[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2432 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 2432

 To provide financial incentives to encourage parents receiving public 
   assistance to have their children appropriately immunized against 
                                disease.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 16, 1993

   Mr. Camp (for himself, Mr. Klug, Mr. Greenwood, Mr. Emerson, Mr. 
Gunderson, Mr. Santorum, Mr. Gingrich, and Ms. Molinari) introduced the 
following bill; which was referred jointly to the Committees on Energy 
             and Commerce, Ways and Means, and Agriculture

_______________________________________________________________________

                                 A BILL


 
 To provide financial incentives to encourage parents receiving public 
   assistance to have their children appropriately immunized against 
                                disease.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Responsible Parent Immunization Plan 
Act of 1993''.

            TITLE I--IMMUNIZATION OF CHILDREN RECEIVING AFDC

SEC. 101. IMMUNIZATION OF CHILDREN RECEIVING AFDC.

    (a) State Plan Requirements.--Section 402(a) of the Social Security 
Act (42 U.S.C. 602(a)) is amended--
            (1) by striking ``and'' at the end of paragraph (44);
            (2) by striking the period at the end of paragraph (45) and 
        inserting ``; and''; and
            (3) by inserting after paragraph (45) the following:
            ``(46)(A) require any parent or caretaker relative applying 
        for or receiving aid under the State plan to ensure that each 
        dependent child of the parent or such relative has received 
        immunizations as recommended for the same kind of child under 
        section 317A(j) of the Public Health Service Act;
            ``(B) provide for monitoring compliance with subparagraph 
        (A); and
            ``(C) at the option of the State, provide that the aid 
        otherwise payable to any family under the State plan will be--
                    ``(i) if the parent or caretaker relative of the 
                family complies with subparagraph (A), increased by not 
                more than $75 per month for not more than 3 months;
                    ``(ii) if the parent or caretaker relative of the 
                family fails to comply with subparagraph (A), decreased 
                by not more than $75 per month until the first month of 
                such compliance or for such number of months as the 
                State may prescribe, whichever ends earlier; or
                    ``(iii) increased in accordance with clause (i) and 
                decreased in accordance with clause (ii).''.
    (b) No Reimbursement of Certain State Expenses.--Section 403(a)(3) 
of such Act (42 U.S.C. 603(a)(3)) is amended by inserting ``, or in 
connection with carrying out subparagraph (A), or (if the State has not 
exhausted any grant received under section 317B of the Public Health 
Service Act) individual monitoring under subparagraph (B), of section 
402(a)(46)'' before the semicolon.
    (c) Effective Date.--The amendments made by this section shall take 
effect on October 1, 1994.

   TITLE II--IMMUNIZATION OF CHILDREN RECEIVING FOOD STAMPS BENEFITS

SEC. 201. AMENDMENT TO THE FOOD STAMP ACT OF 1977.

    (a) Amendment.--Section 8 of the Food Stamp Act of 1977 (7 U.S.C. 
2017) is amended by adding at the end the following:
    ``(f)(1) At the option of the State agency, the value of allotments 
determined under this section without regard to this subsection for all 
households that include a child less that 5 years of age may be--
            ``(A) reduced by not more than $75 per month--
                    ``(i) for each month until the first month 
                beginning after all such children in the particular 
                household have received the age-appropriate 
                immunizations recommended under section 317A(j) of the 
                Public Health Service Act; or
                    ``(ii) for such number of months as the State 
                agency may prescribe;
        whichever period is shorter, if 1 or more of such children have 
        not received such immunizations;
            ``(B) increased by not more than $75 per month for not more 
        than 3 months if all of such children have received such 
        immunizations; or
            ``(C) reduced in accordance with subparagraph (A) and 
        increased in accordance with subparagraph (B).
    ``(2) The State agency, in consultation with the Secretary, shall 
develop procedures to determine whether household members are children 
less than 5 years of age who have received such immunizations. Such 
procedures may not require any household member to appear at any office 
operated by the State agency.
    ``(3) If insufficient funds are made available under section 
317B(l) of the Public Health Service Act to carry out 317B of such Act 
with respect to household members who are children less than 5 years of 
age, then from funds appropriated to carry out this Act the Secretary 
shall make available to the Secretary of Health and Human Services such 
funds as may be necessary to pay 50 percent of such costs.''.
    (b) Effective Date and Application of Amendment.--
            (1) Effective date.--Except as provided in paragraph (2), 
        the amendment made by subsection (a) shall take effect on 
        October 1, 1994.
            (2) Application of amendment.--The amendment made by 
        subsection (a) shall not apply with respect to certification 
        periods beginning before October 1, 1994.

