) shall take effect on April 1,
1995.
SEC. 12102. PHYSICIAN OWNERSHIP STUDY.
(a) STUDY.—The Secretary of Health and Human
Services shall conduct a study concerning—
(1) the desirability of establishing a Federal pro-
hibition on the referral of a patient by a health care
provider to an entity in which the provider has a fi-
nancial interest or from which the provider receives
a financial benefit for such referral; and
(2) different options with respect to the scope of
any prohibition recommended under paragraph (1),
including options for the application of rules defining
prohibited activities that are similar to those imple-
mented under title XVIII of the Social Security Act,
and for the methods of enforcing such a prohibition.
(b) LIMITATION.—The study conducted under sub-
section (a) shall be restricted to determining the desirability
of establishing a prohibition of the type described in such
subsection with respect to patients for whom the health care
services involved are not provided or paid for under a Fed-
eral or State program.
(c) REPORT.—Not later than 6 months after the date
of enactment of this Act, the Secretary of Health and
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Human Services shall prepare and submit to the President
and the appropriate committees of Congress a report con-
cerning the results of the study conducted under subsection
(a).
SEC. 12103. DELAY IN COST-OF-LIVING ADJUSTMENTS IN
FEDERAL EMPLOYEE RETIREMENT BENEFITS
DURING FISCAL YEARS 1994, 1995, AND 1996.
(a) APPLICABILITY.—
(1) IN GENERAL.—This section shall apply with
respect to any cost-of-living increase for any person
described under paragraph (2) scheduled to take
effect, during fiscal year 1994, 1995, or 1996, under
section 8340(b) or 8462(b) of title 5, United States
Code.
(2) ANNUITANTS.—The provisions of paragraph
(1) shall apply to any annuitant who on the date pre-
ceding the date of retirement was a member of the
National Health Service Corps.
(b) DELAY IN EFFECTIVE DATE OF ADJUSTMENTS.—
A cost-of-living increase described in subsection (a) shall
not take effect until the first day of the third calendar
month after the date such increase would otherwise take ef-
fect.
(c) RULE OF CONSTRUCTION.—Nothing in this section
shall be considered to affect any determination relating to
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eligibility for an annuity increase or the amount of the first
increase in an annuity under section 8340(b) or (c) or sec-
tion 8462 (b) or (c) of title 5, United States Code, or com-
parable provisions of law.
SEC. 12104. PERMANENT ELIMINATION OF THE ALTER-
NATIVE-FORM-OF-ANNUITY OPTION EXCEPT
FOR INDIVIDUALS WITH A CRITICAL MEDICAL
CONDITION.
(a) CIVIL SERVICE RETIREMENT SYSTEM; FEDERAL
EMPLOYEES’ RETIREMENT SYSTEM.—A member of the Na-
tional Health Service Corps who is covered under chapter
83 or 84 of title 5, United States Code, and has a life-threat-
ening affliction or other critical medical condition may
elect annuity benefits under section 8343a or 8420a of title
5, United States Code, as the case may be.
(b) EFFECTIVE DATE.—The amendments made by this
section shall become effective on October 1, 1995, and shall
apply with respect to any annuity commencing on or after
that date.
SEC. 12105. FEDERAL TORT CLAIMS AMENDMENTS.
(a) CLARIFICATION OF COVERAGE OF OFFICERS AND
EMPLOYEES
OF CLINICS.—The first sentence of section
224(g)(1) of the Public Health Service Act (42 U.S.C.
233(g)(1)) is amended by striking ‘‘officer, employee, or
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contractor’’ and inserting the following: ‘‘officer or employee
of such an entity, and any contractor’’.
(b) COVERAGE FOR SERVICES FURNISHED TO INDIVID-
UALS OTHER THAN PATIENTS OF CLINIC.—Section 224(g)
of such Act (42 U.S.C. 233(g)(1)), as amended by para-
graph (1), is further amended—
(1) in the first sentence of paragraph (1), by in-
serting after ‘‘Service’’ the following: ‘‘with respect to
services provided to patients of the entity and (subject
to paragraph (7)) to certain other individuals’’; and
(2) by adding at the end the following new para-
graph:
‘‘(7) For purposes of paragraph (1), an officer, em-
ployee, or contractor described in such paragraph may be
deemed to be an employee of the Public Health Service with
respect to services provided to individuals who are not pa-
tients of an entity described in paragraph (4) only if the
Secretary determines—
‘‘(A) that the provision of the services to such in-
dividuals benefits health center patients and general
populations that could be served by the health center
through community-wide intervention efforts within
the communities served by such health center, and fa-
cilitates the provision of services to health center pa-
tients; or
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‘‘(B) that such services are otherwise required to
be provided to such individuals under an employment
contract (or other similar arrangement) between the
individual and the entity.’’.
