[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 886 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                 S. 886

To amend the Social Security Act and the Internal Revenue Code of 1986 
  to improve immunization rates among children and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                May 4 (legislative day, April 19), 1993

Mr. Danforth (for himself, Mrs. Kassebaum, Mr. Durenberger, Mr. Gregg, 
 and Mr. Bond) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend the Social Security Act and the Internal Revenue Code of 1986 
  to improve immunization rates among children and for other purposes.

    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 ``National Immunization Act''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress finds that--
            (1) 90 percent of all children under the age of 2 receive 
        at least one vaccination yet only 40 to 60 percent of these 
        children receive a complete set of vaccinations;
            (2) the low immunization rate for children stems from 
        inadequate immunization delivery systems and a lack of public 
        education concerning the risks related to the nonimmunization 
        of children; and
            (3) government health care programs must coordinate their 
        activities in order to increase immunization rates.
    (b) Purpose.--It is the purpose of this Act to--
            (1) provide an enhanced Federal match under title XIX of 
        the Social Security Act for State making certain low income 
        individuals eligible for immunization services;
            (2) provide authority for reimbursements to vaccine 
        manufacturers under vaccine replacement programs;
            (3) provide authority for states to reduce AFDC benefits 
        for adults who fail to properly immunize their children; and
            (4) extend the Vaccine Injury Compensation Program.

SEC. 3. ENHANCED FEDERAL MATCH FOR STATES MAKING INDIVIDUALS WITH 
              INCOMES UP TO 185 PERCENT OF THE POVERTY LINE ELIGIBLE 
              FOR IMMUNIZATION SERVICES.

    (a) Adjustments to Income Levels.--Section 1902(l)(2) of the Social 
Security Act (42 U.S.C. 1396a(l)(2)) is amended--
            (1) in subparagraph (B), by striking ``(B) For purposes'' 
        and inserting ``(B)(i) Except as provided in clause (ii), for 
        purposes'' and by adding at the end the following new clause:
    ``(ii) For purposes of determining eligibility for immunization 
services under the State plan, the State may apply clause (i) by 
substituting `185 percent' for `133 percent' in order to receive 
enhanced payments under section 1903(a)(7).''; and
            (2) in subparagraph (C), by striking ``(C) For purposes'' 
        and inserting ``(C)(i) Except as provided in clause (ii), for 
        purposes'' and by adding at the end the following new clause:
    ``(ii) For purposes of determining eligibility for immunization 
services under the State plan, the State may apply clause (i) by 
substituting `185 percent' for `100 percent' in order to receive 
enhanced payments under section 1903(a)(7).''.
    (b) Simplified Application and Billing Procedure for Immunization 
Services.--Section 1902(l)(2) of the Social Security Act (42 U.S.C. 
1396a(l)(2)) is amended by adding at the end the following new 
subparagraph:
    ``(D)(i) Each State which establishes income levels under 
subparagraphs (A), (B)(ii), and (C)(ii) which are equal to 185 percent 
of the income official poverty line described in subparagraph (A) for 
only immunization services shall--
            ``(I) implement a simplified application procedure for such 
        services which--
                    ``(aa) permits applications for such services to be 
                submitted at locations described in section 1902(a)(55) 
                and locations where eligibility determinations under 
                section 1920 are made; and
                    ``(bb) complies with requirements established by 
                the Secretary; and
            ``(II) implement a simplified billing procedure for such 
        services which complies with requirements established by the 
        Secretary.
    ``(ii) Not later than 1 year after the date of the enactment of 
this subparagraph, the Secretary shall establish the requirements 
referred to in subclauses (I) and (II) of clause (i).''.
    (c) Enhanced Match.--Section 1903(a) of the Social Security Act (42 
U.S.C. 1396b(a)) is amended by redesignating paragraph (7) as paragraph 
(8) and by inserting after paragraph (6) the following new paragraph:
            ``(7) in the case of a State which--
                    ``(A) has established income levels under 
                subparagraphs (A), (B)(ii), and (C)(ii) of section 
                1902(l)(2) with respect to eligibility under the State 
                plan for immunization services which are equal to 185 
                percent of the income official poverty line (as defined 
                by the Office of Management and Budget, and revised 
                annually in accordance with section 673(2) of the 
                Omnibus Budget Reconciliation Act of 1981) applicable 
                to a family of the size involved,
                    ``(B) has established a simplified application and 
                billing procedure for immunization services as required 
                under subparagraph (D) of section 1902(l)(2), and
                    ``(C) provides reasonable reimbursement to 
                providers of immunization services,
        an amount equal to the product of the total amount expended 
        during such quarter on immunization services, multiplied by 90 
        percent;''.
    (d) Effective Date.--The amendments made by this section shall 
apply to immunization services furnished in calendar quarters beginning 
after June 30, 1993.

SEC. 4. REIMBURSEMENT TO VACCINE MANUFACTURERS.