           TITLE III--CURRENT PROGRAM REGARDING IMMUNIZATIONS

SEC. 301. EXTENSION OF CURRENT PROGRAM OF DISCRETIONARY STATE GRANTS.

    Section 317(j)(1) of the Public Health Service Act (42 U.S.C. 
247b(j)(1)) is amended in the first sentence--
            (1) by striking ``and'' after ``1991,''; and
            (2) by striking ``1995'' and inserting ``1993''; and
            (3) by inserting before the period the following: ``, and 
        $290,000,000 for each of the fiscal years 1994 through 1996''.

             TITLE IV--IMMUNIZATIONS FOR UNINSURED CHILDREN

SEC. 401. ESTABLISHMENT OF PROGRAM OF FORMULA GRANTS TO STATES.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
as amended by sections 303, 306, and 308 of Public Law 102-531, is 
amended--
            (1) by redesignating sections 317A through 317D as sections 
        317D through 317G, respectively; and
            (2) by inserting after section 317 the following section:

   ``formula grants to states regarding immunizations for uninsured 
                                children

    ``Sec. 317A. (a) In General.--For the purpose described in 
subsection (b), 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 determined in accordance 
with subsection (i). 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 Secretary an application in accordance with subsection 
(g).
    ``(b) Purpose of Grants.--The Secretary may make a grant under 
subsection (a) only if the State involved agrees that the grant will be 
expended only for the purpose of--
            ``(1) purchasing pediatric vaccines; and
            ``(2) utilizing the vaccines to provide immunizations to 
        uninsured children without charge for the cost of the vaccine.
    ``(c) Uninsured Children.--For purposes of this section, the term 
`uninsured child' means an individual 18 years of age or younger who is 
uninsured with respect to health insurance policies or plans (including 
group health plans or prepaid health plans).
    ``(d) Arrangements With Providers.--
            ``(1) In general.--The Secretary may make a grant under 
        subsection (a) only if the State involved agrees that the State 
        will enter into arrangements with public and private health 
        care providers to carry out the purpose described in subsection 
        (b)(2).
            ``(2) Request for arrangements.--The Secretary may make a 
        grant under subsection (a) only if the State involved agrees 
        that pediatric vaccines obtained pursuant to such subsection 
        will not be distributed to a health care provider unless--
                    ``(A) the provider submits to the State a written 
                request to participate in the program established by 
                the State pursuant to such subsection;
                    ``(B) the request is in such form and is made in 
                such manner as the Secretary may require; and
                    ``(C) the provider makes the agreements described 
                in this subsection.
            ``(3) Determinations regarding children.--
                    ``(A) In general.--An agreement for a health care 
                provider under paragraph (2) is that the provider--
                            ``(i) before administering a pediatric 
                        vaccine to a child, will ask a parent of the 
                        child such questions as are necessary to 
                        determine whether the child is an uninsured 
                        child;
                            ``(ii) will, for a period of time specified 
                        by the Secretary, maintain records of responses 
                        made to the questions; and
                            ``(iii) will, upon request, make such 
                        records available to the State involved and to 
                        the Secretary, subject to subparagraph (B).
                    ``(B) Restriction on use of information.--Records 
                provided to a State or to the Secretary under 
                subparagraph (A)(iii) may be used only for purposes of 
                audit of the program carried out pursuant to subsection 
                (a) by the State.
            ``(4) Charges for vaccines.--
                    ``(A) Vaccines per se.--An agreement for a health 
                care provider under paragraph (1) is that, in 
                administering a pediatric vaccine to an uninsured child 
                pursuant to subsection (a), the provider will not 
                impose a charge for the cost of the vaccine.
                    ``(B) Administration of vaccines.--With respect to 
                compliance with an agreement under subparagraph (A), a 
                health care provider may impose a charge for the 
                administration of a pediatric vaccine pursuant to 