(c) DETERMINING COMPLIANCE OF ENTITY WITH RE-
QUIREMENTS FOR COVERAGE.—
(1) IN GENERAL.—Section 224(h) of such Act (42
U.S.C. 233(h)), as added by section 2(b) of the Feder-
ally Supported Health Centers Assistance Act of 1992,
is amended by striking ‘‘the entity—’’ and inserting
the following: ‘‘the Secretary, after receiving such as-
surances and conducting such investigation as the
Secretary considers necessary, finds that the entity—
’’.
(2) FINDING.—Section 224 of such Act (42
U.S.C. 233) is amended by adding at the end thereof
the following new subsection:
‘‘(i) With respect to subsection (h), the finding of the
Secretary that an entity meets all of the requirements under
such subsection shall apply for the period specified by the
Secretary, and shall be binding for all parties unless the
Secretary reverses such finding for good cause shown at a
later date.’’.
(d) EFFECTIVE DATE.—The amendments made by this
section shall take effect as if included in the enactment of
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the Federally Supported Health Centers Assistance Act of
1992.
Subtitle 
C—Improved 
Immuniza-
tion Delivery and Monitoring
SEC. 12201. SHORT TITLE, REFERENCES AND PURPOSE.
(a) SHORT TITLE.—This subtitle may be cited as the
‘‘Comprehensive Child Immunization Act of 1993’’.
(b) REFERENCES.—Except as otherwise expressly pro-
vided, whenever in this subtitle an amendment or repeal
is expressed in terms of an amendment to, or repeal of, a
section or other provision, the reference shall be considered
to be made to a section or other provision of the Public
Health Service Act (42 U.S.C. 201 et seq.).
(c) PURPOSE.—It is the purpose of this subtitle to en-
sure that children in the United States are appropriately
immunized against vaccine preventable infectious diseases
at the earliest appropriate age.
SEC. 12202. MONITORING OF CHILDHOOD IMMUNIZATIONS.
Title XXI of the Public Health Service Act (42 U.S.C.
300aa–1 et seq.) is amended by adding at the end thereof
the following new subtitle:
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‘‘Subtitle 3—Improved Immuniza-
tion Delivery and Monitoring
Systems
‘‘Part A—List of Vaccines and Administration
‘‘SEC. 2141. LIST OF PEDIATRIC VACCINES; SCHEDULE FOR
ADMINISTRATION.
‘‘(a) RECOMMENDED PEDIATRIC VACCINES.—
‘‘(1) IN GENERAL.—The Secretary shall establish
a list of the vaccines that the Secretary recommends
for administration to all children for the purpose of
immunizing the children, subject to such contra-
indications for particular medical categories of chil-
dren as the Secretary may establish under subsection
(b)(1)(D). The Secretary shall periodically review the
list, and shall revise the list as appropriate.
‘‘(2) RULE OF CONSTRUCTION.—
‘‘(A) The list of vaccines specified in sub-
paragraph (B) is deemed to be the list of vac-
cines maintained under paragraph (1).
‘‘(B) The list of vaccines specified in this
subparagraph is the list of vaccines that, for pur-
poses of paragraph (1), is established (and peri-
odically reviewed and as appropriate revised) by
the Advisory Committee on Immunization Prac-
tices, an advisory committee established by the
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Secretary, acting through the Director of the
Centers for Disease Control and Prevention.
‘‘(b) RECOMMENDED SCHEDULE
FOR ADMINISTRA-
TION.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), in
the case of a pediatric vaccine, the Secretary shall es-
tablish (and periodically review and as appropriate
revise) a schedule of nonbinding recommendations for
the following:
‘‘(A) The number of immunizations with
the vaccine that children should receive.
‘‘(B) The ages at which children should re-
ceive the immunizations.
‘‘(C) The dose of vaccine that should be ad-
ministered in the immunizations.
‘‘(D) Any contraindications regarding ad-
ministration of the vaccine.
