I
103D CONGRESS
1ST SESSION
H. R. 940
To establish an entitlement program regarding the immunization of infants
against vaccine-preventable diseases.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 17, 1993
Mrs. BYRNE (for herself, Mr. EVANS, Mr. RAHALL, Mr. JEFFERSON, Mr.
WHEAT, Mrs. MORELLA, Mr. PETERSON of Minnesota, and Mr. BROWN
of California) introduced the following bill; which was referred to the
Committee on Energy and Commerce
MAY 13, 1993
Additional sponsors: Mr. BERMAN, Mr. MORAN, Ms. NORTON, Mr. PAYNE of
Virginia, Mr. GONZALEZ, Mr. VALENTINE, Mr. WATT, Mr. BLACKWELL,
Mrs. MEEK, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. RANGEL, Mr.
KILDEE, Mr. UNDERWOOD, Mr. MARTINEZ, Mr. SMITH of New Jersey,
Mr. HINCHEY, Mr. TOWNS, Mr. BOUCHER, Mr. PARKER, Mr. BONIOR,
Mr. KOPETSKI, Ms. FURSE, Ms. DELAURO, Mr. HASTINGS, and Mr.
WYNN
A BILL
To establish an entitlement program regarding the
immunization of infants against vaccine-preventable diseases.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE
This Act may be cited as the ‘‘Immunization Now
Act of 1993’’.
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SEC. 2. FINDINGS.
The Congress finds, with respect to immunizations
against vaccine-preventable diseases, the following:
(1) Childhood illnesses that can be prevented by
timely application of commonly available vaccina-
tions, through a program of Federal and local co-
operation, are rising at an alarming rate.
(2) The incidence of measles increased 336 per-
cent in 1989, increasing to eighteen thousand one
hundred ninety three cases from three thousand
three hundred ninety six in 1988.
(3) The cost of appropriate immunizations is
minimal. One estimate places that cost at $130 per
child.
(4) The typical price per dose of a measles,
mumps, rubella vaccine is approximately $24 to the
practitioner and the average cost of hospitalization
for a child with measles is approximately $5,000–
$6,000.
(5) A child who was not immunized from mea-
sles died in a California hospital after $800,000 was
spent in an effort to treat the child’s measles com-
plications.
(6) In November 1990 the measles rate for the
year had already surpassed the rates of other full
years since 1978 and deaths from measles are the
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highest since 1971. Measles caused more than sixty
deaths in 1990, the largest annual number of re-
ported cases due to measles in almost two decades.
(7) Fifty four percent of measles cases occur
among vaccine-eligible infants and preschool children
who have not been vaccinated.
(8) One-third to one-half of children up to age
two who live in poor, inner-city areas are not prop-
erly immunized.
(9) Preschool children in other Western, indus-
trialized nations have significantly higher immuniza-
tion rates than United States children of the same
age group.
(10) There are seven to nine million uninsured
children in the United States.
(11) While programs to immunize school-aged
children have been very successful, preschoolers as a
group now make up 47 percent of measles cases, up
from 25 percent in 1988.
(12) Computerized systems of tracking immuni-
zation status and utilization from birth have been
operationalized in several countries, including Great
Britain and the Netherlands. Such systems can aid
in surveillance of immunization status, provision of
reminders to parents when vaccines are due, and
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monitoring the distribution of vaccines through pub-
lic and private providers.
SEC. 3. ESTABLISHMENT OF ENTITLEMENT PROGRAM RE-
GARDING 
IMMUNIZATION 
OF 
INFANTS
AGAINST VACCINE-PREVENTABLE DISEASES.
(a) IN
GENERAL.—Each infant in the United
States—
(1) who has not reached the infant’s second
birthday,
(2) who is a citizen or national of the United
States, an alien lawfully admitted for permanent res-
idence, or other alien permanently in the United
States under color of law, and
(3) who is not entitled under a health insurance
policy or other health benefit plan to receive (or have
any payment made for the expenses of) any immuni-
zation specified under section 7, is entitled to receive
without charge, in accordance with this Act, immu-
nizations against vaccine-preventable diseases.
(b) IMPLEMENTATION THROUGH SYSTEM OF VOUCH-
ERS.—The entitlement established in subsection (a) shall
be implemented through the use of vouchers issued under
section 5. Such vouchers represent the obligation of the
Federal Government to pay, subject to section 6, the costs
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of providing the immunizations specified under section 7
for the infants for whom the vouchers are issued.
SEC. 4. OBLIGATION TO PROVIDE IMMUNIZATIONS.
