[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3075 Introduced in House (IH)]
103d CONGRESS
1st Session
H. R. 3075
To promote greater equity in the delivery of health care services to
American women through expanded research on women's health issues and
through improved access to health care services, including preventive
health services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 14, 1993
Mrs. Schroeder (for herself, Ms. Snowe, Ms. Slaughter, Ms. Brown of
Florida, Ms. Byrne, Mrs. Clayton, Mrs. Collins of Illinois, Ms.
DeLauro, Ms. Eshoo, Mrs. Johnson of Connecticut, Mrs. Lloyd, Mrs.
Lowey, Mrs. Kennelly, Ms. McKinney, Mrs. Maloney, Mrs. Meek, Mrs. Mink,
Ms. Molinari, Mrs. Morella, Ms. Pelosi, Ms. Roybal-Allard, Ms. Schenk,
Mr. Thurman, Mrs. Unsoeld, Ms. Velazquez, Ms. Waters, Ms. Woolsey, Mr.
Abercrombie, Mr. Berman, Mr. Brown of California, Mr. Evans, Mr. Frank
of Massachusetts, Mr. Hochbrueckner, Mr. Lantos, Mr. Martinez, Mr.
McDermott, Mr. Nadler, Mr. Sanders, Mr. Wheat, and Mr. Yates)
introduced the following bill; which was referred jointly to the
Committees on Energy and Commerce, Ways and Means, Armed Services,
Education and Labor, Foreign Affairs, the Judiciary, and Veterans'
Affairs
_______________________________________________________________________
A BILL
To promote greater equity in the delivery of health care services to
American women through expanded research on women's health issues and
through improved access to health care services, including preventive
health services.
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 ``Women's Health Equity Act of 1993''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--RESEARCH ON WOMEN'S HEALTH
Subtitle A--NIH Women Scientists Employment Opportunities Act
Sec. 101. Short title.
Sec. 102. Women's scientific employment.
Subtitle B--Women and AIDS Research Initiative Amendments of 1993
Sec. 106. Short title.
Sec. 107. Establishment of general program of research regarding women
and Acquired Immune Deficiency Syndrome.
Subtitle C--Women and Alcohol Research Equity Act of 1993
Sec. 111. Short title.
Sec. 112. Findings.
Sec. 113. Provisions regarding increase in amount of funds expended for
research on alcohol abuse and alcoholism
among women.
Subtitle D--National Breast Cancer Strategy Act of 1993
Sec. 116. Short title.
Part I--Establishment of Office of Breast Cancer and National Breast
Cancer Commission
Sec. 117. Office of breast cancer.
Sec. 118. Establishment of national breast cancer commission.
Part II--Duties of Director of the National Cancer Institute Relating
to Breast Cancer
Sec. 119. Provisions for full funding for National Cancer Institute
with respect to research on breast cancer.
Sec. 120. Duties of Director.
Sec. 121. Specialized programs of research excellence with respect to
breast, lung, and prostate cancer.
Subtitle E--Lupus Research Amendments of 1993
Sec. 126. Short title.
Sec. 127. Findings.
Sec. 128. Expansion and intensification of activities regarding lupus.
Subtitle F--Women's Midlife Health Research Act
Sec. 131. Short title.
Sec. 132. Establishment of program for research centers on women's
midlife health care, including menopause
and menopausal health conditions.
Subtitle G--Osteoporosis and Related Bone Disorders Research Education,
and Health Services Act of 1993
Sec. 136. Short title.
Sec. 137. Findings.
Sec. 138. Osteoporosis research.
Subtitle H--Ovarian Cancer Research and Information Amendments of 1993
Sec. 141. Short title.
Sec. 142. Funding for research on ovarian cancer.
Sec. 143. Public information and education on ovarian cancer.
Subtitle I--Antiprogestin Testing Act of 1993
Sec. 146. Short title.
Sec. 147. Research.
Sec. 148. Report.
Subtitle J--Women's Health Environmental Factors Research Act of 1993
Sec. 151. Short title.
Sec. 152. Research on effect of environmental factors on women's
health.
Subtitle K--Federal Risk Assessment in Women's Health Act of 1993
Sec. 156. Short title.
Sec. 157. Interagency review.
Sec. 158. Study of research needs.
Subtitle L--Pharmaceutical Interactions Safety Act
Sec. 161. Short title.
Sec. 162. Clinical investigations.
Sec. 163. Biological products clinical investigations.
Subtitle M--Pharmaceutical Testing Fairness Act
Sec. 166. Short title.
Sec. 167. New drug clinical investigations.
Sec. 168. Device clinical investigations.
Sec. 169. Biological products clinical investigations.
Subtitle N--Tobacco Advertising and Promotion Studies Act of 1993
Sec. 171. Short title.
Sec. 172. Findings.
Sec. 173. Tobacco advertising studies.
TITLE II--SERVICES REGARDING WOMEN'S HEALTH
Subtitle A--Equity in Health Professions Education Act
Sec. 201. Short title.
Sec. 202. Study regarding curricula of health professions schools and
women's health conditions.
Subtitle B--Women's Health Office Act of 1993
Sec. 206. Short title.
Sec. 207. Public Health Service Office of Women's Health.
Sec. 208. Centers for Disease Control and Prevention Office of Women's
Health.
Sec. 209. Agency for Health Care Policy and Research Office of Women's
Health.
Sec. 210. Health Resources and Services Administration Office of
Women's Health.
Sec. 210A. Food and Drug Administration Office of Women's Health.
Subtitle C--Women's Health Information Act of 1993
Sec. 211. Short title.
Sec. 212. Findings.
Sec. 213. Interagency Committee on Health Communications.
Sec. 214. Dissemination efforts of women's health information within
public health service.
Sec. 215. Study on effectiveness of health communications.
Subtitle D--Breast and Cervical Cancer Amendments of 1993
Sec. 216. Short title.
Sec. 217. Revisions in program of State grants regarding breast and
cervical cancer.
Sec. 218. Funding.
Subtitle E--Women's Preventive Health Amendments of 1993
Sec. 221. Short title.
Sec. 222. Establishment of demonstration program of grants for
additional preventive health services for
women.
Sec. 223. Funding.
Subtitle F--Postreproductive Health Care Act
Sec. 226. Short title.
Sec. 227. Establishment of program for postreproductive health care.
Subtitle G--Medicare Bone Mass Measurement Coverage Act of 1993
Sec. 231. Short title.
Sec. 232. Medicare coverage of bone mass measurements.
Subtitle H--Mickey Leland Adolescent Pregnancy Prevention and
Parenthood Act of 1993
Sec. 236. Short title.
Sec. 237. Adolescent pregnancy prevention, care, and research grants.
Subtitle I--Adolescent Health Demonstrations Projects Act of 1993
Sec. 241. Short title.
Sec. 242. Establishment or support of demonstration projects.
Sec. 243. Project requirements.
Sec. 244. Areas to be served.
Sec. 245. Abortion restriction.
Sec. 245A. Report.
Subtitle J--Eating Disorders Information and Education Act of 1993
Sec. 246. Short title.
Sec. 247. Findings.
Sec. 248. Public information and education on eating disorders.
Subtitle K--Women and HIV Outreach and Prevention Act
Sec. 251. Short title.
Sec. 252. Preventive health programs regarding women and human
immunodeficiency virus.
Sec. 253. Treatment of women for substance abuse.
Sec. 254. Early intervention services for women.
Subtitle L--Standby Guardianship Act
Sec. 256. Short title.
Sec. 257. States required to have standby guardianship law as a
condition of eligibility for Federal funds
for foster care and adoption assistance.
Subtitle M--Federal Prohibition of Female Genital Mutilation Act of
1993
Sec. 261. Short title.
Sec. 262. Title 18 amendment.
Sec. 263. Education and outreach.
Sec. 264. Effective dates.
Subtitle N--Smoking Prevention and Cessation in WIC Clinics Act
Sec. 266. Short title.
Sec. 267. Smoking cessation demonstration programs for WIC
participants.
Subtitle O--Family and Medical Leave Health Care Reform Resolution of
1993
Sec. 271. Short title.
Sec. 272. Findings.
Sec. 273. Sense of Congress.
Subtitle P--Veteran Women's Health Improvement Act of 1993
Sec. 276. Short title.
Sec. 277. Women's health services.
Sec. 278. Expansion of research relating to women veterans.
Sec. 279. Mammography quality standards.
Subtitle Q--Defense Women's Health Improvement Act of 1993
Sec. 281. Short title.
Part I--Women's Health Care
Sec. 282. Primary and preventive health-care services for women.
Sec. 283. Report on the provision of health-care services to women.
Part II--Women's Health Research
Sec. 284. Defense women's health research center.
Sec. 285. Continuation of Army breast cancer research program.
Sec. 286. Inclusion of women and minorities in clinical research
projects.
Sec. 287. Report on research relating to female members of the
uniformed services and female covered
beneficiaries.
Part III--Women's Health Education
Sec. 288. Women's health curriculum advisory committee.
Subtitle R--International Population Stabilization and Reproductive
Health Act
Sec. 291. Short title.
Sec. 292. Authorities relating to United States population assistance.
Sec. 293. Authorizations of appropriations.
Sec. 294. Economic and social development initiatives to stabilize
world population.
Sec. 295. AIDS prevention and control fund.
Sec. 296. Oversight of multilateral development banks.
Sec. 297. Commission on world population stabilization and reproductive
health.
Sec. 298. Support for United Nations forward looking strategies for the
advancement of women.
Sec. 299. Support for the Convention on the Elimination of All Forms of
Discrimination Against Women.
TITLE I--RESEARCH ON WOMEN'S HEALTH
Subtitle A--NIH Women Scientists Employment Opportunites Act
SEC. 101. SHORT TITLE.
This subtitle may be cited as the ``NIH Women Scientists Employment
Opportunity Act''.
SEC. 102. WOMEN'S SCIENTIFIC EMPLOYMENT.
Subpart A of title IV of the Public Health Service Act (42 U.S.C.
281 et seq.), as amended by section 209 of Public Law 103-43 (107 Stat.
149), is amended by adding at the end the following section:
``women's scientific employment
``Sec. 404F. (a) In General.--The Director of NIH shall--
``(1) establish policies for the National Institutes of
Health on matters relating to the employment by the National
Institutes of Health of women as scientists; and
``(2) monitor the extent of compliance with such policies
and take appropriate action in cases in which the Director
determines that the policies have been violated.
``(b) Certain Functions.--In carrying out subsection (a), the
Director of NIH shall provide for the following:
``(1) Implementing the recommendations of the group known
as the Task Force on the Status of NIH Intramural Women
Scientists.
``(2) Determining the concerns of intramural women
scientists.
``(3) Developing a policy defining the standard tenure
process for employment at the National Institutes of Health.
``(4) Determining the reason for departure from such
Institutes by interviewing women and men scientists as they
leave.
``(5) Distributing yearly to all employees of such
Institutes the policy of such Institutes on flexible family
leave.
``(6) Monitoring the number of women, including minority
women, included on the committees, panels, and other working
groups (and in meetings) of such Institutes.
``(7) Making efforts to recruit minority women, based on
the small numbers of tenured minority women scientists.
``(8) Developing additional goals related to women and
minority women scientists at such Institutes.
``(c) Inclusion of Women on Intramural and Extramural Conferences
and Other Groups.--
``(1) In general.--The Director of NIH shall establish a
policy at the National Institutes of Health of requiring
inclusion of women scientists in greater numbers on or in
intramural and extramural conferences, workshops, meetings,
international congresses, and other groups funded or sponsored
by such Institutes. Such policy shall provide for the inclusion
of not less than one woman scientist in each such group, except
as provided in paragraph (2).
``(2) Exclusion; written explanation.--The policy
established in paragraph (1) may provide that no woman
scientist will be included in a group for purposes of such
paragraph if the Director of NIH provides a waiver of the
requirement. The Director may grant such a waiver only if--
``(A) the individual with the chief responsibility
for the group involved submits to the Director a
written request for the waiver and the request provides
an explanation of the reasons underlying the need for
the waiver; and
``(B) the Director makes a determination that
extraordinary circumstances justify providing the
waiver.
``(d) Study on Pay Equity.--
``(1) In general.--The Director of NIH shall provide for
study to identify any pay differences among men and women
scientists employed by the National Institutes of Health, both
tenured and untenured. The study shall include recommendations
on measures to adjust any disparities or inequities, and shall
identify a program to communicate information on salary ranges
to all employees.
``(2) Report.--Not later than 240 days after the date of
the enactment of the NIH Women Scientist Employment Opportunity
Act, the Director of NIH shall complete the study required in
paragraph (1) and submit to the Committee on Energy and
Commerce of the House of Representatives, and to the Committee
on Labor and Human Resources of the Senate, a report describing
the findings made as a result of the study.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1994 through 1996.''.
Subtitle B--Women and AIDS Research Initiative Amendments of 1993
SEC. 106. SHORT TITLE.
This subtitle may be cited as the ``Women and AIDS Research
Initiative Amendments of 1993''.
SEC. 107. ESTABLISHMENT OF GENERAL PROGRAM OF RESEARCH REGARDING WOMEN
AND ACQUIRED IMMUNE DEFICIENCY SYNDROME.