    (a) In General.--Section 1902(a)(32) of the Social Security Act (42 
U.S.C. 1396a(32)) is amended--
            (1) by striking ``and'' at the end of subparagraph (B);
            (2) by striking the period at the end of subparagraph (C) 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(D) nothing in this paragraph shall be construed 
                to prevent the making of such a payment to a 
                manufacturer of a childhood vaccine under a contract 
                with the State pursuant to which the manufacturer 
                participates in a vaccine replacement program described 
                in subsection (z).''.
    (b) Vaccine Replacement Program.--Section 1902 of such Act (42 
U.S.C. 1396) is amended by adding at the end the following new 
subsection:
    ``(z)(1) A vaccine replacement program described in this subsection 
is a program under which a State with a State plan approved under this 
title contracts with each manufacturer of childhood vaccines selling 
such vaccines in the State to--
            ``(A) supply doses of childhood vaccines to providers (or 
        in the case of a State medicaid vaccine program, the State) 
        administering such vaccines to individuals eligible to receive 
        medical assistance under the State plan and replace such 
        vaccines as needed; and
            ``(B) charge the State agency for such doses of childhood 
        vaccines the price under the most recent bid (determined once 
        such bid price is made public) submitted by the manufacturer 
        who received the Centers for Disease Control and Prevention 
        contract with respect to the childhood immunization program, 
        plus a reasonable fee to cover shipping and handling of returns 
        for such doses.
    ``(2) Any manufacturer of childhood vaccines which does not 
participate in a vaccine replacement program described in paragraph (1) 
shall be ineligible to bid for Centers for Disease Control and 
Prevention immunization contracts under section 317(j) of the Public 
Health Services Act.''.
    (c) Agreements With the State.--Section 1902(a)(27) of such Act (42 
U.S.C. 1396a(a)(27)) is amended--
            (1) by striking ``under the State plan'' and inserting 
        ``under the State plan and with any entity that is a 
        manufacturer of a childhood vaccine under a contract with the 
        State pursuant to which the manufacturer participates in a 
        vaccine replacement program described in subsection (z)''; and
            (2) by striking ``such person or institution'' each place 
        it appears and inserting ``such person, institution, or 
        entity''.
    (d) Effective Date.--The amendments made by this section shall be 
effective on the date of the enactment of this Act.

SEC. 5. STATE OPTION TO PROVIDE THAT CERTAIN PAYMENTS UNDER AFDC ARE 
              CONDITIONED ON RECEIPT OF IMMUNIZATIONS.

    (a) In General.--Section 402 of the Social Security Act (42 U.S.C. 
602) is amended--
            (1) in paragraph (44), by striking ``; and'' and inserting 
        a semicolon;
            (2) in paragraph (45), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following new paragraph:
            ``(46) at the option of the State, provide that for any 
        month in which a family receiving aid to families with 
        dependent children has a member who is an individual who has 
        not attained 6 years of age and who has not received 
        appropriate immunizations (as determined by the State), may 
        take actions designed to encourage timely immunization of such 
        children, including but not limited to reducing the total 
        benefits received by such family for such month by the amount 
        of such benefits, or any portion thereof, allocable to the 
        parent or guardian of the child in question.''.
    (c) Effective Date.--The amendment made by subsection (a) shall 
become effective on the date of the enactment of this Act.

SEC. 6. NATIONAL VACCINE INJURY COMPENSATION PROGRAM AMENDMENTS.

    (a) Tax.--
            (1) In general.--Subsection (c) of section 4131 of the 
        Internal Revenue Code of 1986 (relating to tax on certain 
        vaccines) is repealed.
            (2) Reinstatement of tax.--The tax imposed by section 4131 
        of the Internal Revenue Code of 1986 is hereby reinstated 
        effective on the date of enactment of this Act.
    (b) Trust Fund.--
            (1) Paragraph (1) of section 9510(c) of such Code (relating 
        to expenditures from Vaccine Injury Compensation Trust Fund) is 
        amended by striking ``and before October 1, 1992,''.
            (2) Section 6601(r) of the Omnibus Budget Reconciliation 
        Act of 1989 is amended by striking out ``$2,500,000 for each of 
        fiscal years 1991 and 1992'' each place it appears and 
        inserting in lieu thereof ``$3,000,000 for fiscal year 1994 and 
        each fiscal year thereafter'' (in three places).
    (c) Study.--The Secretary of the Treasury, in consultation with the 
Secretary of Health and Human Services, shall conduct a study of--
            (1) the estimated amount that will be paid from the Vaccine 
        Injury Compensation Trust Fund with respect to vaccines 
        administered after September 30, 1988, and before October 1, 
        1994;
            (2) the rates of vaccine-related injury or death with 
        respect to the various types of such vaccines;
            (3) new vaccines and immunization practices being developed 
        or used for which amounts may be paid from such Trust Fund;
            (4) whether additional vaccines should be included in the 
        vaccine injury compensation program;
            (5) whether the current levels of excise tax are 
        appropriate to the estimated needs of the Fund; and
            (6) the appropriate treatment of vaccines produced by State 
        governmental entities.
The report of such study shall be submitted not later than January 1, 
1994, to the Committee on Ways and Means of the House of 
Representatives and the Committee on Finance of the Senate.

SEC. 7. MATERNITY SERVICES INFORMATION.

    (a) In General.--The Secretary shall develop and through State 
health officials disseminate, to all hospitals that provide maternity 
services, informational materials concerning immunization and well-baby 
care, including an immunization schedule.
    (b) Dissemination by Providers.--To be eligible for funds under 
title XVIII or XIX of the Social Security Act, a health care provider 
providing maternity services shall disseminate the immunization 
materials described in subsection (a) to new parents to which such 
provider provides services.

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