                subsection (a), subject to an agreement by the provider 
                that the provider will not impose such charge with 
                respect to an uninsured child if a parent of the child 
                certifies to the provider that the parent is unable to 
                pay the charge.
            ``(5) Rules of construction.--
                    ``(A) Extent of participation.--With respect to a 
                health care provider that enters into an arrangement 
                under paragraph (2), this subsection may not be 
                construed as requiring that the provider administer a 
                pediatric vaccine pursuant to subsection (a) to each 
                uninsured child for whom an immunization with the 
                vaccine is sought from the provider.
                    ``(B) Verification of information.--With respect to 
                compliance with agreements under paragraphs (3) and 
                (4), such agreements may not be construed as requiring 
                a health care provider to verify independently the 
                information provided to the provider by a parent 
                pursuant to such paragraphs.
    ``(e) Federal Criteria Regarding Vaccines.--
            ``(1) Issuance of criteria.--Not later than 180 days after 
        the date of the enactment of this section, the Secretary shall, 
        through publication in the Federal Register, establish criteria 
        for the purchase and delivery of pediatric vaccines pursuant to 
        subsection (a).
            ``(2) Vaccines in lieu of grant funds.-- In establishing 
        criteria under paragraph (1), the Secretary may provide that 
        part or all of a grant under subsection (a) to a State will be 
        in the form of pediatric vaccines or related services rather 
        than cash.
            ``(3) Compliance by states.--The Secretary may make a grant 
        under subsection (a) only if the State involved agrees to 
        maintain compliance with the criteria established under 
        paragraph (1).
    ``(f) Coordination by States of Immunization Activities.--The 
Secretary may make a grant under subsection (a) only if the State 
involved agrees to ensure that all activities carried out by the State 
with respect to the immunization of children are coordinated by a 
single agency of the State, including coordination regarding--
            ``(1) activities carried out under this section;
            ``(2) activities under section 317, section 317B, and part 
        A of title XIX; and
            ``(3) activities under part A of title IV of the Social 
        Security Act and under the Food Stamp Act of 1977.
    ``(g) Application for Grant.--An application by a State for a grant 
under subsection (a) is in accordance with this subsection if the 
application--
            ``(1) is submitted not later than the date specified by the 
        Secretary;
            ``(2) contains each agreement required in this section; and
            ``(3) is in such form, is made in such manner, and contains 
        such agreements, assurances, and information as the Secretary 
        determines to be necessary to carry out this section.
    ``(h) Contracts With Manufacturers of Vaccines.--
            ``(1) In general.--Subject to the provisions of this 
        subsection, the Secretary shall periodically issue requests for 
        proposals from manufacturers of pediatric vaccines for the 
        purpose of maintaining contracts under which the Secretary, for 
        purposes of grants under subsection (a), provides for the 
        purchase and delivery of pediatric vaccines.
            ``(2) Charges for shipping and handling.--The Secretary may 
        enter into a contract under paragraph (1) only if the 
        manufacturer involved agrees that the manufacturer will provide 
        for delivering pediatric vaccines on behalf of the States in 
        accordance with the criteria established by the Secretary under 
        subsection (e), and will not impose any charges for the costs 
        of such delivery (except to the extent such costs are provided 
        for in the price of the vaccines under the contract).
            ``(3) Quantity of vaccines.--The Secretary may enter into a 
        contract under paragraph (1) only if the contract provides for 
        maintaining a supply of vaccines sufficient to meet the 
        obligation of the Federal Government under subsection (a) for a 
        period of six months. In carrying out the preceding sentence, 
        the Secretary shall consider the potential for outbreaks of the 
        diseases with respect to which the vaccines have been 
        developed.
            ``(4) Authority of secretary regarding contracts.--In 
        carrying out paragraph (1), the Secretary, to the extent 
        determined by the Secretary to be appropriate, may enter into 