Part B of title XXIII of the Public Health Service Act (42 U.S.C.
300cc-11 et seq.) is amended by adding at the end the following
section:
``SEC. 2321. RESEARCH REGARDING WOMEN.
``(a) In General.--With respect to cases of infection with the
human immunodeficiency virus, the Secretary shall establish a program
for the purpose of conducting biomedical and behavioral research on
such cases in women, including research on the prevention of such
cases. The Secretary may conduct such research directly, and may make
grants to public and nonprofit private entities for the conduct of the
research.
``(b) Certain Forms of Research.--In carrying out subsection (a),
the Secretary shall provide for research on--
``(1) the manner in which the human immunodeficiency virus
is transmitted to women, including the relationship between
cases of infection with such virus and other cases of sexually
transmitted diseases, including clinical trials which examine
the question of how much human immunodeficiency virus infection
can be prevented by finding and treating sexually transmitted
diseases in women;
``(2) measures for the prevention of exposure to and the
transmission of such virus, including research on--
``(A) the prevention of any sexually transmitted
disease that may facilitate the transmission of the
virus;
``(B) rapid, inexpensive, easy-to-use sexually
transmitted disease diagnostic tests for women;
``(C) inexpensive single dose therapy for treatable
sexually transmitted diseases;
``(D) the development of methods of prevention for
use by women; and
``(E) the development and dissemination of
prevention programs and materials whose purpose is to
reduce the incidence of substance abuse among women;
``(3) the development and progression of symptoms resulting
from infection with such virus, including research regarding
gynecological infections as well as breast changes, hormonal
changes, and menses and menopause changes, whose occurrence
becomes probable as a result of the deterioration of the immune
system;
``(4) the treatment of cases of such infection, including
clinical research; and
``(5) behavioral research on the prevention of such cases
and research on model educational programs for such prevention.
``(c) Clinical Trials.--
``(1) Gynecological evaluations.--In clinical trials
regarding the human immunodeficiency virus in which women
participate as subjects, the Secretary shall ensure that--
``(A) each female subject who is infected with the
human immunodeficiency virus--
``(i) undergoes a gynecological examination
as part of the evaluation of the medical status
of the woman prior to participation in the
trial; and
``(ii) receives appropriate follow-up
services regarding such examination; and
``(B) the results of the gynecological examinations
are analyzed to determine the relationship between
gynecological conditions and the infection with such
virus.
``(2) Standard treatments for gynecological conditions.--
The Secretary shall conduct or support clinical trials under
subsection (a) to determine whether standard methods of
treating gynecological conditions are effective in the case of
such conditions that arise as a result of infection with the
human immunodeficiency virus.
``(3) Effectiveness of certain treatment protocols.--With
respect to cases of infection with the human immunodeficiency
virus, the Secretary shall conduct or support clinical trials
under subsection (a) to determine whether treatment protocols
approved for men with such cases are effective for women with
such cases.
``(4) Support services.--
``(A) In conducting or supporting clinical trials
regarding the human immunodeficiency virus in which
women participate as subjects, the Secretary shall
provide the women with such transportation, child care,
and other support services (including medical and
mental health services, treatment for drug abuse, and
social services, including services addressing domestic
violence) as may be necessary to enable the women to
participate as such subjects.
``(B) Services under subparagraph (A) shall include
services designed to respond to the particular needs of
women with respect to participation in the clinical
trials involved, including, as appropriate, training of
the individuals who conduct the trials.
``(d) Prevention Programs.--
``(1) Sexual transmission.--
``(A) With respect to preventing the sexual
transmission of the human immunodeficiency virus, the
Secretary shall conduct or support research under
subsection (a) on barrier methods for prevention of
sexually transmitted diseases, including human
immunodeficiency virus disease, that women can use
without their sexual partner's cooperation or
knowledge.
``(B) In carrying out subparagraph (A), the
Secretary shall give priority to identified research
needs and opportunities identified at the National
Institutes of Health sponsored meeting on Development
of Topical Microbicides held in May 1993, including
research on--
``(i) the early steps in infectious
processes;
``(ii) identification, formulation, and
preclinical evaluation of new preparations;
``(iii) clinical testing for safety and
efficacy; and
``(iv) studies on acceptability and
compliance of safe, effective microbicides.
``(2) Epidemiological research.--The Secretary shall
conduct or support epidemiological research under subsection
(a) to determine the factors of risk regarding infection with
the human immunodeficiency virus that are particular to women,
including research regarding--
``(A) the use of various contraceptive methods;
``(B) the use of tampons;
``(C) the relationship between such infection and
other sexually transmitted diseases;
``(D) the relationship between such infection and
various forms of substance abuse (including use of the
form of cocaine commonly known as crack); and
``(E) the relationship between such infection and
noncoital forms of sexual activity.
``(e) Interagency Study.--With respect to the study (known as the
Women's Interagency HIV Study) that, as of June 1993, is being carried
out by the Secretary through various agencies of the Public Health
Service for the purpose of monitoring the progression in women of
infection with the human immunodeficiency virus, and determining
whether such progression is different in women than in men, the
following applies:
``(1) The Secretary shall ensure that not less than 5,000
women with such infection are included in the study.
``(2) The Secretary shall provide for an increase in the
number of sites at which the study is to be conducted.
``(3) The Secretary shall ensure that the study period is
for a minimum of 8 years.
``(4) With respect to markers of human immunodeficiency
virus disease progression and viral activity, including the
cells commonly known as CD4 cells, the Secretary shall ensure
that the study adequately addresses the relationship between
such markers and the development of serious illnesses in such
women, including the relationship between the number of such
cells and the development of such illnesses. For purposes of
the preceding sentence, the study shall address gynecological
conditions, and other conditions particular to women, that are
not currently included in the list of conditions arising from
such infection that, for surveillance purposes, is maintained
by the Director of the Centers for Disease Control and
Prevention.
``(f) Definitions.--For purposes of this section, the term `human
immunodeficiency virus' means the etiologic agent for acquired immune
deficiency syndrome.
``(g) Authorizations of Appropriations.--
``(1) Clinical trials.--
``(A) For the purpose of carrying out subsection
(c)(1), there are authorized to be appropriated
$20,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 through
1996.
``(B) For the purpose of carrying out subsection
(c)(2), there are authorized to be appropriated
$10,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 through
1996.
``(C) For the purpose of carrying out subsection
(c)(3), there are authorized to be appropriated
$10,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 through
1996.
``(D) For the purpose of carrying out subsection
(c)(4), there are authorized to be appropriated
$15,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 and
1996.
``(2) Prevention programs.--
``(A) For the purpose of carrying out subsection
(d)(1), there are authorized to be appropriated
$30,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 through
1996.
``(B) For the purpose of carrying out subsection
(d)(2), there are authorized to be appropriated
$10,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 through
1996.
``(3) Interagency study.--For the purpose of carrying out
subsection (e), there are authorized to be appropriated
$15,000,000 for fiscal year 1994, and such sums as may be
necessary for each of the fiscal years 1995 through 1996.''.
Subtitle C--Women and Alcohol Research Equity Act of 1993
SEC. 111. SHORT TITLE.
This subtitle may be cited as the ``Women and Alcohol Research
Equity Act of 1993''.
SEC. 112. FINDINGS.
The Congress finds as follows with respect to the United States:
(1) One of every 3 alcoholics receiving treatment is a
woman.
(2) In fiscal year 1992, the National Institute on Alcohol
Abuse and Alcoholism had a total research budget of
$169,000,000, and only $14,200,000 of the budget (approximately
8 percent) was available for research on alcohol abuse and
alcoholism among women. Research on this topic is critical
because alcoholism has long been known to be a gender-specific
disease.
(3) Women continue to be underrepresented in treatment
programs. Women make up less than 25 percent of all publicly
funded alcohol treatment admissions and about 30 percent of
treatment admissions for other drug dependencies although women
make up an estimated 50 percent of the total alcohol and drug
dependent population.
(4) Alcohol use by pregnant women is the leading known
cause of mental retardation in newborns. Fetal alcohol
syndrome, which is marked by dysfunction of the central nervous
system and by prenatal and postnatal growth deficiency and
facial malformations, strikes 1 to 3 out of every 1,000
newborns, or 3,600 to 10,000 babies a year. The incidence of
less severe fetal alcohol effects is at least 3 times that of
fetal alcohol syndrome. Research is also needed on the male
contribution to birth abnormalities related to alcohol and
other drug use.
(5) Most treatment programs do not provide child care or
adequate alternatives for women entering treatment.
(6) The death rate of female alcoholics is 50 to 100
percent higher than for male alcoholics.
(7) More alcoholic women die of cirrhosis of the liver than
do alcoholic men.
(8) Combined effects of estrogen and alcohol augment liver
damage.
(9) Women experience greater physiological damage from
consumption of alcohol than do their male counterparts. The
interval between the onset of drinking and entry into treatment
appears to be shorter for women than men.
(10) Negative effects of drinking show up earlier in women
than men, even when they consume less alcohol than men. This
disease process is ``telescoped'' or accelerated in women.
(11) Women become intoxicated faster than men. This is due
to a different enzyme activity than men and hormonal
fluctuations in women.
(12) Chronic, heavy drinking contributes to menstrual
disorders, fertility problems, and premature menopause.
(13) Alcohol use may be associated with an increased risk
of breast cancer. Research indicates that the incidence of
breast cancer increases when a woman consumes 1 ounce or more
of absolute alcohol daily.
(14) The National Institute on Alcohol Abuse and Alcoholism
has identified areas for future research on alcohol abuse and
alcoholism among women. These areas were identified by the
Institute more than a decade ago, yet a sufficient number of
research projects regarding such areas has yet to be conducted.
SEC. 113. PROVISIONS REGARDING INCREASE IN AMOUNT OF FUNDS EXPENDED FOR
RESEARCH ON ALCOHOL ABUSE AND ALCOHOLISM AMONG WOMEN.
Section 464H(d)(1) of the Public Health Service Act (42 U.S.C.
285n(d)(1)), as added by section 122 of Public Law 102-321 (106 Stat.
358), is amended by adding at the end the following new sentence: ``For
fiscal year 1994, of the first $131,606,000 appropriated under the
preceding sentence, the Director of the Institute shall obligate not
less than $14,200,000 for the purpose of carrying out under this
subpart projects of research on alcohol abuse and alcoholism among
women, and of the amounts appropriated under such sentence in excess of
$131,606,000, the Director shall obligate for such purpose not less
than $23,250,000.''.
Subtitle D--National Breast Cancer Strategy Act of 1993
SEC. 116. SHORT TITLE.
This subtitle may be cited as the ``National Breast Cancer Strategy
Act of 1993''.
PART I--ESTABLISHMENT OF OFFICE OF BREAST CANCER AND NATIONAL BREAST
CANCER COMMISSION
SEC. 117. OFFICE OF BREAST CANCER.
Title XVII of the Public Health Service Act (42 U.S.C. 300uu et
seq.) is amended by adding at the end the following new section:
``SEC. 1709. ESTABLISHMENT OF OFFICE OF BREAST CANCER.
``(a) In General.--There is established an Office of Breast Cancer
within the Office of the Assistant Secretary for Health. The Office
shall have a Director who shall be appointed by the Secretary. The
Secretary, acting through the Director, shall carry out this section.
``(b) Duties.--The Secretary shall coordinate, in conjunction with
the Director of the National Cancer Institute, the activities of the
Institute relating to breast cancer with similar activities of other
agencies of the Federal Government, including the other agencies of the
National Institutes of Health, and with similar activities of other
public entities and of private entities.''.
SEC. 118. ESTABLISHMENT OF NATIONAL BREAST CANCER COMMISSION.
Title XVII of the Public Health Service Act (42 U.S.C. 300uu et
seq.), as amended by section 117, is amended by adding at the end the
following new section:
``SEC. 1710. NATIONAL BREAST CANCER COMMISSION.
``(a) Establishment.--There is established a commission to be known
as the `National Breast Cancer Commission' (in this section referred to
as the `Commission').
``(b) Study.--The Commission shall conduct a study on current
efforts in both the public and private sectors relating to the
prevention, early detection, treatment, education, and research
relating to breast cancer.
``(c) Report.--Not later than 1 year after the date on which the
initial appointments of the members have been completed under
subsection (d), the Commission shall submit to the President and the
Congress a report containing--
``(1) the results of the study conducted under subsection
(b); and
``(2) recommendations relating to such study.
``(d) Number and Appointment.--
``(1) Appointment.--The Commission shall be composed of 15
members as follows:
``(A) 5 members shall be appointed by the
President--
``(i) 3 of whom shall be--
``(I) the Secretary of Health and
Human Services;
``(II) the Secretary of Veterans
Affairs; and
``(III) the Secretary of Defense;
who shall be nonvoting members, except that, in
the case of a tie vote by the Commission, the
Secretary of Health and Human Services shall be
a voting member; and
``(ii) 2 of whom shall be selected from the
general public on the basis of such individuals
being specially qualified to serve on the
Commission by reason of their education,
training, or experience.
