text: SECTION 1. SHORT TITLE
  
      This Act may be cited as the ``Immunization Now Act of 1993''.
  
  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 vaccinations, through a 
          program of Federal and local cooperation, are rising at an 
          alarming rate.
              (2) The incidence of measles increased 336 percent 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 measles died in a 
          California hospital after $800,000 was spent in an effort to 
          treat the child's measles complications.
              (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 highest since 1971. Measles caused 
          more than sixty deaths in 1990, the largest annual number of 
          reported 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 properly immunized.
              (9) Preschool children in other Western, industrialized 
          nations have significantly higher immunization 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 immunization 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 
          monitoring the distribution of vaccines through public and 
          private providers.
  
  SEC. 3. ESTABLISHMENT OF ENTITLEMENT PROGRAM REGARDING 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 residence, 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 immunization specified under section 
          7, is entitled to receive without charge, in accordance with 
          this Act, immunizations against vaccine-preventable diseases.
      (b) Implementation Through System of Vouchers.--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 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 professional 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 
  immunizations 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 otherwise receives Federal 
  payments or Federal financial assistance 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--
              (1) bear a seal for purposes of indicating that the voucher 
          has been issued for purposes of the entitlement 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 immunizations are 
          needed and why.
      (b) Eligibility.--A voucher shall not be issued under this section 
  with respect to an infant unless the infant 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 infant, obtain the 
          signature of a parent as to the accuracy of the information 
          supplied, and forward the application to the Secretary.
              (2) Community health centers.--The Secretary shall provide 
          for a process by which a community 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 application 
          for the voucher on behalf of the infant, obtain the signature 
          of a parent as to the accuracy of the information supplied, and 
          forward the application 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.
  
  SEC. 6. REIMBURSEMENT FOR PROVISION OF IMMUNIZATIONS.
  
      (a) In General.--In the case of a professional or provider 
  providing immunizations pursuant to the presentation of vouchers issued 
  under section 5, the Secretary shall make a single payment to the 
  professional or provider each quarter of the fiscal year as 
  reimbursement for the costs of immunizations provided in the preceding 
  quarter 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 necessary to carry out paragraph 
          (2).
      (b) Amount of Reimbursement.--The Secretary shall establish amounts 
  of reimbursement that will be provided for types of immunizations 
  specified under section 7. Each such reimbursement shall include 
  reimbursement both for the vaccine and for the professional service of 
  providing the immunization.
  
  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 Program.--The Secretary 
  shall carry out activities--
              (1) to inform the public of the entitlement established in 
          section 3(a), including the manner in which an application 
          under section 5(c) may be obtained; 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 regulation 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.
      (d) Definitions.--For purposes of this Act:
              (1) The term ``Secretary'' means the Secretary of Health 
          and Human Services.
              (2) The term ``parent'' means any parent, step-parent, 
          grandparent, or duly appointed guardian.
              (3) The term ``United States'' includes Puerto Rico, Guam, 
          the Virgin Islands, American Samoa, and the Northern Mariana 
          Islands.
      (e) Authorization of Appropriations.--For the purpose of carrying 
  out this Act, there are authorized to be appropriated such sums as may 
  be necessary for fiscal year 1994 and each subsequent fiscal year.
  
  SEC. 9. NATIONAL IMMUNIZATION REGISTRY SYSTEM.
  
      (a) In General.--The Secretary, acting through the Director of the 
  Centers for Disease Control, shall establish a national immunization 
  registry system (in this section referred to as the ``registry''). The 
  purpose of the system is to provide for national surveillance of 
  childhood immunization status through age six.
      (b) 2-Year Research and Demonstration Phase.--
              (1) In general.--The Secretary shall make grants to public 
          and nonprofit private entities to conduct research and 
          demonstration projects aimed at identifying mechanisms and 
          structures to develop the registry, including--
                      (A) projects to test methods for collecting birth 
                  certificate and immunization information in a large 
                  central data system;
                      (B) projects to evaluate the capacity of public 
                  health agencies to provide birth certificate and 
                  immunization information in a cost-effective and 
                  efficient manner;
                      (C) projects to assess techniques for tracking 
                  children in mobile populations across geographic areas;
                      (D) projects to explore the feasibility of a 
                  registry which requires the participation by private 
                  providers of immunization services; and
                      (E) projects to demonstrate the efficient use of 
                  registry information in providing immunization status.
              (2) Authorization of appropriations.--There are authorized 
          to be appropriated to carry out this subsection $7,000,000 in 
          fiscal year 1994 and $12,000,000 in fiscal year 1995.
      (c) Enhancement of Information Systems.--
              (1) In general.--The Secretary, based on projects conducted 
          under subsection (b), shall expand the registry to cover the 
          entire Nation. In doing this, the Secretary shall--
                      (A) develop the capacity to link and process all 
                  birth certificate records through a central registry;
                      (B) enhance State and local technical capacity to 
                  provide information through use of resources (such as 
                  new computer hardware and software or technical 
                  assistance);
                      (C) promote participation by private providers who 
                  administer childhood vaccines; and
                      (D) develop mechanisms to collect information on 
                  all doses of vaccine administered to preschool age 
                  children in both the public and private sectors.
              (2) Authorization of appropriations.--There are authorized 
          to be appropriated to carry out this subsection $50,000,000 in 
          fiscal year 1996.
      (d) Full Implementation.--
              (1) In general.--Beginning with fiscal year 1997, the 
          Secretary shall provide for full implementation of the 
          registry. In implementing such registry, the Secretary shall 
          provide that--
                      (A) all infants born in the United States are 
                  registered through birth certificate information that 
                  relates to immunization tracking and vaccine 
                  administration;
                      (B) information on doses of vaccines administered 
                  to all children under six years of age is collected;
                      (C) appropriate notices are provided to parents 
                  regarding overdue vaccinations; and
                      (D) appropriate records are provided to parents for 
                  their children entering schools or day care programs.
          The Secretary shall include information on the operation of the 
          registry with annual reports submitted to Congress on the 
          operation of the vaccine system provided under the other 
          provisions of this Act.
              (2) Authorization of appropriations.--There are authorized 
          to be appropriated to carry out this subsection $50,000,000 in 
          each fiscal year, beginning with fiscal year 1997.
target: Immunization Now Act of 1993 - Entitles each infant in the United States under two years old who does not have other health insurance and who meets other requirements to receive immunizations without charge. 
  Requires any licensed health care professional to provide immunizations in exchange for vouchers issued through hospitals or community health centers or on direct application by the parent, with quarterly reimbursements to health care providers in amounts set by the Secretary of Health and Human Services. 
  Directs the Secretary to carry out activities to inform the public and health care providers regarding the program. 
  Authorizes appropriations. 
  Establishes a national immunization registry system to provide for national surveillance of childhood immunization status through age six. 
  Mandates grants for research and demonstration projects to identify mechanisms and structures to develop the registry.  Requires certain measures to expand the registry from the projects to cover the entire Nation.  Requires full implementation of the registry by 1997.  Authorizes appropriations.
feat_title: Immunization Now Act of 1993