        contracts described in such paragraph, may decline to enter 
        into such contracts, and with the consent of the manufacturers 
        involved, may modify such agreements and may extend such 
        agreements.
            ``(5) Duration of contracts.--A contract entered into by 
        the Secretary subsection under paragraph (1) is effective for 
        such period as the Secretary and the manufacturer involved may 
        agree in the contract.
            ``(6) Rule of construction regarding multiple suppliers.--
        With respect to a pediatric vaccine, this subsection may not be 
        construed as prohibiting the Secretary from entering into 
        contracts under paragraph (1) with more than one manufacturer 
        of the vaccine, or from having in effect different prices under 
        each of such contracts.
    ``(i) Determination of Amount of Allotment.--The allotment under 
subsection (a) for a State for a fiscal year shall be an amount equal 
to the product of--
            ``(1) an amount equal to the amount appropriated under 
        subsection (l) for grants under subsection (a) for the fiscal 
        year; and
            ``(2) the percentage equal to the quotient of--
                    ``(A) an amount equal to the number of children in 
                the State who are 5 years of age or younger; divided by
                    ``(B) an amount equal to the number of children in 
                the United States who are 5 years of age or younger (as 
                determined by the sum of the respective amounts 
                determined under subparagraph (A)).
    ``(j) List of Pediatric Vaccines; Schedule for Administration.--
            ``(1) Recommended pediatric vaccines.--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 contraindications for 
        particular medical categories of children as the Secretary may 
        establish under paragraph (2)(A)(iv). The Secretary shall 
        periodically review the list, and shall revise the list as 
        appropriate.
            ``(2) Recommended schedule for administration.--
                    ``(A) In general.--Subject to subparagraph (B), in 
                the case of a pediatric vaccine, the Secretary shall 
                establish (and periodically review and as appropriate 
                revise) a schedule of nonbinding recommendations for 
                the following:
                            ``(i) The number of immunizations with the 
                        vaccine that children should receive.
                            ``(ii) The ages at which children should 
                        receive the immunizations.
                            ``(iii) The dosage of vaccine that should 
                        be administered in the immunizations.
                            ``(iv) Any contraindications regarding 
                        administration of the vaccine to particular 
                        medical categories of children.
                            ``(v) Such other guidelines as the 
                        Secretary determines to be appropriate with 
                        respect to administering the vaccine to 
                        children.
                    ``(B) Variations in medical practice.--In 
                establishing and revising a schedule under subparagraph 
                (A), 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 
                regarding the administration of the vaccine, subject to 
                remaining within medical norms.
            ``(3) Rules of construction.--
                    ``(A) In general.--The list established under 
                paragraph (1) and the schedules established under 
                paragraph (2) do not constitute guidelines, standards, 
                performance measures, or review criteria for purposes 
                of the program carried out by the Administrator for 
                Health Care Policy and Research under part B of title 
                IX or under section 1142 of the Social Security Act.
                    ``(B) State laws.--This section does not supersede 
                any State law on requirements with respect to receiving 
                immunizations (including any such law relating to 
                religious exemptions or medical exemptions).
            ``(4) 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 
        paragraph (1) and the schedule required in paragraph (2).
    ``(k) Definitions.--For purposes of this section:
            ``(1) The term `immunization' means an immunization against 
        a vaccine-preventable disease.
            ``(2) The term `pediatric vaccine' means a vaccine included 
        on the list established under subsection (j)(1).
    ``(l) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $100,000,000 
for each of the fiscal years 1994 through 1996.''.