``(B) 5 members shall be appointed by the Speaker
of the House of Representatives on the joint
recommendation of the Majority and Minority Leaders of
the House of Representatives.
``(C) 5 members shall be appointed by the President
pro tempore of the Senate on the joint recommendation
of the Majority and Minority Leaders of the Senate.
``(2) Congressional committee recommendations.--In making
appointments under subparagraphs (B) and (C) of paragraph (1),
the Majority and Minority leaders of the House of
Representatives and the Senate shall duly consider the
recommendations of the Chairmen and Ranking Minority Members of
committees with jurisdiction over laws contained in chapter 17
of title 38, United States Code (relating to veterans' health
care), title XIX of the Social Security Act (42 U.S.C. 1901 et
seq.) (relating to Medicaid), and the Public Health Service Act
(42 U.S.C. 201 et seq.) (relating to the Public Health
Service).
``(3) Requirements of appointments.--The Majority and
Minority leaders of the Senate and the House of Representatives
shall--
``(A) select individuals who are specially
qualified to serve on the Commission by reason of their
education, training, or experience; and
``(B) engage in consultations for the purpose of
ensuring that the expertise of the 10 members appointed
by the Speaker of the House of Representatives and the
President pro tempore of the Senate shall provide as
much of a balance as possible and, to the greatest
extent possible, cover the fields of medicine, science,
law, ethics, health-care and social services.
``(4) Term of members.--Members of the Commission (other
than members appointed under paragraph (1)(A)(i)) shall serve
for the life of the Commission.
``(5) Vacancy.--A vacancy on the Commission shall be filled
in the manner in which the original appointment was made.
``(e) Chairman.--Not later than 15 days after the members of the
Commission are appointed, such members shall select a Chairman from
among the members of the Commission.
``(f) Quorum.--7 members of the Commission shall constitute a
quorum, but a lesser number may be authorized by the Commission to
conduct hearings.
``(g) Meetings.--The Commission shall hold its 1st meeting on a
date specified by the Chairman. After the initial meeting, the
Commission shall meet at the call of the Chairman or a majority of its
members, but shall meet at least 3 times each year during the life of
the Commission.
``(h) Pay.--Members of the Commission who are officers or employees
or elected officials of a government entity shall receive no additional
compensation by reason of their service on the Commission.
``(i) Per Diem.--While away from their homes or regular places of
business in the performance of duties for the Commission, members of
the Commission shall be allowed travel expenses, including per diem in
lieu of subsistence, at rates authorized for employees of agencies
under sections 5702 and 5703 of title 5, United States Code.
``(j) Deadline for Appointment.--The members of the Commission
shall be appointed not later than 60 days after the date of the
enactment of this section.
``(k) Termination.--The Commission shall cease to exist 60 days
after the date on which its final report is submitted under subsection
(c).''.
PART II--DUTIES OF DIRECTOR OF THE NATIONAL CANCER INSTITUTE RELATING
TO BREAST CANCER
SEC. 119. PROVISIONS FOR FULL FUNDING FOR NATIONAL CANCER INSTITUTE
WITH RESPECT TO RESEARCH ON BREAST CANCER.
Section 408(a)(1) of the Public Health Service Act (42 U.S.C.
284c(a)(1)) is amended by adding at the end the following subparagraph:
``(C) For the purpose of conducting and supporting research
on breast cancer through the National Cancer Institute, there
is authorized to be appropriated for fiscal year 1994 an amount
equal to the sum of $300,000,000 and the amount obligated by
such Institute for such research for fiscal year 1993. For such
purpose, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1995 and 1996.''.
SEC. 120. DUTIES OF DIRECTOR.
Subpart 1 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285 et seq.) is amended by adding at the end the following
new section:
``SEC. 417. DUTIES OF DIRECTOR OF THE INSTITUTE RELATING TO BREAST
CANCER RESEARCH.
``(a) The Director of the Institute shall conduct and support
biomedical and behavioral research and research training, the
dissemination of health information, and other programs with respect to
breast cancer.
``(b) In carrying out subsection (a), the Director of the Institute
shall conduct or support multidisciplinary clinical research on breast
cancer, including research on assisting individuals with such cancers
(and the families of such individuals) and with responding to
psychological and social problems that arise as the result of the
cancer.
``(c)(1) The Director of the Institute shall establish the Rose
Kushner Scholarship Program for the purpose of entering into contracts
with individuals under which--
``(A) the Director of the Institute agrees to provide to
the individuals scholarships for attendance at accredited
health professions schools; and
``(B) the individuals agree--
``(i) to complete the programs of education for
which the scholarships are provided;
``(ii) to complete a program of postgraduate
clinical training in oncology; and
``(iii) after completing a program of such
training, to serve as employees of the National
Institutes of Health, for the period described in
paragraph (2), in positions that are needed by such
Institutes in carrying out programs with respect to
breast cancer.
``(2)(A) For purposes of paragraph (1)(B)(iii), the period of
service for which an individual is obligated to serve as an employee of
the National Institutes of Health is 12 months for each academic year
for which the scholarship under such subsection is provided.
``(B) The Director of the Institute may defer the obligation of an
individual to provide a period of service under paragraph (1)(B)(iii),
if the Director determines that such a deferral is appropriate.
``(C) For any period in which an individual provides service as an
employee of the National Institutes of Health in satisfaction of the
obligation of the individual under paragraph (1)(B)(iii), the
individual may be appointed as such an employee without regard to the
provisions of title 5, United States Code, relating to appointment and
compensation.
``(3)(A) The Director of the Institute may not provide a
scholarship under paragraph (1) for an academic year unless--
``(i) the individual applying for the scholarship has
submitted to the Director a proposed academic program for the
year and the Director has approved the program; and
``(ii) the individual agrees that the program will not be
altered without the approval of the Director.
``(B) The Director of the Institute may not provide a scholarship
under paragraph (1) for an academic year unless the individual applying
for the scholarship agrees to maintain an acceptable level of academic
standing, as determined by the educational institution involved in
accordance with regulations issued by the Secretary.
``(4)(A) The Director of the Institute may not provide a
scholarship under paragraph (1) for an academic year in an amount
exceeding $10,000.
``(B) A scholarship provided under paragraph (1) may be expended
only for tuition expenses, other reasonable educational expenses, and
reasonable living expenses incurred while attending the health
professions school involved.
``(C) In the case of a health professions school with respect to
which a scholarship under paragraph (1) is provided, the Director of
the Institute may enter into a contract with the school under which the
amounts provided in the scholarship for tuition and other educational
expenses are paid directly to the school. Payments to the school under
the contract may be made without regard to section 3324 of title 31,
United States Code.
``(5) The provisions of section 338E shall apply to the program
established in paragraph (1) to the same extent and in the same manner
as such provisions apply to the National Health Service Corps Loan
Repayment Program established in section 338B.
``(6) The Director of the Institute may not provide a scholarship
under paragraph (1) unless an application for the scholarship is
submitted to the Director and the application is in such form, is made
in such manner, and contains such agreements, assurances, and
information as the Director determines to be necessary to carry out
this section.
``(d)(1) The Director of the Institute shall, subject to paragraph
(2), carry out a program of entering into contracts with appropriately
qualified health professionals under which the professionals agree to
carry out activities with respect to breast cancer as employees of the
National Institutes of Health in consideration of the Federal
Government agreeing to pay, for each year of such service, not more
than $20,000 of the principal and interest of the educational loans of
the professionals.
``(2) The Director of the Institute may not enter into a contract
with a health professional pursuant to paragraph (1) unless the
professional has a substantial amount of educational loans relative to
income.
``(3) Except to the extent inconsistent with this section, 338E
shall apply to the program established in paragraph (1) to the same
extent and in the same manner as such section applies to the National
Health Service Corps Loan Repayment Program established in section
338B.''.
SEC. 121. SPECIALIZED PROGRAMS OF RESEARCH EXCELLENCE WITH RESPECT TO
BREAST, LUNG, AND PROSTATE CANCER.
Section 408(a)(1) of the Public Health Service Act, as amended by
section 119, is amended by adding at the end the following
subparagraph:
``(D)(i) For the purpose of carrying out not less than 10
programs for research on breast cancer, lung cancer, or
prostate cancer under the programs designated by the Director
of the National Cancer Institute as the Specialized Programs of
Research Excellence, there is authorized to be appropriated
such sums as may be necessary for each of the fiscal years 1994
through 1996.
``(ii) With respect to the purpose described in clause (i),
the authorizations of appropriations established in such clause
may not be construed as terminating the availability for such
purpose of any other authorization of appropriations (including
the authorization established in subparagraph (A).''.
Subtitle E--Lupus Research Amendments of 1993
SEC. 126. SHORT TITLE.
This subtitle may be cited as the ``Lupus Research Amendments of
1993''.
SEC. 127. FINDINGS.
The Congress finds that--
(1) lupus is a serious, complex, inflammatory, autoimmune
disease of particular concern to women;
(2) lupus affects women 9 times more often than men;
(3) there are 3 main types of lupus: systemic lupus, a
serious form of the disease that affects many parts of the
body; discoid lupus, a form of the disease that affects mainly
the skin; and drug-induced lupus caused by certain medications;
(4) lupus can be fatal if not detected and treated early;
(5) the disease can simultaneously affect various areas of
the body, such as the skin, joints, kidneys, and brain, and can
be difficult to diagnose because the symptoms of lupus are
similar to those of many other diseases;
(6) lupus disproportionately affects African-American
women, as the prevalence of the disease among such women is 3
times the prevalence among white women, and an estimated 1 in
250 African-American women between the ages of 15 and 65
develops the disease;
(7) it has been estimated that over 500,000 Americans have
been diagnosed with the disease, and that many more have
undiagnosed cases;
(8) current treatments for the disease can be effective,
but may lead to damaging side effects; and
(9) many victims of the disease suffer debilitating pain
and fatigue, making it difficult to maintain employment and
lead normal lives.
SEC. 128. EXPANSION AND INTENSIFICATION OF ACTIVITIES REGARDING LUPUS.
Subpart 4 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285d et seq.) is amended by inserting after section 441 the
following section:
``lupus
``Sec. 441A. (a) In General.--The Director of the Institute shall
expand and intensify research and related activities of the Institute
with respect to lupus.
``(b) Coordination With Other Institutes.--The Director of the
Institute shall coordinate the activities of the Director under
subsection (a) with similar activities conducted by the other national
research institutes and agencies of the National Institutes of Health
to the extent that such Institutes and agencies have responsibilities
that are related to lupus.
``(c) Programs for Lupus.--In carrying out subsection (a), the
Director of the Institute shall conduct or support research to expand
the understanding of the causes of, and to find a cure for, lupus.
Activities under such subsection shall include research to determine
the reasons underlying the elevated prevalence of the disease among
African-American and other women. Activities under such subsection
shall provide for an expansion and intensification of the conduct and
support of--
``(1) basic research concerning the etiology and causes of
lupus;
``(2) epidemiological studies to address the frequency and
natural history of the disease and the differences among the
sexes and among racial and ethnic groups with respect to the
disease;
``(3) the development of improved screening techniques;
``(4) clinical research for the development and evaluation
of new treatments, including new biological agents; and
``(5) information and education programs for health care
professionals and the public.
``(d) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $20,000,000
for fiscal year 1994, and such sums as may be necessary for each of the
fiscal years 1994 through 1996. The authorization of appropriations
established in the preceding sentence is in addition to any other
authorization of appropriations that is available for such purpose.''.
Subtitle F--Women's Midlife Health Research Act
SEC. 131. SHORT TITLE.
This subtitle may be cited as the ``Women's Midlife Health Research
Act''.
SEC. 132. ESTABLISHMENT OF PROGRAM FOR RESEARCH CENTERS ON WOMEN'S
MIDLIFE HEALTH CARE, INCLUDING MENOPAUSE AND MENOPAUSAL
HEALTH CONDITIONS.
Subpart 5 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285e et seq.) is amended by adding at the end the following
section:
``research centers on menopause and menopausal health conditions
``Sec. 445G. (a) The Director of the Institute, after consultation
with the advisory council for the Institute, shall provide for the
development or expansion of not less than 5 centers for research on--
``(1) the process by which the functioning of the ovaries
diminishes or ceases completely (in this section referred to as
`menopause'); and
``(2) conditions arising from the diminished or complete
cessation of the functioning of the ovaries, whether occurring
naturally or otherwise (in this section referred to as
`menopausal health conditions').
``(b) Each center assisted under this section shall--
``(1)(A) use the facilities of a single institution or a
consortium of cooperating institutions; and
``(B) meet such qualifications as may be prescribed by the
Secretary;
``(2) conduct basic and clinical research into the natural
history of menopause in order to improve the state of medical
knowledge or methods regarding the cause, diagnosis, early
detection, prevention, control, and treatment of menopausal
health conditions;
``(3) develop multidisciplinary models of health care
regarding menopause and menopausal health conditions;
``(4) conduct educational and training programs on
menopause and menopausal health conditions for physicians,
scientists, and other health and allied health professionals;
``(5) conduct information and continuing education programs
for physicians and other health and allied health professionals
who provide care for patients with such conditions; and
``(6) conduct programs for the dissemination to the general
public of information on menopause and menopausal health
conditions.