‘‘(E) Such other guidelines as the Secretary
determines to be appropriate with respect to ad-
ministering the vaccine to children.
‘‘(2) VARIATIONS IN MEDICAL PRACTICE.—In es-
tablishing and revising a schedule under paragraph
(1), the Secretary shall ensure that, in the case of the
pediatric vaccine involved, the schedule provides for
the full range of variations in medical judgment re-
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garding the administration of the vaccine, subject to
remaining within medical norms.
‘‘(3) RULE OF CONSTRUCTION.—
‘‘(A) The schedule specified in subparagraph
(B) is deemed to be the schedule maintained
under paragraph (1).
‘‘(B) 
The 
schedule 
specified 
in 
this
subparagraph is the schedule that, for purposes
of paragraph (1), is established (and periodi-
cally reviewed and as appropriate revised) by
the advisory committee specified in subsection
(a)(2)(B).
‘‘(c) GENERALLY APPLICABLE RULES OF CONSTRUC-
TION.—This section does not supersede any State law or
requirements with respect to receiving immunizations (in-
cluding any such law relating to religious exemptions or
other exemptions under such State laws).
‘‘(d) ISSUANCE OF LIST AND SCHEDULES.— Not later
than 180 days after the date of the enactment of this section,
the Secretary shall establish the initial list required in sub-
section (a) and the schedule required in subsection (b).
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‘‘Part B—State Registry System for Immunization
Information
‘‘SEC. 2145. PURPOSE.
‘‘It is the purpose of this part to authorize the Sec-
retary, in consultation with State public health officials,
to establish State registry systems to monitor the immuni-
zation status of all children.
‘‘SEC. 2146. GRANTS FOR IMMUNIZATION REGISTRIES.
‘‘(a) IN GENERAL.—For the purpose described in sec-
tion 2145, the Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall make an
allotment each fiscal year for each State in an amount de-
termined in accordance with section 2151. 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 Sec-
retary an application in accordance with section 2150 on
behalf of the chief executive officer of such State.
‘‘(b) DESIGN OF STATE REGISTRIES.—To carry out
the purpose described in section 2145, a State registry es-
tablished under this part shall be designed to—
‘‘(1) provide accurate and up to date surveil-
lance data regarding immunization rates at the State
and local levels;
‘‘(2) assist in identifying localities with inad-
equate immunization rates to target for necessary re-
medial assistance;
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‘‘(3) assist in the effective administration and
management of immunization programs at State and
local levels by providing data to guide immunization
program efforts;
‘‘(4) assist the State in providing and receiving
information on the immunization status of children
who move across geographic boundaries that are cov-
ered by different State or local registries; and
‘‘(5) facilitate the linkage of vaccine dosage in-
formation to adverse events reported to the Centers for
Disease Control and Prevention under section 2125(b)
and disease outbreak patterns, for the purpose of mon-
itoring vaccine safety and effectiveness.
‘‘(c) ELIGIBLE USE OF FUNDS.—The Secretary may
make a grant under subsection (a) only if the State agrees
to expend the grant for the purpose of—
‘‘(1) collecting the data described in section 2147;
‘‘(2) operating registries to maintain the data
(and establishing such registries, in the case of a
State that is not operating such a registry);
‘‘(3) utilizing the data to monitor the extent to
which children have received immunizations in ac-
cordance with the schedule established under section
2141;
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‘‘(4) notifying parents, as appropriate, if chil-
dren have not received immunizations in accordance
with such schedule;
‘‘(5) coordinating and exchanging information
with other State registries to allow the monitoring of
the immunization status of children changing State of
residence; and
‘‘(6) such other activities as the Secretary may
authorize with respect to achieving the objectives es-
tablished by the Secretary for the year 2000 for the
immunization status of children in the United States.
‘‘(d) REQUIREMENT REGARDING STATE LAW.—
‘‘(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 accord-
ance with this part, 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 registry
in accordance with this part as may be author-
ized in the law and regulations of the State.
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‘‘(2) RULES OF CONSTRUCTION.—
‘‘(A) With respect to the agreements made
by a State under this part, other than para-
graph (1)(B), the Secretary may require compli-
ance with the agreements only to the extent con-
sistent with such paragraph.