  TITLE V--MONITORING SYSTEM WITH RESPECT TO IMMUNIZATION OF CERTAIN 
                                CHILDREN

SEC. 501. ESTABLISHMENT OF PROGRAM OF FORMULA GRANTS TO STATES.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
as amended by section 401 of this Act, is amended by inserting after 
section 317A the following section:

 ``monitoring system regarding immunization status of certain children

    ``Sec. 317B. (a) Formula Grants to States.--For the purpose 
described in subsection (b), 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 determined in 
accordance with subsection (j). 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 Secretary an application in accordance with 
subsection (h).
    ``(b) Authorized Activities.--With respect to designated children 
(as defined in subsection (c)), the Secretary may make a grant under 
subsection (a) only if the State agrees to expend the grant for the 
purpose of--
            ``(1) collecting such data as may be necessary to indicate 
        whether designated children have received immunizations in 
        accordance with the schedule established by the Secretary under 
        section 317A(j);
            ``(2) operating registries to maintain the data (and 
        establishing such registries, in the case of a State that is 
        not operating such a registry);
            ``(4) notifying parents of designated children if the 
        children have not received immunizations in accordance with 
        such schedule, and encouraging parents to ensure that the 
        children receive such immunizations; and
            ``(5) providing to parents of designated children 
        information, education, and outreach with respect to such 
        schedule.
    ``(c) Designated Children.--For purposes of this section, the term 
`designated child' means an individual 18 years of age or younger who--
            ``(1) is uninsured with respect to health insurance 
        policies or plans (including group health plans or prepaid 
        health plans);
            ``(2) is a member of a household participating in the Food 
        Stamp Act of 1977; or
            ``(3) with respect to the State involved--
                    ``(A) is entitled to medical assistance under the 
                plan approved for the State under title XIX of the 
                Social Security Act (including a State operating under 
                a statewide waiver under section 1115 of such Act);
                    ``(B) is receiving assistance under the plan 
                approved for the State under part A of title IV of the 
                Social Security Act; or
                    ``(C) is receiving services under the special 
                supplemental food program for women, infants, and 
                children under section 17 of the Child Nutrition Act of 
                1966.
    ``(d) Requirement Regarding State Laws.--
            ``(1) In general.--The Secretary may make a grant under 
        subsection (a) only if the State involved--
                    ``(A) provides assurances satisfactory to the 
                Secretary that, not later than October 1, 1996, the 
                State will be operating a registry in accordance with 
                this section, 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 section as may be authorized in 
                the law and regulations of the State.
            ``(2) Rules of construction.--
                    ``(A) With respect to the agreements made by a 
                State under this section, other than paragraph (1)(B), 
                the Secretary may require compliance with the 
                agreements only to the extent consistent with such 
                paragraph.
                    ``(B) This section does not authorize the 
                Secretary, as a condition of the receipt 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 exemption from the requirements 
                established by the State pursuant to this section for 
                the collection of data regarding any child of the 
                parent.
    ``(e) Authority Regarding Monitoring Methodology.--
            ``(1) Representative sampling.--With respect to compliance 
        with the agreement under subsection (b)(1) to determine the 
        immunization status of designated children, a State may 
        determine such status through representative sampling of the 
        population of such children in the State, subject to 
        maintaining compliance with criteria issued by the Secretary 
        under paragraph (2).
            ``(2) Federal criteria.--Not later than 180 days after the 
        date of the enactment of the Responsible Parent Immunization 
        Plan Act of 1993, the Secretary shall issue criteria for 
        representative sampling under paragraph (1).
    ``(f) Coordination by States of Immunization Activities.--The 
Secretary may make a grant under subsection (a) only if the State 
involved agrees to ensure that all activities carried out by the State 
with respect to the immunization of children are coordinated by a 
single agency of the State, including coordination regarding--
            ``(1) the reports required in subsection (g);
            ``(2) other activities carried out under this section;
            ``(3) activities under section 317, section 317A, and part 
        A of title XIX; and
            ``(4) activities under part A of title IV of the Social 
        Security Act and under the Food Stamp Act of 1977.
    ``(g) Reports to Secretary.--The Secretary may make a grant under 
subsection (a) only if the State involved agrees that, not later than 
February 1 of the fiscal year following the fiscal year for which the 
grant is made, the State will submit to the Secretary a report on the 
immunization status of designated children in the State.
    ``(h) Application for Grant.--An application by a State for a grant 
under subsection (a) is in accordance with this subsection if the 
application--
            ``(1) is submitted not later than the date specified by the 
        Secretary;
            ``(2) contains each agreement required in this section;
            ``(3) provides assurances satisfactory to the Secretary 
        that the State is operating a registry pursuant to subsection 
        (a), in the case of fiscal year 1996 and subsequent fiscal 
        years; and
            ``(4) is in such form, is made in such manner, and contains 
        such agreements, assurances, and information as the Secretary 
        determines to be necessary to carry out this section.
    ``(i) Use of Social Security Account Numbers.--Subject to the 
provisions of the Social Security Act (or other applicable Federal 
law), the Secretary may authorize grantees under subsection (a) to 
utilize social security account numbers in carrying out the purpose 
described in subsection (b).
    ``(j) Determination of Amount of Allotment.--The allotment under 
subsection (a) for a State for a fiscal year shall be an amount equal 
to the product of--
            ``(1) an amount equal to the amount appropriated under 
        subsection (l) for grants under subsection (a) for the fiscal 
        year; and
            ``(2) the percentage equal to the quotient of--
                    ``(A) an amount equal to the number of children in 
                the State who are 5 years of age or younger; divided by
                    ``(B) an amount equal to the number of children in 
                the United States who are 5 years of age or younger (as 
                determined by the sum of the respective amounts 
                determined under subparagraph (A)).
    ``(k) Definitions.--For purposes of this section:
            ``(1) The term `designated child' has the meaning given 
        such term in subsection (c).
            ``(2) The term `immunization' means an immunization against 
        a vaccine-preventable disease.
            ``(3) The term `immunization schedule' means the schedule 
        established by the Secretary under section 317A(j).
            ``(4) The term `immunization status', with respect to a 
        child, means the extent to which the child has been immunized 
        in accordance with the immunization schedule.
            ``(5) The term `parent', with respect to a child, means the 
        legal guardian of the child.
    ``(l) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $75,000,000 
for each of the fiscal years 1994 through 1996.''.