``(c) In carrying out subsection (b)(2), the Director of the
Institute shall ensure that centers assisted under this section--
``(1) conduct research on hormonal treatments for
menopausal health conditions, research on nonhormonal
treatments of symptoms arising from such conditions, and
research on the relationship between such conditions and
cardiovascular disease, osteoporosis, bone fractures, bladder
conditions, breast and uterine cancers, and other conditions
that research indicates may be relevant; and
``(2) conduct research to determine whether and to what
extent differences may exist, with respect to menopause and
menopausal health conditions, among various socioeconomic
groups, ethnic groups, and racial groups.
``(d) In carrying out subsection (a), the Director of the
Institute, in consultation with the Director of NIH and the
Administrator for Health Care Policy and Research, shall establish a
program to develop protocols for the prevention and treatment of
menopausal health conditions and other conditions regarding women's
midlife health.
``(e) A center may use funds provided under subsection (a) to
provide stipends for health professionals enrolled in educational or
training programs described in subsection (b)(4).
``(f) The Director shall ensure that the activities of centers
assisted under this section are coordinated among the centers.
``(g) The Director of the Institute shall, to the extent
practicable, provide for an equitable geographical distribution of
centers assisted under this section.
``(h) Support of a center under this section may be for a period of
not to exceed five years. Such period may be extended by the Director
of the Institute for one or more additional periods of not more than
five years if the operations of such center have been reviewed by an
appropriate technical and scientific peer review group established by
the Director and if such group has recommended to the Director that
such period should be extended.''.
Subtitle G--Osteoporosis and Related Bone Disorders Research Education,
and Health Services Act of 1993
SEC. 136. SHORT TITLE.
This subtitle may be cited as the ``Osteoporosis and Related Bone
Disorders Research, Education, and Health Services Act of 1993''.
SEC. 137. FINDINGS.
The Congress finds that--
(1) osteoporosis, or porous bone, is a condition
characterized by an excessive loss of bone tissue and an
increased susceptibility to fractures of the hip, spine, and
wrist;
(2) an estimated 25,000,000 Americans have osteoporosis,
with many cases undiagnosed because the condition develops
without symptoms until a strain, bump, or fall causes a
fracture;
(3) between 3 and 4 million Americans have Paget's disease,
Osteogenesis Imperfecta, and other related metabolic bone
disorders;
(4) osteoporosis is responsible for 1,300,000 bone
fractures annually, including more than 250,000 hip fractures,
500,000 vertebral fractures, 200,000 fractures of the wrist,
and the remaining fractures at other limb sites;
(5) osteoporosis affects one-third to one-half of all
postmenopausal women and nearly half of all people over age 75;
(6) direct medical costs of osteoporosis reached an
estimated $10,000,000,000 in 1988 for the United States, not
including the costs of family care and lost work for
caregivers;
(7) direct medical costs of osteoporosis are expected to
increase precipitously because the proportion of the population
comprised of older persons is expanding and each generation of
older persons tends to have a higher incidence of osteoporosis
than preceding generations;
(8) technology now exists, and new technology is
developing, that will permit early diagnosis and prevention of
osteoporosis as well as management of the condition once it has
developed;
(9) funding for research on osteoporosis and related bone
disorders is severely constrained at key research institutes,
including the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, the National Institute on
Aging, and the National Institute of Diabetes and Digestive and
Kidney Diseases;
(10) further research is needed to improve medical
knowledge concerning--
(A) cellular mechanisms related to the processes of
bone resorption and bone formation, and the effect of
different agents on bone remodeling;
(B) risk factors for osteoporosis, including newly
discovered risk factors, risk factors related to groups
not ordinarily studied, such as men and minorities, and
the relationship of aging processes to the development
of osteoporosis;
(C) bone mass measurement technology, including
techniques for making faster and more precise
measurements and for interpreting measurements;
(D) calcium, including bioavailability, intake
requirements, and the role of calcium in building
heavier and denser skeletons;
(E) prevention and treatment, including the
efficacy of current therapies, alternative drug
therapies for prevention and treatment, and the role of
exercise; and
(F) rehabilitation; and
(11) further educational efforts are needed to increase
public and professional knowledge of the causes of, methods for
avoiding, and treatment of osteoporosis.
SEC. 138. OSTEOPOROSIS RESEARCH.
Subpart 4 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285d et seq.) is amended--
(1) by inserting after the subpart designation and heading
the following:
``DIVISION A--ARTHRITIS'';
and
(2) by adding at the end the following:
``DIVISION B--OSTEOPOROSIS
``SEC. 442A. DEFINITIONS.
``As used in this division:
``(1) Advisory panel.--The term `Advisory Panel' means the
Advisory Panel on Osteoporosis and Related Disorders,
established in section 442D.
``(2) Council.--The term `Council' means the Interagency
Council on Osteoporosis and Related Disorders, established in
section 442C.
``(3) Department.--The term `Department' means the
Department of Health and Human Services.
``(4) Related disorders.--The term `related bone disorders'
includes--
``(A) Paget's disease, a bone disease characterized
by enlargement and loss of density with bowing and
deformity of the bones;
``(B) Osteogenesis Imperfecta, a familial disease
marked by extreme brittleness of the long bones;
``(C) hyperparathyroidism, a condition
characterized by the presence of excess parathormone in
the body resulting in disturbance of calcium metabolism
with loss of calcium from bone and renal damage;
``(D) hypoparathyroidism, a condition characterized
by the absence of parathormone resulting in
disturbances of calcium metabolism;
``(E) renal bone disease, a disease characterized
by metabolic disturbances from dialysis, renal
transplants, or other renal disturbances;
``(F) primary or postmenopausal osteoporosis and
secondary osteoporosis, such as that induced by
corticosteroids; and
``(G) other general disorders of bone and mineral
metabolism including abnormalities of vitamin D.
``(5) Resource center.--The term `Resource Center' means
the Resource Center on Osteoporosis and Related Disorders,
established in section 442E.
``SEC. 442B. EXPANSION OF RESEARCH ON OSTEOPOROSIS AND RELATED BONE
DISORDERS.
``(a) Research.--The Director of the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, the Director of the
National Institute on Aging, and the Director of the National Institute
of Diabetes and Digestive and Kidney Diseases shall expand and
intensify research on osteoporosis and related bone disorders. The
research shall be in addition to research that is authorized under any
other provision of law.
``(b) Research Centers.--The Director of the National Institute of
Arthritis and Musculoskeletal and Skin Diseases shall increase the
number of Specialized Centers of Research devoted to research on
osteoporosis and related bone disorders. The Director of the National
Institute on Aging shall increase the number of program project grants
devoted to creating centers of excellence in osteoporosis and related
bone disorders. The Director of the National Institute of Diabetes and
Digestive and Kidney Diseases shall increase the number of program
projects grants in osteoporosis.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $36,000,000 for the National
Institute of Arthritis and Musculoskeletal and Skin Diseases,
$24,000,000 for the National Institute on Aging, and $2,000,000 for the
National Institute of Diabetes and Digestive and Kidney Diseases for
each of the fiscal years 1994 through 1996, and such sums as may be
necessary for subsequent fiscal years. These funds are in addition to
amounts authorized to be appropriated for biomedical research relating
to osteoporosis and related bone disorders under any other provision of
law.
``SEC. 442C. INTERAGENCY COUNCIL ON OSTEOPOROSIS AND RELATED BONE
DISORDERS.
``(a) Establishment.--There is established in the Department an
Interagency Council on Osteoporosis and Related Disorders. The Council
shall be composed of--
``(1) the Assistant Secretary for Health;
``(2) the Surgeon General of the United States;
``(3) the Assistant Secretary for Planning and Evaluation
of the Department;
``(4) the Director of the National Institute of Arthritis
and Musculoskeletal and Skin Diseases;
``(5) the Director of the National Institute on Aging;
``(6) the Director of the National Institute of Diabetes,
Digestive, and Kidney Diseases;
``(7) the Director of the National Institute of Mental
Health;
``(8) the Director of the National Institute of Child
Health and Human Development;
``(9) the Administrator of the Health Care Financing
Administration;
``(10) the Administrator for Health Care Policy and
Research;
``(11) the Director of the Bureau of Child and Maternal
Health;
``(12) the Commissioner of Food and Drugs;
``(13) the Director of the National Institute of Dental
Research;
``(14) the Commissioner on Aging;
``(15) the Director of the Office of Disease Prevention and
Health Promotion; and
``(16) such additional members as the Secretary considers
appropriate.
``(b) Functions.--The Council shall--
``(1) coordinate research conducted by or through the
Department on osteoporosis and related bone disorders;
``(2) establish a mechanism for sharing information on
osteoporosis and related bone disorders among all officers and
employees of the Department involved in carrying out programs
serving older persons, midlife women, and young persons, in
order to provide for full communication and exchange of
information;
``(3) review and coordinate the most promising areas of
research concerning osteoporosis and related bone disorders;
``(4) assist the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, the National Institute on
Aging, the National Institute of Diabetes, Digestive and Kidney
Disease, the National Institute on Dental Research, and other
institutes in developing and coordinating plans for research on
osteoporosis and related bone disorders;
``(5) assist the Office of Disease Prevention and Health
Promotion and the Administration on Aging and other offices in
developing and coordinating plans for education and health
promotion on osteoporosis and related bone disorders; and
``(6) establish mechanisms to use the results of research
concerning osteoporosis and related bone disorders in the
development of policies, programs, and other measures to
improve the quality of life for older Americans.
``(c) Chairperson.--The Secretary shall select a Chairperson or co-
Chairpersons for the Council from among its members.
``(d) Quorum.--A majority of the members of the Council shall
constitute a quorum, but a lesser number may hold hearings.
``(e) Meetings.--The Council shall meet periodically at the call of
the Chairperson, but not less often than twice each year.
``(f) Executive Secretary.--The Secretary shall appoint an
Executive Secretary for the Council.
``(g) Administrative Staff and Support.--The Secretary shall
provide the Council with such additional administrative staff and
support as may be necessary to enable the Council to carry out its
functions.
``(h) Reports.--
``(1) Initial report.--
``(A) Preparation.--Not later than 9 months after
the date of enactment of this division, the Executive
Secretary of the Council shall prepare a report
detailing the research plans referred to in paragraphs
(4) and (5) of subsection (b). The report shall
describe the activities to be carried out under the
research plans during each of the fiscal years 1994
through 1996.
``(B) Other federal programs.--To the maximum
extent feasible, the report shall ensure that
activities carried out under the research plans are
coordinated with, and use the resources of, other
Federal programs concerning osteoporosis and related
bone disorders, including--
``(i) centers supported by the National
Institute of Arthritis and Musculoskeletal and
Skin Diseases, the National Institute on Aging,
and the National Institute of Diabetes,
Digestive and Kidney Disease;
``(ii) other centers supported by Federal
funds involved in research on osteoporosis and
related bone disorders; and
``(iii) other programs concerning
osteoporosis and related bone disorders that
are planned or conducted by Federal agencies
such as the Administration on Aging and the
Office of Disease Prevention and Health
Promotion, Federal agencies outside the
Department, State or local agencies, community
organizations, or private foundations.
``(C) Distribution.--The Executive Secretary of the
Council shall--
``(i) transmit the report to Congress; and
``(ii) make the report available to the
public and to the Advisory Panel.
``(2) Subsequent reports.--Not later than 12 months after
the date on which the report required by paragraph (1) is
transmitted to Congress, and annually thereafter, the Executive
Secretary of the Council shall--
``(A) prepare a report that--
``(i) describes research and educational
initiatives sponsored by the Federal Government
on osteoporosis and related bone disorders; and
``(ii) makes recommendations for new
research and educational initiatives on
osteoporosis and related bone disorders; and
``(B) transmit the report to Congress and make the
report available to the public.
``SEC. 442D. ADVISORY PANEL ON OSTEOPOROSIS AND RELATED DISORDERS.
``(a) Establishment.--There is established in the Department an
Advisory Panel on Osteoporosis and Related Disorders. The Advisory
Panel shall be composed of the following 15 voting members and
additional nonvoting, ex officio members:
``(1) Voting members.--The Director of the Office of
Technology Assessment shall appoint to the Advisory Panel--
``(A) 5 members who are biomedical research
scientists with demonstrated achievement in biomedical
research on osteoporosis and related bone disorders,
including at least 1 researcher at a specialized center
for research in osteoporosis;
``(B) 2 members with demonstrated achievements in
research on community-based and family services
covering osteoporosis and related bone disorders;
``(C) 1 member who is knowledgeable in health
promotion and disease prevention programs concerning
osteoporosis and related bone disorders;
``(D) 2 members who are associated with specialized
bone programs affiliated with academic health centers;
``(E) 2 members who are experts in private health
care insurance and long-term care financing; and
``(F) 3 members who are representatives of national
voluntary organizations that are concerned with the
problems of individuals with osteoporosis and related
bone disorders and their families.