‘‘(B) The provisions of this part do not au-
thorize the Secretary, as a condition of the re-
ceipt of a grant under subsection (a) by a State,
to prohibit the State from providing any parent,
upon the request of the parent, with an exemp-
tion from the requirements established by the
State pursuant to this part for the collection of
data regarding any child of the parent.
‘‘SEC. 2147. REGISTRY DATA.
‘‘(a) 
IN
GENERAL.—For 
purposes 
of 
section
2146(c)(1), the data described in this section are the data
described in subsection (b) and the data described in sub-
section (c).
‘‘(b) DATA REGARDING BIRTH OF CHILD.—With re-
spect to the birth of a child, the data described in this sub-
section is as follows:
‘‘(1) The name of each child born in the State
involved after the date of the implementation of the
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registry (in no event shall such date be later than Oc-
tober 1, 1996).
‘‘(2) Demographic data on the child.
‘‘(3) The name of one or both of the parents of
the child. If the child has been given up for adoption,
any information regarding the identity of the birth
parent or parents of the child may not be entered into
the registry, or if entered, shall be deleted.
‘‘(4) The address, as of the date of the birth of
the child, of each parent whose name is received in
the registry pursuant to paragraph (3).
‘‘(c) 
DATA
REGARDING
INDIVIDUAL
IMMUNIZA-
TIONS.—With respect to a child to whom a pediatric vac-
cine is administered in the State involved, the data de-
scribed in this subsection is as follows:
‘‘(1) The name, age, and address of the child.
‘‘(2) The date on which the vaccine was adminis-
tered to the child.
‘‘(3) The name and business address of the health
care provider that administered the vaccine.
‘‘(4) The address of the facility at which the vac-
cine was administered.
‘‘(5) The name and address of one or both par-
ents of the child as of the date on which the vaccine
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was administered, if such information is available to
the health care provider.
‘‘(6) The type of vaccine.
‘‘(7) The lot number or other information identi-
fying the particular manufacturing batch of the vac-
cine.
‘‘(8) The dose of vaccine that was administered.
‘‘(9) A notation of the presence of any adverse
medical reactions that the child experienced in rela-
tion to the vaccine and of which the health care pro-
vider is aware, in accordance with section 2125.
‘‘(10) The presence of contraindications noted by
the health care provider with respect to administra-
tion of the vaccine to the child.
‘‘(11) Such other data regarding immunizations
for the child, including identifying data, as the Sec-
retary, in consultation with State public health offi-
cials, may require consistent with applicable law (in-
cluding social security account numbers furnished
pursuant to section 205(c)(2)(E) of the Social Secu-
rity Act).
‘‘(d) LIMITATION.—The Secretary may not establish
information reporting requirements in addition to those de-
scribed in subsection (c) if such requirements are unduly
burdensome.
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‘‘(e) DATE CERTAIN FOR SUBMISSION TO REGISTRY.—
The Secretary may make a grant under section 2146 only
if the State involved agrees to ensure that, with respect to
a child—
‘‘(1) the data described in subsection (b) are sub-
mitted to the registry under such section as soon as
possible but in no event later than 8 weeks after the
date on which the child is born; and
‘‘(2) the data described in subsection (c) with re-
spect to a vaccine are submitted to such registry as
soon as possible but in no event later than 4 weeks
after the date on which the vaccine is administered to
the child.
‘‘(f) UNIFORMITY IN METHODOLOGIES.—The Secretary
shall, in consultation with State public health officials, es-
tablish standards regarding the methodologies used in estab-
lishing and operating registries under section 2146, and
may make a grant under such section only if the State
agrees to comply with the standards. The Secretary shall
provide maximum flexibility to the States while also retain-
ing a reasonable degree of uniformity among the States in
such methodologies for the purpose of ensuring the utility,
comparability, and exchange of the data maintained in
such registries.
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‘‘(g) COORDINATION AMONG STATES.—The Secretary
may make a grant under section 2146 to a State only if,
with respect to the operation of the registry of the State
under such section, the State agrees to transfer that infor-
mation contained in the State registry pursuant to section
2146 to other States upon the request of such States for such
information.
‘‘SEC. 2148. FEDERAL STANDARDS ON CONFIDENTIALITY.