  TITLE VI--PARENTAL BEHAVIOR WITH RESPECT TO CHILDHOOD IMMUNIZATIONS

SEC. 601. ESTABLISHMENT OF DEMONSTRATION PROGRAM.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.), as amended by section 501 of this Act, is amended by 
inserting after section 317B the following section:

      ``parental behavior with respect to childhood immunizations

    ``Sec. 317C. (a) Grants for Demonstration Projects.--The Secretary 
may make grants to public and nonprofit private entities to carry out 
demonstration projects for the purpose of developing innovative methods 
to encourage parents to ensure that the children of the parents are 
immunized in accordance with the schedule established by the Secretary 
under section 317A(j).
    ``(b) Parental Incentives.--With respect to methods to encourage 
parents for purposes of subsection (a), the Secretary may make a grant 
under such subsection for any of the following:
            ``(1) Evaluating the reasons provided by parents in 
        explanation of the failure of the parents to ensure that the 
        children of the parents are immunized in accordance with the 
        immunization schedule.
            ``(2) With respect to health clinics that provide 
        immunizations:
                    ``(A) Evaluating the reasons provided by the 
                clinics in explanation of such failure of the parents.
                    ``(B) Evaluating activities carried out by clinics 
                to encourage parents to ensure that the children of the 
                parents are immunized in accordance with the 
                immunization schedule.
                    ``(C) Increasing the number of hours during which 
                the clinics provide immunizations.
                    ``(D) Providing transportation to the clinics for 
                parents and the children of the parents.
            ``(3) Utilizing mobile medical units to provide 
        immunizations.
            ``(4) Providing immunizations on the premises of public 
        housing projects or at sites in close proximity to such 
        projects.
            ``(5) Subject to applicable law, determining the 
        immunization status of siblings of a child whenever the 
        immunization status of the child is determined pursuant to 
        entering school, pursuant to receiving day-care services, or 
        pursuant to participation in Federal, State, or local programs.
            ``(6) Subject to applicable law, increasing or decreasing 
        benefits of parents and children under Federal, State, and 
        local programs on the basis of the extent to which the children 
        have been immunized in accordance with the immunization 
        schedule.
            ``(7) Such other methods as the Secretary determines to be 
        appropriate.
    ``(c) Requirement of Application.--The Secretary may make a grant 
under subsection (a) only if an application for the grant is submitted 
to the Secretary and the application is in such form, is made in such 
manner, and contains such agreements, assurances, and information as 
the Secretary determines to be necessary to carry out this section.
    ``(d) Definitions.--For purposes of this section:
            ``(1) The term `immunization' means an immunization against 
        a vaccine-preventable disease.
            ``(2) The term `immunization schedule' means the schedule 
        established by the Secretary under section 317A(j).
            ``(3) The term `immunization status', with respect to a 
        child, means the extent to which the child has been immunized 
        in accordance with the immunization schedule.
            ``(4) The term `parent', with respect to a child, means the 
        legal guardian of the child.
    ``(e) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there are authorized to be 
        appropriated $50,000,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 through 
        1996.
            ``(2) Allocation.--Of the amounts appropriated under 
        paragraph (1) for a fiscal year, the Secretary shall make 
        available not less than an aggregate 20 percent for grants 
        under subsection (a) for the purposes specified in 
        subparagraphs (A) and (B) of paragraph (2) of subsection (b) 
        and in paragraph (6) of such subsection.''.

 TITLE VII--USE OF MEDICAID FUNDS FOR MONITORING MEDICAID BENEFICIARIES

SEC. 701. USE OF MEDICAID FUNDS FOR MONITORING MEDICAID BENEFICIARIES.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by inserting after subsection (g) the following new subsection:
    ``(h) For purposes of subsection (a)(7), in determining the amounts 
expended by a State during a quarter for the proper and efficient 
administration of the State plan, the Secretary shall take into account 
amounts expended in determining the immunization status of children 
entitled to medical assistance under the State plan, in accordance with 
the program of the State described in section 317B of the Public Health 
Service Act (but only if the State has exhausted any grant received 
under section 317B of such Act).''.

                                 <all>

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