``(2) Nonvoting, ex officio members.--The Advisory Panel
shall include as nonvoting, ex officio members--
``(A) the Chairperson of the Council;
``(B) the Director of National Institute of
Arthritis and Musculoskeletal and Skin Diseases;
``(C) the Director of the National Institute on
Aging;
``(D) the Director of the National Institute of
Diabetes and Digestive and Kidney Diseases; and
``(E) such other members as the Secretary may
appoint.
``(3) Appointment.--The Director of the Office of
Technology Assessment shall appoint members to the Advisory
Panel within 90 days after the date of enactment of this
division. The Director shall not appoint to the Advisory Panel
individuals who are officers or employees of the Federal
Government.
``(b) Functions.--The Advisory Panel shall advise the Secretary and
Council with respect to the identification of--
``(1) research priorities for projects on osteoporosis,
related bone disorders, and the care of individuals with
osteoporosis or related bone disorders;
``(2) emerging issues in and promising areas of biomedical,
clinical, and behavioral research on osteoporosis and related
bone disorders;
``(3) emerging issues in research on health services for
individuals, and the families of individuals, with osteoporosis
or related bone disorders;
``(4) emerging issues in home-based and community-based
services and systems of services for individuals, and the
families of individuals, with osteoporosis or related bone
disorders;
``(5) emerging issues in financing health care services and
social services for individuals, and the families of
individuals, with osteoporosis and related bone disorders;
``(6) emerging issues in health promotion programs
concerning osteoporosis; and
``(7) emerging issues in professional and public education
concerning osteoporosis.
``(c) Chairperson.--The Secretary shall appoint a Chairperson of
the Advisory Panel from among the members appointed.
``(d) Term of Office.--The term of a member of the Advisory Panel
shall be for the life of the Advisory Panel. A vacancy on the Advisory
Panel shall be filled in the same manner as the original appointment
was made. A vacancy on the Advisory Panel shall not affect its powers.
``(e) Quorum.--A majority of the members of the Advisory Panel
appointed shall constitute a quorum, but a lesser number may hold
hearings. The Advisory Panel may establish such subcommittees as the
Advisory Panel considers appropriate.
``(f) Meetings.--The Advisory Panel shall meet at the call of the
Chairperson, but not less often than twice per year.
``(g) Executive Secretary.--The Executive Secretary of the Council
shall serve as Executive Secretary of the Advisory Panel.
``(h) Staff and Support.--The Secretary shall provide the Advisory
Panel with such additional administrative staff and support as may be
necessary to enable the Advisory Panel to carry out its functions.
``(i) Compensation and Travel Expenses.--
``(1) Compensation.--Subject to paragraph (2), no member of
the Advisory Panel shall receive compensation for service on
the Advisory Panel.
``(2) Travel expenses.--Each member of the Advisory Panel
shall receive reimbursement for travel, subsistence, and other
necessary expenses incurred in the performance of duties of the
Advisory Panel.
``(j) Report.--The Advisory Panel shall--
``(1) prepare an annual report, which shall contain
recommendations for administrative and legislative actions to--
``(A) improve services, education, and information
for individuals, and families of individuals, with
osteoporosis and related bone disorders;
``(B) improve professional education; and
``(C) provide for promising biomedical research
related to osteoporosis and related bone disorders; and
``(2) transmit the annual report to the Congress, the
Secretary, and the Council and make it available to the public.
``(k) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $200,000 for each of fiscal
years 1994 through 1996.
``SEC. 442E. RESOURCE CENTER ON OSTEOPOROSIS AND RELATED DISORDERS.
``(a) Establishment.--The Director of the National Institute of
Arthritis and Musculoskeletal and Skin Diseases shall make grants or
enter into contracts with eligible organizations to establish a
Resource Center on Osteoporosis and Related Disorders.
``(b) Purpose.--The purpose of the Resource Center shall be to
facilitate and enhance knowledge and understanding of osteoporosis and
related bone disorders by disseminating information about research
results, services and educational materials, to health professionals,
patients, and the public.
``(c) Functions.--An organization receiving a grant or contract
under this section shall--
``(1) compile, archive, and disseminate information
concerning research, demonstration, evaluation, and training
programs and projects concerning osteoporosis and related bone
disorders;
``(2) annually publish a summary of the information
compiled under paragraph (1) during the preceding 12-month
period, and make the information available on request to
appropriate individuals and entities, including educational
institutions, research entities, and Federal and public
agencies;
``(3) provide information and assistance in accessing
community services to patients and the public;
``(4) coordinate regional training programs for the
development of health professional resource networks on
osteoporosis and related bone disorders; and
``(5) maintain a resource library on osteoporosis and
related bone disorders.
``(d) Information System and Telephone Line.--
``(1) Information system.--An organization receiving a
grant or contract under this section shall establish a central
computerized information system to--
``(A) compile and disseminate information
concerning initiatives by State and local governments
and private entities to provide programs and services
for individuals with osteoporosis; and
``(B) translate scientific and technical
information concerning the initiatives into information
readily understandable by the general public, and make
the information available on request.
``(2) Telephone line.--An organization receiving a grant or
contract under this section shall establish a national toll-
free telephone line to make available the information described
in paragraph (1) and information concerning Federal programs,
services, and benefits for individuals with osteoporosis and
their families.
``(e) Fees.--In accordance with regulations issued by the
Secretary, the organization receiving a grant or contract under this
section shall charge appropriate fees for providing information through
the Research Center as specified in subsections (c) or (d). The
organization may make exceptions to the fees for individuals and
organizations who are not financially able to pay the fees. The
organization shall transfer the sums obtained from payment of the fees
to the Secretary, who shall use the sums to carry out this section.
``(f) Application or Proposal.--In order to receive a grant or
enter into a contract under this section, an organization shall submit
an application or proposal to the Director of the National Institute of
Arthritis and Musculoskeletal and Skin Diseases. The application or
proposal shall contain--
``(1) information demonstrating that the organization has a
network of contacts that will enable the organization to
receive information necessary to operate the central
computerized information system described in subsection (d)(1);
and
``(2) such other information as the Director may prescribe.
``(g) Eligible Organizations.--Organizations eligible to receive
grants under this section shall include public and private nonprofit
organizations that are knowledgeable about osteoporosis and related
bone disorders. The Secretary shall establish additional eligibility
criteria for organizations to receive grants or enter into contracts
under this section.
``(h) Research Summaries.--The Director of the National Institute
of Arthritis and Musculoskeletal and Skin Diseases, the National
Institute on Aging, the National Institute of Diabetes, Digestive, and
Kidney Diseases, the National Institute on Dental Research, and other
agencies specified by the Secretary shall provide to the Resource
Center summaries of the findings of research conducted on osteoporosis,
related bone disorders, or relevant treatments for osteoporosis or
related bone disorders.
``(i) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $500,000 for fiscal year 1994,
and such sums as may be necessary for fiscal years 1995 and 1996.''.
Subtitle H--Ovarian Cancer Research and Information Amendments of 1993
SEC. 141. SHORT TITLE.
This subtitle may be cited as the ``Ovarian Cancer Research and
Information Amendments of 1993''.
SEC. 142. FUNDING FOR RESEARCH ON OVARIAN CANCER.
Section 417B(b)(2) of the Public Health Service Act, as added by
section 403 of Public Law 103-43, is amended--
(1) by striking ``cancers.--For the purpose of'' and all
that follows through ``417,'' and inserting the following:
``cancers.--
``(A) For the purpose of carrying out section
417(d),''; and
(2) by adding at the end the following subparagraph:
``(B)(i) For the purpose of carrying out research
under section 417(d) on ovarian cancer, there are
authorized to be appropriated $90,000,000 for fiscal
year 1994, and such sums as may be necessary for each
of the fiscal years 1995 and 1996. With respect to such
purpose, such authorizations of appropriations are in
addition to the authorizations of appropriations
established in subparagraph (A) and in subsection (a).
``(ii) Of the amounts appropriated under clause
(i), the Director of the Institute shall reserve 50
percent for research described in such clause that does
not involve treatment or clinical trials, and 50
percent for research described in such clause that does
involve treatment and clinical trials.
``(iii) In expending the amounts reserved under
clause (ii), the Director of the Institute shall ensure
that 1 or more programs of research on ovarian cancer
are carried out under the programs designated by the
Director as the Specialized Programs of Research
Excellence.''.
SEC. 143. PUBLIC INFORMATION AND EDUCATION ON OVARIAN CANCER.
Section 417(d)(4) of the Public Health Service Act, as added by
section 401 of Public Law 103-43, is amended by striking ``section 413;
and'' and inserting the following: ``section 413, which programs shall
include programs on ovarian cancer that (subject to changes in the
applicable facts) provide information and education regarding--
``(A) screening procedures for such cancer,
including the fact that there is not a procedure that
reliably provides for the early detection of such
cancer;
``(B) the fact that there may be a genetic basis to
such cancer;
``(C) factors indicating a substantial risk of such
cancer; and
``(D) the various treatments for such cancer and
the extent to which the treatments are effective;
and''.
Subtitle I--Antiprogestin Testing Act of 1993
SEC. 146. SHORT TITLE.
This subtitle may be cited as the ``Antiprogestin Testing Act of
1993''.
SEC. 147. RESEARCH.
(a) In General.--The Secretary of Health and Human Services, acting
through the Director of the National Institutes of Health, may conduct
and support research (including clinical trials) on antiprogestin drugs
for their safety and efficacy for any potential use, including
termination of pregnancy and contraception, and when used
therapeutically for cancer, endocrine disorders, and endometriosis.
(b) Institutional Review Boards and Peer Review.--Research
conducted or supported under subsection (a) shall be subject to
sections 491 and 492 of the Public Health Service Act (42 U.S.C. 289,
289a).
(c) Priorities.--In determining priorities for research under
subsection (a), the Secretary shall consider data from previous
research.
SEC. 148. REPORT.
The Secretary of Health and Human Services shall report to Congress
the results of research conducted or supported under section 2(a) on
January 1, 1994, and annually thereafter.
Subtitle J--Women's Health Environmental Factors Research Act of 1993
SEC. 151. SHORT TITLE.
This subtitle may be cited as the ``Women's Health Environmental
Factors Research Act of 1993''.
SEC. 152. RESEARCH ON EFFECT OF ENVIRONMENTAL FACTORS ON WOMEN'S
HEALTH.
Subpart 12 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285), as amended by section 1301 of Public Law 103-43 (107
Stat. 169), is amended by adding at the end the following section:
``effect of environmental factors on women's health
``Sec. 463B. (a) The Director of the Institute shall carry out
research on the effects that environmental factors have on women's
health conditions (as defined in section 486), including the effect of
such factors on breast cancer, immune disfunction, and estrogen-like
compounds (and related compounds).
``(b) For the purpose of carrying out subsection (a), there are
authorized to be appropriated $30,000,000 for fiscal year 1994, and
such sums as may be necessary for each of the fiscal years 1995 and
1996. Such authorization is in addition to any other authorization of
appropriations that is established with respect to such purpose.''.
Subtitle K--Federal Risk Assessment in Women's Health Act of 1993
SEC. 156. SHORT TITLE.
This subtitle may be cited as the ``Federal Risk Assessment in
Women's Health Act of 1993''.
SEC. 157. INTERAGENCY REVIEW.
The Office of Science and Technology Policy, through the Federal
Coordinating Council for Science, Engineering, and Technology, and in
consultation with the Office of Research on Women's Health of the
National Institutes of Health, shall conduct a review of all Federal
programs that assess or mitigate the risks to women's health from
environmental exposures, including programs setting standards for
exposure to various pollutants, toxic substances, pesticide use, and
pesticide residues. The results of such review, including
recommendations for ensuring that women's health needs are addressed by
Federal programs and policies, shall be transmitted to the Congress
within 6 months after the date of enactment of this Act.
SEC. 158. STUDY OF RESEARCH NEEDS.
The National Institute of Environmental Health Sciences shall enter
into a contract with the National Research Council of the National
Academy of Sciences for the carrying out by such Council, in
consultation with the Office of Research on Women's Health of the
National Institutes of Health, for a study to determine the status of
the science base and needs of the Federal Government for research
relating to the risks to women's health from environmental exposures,
for the purpose of assessing and mitigating such risks. The results of
such study shall be transmitted to the Congress within one year after
the date of enactment of this Act.
Subtitle L--Pharmaceutical Interactions Safety Act
SEC. 161. SHORT TITLE.
This subtitle may be cited as the ``Pharmaceutical Interactions
Safety Act''.
SEC. 162. CLINICAL INVESTIGATIONS.
Section 505(b) of the Federal Food, Drug, and Cosmetic Act is
amended by adding at the end the following:
``(4) Clinical investigations to be submitted as part of an
application in accordance with paragraph (1)(A) shall include
investigations of the possible interaction of the drug with relevant
female or male hormones or related substances unless there is
substantial evidence that there are no significant interactions between
the drug under investigation and such substances or the inclusion of
such investigations is otherwise inappropriate under guidelines
established by the Secretary by rule.''.
SEC. 163. BIOLOGICAL PRODUCTS CLINICAL INVESTIGATIONS.