‘‘(a) ESTABLISHMENT.—
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the States, shall by regulation establish
standards providing for maintaining the confidential-
ity of the identity of individuals with respect to
whom data are maintained in registries under section
2146. Such standards shall, with respect to a State,
provide that the State is to have in effect laws or reg-
ulations regarding such confidentiality, including ap-
propriate penalties for violation of the laws. The Sec-
retary may make a grant under such section only if
the State involved agrees to comply with the stand-
ards.
‘‘(2) USE OF DISCLOSURE.—
‘‘(A) No personally identifiable information
relating to a child or to the parent or guardian
of such child that is collected or maintained by
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the State registry may be used or disclosed by
any holder of such information except as per-
mitted for—
‘‘(i) the monitoring of a child’s immu-
nization status;
‘‘(ii) oversight, audit, and evaluation
of the immunization delivery and registry
systems;
‘‘(iii) activities relating to establishing
and maintaining a safe and effective supply
of recommended childhood vaccine;
‘‘(iv) processing of insurance claims for
payment for vaccine administration (but
only to the extent necessary for processing
claims); and
‘‘(v) administration of the National
Vaccine Injury Compensation Program
under subtitle 2.
‘‘(B) Information regarding immunizations
provided as described in subparagraph (A)(i)
may be used or disclosed only with the written
authorization of the individual to whom it refers
or to the parent with custody of such individual.
‘‘(b) USE OF SOCIAL SECURITY ACCOUNT NUMBERS.—
Any usage or disclosure of data in registries under section
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2146 that consists of social security account numbers and
related information which is otherwise permitted under this
part may be exercised only to the extent permitted under
section 205(c)(2)(E) of the Social Security Act. For pur-
poses of the preceding sentence, the term ‘related informa-
tion’ has the meaning given such term in clause (iv)(II)
of such section.
‘‘SEC. 2149. PROVIDER PARTICIPATION.
‘‘(a) IN GENERAL.—The State shall monitor and en-
force compliance by health care providers with the require-
ments of sections 2147 and 2148 and section 2155(b) for
all doses of pediatric vaccine administered in the State. The
State shall establish procedures satisfactory to the Secretary
for discontinuing the distribution of federally purchased or
State purchased vaccine for any health care provider who
fails to comply with the requirements of section 2147 and
for reinstating such vaccine supply to such provider upon
receiving from such provider—
‘‘(1) the reports necessary to make current and
complete the information that would have been fur-
nished to the State registry between the dates of the
provider’s termination and reinstatement; and
‘‘(2) satisfactory assurances regarding the pro-
vider’s future compliance.
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‘‘(b) REPORTS TO SECRETARY.—The Secretary may
make a grant under section 2146 only if the State involved
agrees to submit to the Secretary such reports as the Sec-
retary determines to be appropriate with respect to the ac-
tivities of the State under this part.
‘‘SEC. 2150. APPLICATION FOR GRANT.
‘‘An application by a State for a grant under section
2146 is in accordance with this section if the application—
‘‘(1) is submitted not later than the date speci-
fied by the Secretary;
‘‘(2) contains each agreement required in this
part;
‘‘(3) contains any information required in this
part to be submitted to the Secretary; and
‘‘(4) is in such form, is made in such manner,
and contains such agreements, assurances, and infor-
mation as the Secretary determines to be necessary to
carry out this part.
‘‘SEC. 2151. DETERMINATION OF AMOUNT OF ALLOTMENT.
‘‘The Secretary shall determine the amount of the allot-
ments required in section 2146 for States for a fiscal year
in accordance with a formula established by the Secretary
that allots the amounts appropriated under section 2152
for the fiscal year on the basis of the costs of the States
in establishing and operating registries under section 2146.
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‘‘SEC. 2152. AUTHORIZATION OF APPROPRIATIONS.
‘‘For the purpose of carrying out this part, other than
section 2153, there are authorized to be appropriated
$152,000,000 for fiscal year 1994, $125,000,000 for fiscal
year 1995, and $35,000,000 for each of the fiscal years 1996
through 1999.
‘‘SEC. 2153. NATIONAL IMMUNIZATION SURVEILLANCE PRO-
GRAM.
‘‘(a) IN GENERAL.—The Secretary shall establish a na-
tional immunization surveillance program for the purpose
of assessing the effects of the programs and activities pro-
vided for in this subtitle towards appropriately immuniz-
ing children and facilitating State immunization registries.
