article: 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.
summary: 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.