(a) IN GENERAL.—Any licensed health care profes-
sional or provider who or which is authorized by law to
provide immunizations specified under section 7 and who
or which is engaged in the public or private practice of
pediatrics or family medicine shall provide the immuniza-
tions specified under section 7 that are appropriate for
the age of the infant involved if a voucher issued under
section 5 for the infant is presented to the professional
or provider.
(b) APPLICABILITY.—The requirement established in
subsection (a) shall apply to a professional or provider
without regard to whether the professional or provider
provides health services as a participant in the program
established in title XVIII of the Social Security Act or
the program established in title XIX of such Act, and
without regard to whether the professional or provider oth-
erwise receives Federal payments or Federal financial as-
sistance for any purpose.
SEC. 5. ISSUANCE OF VOUCHERS.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall provide for the issuance of vouchers
for purposes of section 3(b). Each such voucher shall—
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(1) bear a seal for purposes of indicating that
the voucher has been issued for purposes of the enti-
tlement established in section 3(a);
(2) contain the name of the infant for whom
the voucher is issued and the name and address of
not less than one parent of the infant;
(3) in summary form state the principal legal
rights and obligations arising with respect to the
voucher; and
(4) contain a simple explanation of what immu-
nizations are needed and why.
(b) ELIGIBILITY.—A voucher shall not be issued
under this section with respect to an infant unless the in-
fant is described in section 3(a) and an application for
the voucher has been made and signed by a parent of the
infant.
(c) APPLICATION FOR ISSUANCE.—
(1) HOSPITALS.—The Secretary shall provide
for a process by which a hospital, in which an infant
eligible for a voucher is born, issues the voucher to
the parent of the infant at the time of birth if the
hospital determines, based on information supplied
by the parent, that the infant is described in section
3(a). Under the process, the hospital shall complete
the application for the voucher on behalf of the in-
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fant, obtain the signature of a parent as to the accu-
racy of the information supplied, and forward the
application to the Secretary.
(2) COMMUNITY HEALTH CENTERS.—The Sec-
retary shall provide for a process by which a commu-
nity health center issues a voucher to the parent of
an infant if—
(A) based upon information supplied by
the parent to the center, the center determines
that the infant is described in section 3(a) and
a voucher has not been previously issued with
respect to the infant, and
(B) the infant is a patient at the center.
Under the process, the center shall complete the ap-
plication for the voucher on behalf of the infant, ob-
tain the signature of a parent as to the accuracy of
the information supplied, and forward the applica-
tion to the Secretary.
(3) SECRETARY.—In cases not described in
paragraph (1) or (2), the Secretary shall provide for
direct issuance of a voucher to a parent of an infant
described in section 3(a) upon application by the
parent.
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SEC. 6. REIMBURSEMENT FOR PROVISION OF IMMUNIZA-
TIONS.
(a) IN GENERAL.—In the case of a professional or
provider providing immunizations pursuant to the presen-
tation of vouchers issued under section 5, the Secretary
shall make a single payment to the professional or pro-
vider each quarter of the fiscal year as reimbursement for
the costs of immunizations provided in the preceding quar-
ter if—
(1) the professional or provider submits to the
Secretary the vouchers involved;
(2) the Secretary determines that the vouchers
were obtained, and the immunizations involved were
provided, in accordance with this Act; and
(3) the vouchers are submitted to the Secretary
in accordance with such procedures and meet such
requirements as the Secretary determines to be nec-
essary to carry out paragraph (2).
(b) AMOUNT OF REIMBURSEMENT.—The Secretary
shall establish amounts of reimbursement that will be pro-
vided for types of immunizations specified under section
7. Each such reimbursement shall include reimbursement
both for the vaccine and for the professional service of pro-
viding the immunization.
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SEC. 7. SPECIFICATION OF IMMUNIZATIONS.
The immunizations specified in this section are such
immunizations as may be established by the Secretary
based on the recommendations of the Advisory Committee
on Immunization Practice of the Centers for Disease
Control.
SEC. 8. GENERAL PROVISIONS.
(a) PROVISION OF INFORMATION REGARDING PRO-
GRAM.—The Secretary shall carry out activities—
(1) to inform the public of the entitlement es-
tablished in section 3(a), including the manner in
which an application under section 5(c) may be ob-
tained; and
(2) to inform professionals and providers of
their legal rights and obligations regarding vouchers
issued under section 5.
(b) REGULATIONS.—The Secretary shall by regula-
tion issue criteria for carrying out sections 3 through 7.
For purposes of the preceding sentence, the final rule shall
be issued not later than ninety days after the date of the
enactment of this Act.
(c) APPLICABILITY.—The entitlement established in
section 3(a) shall apply upon the expiration of the forty-
five day period beginning on the date on which the final
rule referred to in subsection (b) is required under such
subsection to be issued.