The national immunization surveillance program shall—
‘‘(1) provide technical assistance to States for the
development of vaccination registries and monitoring
systems; and
‘‘(2) receive aggregate epidemiologic data (that is
in a format that is not person specific) collected by
States as provided for in section 2147 at intervals de-
termined appropriate by the Secretary for the purpose
of—
‘‘(A) compiling accurate and up-to-date
surveillance data regarding immunization rates
at the State level in order to assess the progress
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made towards achieving nationally established
immunization goals;
‘‘(B) assisting in the effective administra-
tion and management of immunization pro-
grams at the State level by providing technical
assistance to guide immunization program ef-
forts at the request of the State;
‘‘(C) providing technical assistance to
States and localities to facilitate monitoring the
immunization status of children who move across
geographic boundaries that are covered by dif-
ferent State or local registries at the request of
such States or localities; and
‘‘(D) monitoring the safety and effectiveness
of vaccines by linking vaccine dosage informa-
tion with adverse events reporting under section
2125(b) and disease outbreak patterns.
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sub-
title shall be construed to authorize the release of person
specific information to the Secretary for the purpose of im-
munization surveillance.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There are
authorized to be appropriated such sums as may be nec-
essary to carry out this section in each of the fiscal years
1994 through 1999.
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‘‘SEC. 2154. REPORT.
‘‘Not later than January 1, 1995, and biennially there-
after, the Secretary shall prepare and submit to the appro-
priate committees of Congress a report concerning the plan-
ning, development, operation and effectiveness of the na-
tional immunization surveillance program and the State
immunization registries.
‘‘Part C—Distribution of Vaccines, Public Outreach
and Education
‘‘SEC. 2155. DISTRIBUTION OF VACCINES.
‘‘(a) IN GENERAL.—
‘‘(1) HEALTH CARE PROVIDERS.—The Secretary
shall provide for the distribution, without charge, of
recommended pediatric vaccines (in accordance with
section 2141) purchased by the Secretary to health
care providers who serve children and who—
‘‘(A) are members of a uniformed service, or
are officers or employees of the United States;
‘‘(B) are health centers (as defined in sec-
tion 2162(2)); or
‘‘(C) provide services under section 503 of
the Indian Health Care Improvement Act or
pursuant to a contract under section 102 of the
Indian Self Determination Act.
‘‘(2) STATES.—The Secretary shall provide for
the distribution, without charge, of those rec-
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ommended pediatric vaccines that are purchased by
the Secretary and provided to States for the purposes
of immunizing medicaid-eligible children, and addi-
tional vaccines that may be purchased by the Sec-
retary for children within those States.
‘‘(b) DUTIES OF HEALTH CARE PROVIDERS.—
‘‘(1) FREE PROVISION TO CHILDREN.—A health
care provider or entity receiving vaccine under this
section may use such vaccine only for administration
to children and may not impose a charge for such
vaccine. A provider or health care entity may impose
a fee that reflects actual regional costs as determined
by the Secretary for the administration of such vac-
cine, except that a provider may not deny a child a
vaccination due to the inability of the child’s parent
to pay an administration fee.
‘‘(2) REPORTING REQUIREMENTS.—A health care
provider receiving vaccine under this section shall re-
port the information required under section 2147 to
the applicable State registry operated pursuant to a
grant under section 2146 if such State registry exists.
The provider shall additionally report to such State
registry any occurrence reported to the Secretary pur-
suant to section 2125(b). The provider shall also pro-
vide regular and periodic estimates to the State of the
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provider’s future dosage needs for recommended child-
hood vaccines distributed under this section. All re-
ports shall be made with such frequency and in such
detail as the Secretary, in consultation with State
public health officials, may prescribe.
‘‘SEC. 2156. IMPROVED IMMUNIZATION DELIVERY, OUT-
REACH AND EDUCATION.
‘‘(a) FEDERAL
EFFORTS.—The Secretary, acting
through the Centers for Disease Control and Prevention and
in conjunction with State health officials and other appro-
priate public and private organizations, shall conduct the
following activities to improve Federal, State and local vac-
cine delivery systems and immunization outreach and edu-
cation efforts:
‘‘(1) NATIONAL PUBLIC AWARENESS CAMPAIGN.—
‘‘(A) IN GENERAL.—The Secretary, in con-
junction with State health officials and other ap-
propriate public and private organizations, shall
develop and implement a National Immuniza-
tion Public Awareness Campaign to assist fami-
lies (through bilingual means if necessary) of
children under the age of 2 years, and expectant
parents, in obtaining knowledge concerning the
importance of having their children immunized
and in identifying the vaccines, schedules for im-
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munization, and vaccine provider locations, ap-
propriate with respect to their children.