Section 351(c) of the Public Health Service Act (42 U.S.C. 262(c))
is amended by adding at the end the following:
``(3) Clinical investigations submitted as part of an application
for a biological product in accordance with paragraph (1) shall include
investigations of the possible interaction of the biological product
with relevant female or male hormones or related substances unless
there is substantial evidence that there are no significant
interactions between the biological product under investigation and
such substances or the inclusion of such investigations is otherwise
inappropriate under guidelines established by the Secretary by rule.''.
Subtitle M--Pharmaceutical Testing Fairness Act
SEC. 166. SHORT TITLE.
This subtitle may be cited as the ``Pharmaceutical Testing Fairness
Act''.
SEC. 167. NEW DRUG CLINICAL INVESTIGATIONS.
Section 505(b) of the Federal Food, Drug, and Cosmetic Act is
amended by adding at the end the following:
``(4)(A) Clinical investigations submitted as part of an
application in accordance with paragraph (1)(A) shall include women and
members of minority groups as subjects of such investigations unless
the inclusion of women and minority groups is inappropriate with
respect to the drug under investigation or is otherwise inappropriate
under such guidelines as the Secretary shall by rule establish in
accordance with subparagraph (B).
``(B) The guidelines of the Secretary respecting the inclusion of
women and members of minority groups in clinical investigations--
``(i) shall provide that the costs of such inclusion is not
a permissible consideration in determining whether such
inclusion is inappropriate,
``(ii) shall provide that women or minority groups are not
required to be included if women or minority groups will not be
using the drug under investigation, and
``(iii) may provide that such inclusion is not required if
there is substantial scientific data demonstrating that there
is no significant difference between the effects that the
variables to be studied in the investigation have on women or
members of minority groups, respectively, and on the other
individuals who would serve as subjects in the investigation in
the event that the inclusion of women and members of minority
groups was not required.
``(C) Phase three clinical investigations which are submitted as
part of an application in accordance with paragraph (1)(A) shall be
designed so that there is a valid analysis of whether the drug under
investigation affects women or members of minority groups differently
than other users of the drug. If the Secretary determines that it would
be appropriate for other phases of such investigations to be so
designed, such other phases shall be so designed.''.
SEC. 168. DEVICE CLINICAL INVESTIGATIONS.
Section 515(c) of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 360e(c)) is amended by adding at the end the following:
``(3)(A) Clinical investigations submitted as part of an
application in accordance with paragraph (1) shall include women and
members of minority groups as subjects of such investigations unless
the inclusion of women and minority groups is inappropriate with
respect to the device under investigation or is otherwise inappropriate
under such guidelines as the Secretary shall by rule establish in
accordance with subparagraph (B).
``(B) The guidelines of the Secretary respecting the inclusion of
women and members of minority groups in clinical investigations--
``(i) shall provide that the costs of such inclusion is not
a permissible consideration in determining whether such
inclusion is inappropriate,
``(ii) shall provide that women or minority groups are not
required to be included if women or minority groups will not be
using the device under investigation, and
``(iii) may provide that such inclusion is not required if
there is substantial scientific data demonstrating that there
is no significant difference between the effects that the
variables to be studied in the investigation have on women or
members of minority groups, respectively, and on the other
individuals who would serve as subjects in the investigation in
the event that the inclusion of women and members of minority
groups was not required.
``(C)(i) Clinical investigations designated by the Secretary under
clause (ii) which are submitted as part of an application in accordance
with paragraph (1) shall be designed so that there is a valid analysis
of whether the device under investigation affects women or members of
minority groups differently than other users of the device.
``(ii) The Secretary shall designate which of the clinical
investigations submitted as part of an application under paragraph (1)
shall be subject to the requirement of clause (i).''.
SEC. 169. BIOLOGICAL PRODUCTS CLINICAL INVESTIGATIONS.
Section 351(c) of the Public Health Service Act (42 U.S.C. 262(c))
is amended by adding at the end the following:
``(3)(A) Clinical investigations submitted as part of an
application in accordance with paragraph (1) shall include women and
members of minority groups as subjects of such investigations unless
the inclusion of women and minority groups is inappropriate with
respect to the biological product under investigation or is otherwise
inappropriate under such guidelines as the Secretary shall by rule
establish in accordance with subparagraph (B).
``(B) The guidelines of the Secretary respecting the inclusion of
women and members of minority groups in clinical investigations--
``(i) shall provide that the costs of such inclusion is not
a permissible consideration in determining whether such
inclusion is inappropriate,
``(ii) shall provide that women or minority groups are not
required to be included if women or minority groups will not be
using the biological product under investigation, and
``(iii) may provide that such inclusion is not required if
there is substantial scientific data demonstrating that there
is no significant difference between the effects that the
variables to be studied in the investigation have on women or
members of minority groups, respectively, and on the other
individuals who would serve as subjects in the investigation in
the event that the inclusion of women and members of minority
groups was not required.
``(C)(i) Clinical investigations designated by the Secretary under
clause (ii) which are submitted as part of an application in accordance
with paragraph (1) shall be designed so that there is a valid analysis
of whether the device under investigation affects women or members of
minority groups differently than other users of the device.
``(ii) The Secretary shall designate which of the clinical
investigations submitted as part of an application under paragraph (1)
shall be subject to the requirement of clause (i).''.
Subtitle N--Tobacco Advertising and Promotion Studies Act of 1993
SEC. 171. SHORT TITLE.
This subtitle may be cited as the ``Tobacco Advertising and
Promotion Studies Act of 1993''.
SEC. 172. FINDINGS.
(a) Women.--The Congress makes the following findings respecting
women and tobacco:
(1) The fastest growing sector of smokers in the United
States are women under the age of 23. Approximately 2,000 women
smoke their first cigarette every day.
(2) It is expected that between the years 2005 and 2010,
the number of women dying from smoking related diseases will
exceed the number of men so dying.
(3) Each year tobacco kills more than 147,000 women in the
United States, mostly through cigarette smoking induced heart
disease, lung cancer, and other lung diseases.
(4) As smoking by women has increased, lung cancer in women
has skyrocketed. In 1987 lung cancer surpassed breast cancer as
the leading cancer killer of women.
(5) Women who smoke as little as one to 4 cigarettes each
day increase their risk of heart attack by 2 to 3 times.
(6) Once women start to smoke they find it more difficult
to quit than do men.
(7) Women who smoke cigarettes during pregnancy increase
the risk for low birth weight and premature infants,
miscarriage, stillbirths, sudden infant death syndrome, and
infant mortality.
(8) Pregnant women who smoke deliver babies an average of
one-half inch shorter and 7 ounces lighter than the babies of
nonsmoking mothers. There is a 25 to 50 percent higher rate of
fetal and infant death among women who smoke during pregnancy
compared with those who do not smoke. It is estimated that
4,000 infants die each year because of their mother's smoking.
(9) Approximately 44 percent of all women who currently
smoke have attempted to quit smoking in the past year.
(10) Cigarette smoking increases women's risk of
contracting cervical cancer.
(b) Minorities.--The Congress makes the following findings
respecting minorities and tobacco:
(1) Tobacco use by African-Americans is responsible for
nearly 48,000 deaths each year in the United States.
(2) Tobacco companies aggressively target members of the
African-American community and the growing Hispanic population,
particularly in the urban, inner-city environment.
(3) As of 1991, 29.2 percent of African-American adults
(aged 18 and older) smoked cigarettes, including 35.1 percent
of African-American men and 24.4 percent of African-American
women.
(4) As of 1991, 16 percent of Asian/Pacific Islander adults
(aged 18 and older) smoke cigarettes, including 24.2 percent of
Asian/Pacific Islander men and 7.5 percent of Asian/Pacific
Islander women.
(5) As of 1991, 31.4 percent of American Indian/Alaskan
Natives adults (aged 18 and older) smoked cigarettes, including
27.9 percent of American Indian/Alaskan Natives men and 35.2
percent of American Indian/Alaskan Natives women.
(6) As of 1991, 20.2 percent of Hispanic adults (aged 18
and older) smoked cigarettes, including 25.2 percent of
Hispanic men and 15.5 percent Hispanic women.
(7) African Americans suffer from tobacco-related disease
at a higher rate than whites, including a higher incidence of
respiratory system, esophagus, and oral cavity cancers.
(8) Lung cancer is increasing among Hispanic men.
SEC. 173. TOBACCO ADVERTISING STUDIES.
(a) Studies.--The Federal Trade Commission shall conduct the
following studies which should be based on existing studies and on
significant original market research:
(1) Women and minorities.--A study of current tobacco
advertising to determine--
(A) if and in what forms such advertising is
designed and disseminated in such a way as to appeal
specifically to (i) girls and women and (ii) minorities
to promote their use of tobacco, and
(B) whether targeting girls, women, and minorities
increases tobacco use.
In connection with such study, advertising of alcoholic
beverages shall be reviewed to determine the extent to which
such advertising targets girls and women and minorities.
(2) Weight loss and maintenance.--
(A) In general.--A study of current cigarette
advertising to investigate the targeting of girls and
women in cigarette advertising and tobacco companies'
use of messages in their advertising concerning weight
loss and weight maintenance, the wording and overall
imagery used in such advertising and its impact on
girls and women, and the perception of girls and women,
including smokers and non-smokers, of the relation
between the use of tobacco and weight control and
maintenance.
(B) Terms and imagery.--In conducting the study
under subparagraph (A), the Federal Trade Commission
shall examine--
(i) whether women interpret the use of the
terms ``slim'', ``light'', ``thin'',
``superslim'', and related terms and the shape
of cigarettes employing such terms as implying
that cigarette smoking results in weight loss
or weight maintenance,
(ii) whether girl's and women's
interpretation of such terms and imagery
accurately reflects the actual effect of
cigarette smoking on weight,
(iii) the relative impact of cigarette
smoking on the health of girls and women, and
(iv) what action should be taken by the
Federal Trade Commission with respect to
advertising using such terms and imagery.
(3) Demographics.--A study of the demographics of cigarette
advertising and promotions which are targeted at girls, women,
and minorities, including the age, gender, race, ethnicity, and
socio-economic groups of the girls, women, and minorities and,
in the case of minorities, the demographics of such advertising
and promotions for smokeless tobacco products. Such study shall
include an examination of the expenditures for advertising and
promotions for each of the aspects of girls, women, and
minorities referred to in the preceding sentence.
(b) Report.--The Federal Trade Commission shall complete each of
the studies identified in subsection (a) not later than 9 months after
the date of the enactment of this Act and shall, not later than 12
months after such date, report to the Congress--
(1) the results of such studies, and
(2) any actions the Commission proposes to take on the
basis of such findings.
TITLE II--SERVICES REGARDING WOMEN'S HEALTH
Subtitle A--Equity in Health Professions Education Act
SEC. 201. SHORT TITLE.
This subtitle may be cited as the ``Equity in Health Professions
Education Act''.
SEC. 202. STUDY REGARDING CURRICULA OF HEALTH PROFESSIONS SCHOOLS AND
WOMEN'S HEALTH CONDITIONS.
(a) In General.--The Secretary of Health and Human Services, acting
through the Administrator of the Health Resources and Services
Administration, shall conduct a study for the purpose of determining
the extent to which health professions schools provide adequate
education to students on women's health conditions. The Secretary shall
give priority in the study to schools of medicine and osteopathic
medicine.
(b) Consultations.--The Secretary shall carry out subsection (a) in
consultation with the Director of the Office of Research on Women's
Health and the Director of the Office of Women's Health.
(c) Certain Elements of Study.--In conducting the study under
subsection (a), the Secretary--
(1) shall assess the content of the educational programs of
health professions schools with respect to women's health
conditions, including the content of programs providing
clinical training; and
(2) shall, if the Secretary determines that the extent of
education on such conditions is inadequate, determine the
extent to which such inadequacy is affecting the health of
women.
(d) Comments and Recommendations of Public and Private Entities.--
In carrying out subsection (a), the Secretary shall consider the
comments and recommendations of public and private entities regarding
the study under such subsection, including representatives of health
professions schools and representatives of organizations concerned with
women's health conditions.
(e) Report.--Not later than April 1, 1995, the Secretary shall
complete the study required in subsection (a) and submit to the
Committee on Energy and Commerce and the Committee on Appropriations of
the House of Representatives, and to the Committee on Labor and Human
Resources and the Committee on Appropriations of the Senate, a report
describing the findings made as a result of the study and containing
any recommendations of the Secretary regarding such findings, including
recommendations regarding the accreditation of health professions
schools and the licensure of health professionals.
(f) Definitions.--For purposes of this section:
(1) The term ``health professions schools'' means--
(A) the schools and programs defined in section
799(1) of the Public Health Service Act (other than
schools of veterinary medicine); and
(B) schools of nursing, as defined in section 853
of such Act.
(2) The term ``Office of Research on Women's Health'' means
the Office of Research on Women's Health established within the
Office of the Director of the National Institutes of Health.
(3) The term ``Office of Women's Health'' means the Office
of Women's Health established within the Office of the
Assistant Secretary for Health.
(4) The term ``Secretary'' means the Secretary of Health
and Human Services.
(5) The term ``women's health conditions'' has the meaning
given such term in section 486 of the Public Health Service
Act.