‘‘(B) IMPLEMENTATION.—In implementing
the Campaign under subparagraph (A), the Sec-
retary shall ensure that—
‘‘(i) new and innovative methods are
developed and utilized to publicly advertise
the need to have children immunized in a
timely manner;
‘‘(ii) print, radio and television media
are utilized to convey immunization infor-
mation to the public; and
‘‘(iii) with respect to immunization in-
formation, efforts are made to target preg-
nant women and the parents of children
under the age of 2.
‘‘(2) INTERAGENCY
COMMITTEE
ON
IMMUNIZA-
TION.—The Secretary, in conjunction with the Sec-
retary of Agriculture, the Secretary of Housing and
Urban Development, and the Secretary of Education,
shall carry out activities through the Interagency
Committee on Immunization to incorporate immuni-
zation status assessments and referral services as an
integral part of the process by which individuals
apply for assistance under—
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‘‘(A) the food stamp program under the
Food Stamp Act of 1977;
‘‘(B) section 17 of the Child Nutrition Act
of 1966;
‘‘(C) the Head Start Act;
‘‘(D) part A of title IV of the Social Secu-
rity Act;
‘‘(E) title XIX of the Social Security Act;
‘‘(F) any of the housing assistance laws of
the United States; and
‘‘(G) other programs determined appro-
priate by any of the Secretaries described in this
paragraph.
‘‘(3) EXPANDED
OPPORTUNITY
FOR
NATIONAL
SERVICE.—The Secretary, in conjunction with the
Commission on National and Community Service
and other independent agencies, is encouraged to de-
velop opportunities for participants in national and
community service programs to contribute to local
initiatives for the improvement of immunization serv-
ices, including public outreach and education efforts.
‘‘(b) GRANTS TO STATES.—
‘‘(1) IN GENERAL.—
‘‘(A) The Secretary may award grants to
States to enable such State to develop, revise and
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implement immunization improvement plans as
described in paragraph (2).
‘‘(B) To be eligible to receive a grant under
subparagraph (A), a State shall prepare and
submit to the Secretary an application at such
time, in such manner, and containing such in-
formation as the Secretary may require.
‘‘(2) DESIGN.—A State immunization improve-
ment plan shall be designed to improve immunization
delivery, outreach, education and coordination within
the State. Such plan shall provide for the creation
of—
‘‘(A) a vaccine provider education cam-
paign and the distribution of any other mate-
rials determined to be appropriate by State
health officials—
‘‘(i) to enable such providers to make
the best use of vaccination opportunities;
and
‘‘(ii) to educate such providers concern-
ing their obligation to report immunization
information with respect to their patients to
State registries;
‘‘(B) expanded capacity for the delivery of
immunizations through—
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section (a)(1)(E) shall be considered the date that the indi-
vidual first enters on active duty.’’.
SEC. 13004. PERMANENT EXTENSION OF PROCEDURES AP-
PLICABLE TO LIQUIDATION SALES UPON DE-
FAULT OF HOME LOANS GUARANTEED BY
THE DEPARTMENT OF VETERANS AFFAIRS.
(a) INCLUSION OF RESALE LOSSES IN NET-VALUE
CALCULATION.—Paragraph (1)(C) of section 3732(c) of title
38, United States Code, is amended by inserting ‘‘(includ-
ing losses sustained on the resale of the property)’’ after
‘‘resale’’.
(b) PERMANENT EXTENSION OF AUTHORITY.—Para-
graph (11) of such section is repealed.
SEC. 13005. INCREASE IN CERTAIN LOAN FEES.
(a) FEE INCREASE.—Paragraph (2) of section 3729(a)
of title 38, United States Code, is amended—
(1) in the matter above subparagraph (A), by
striking out ‘‘1.25 percent’’ and inserting in lieu
thereof ‘‘2 percent’’;
(2) in subparagraph (A), by striking out ‘‘one
percent’’ and inserting in lieu thereof ‘‘1 percent’’;
(3) in subparagraph (B), by striking out ‘‘0.75
percent’’ and inserting in lieu thereof ‘‘1.50 percent’’;