Subtitle B--Women's Health Office Act of 1993
SEC. 206. SHORT TITLE.
This subtitle may be cited as the ``Women's Health Office Act of
1993''.
SEC. 207. PUBLIC HEALTH SERVICE OFFICE OF WOMEN'S HEALTH.
Part A of title III of the Public Health Service Act (42 U.S.C. 241
et seq.) is amended by adding at the end thereof the following new
section:
``public health service office of women's health
``Sec. 310A. (a) Establishment of Office.--There is established an
Office of Women's Health (hereafter referred to in this section as the
`Office') within the Office of the Assistant Secretary for Health.
``(b) Assistant Secretary.--There shall be in the Department of
Health and Human Services a Deputy Assistant Secretary for Women's
Health, who shall be the head of the Office. The Secretary, acting
through such Deputy Assistant Secretary, shall carry out this section.
``(c) Duties.--The Secretary, acting through the Office, shall,
with respect to the health concerns of women--
``(1) establish short-range and long-range goals and
objectives and coordinate all other activities within the
Department of Health and Human Services that relate to disease
prevention, health promotion, service delivery, and research
concerning women;
``(2) advise the Assistant Secretary for Health concerning
scientific, legal, ethical, and policy issues relating to
women's health;
``(3) monitor Public Health Service agency and regional
activities regarding women's health, and coordinate activities
of such agency Offices of Women's Health;
``(4) establish a women's health resource center to
facilitate the exchange of information regarding matters
relating to health information and health promotion, preventive
health services, and education in the appropriate use of health
care, to facilitate access to such information, to assist in
the analysis of issues and problems relating to such matters,
and to provide technical assistance with respect to the
exchange of such information (including facilitating the
development of materials for such technical assistance); and
``(5) coordinate efforts to promote women's health programs
and policies in the voluntary and corporate sectors.
``(d) Reports.--Not later than January 31, 1995, and January 31 of
each second year thereafter, the Secretary shall prepare and submit to
the appropriate committees of Congress a report describing the
activities carried out under this section during the preceding 2 fiscal
years.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1994 through 1996.''.
SEC. 208. CENTERS FOR DISEASE CONTROL AND PREVENTION OFFICE OF WOMEN'S
HEALTH.
Part A of title III of the Public Health Service Act (42 U.S.C. 241
et seq.) (as amended by section 2) is further amended by adding at the
end thereof the following new section:
``centers for disease control and prevention office of women's health
``Sec. 310B. (a) Establishment.--There is established within the
Office of the Director of the Centers for Disease Control and
Prevention an office to be known as the Office of Women's Health
(hereafter referred to in this section as the `Office'). The Office
shall be headed by a director who shall be appointed by the Director of
the Centers.
``(b) Purpose.--The Director of the Office shall--
``(1) determine the current level of the Centers activity
regarding women's health conditions, across age, biological,
and sociocultural contexts, in all aspects of the Centers work,
including prevention programs, public and professional
education, services, and treatment;
``(2) establish short-range and long-range goals and
objectives for women's health and coordinate all other
activities within the Centers that relate to prevention,
research, education and training, service delivery, and policy
development;
``(3) identify projects in women's health that should be
conducted or supported by the National Centers;
``(4) consult with health professionals, non-governmental
organizations, consumer organizations, women's health
professionals, and other individuals and groups, as
appropriate, on the policy of the Centers with regard to women;
and
``(5) coordinate agency activities on women's health with
the Public Health Service Office of Women's Health established
under section 310A.
``(c) Coordinating Committee.--
``(1) Establishment.--In carrying out subsection (b), the
Director of the Office shall establish a committee to be known
as the Coordinating Committee on Research on Women's Health
(hereafter referred to in this subsection as the `Coordinating
Committee').
``(2) Composition.--The Coordinating Committee shall be
composed of the Directors of the National Centers.
``(3) Chairperson.--The Director of the Office shall serve
as the chairperson of the Coordinating Committee.
``(4) Duties.--With respect to women's health, the
Coordinating Committee shall assist the Director of the Office
in--
``(A) identifying the need for programs and
activities that focus on women's health;
``(B) identifying needs regarding the coordination
of activities, including intramural and extramural
multidisciplinary activities; and
``(C) making recommendations to the Director of the
Centers for Disease Control and Prevention concerning
findings made under subparagraphs (A) and (B).
``(d) Reports.--Not later than January 31, 1995, and January 31 of
each second year thereafter, the Director shall prepare and submit to
the Director of the Public Health Service Office of Women's Health, a
report describing the activities carried out under this section during
the preceding 2 fiscal years.
``(e) Definition.--As used in this section the term `women's health
conditions', with respect to women of all age, ethnic, and racial
groups, means all diseases, disorders, and conditions--
``(1) unique to, more serious, or more prevalent in women;
and
``(2) for which the factors of medical risk or type of
medical intervention are different for women, or for which it
is unknown whether such factors or types are different for
women.''.
SEC. 209. AGENCY FOR HEALTH CARE POLICY AND RESEARCH OFFICE OF WOMEN'S
HEALTH.
Part C of title IX of the Public Health Service Act (42 U.S.C. 299c
et seq.) is amended--
(1) by redesignating section 927 as section 928; and
(2) by inserting after section 926, the following new
section:
``SEC. 927. OFFICE OF WOMEN'S HEALTH.
``(a) Establishment.--There is established within the Office of the
Director of the Agency for Health Care Policy and Research an office to
be known as the Office of Women's Health (hereafter referred to in this
section as the `Office'). The Office shall be headed by a Director who
shall be appointed by the Director of the Agency.
``(b) Purpose.--The Director of the Office shall--
``(1) determine the current Agency level of activity
regarding women's health, across age, biological, and
sociocultural contexts, in all aspects of Agency work,
including drafting clinical practice guidelines, and conducting
research into patient outcomes, delivery of health care
services, and access to health care;
``(2) establish short-range and long-range goals and
objectives for research important to women's health and
coordinate all other activities within the Agency that relate
to health services and medical effectiveness research;
``(3) identify projects in women's health that should be
conducted or supported by the Agency;
``(4) consult with health professionals, non-governmental
organizations, consumer organizations, women's health
professionals, and other individuals and groups, as
appropriate, on Agency policy with regard to women; and
``(5) coordinate agency activities on women's health with
the Public Health Service Office of Women's Health established
under section 310A.
``(c) Coordinating Committee.--
``(1) Establishment.--In carrying out subsection (b), the
Director of the Office shall establish a committee to be known
as the Coordinating Committee on Research on Women's Health
(hereafter referred to in this subsection as the `Coordinating
Committee').
``(2) Composition.--The Coordinating Committee shall be
composed of the Directors of the Offices.
``(3) Chairperson.--The Director of the Office shall serve
as the chairperson of the Coordinating Committee.
``(4) Duties.--With respect to research on women's health,
the Coordinating Committee shall assist the Director of the
Office in--
``(A) identifying the need for such research, and
making an estimate each fiscal year of the funds needed
to adequately support the research;
``(B) identifying needs regarding the coordination
of research activities, including intramural and
extramural multidisciplinary activities; and
``(C) making recommendations to the Director of the
Agency for Health Care Policy and Research concerning
findings made under subparagraphs (A) and (B).
``(d) Reports.--Not later than January 31, 1995, and January 31 of
each second year thereafter, the Director shall prepare and submit to
the Director of the Public Health Service Office of Women's Health, a
report describing the activities carried out under this section during
the preceding 2 fiscal years.''.
SEC. 210. HEALTH RESOURCES AND SERVICES ADMINISTRATION OFFICE OF
WOMEN'S HEALTH.
Title VII of the Social Security Act (42 U.S.C. 901 et seq.) is
amended by adding at the end thereof the following new section:
``office of women's health
``Sec. 712. (a) Establishment.--There is established within the
Office of the Administrator of the Health Resources and Services
Administration an office to be known as the Office of Women's Health
(hereafter referred to in this section as the `Office'). The Office
shall be headed by a director who shall be appointed by the Director of
the Administration.
``(b) Purpose.--The Director of the Office shall--
``(1) determine the current agency level of activity
regarding women's health across age, biological, and
sociocultural contexts;
``(2) establish short-range and long-range goals and
objectives for women's health and coordinate all other
activities within the agency that relate to health care
provider training, health service delivery, research, and
demonstration projects;
``(3) identify projects in women's health that should be
conducted or supported by the Bureaus;
``(4) consult with health professionals, non-governmental
organizations, consumer organizations, women's health
professionals, and other individuals and groups, as
appropriate, on agency policy with regard to women; and
``(5) coordinate agency activities on women's health with
the Public Health Service Office of Women's Health established
under section 310A of the Public Health Service Act.
``(c) Coordinating Committee.--
``(1) Establishment.--In carrying out subsection (b), the
Director of the Office shall establish a committee to be known
as the Coordinating Committee on Research on Women's Health
(hereafter referred to in this subsection as the `Coordinating
Committee').
``(2) Composition.--The Coordinating Committee shall be
composed of the Directors of the Bureaus.
``(3) Chairperson.--The Director of the Office shall serve
as the Chairperson of the Coordinating Committee.
``(4) Duties.--With respect to research on women's health,
the Coordinating Committee shall assist the Director of the
Office in--
``(A) identifying the need for programs and
activities that focus on women's health;
``(B) identifying needs regarding the coordination
of activities, including intramural and extramural
multidisciplinary activities; and
``(C) making recommendations to the Director of the
Centers for Disease Control and Prevention concerning
findings made under subparagraphs (A) and (B).
``(d) Reports.--Not later than January 31, 1995, and January 31 of
each second year thereafter, the Director of the Office shall prepare
and submit to the Director of the Public Health Service Office of
Women's Health, a report describing the activities carried out under
this section during the preceding 2 fiscal years.''.
SEC. 210A. FOOD AND DRUG ADMINISTRATION OFFICE OF WOMEN'S HEALTH.
Chapter IX of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
391 et seq.) is amended by adding at the end thereof the following new
section:
``SEC. 906. OFFICE OF WOMEN'S HEALTH.
``(a) Establishment.--There is established within the Office of the
Commissioner of the Food and Drug Administration an office to be known
as the Office of Women's Health (hereafter referred to in this section
as the `Office'). The Office shall be headed by a Director who shall be
appointed by the Commissioner of the Administration.
``(b) Purpose.--The Director of the Office shall--
``(1) determine current Commission levels of activity
regarding women's participation in clinical trials the study of
gender differences in the testing of drugs, medical devices,
and biological products, across, age, sociocultural, and, where
deemed appropriate, biological contexts.
``(2) establish short-range and long-range goals and
objectives for adequate inclusion of women in all Commission
protocols and policies;
``(3) provide guidance or criteria for drug and device
manufacturers to use in determining the extent and sufficiency
of female representation in clinical trials;
``(4) consult with pharmaceutical manufacturers, health
professionals with expertise in women's issues, consumer
organizations, and women's health professionals on Commission
policy with regard to women;
``(5) make annual estimates of funds needed to monitor
clinical trials in accordance with needs that are identified;
and
``(6) coordinate Commission activities on women's health
with the Public Health Service Office of Women's Health
established under section 310A of the Public Health Service
Act.
``(c) Coordinating Committee.--
``(1) Establishment.--In carrying out subsection (b), the
Director of the Office shall establish a committee to be known
as the Coordinating Committee on Women's Health (hereafter
referred to in this subsection as the `Coordinating
Committee').
``(2) Composition.--The Coordinating Committee shall be
composed of the Directors of the Food and Drug Administration
Centers.
``(3) Chairperson.--The Director of the Office shall serve
as the Chairperson of the Coordinating Committee.
``(4) Duties.--With respect to studies on women's health,
the Coordinating Committee shall assist the Director of the
Office in--
``(A) identifying the need for further studies in
specific areas of women's health that fall within the
mission of the Commission, and developing strategies to
foster such studies;
``(B) identifying needs regarding the coordination
of Commission activities, including intramural and
extramural studies;
``(C) maintaining the Commission's focus in areas
of importance to women;
``(D) supporting the development of methodologies
to determine the circumstances in which obtaining data
specific to women (including data relating to the age
of women and the membership of women in ethnic or
racial groups) is an appropriate function of clinical
trials of treatments and therapies;
``(E) supporting the development and expansion of
clinical trials of treatments and therapies for which
obtaining such data has been determined to be an
appropriate function; and
``(F) encouraging the Food and Drug Administration
Centers to conduct and support such studies, including
such clinical trials.
``(d) Reports.--Not later than January 31, 1995, and January 31 of
each second year thereafter, the Director shall prepare and submit to
the Director of the Public Health Service Office of Women's Health, a
report describing the activities carried out under this section during
the preceding 2 fiscal years.''.
Subtitle C--Women's Health Information Act of 1993
SEC. 211. SHORT TITLE.
This subtitle may be cited as the ``Women's Health Information Act
of 1993''.
SEC. 212. FINDINGS.
The Congress finds as follows:
(1) A report by the General Accounting Office indicates
that the Department of Health and Human Services, which is
responsible for providing health information to the public,
lacks an overall strategy for providing such information to
women.
(2) Such Department has no overall strategy to ensure that
the most needed and useful health information is distributed to
the public.
(3) Health information activities of the Department are
left to the discretion of the agencies of the Public Health
Service, each of which largely plans the production and
dissemination of information independently of the other
agencies of the Service.
(4) Even when health information for the public is produced
and disseminated by the Department, it is not always easily
accessible to the public.
(5) With respect to health information, the agencies of
such Department cannot determine whether the efforts of the
agencies are appropriately targeted to raise women's awareness
and increase their knowledge about conditions that confront
them.
SEC. 213. INTERAGENCY COMMITTEE ON HEALTH COMMUNICATIONS.
(a) In General.--The Secretary of Health and Human Services shall
establish an Interagency Committee on Health Communications (in this
section referred to as the ``Committee'').
(b) Duties.--
(1) In general.--The Committee shall provide advice to the
Secretary of Health of Human Services on developing,
overseeing, and coordinating Federal promotion and education
activities, including such activities within the Public Health
Service.
(2) Women's health.--In carrying out paragraph (1), the
Committee shall give priority to carrying activities regarding
women's health.
(c) Chair.--The Committee shall be chaired by the Assistant
Secretary for Health.
(d) Composition.--
(1) In general.--Subject to paragraph (2), the Committee
shall be composed of one representative from each agency with
authority to speak for the agency, in order to address
activities and goal-setting with regard to communications
specific to women's health. Decisions shall be implemented
either individually or collectively as required.
(2) Women's health.--The Director of the Office of Women's
Health at the Public Health Service shall serve as a member of
the Committee to ensure that the efforts of the Committee and
the Public Health Service reflect pertinent recommendations and
objectives to improve women's health.
(e) Meetings.--
(1) In general.--The Committee shall, as appropriate, meet
not fewer than 4 times a year in order to promote
collaboration, enhance cooperation, and develop effective
strategies in this effort.
(2) Annual forum.--The Assistant Secretary for Health shall
convene a forum once a year to hear testimony by interested
public and private individuals and organizations regarding
priorities for areas of women's health, and shall respond to
the testimony and make recommendations regarding the testimony.
(f) Report.--The Assistant Secretary of Health shall issue a yearly
report on the progress of the Committee's efforts to establish a
coordinated strategy of health promotion and disease prevention
activities at the Public Health Service.
SEC. 214. DISSEMINATION EFFORTS OF WOMEN'S HEALTH INFORMATION WITHIN
PUBLIC HEALTH SERVICE.
(a) Clearinghouse on Women's Health.--The Assistant Secretary for
Health shall establish the Clearinghouse on Women's Health to compile,
archive, and disseminate information concerning women's health and to
publish a yearly summary of such materials to be made available upon
request.
(b) Other Activities.--
(1) In general.--The Secretary of Health and Human Services
may make a grant, or enter into a contract with one or more
organizations representing women--
(A) to make available information concerning
Federal programs, services, informational resources,
and benefits related to women's health;
(B) establish a toll-free hotline; and
(C) assess demand for publications and costs on an
annual basis, and develop publications as needed.
(2) Fees regarding toll-free hotline.--The Clearinghouse
may, as necessary, charge an appropriate fee for information
provided by the toll-free hotline. Exceptions shall be made for
individuals or organizations that are financially unable to pay
such fees.
(c) Advertising Campaign.--The Secretary of Health and Human
Services shall conduct an outreach and advertising campaign to women
and health professionals regarding the existence of the clearinghouse
and the toll-free number.
(d) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1994 through 1999.
SEC. 215. STUDY ON EFFECTIVENESS OF HEALTH COMMUNICATIONS.
The Secretary of Health and Human Services shall convene a study of
the Agency for Health Care Policy and Research to evaluate the overall
effectiveness of health communications, including the efficacy of
existing policies and techniques utilized by the Public Health Service
to develop and disseminate such information. The study shall involve
evaluation of effort, mode, use of toll-free numbers, and assessment of
organization and competency. The study shall also include an analysis
of efforts regarding reaching underserved populations. The Agency for
Health Care Policy and Research shall make recommendations to the
Assistant Secretary for Health on the most effective strategy for
reaching the public and presenting health communications.
Subtitle D--Breast and Cervical Cancer Amendments of 1993
SEC. 216. SHORT TITLE.
This subtitle may be cited as the ``Breast and Cervical Cancer
Amendments of 1993''.
SEC. 217. REVISIONS IN PROGRAM OF STATE GRANTS REGARDING BREAST AND
CERVICAL CANCER.
(a) Limited Authority Regarding For-Profit Entities.--
(1) In general.--Section 1501(b) of the Public Health
Service Act (42 U.S.C. 300k(b)) is amended--
(A) by striking ``States.--A State'' and all that
follows through ``may expend'' and inserting the
following: ``States.--
``(1) In general.--A State receiving a grant under
subsection (a) may, subject to paragraph (2), expend''; and
(B) by adding at the end the following paragraph:
``(2) Limited authority regarding other entities.--In
addition to the authority established in paragraph (1) for a
State with respect to grants and contracts, the State may
provide for screenings under subsection (a)(1) through entering
into contracts with private entities. The amount paid by a
State to a private entity under the preceding sentence for a
screening procedure may not exceed the amount that would be
paid under part B of title XVIII of the Social Security Act if
payment were made under such part for furnishing the procedure
to a woman enrolled under such part.''.
(2) Conforming amendment.--Section 1505(3) of the Public
Health Service Act (42 U.S.C. 300n-1(3)) is amended by
inserting before the semicolon the following: ``(and
additionally, in the case of services and activities under
section 1501(a)(1), with any similar services or activities of
private entities)''.
(b) Quality Assurance Regarding Screening Procedures.--
(1) In general.--Section 1503 of the Public Health Service
Act (42 U.S.C. 300m) is amended by striking subsections (c)
through (e) and inserting the following:
``(c) Quality Assurance Regarding Screening Procedures.--The
Secretary may not make a grant under section 1501 unless the State
involved agrees that the State will, in accordance with applicable law,
assure the quality of screening procedures conducted pursuant to such
section.''.
(2) Transition rule regarding mammographies.--With respect
to the screening procedure for breast cancer known as a
mammography, the requirements in effect on the day before the
date of the enactment of this subtitle under section 1503(c) of
the Public Health Service Act remain in effect (for an
individual or facility conducting such procedures pursuant to a
grant to a State under section 1501 of such Act) until there is
in effect for the facility a certificate (or provisional
certificate) issued under section 354 of such Act.
(c) Statewide Provision of Services.--Section 1504(c) of the Public
Health Service Act (42 U.S.C. 300n(c)) is amended by adding at the end
the following paragraph:
``(3) Grants to tribes and tribal organizations.--
``(A) The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, may
make grants to tribes and tribal organizations (as such
terms are used in paragraph (1)) for the purpose of
carrying out programs described in section 1501(a).
This title (other than section 1501(c)) applies to such
a grant (in relation to the jurisdiction of the tribe
or organization) to the same extent and in the same
manner as such title applies to grants to States under
section 1501 (in relation to the jurisdiction of the
States).
``(B) If a tribe or tribal organization is
receiving a grant under subparagraph (A) and the State
in which the tribe or organization is located is
receiving a grant under section 1501, the requirement
established in paragraph (1) for the State regarding
the tribe or organization is deemed to have been waived
under paragraph (2).''.
(d) Evaluations and Reports.--Section 1508 of the Public Health
Service Act (42 U.S.C. 300n-4) is amended--
(1) in subsection (a), by adding at the end the following
sentence: ``Such evaluations shall include evaluations of the
extent to which States carrying out such programs are in
compliance with section 1501(a)(2) and with section 1504(c).'';
and
(2) in subsection (b), by inserting before the period the
following: ``, including recommendations regarding compliance
by the States with section 1501(a)(2) and with section
1504(c)''.
(e) Establishment of Coordinating Committee.--Section 1501 of the
Public Health Service Act (42 U.S.C. 300k) is amended by adding at the
end the following subsection:
``(c) Coordinating Committee Regarding Year 2000 Health
Objectives.--The Secretary, acting through the Director of the Centers
for Disease Control and Prevention, shall establish a committee to
coordinate the activities of the agencies of the Public Health Service
(and other appropriate Federal agencies) that are carried out toward
achieving the objectives established by the Secretary for reductions in
the incidence of breast and cervical cancer in the United States by the
year 2000. Such committee shall be comprised of Federal officers or
employees designated by the heads of the agencies involved to serve on
the committee as representatives of the agencies, and such
representatives from other public or private entities as the Secretary
determines to be appropriate.''.
(f) Technical Corrections.--Title XV of the Public Health Service
Act (42 U.S.C. 300k et seq.) is amended--
(1) in section 1501(a), in the matter preceding paragraph
(1), by striking ``Control,'' and inserting ``Control and
Prevention,''; and
(2) in section 1505(4), by inserting ``will'' before ``be
used''.
SEC. 218. FUNDING.
Section 1509(a) of the Public Health Service Act (42 U.S.C. 300n-
5(a)) is amended--
(1) by striking ``and'' after ``1991,''; and
(2) by inserting before the period the following: ``,
$100,000,000 for fiscal year 1994, and such sums as may be
necessary for each of the fiscal years 1995 through 1998''.
Subtitle E--Women's Preventive Health Amendments of 1993
SEC. 221. SHORT TITLE.
This subtitle may be cited as the ``Women's Preventive Health
Amendments of 1993''.
SEC. 222. ESTABLISHMENT OF DEMONSTRATION PROGRAM OF GRANTS FOR
ADDITIONAL PREVENTIVE HEALTH SERVICES FOR WOMEN.
Title XV of the Public Health Service Act (42 U.S.C. 300k et seq.)
is amended--
(1) by redesignating section 1509 as section 1510; and
(2) by inserting after section 1508 the following section:
``SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL PREVENTIVE HEALTH
SERVICES.
``(a) Demonstration Projects.--In the case of States receiving
grants under section 1501, the Secretary, acting through the Director
of the Centers for Disease Control and Prevention, may make grants to
not more than 3 such States to carry out demonstration projects for the
purpose of--
``(1) providing to women preventive health services, and
health promotion services, in addition to the services
authorized in such section;
``(2) providing appropriate referrals for medical treatment
of women receiving services pursuant to paragraph (1) and
ensuring, to the extent practicable, the provision of
appropriate follow-up services; and
``(3) evaluating activities conducted under paragraphs (1)
and (2) through appropriate surveillance or program-monitoring
activities.
``(b) Status as Participant in Program Regarding Breast and
Cervical Cancer.--The Secretary may not make a grant under subsection
(a) unless the State involved agrees that services under the grant will
be provided only through entities that are screening women for breast
or cervical cancer pursuant to a grant under section 1501.
``(c) Requirements Regarding Matching Funds, Fees for Services, and
Certain Other Matters.--The Secretary may not make a grant under
subsection (a) unless the State involved agrees that section 1502, and
sections 1504 through 1506, apply to a grant under subsection (a) to
the same extent and in the same manner as such sections apply to a
grant under section 1501.
``(d) Technical Assistance; Supplies and Services in Lieu of Grant
Funds.--Section 1507 applies to a grant under subsection (a) to the
same extent and in the same manner as such section applies to a grant
under section 1501.
``(e) Evaluations and Reports.--Section 1508 applies to a grant
under subsection (a) to the same extent and in the same manner as such
section applies to a grant under section 1501.''.
SEC. 223. FUNDING.
Section 1510 of the Public Health Service Act, as redesignated by
section 222 of this Act, is amended to read as follows:
``SEC. 1510. FUNDING.
``(a) Program Regarding Breast and Cervical Cancer.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this title other than section 1509, there are
authorized to be appropriated such sums as may be necessary for
fiscal year 1994.
``(2) Set-aside for technical assistance and provision of
supplies and services.--Of the amounts appropriated under
paragraph (1) for a fiscal year, the Secretary shall reserve
not more than 20 percent for carrying out section 1507.
``(b) Program Regarding Additional Preventive Health Services.--
``(1) Authorization of appropriations.--Subject to
paragraph (2), for the purpose of carrying out section 1509,
there are authorized to be appropriated such sums as may be
necessary for each of the fiscal years 1994 through 1996.
``(2) Limitation regarding funding with respect to breast
and cervical cancer.--The authorization of appropriations
established in paragraph (1) is not effective for a fiscal year
unless the amount appropriated under subsection (a)(1) for the
fiscal year equals or exceeds the amount appropriated under
such subsection for the preceding fiscal year.''.
Subtitle F--Postreproductive Health Care Act
SEC. 226. SHORT TITLE.
This subtitle may be cited as the ``Postreproductive Health Care
Act''.
SEC. 227. ESTABLISHMENT OF PROGRAM FOR POSTREPRODUCTIVE HEALTH CARE.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by adding at the end the following new
subpart:
``Subpart IX--Postreproductive Health Care
``postreproductive health care
``Sec. 340D. (a) In General.--The Secretary shall make grants for
the purpose of providing the services described in subsection (b) to
women who are of menopausal age or older. Such grants may be made only
to public or nonprofit private entities that provide health services to
a significant number of low-income women.
``(b) Authorized Services.--The services referred to in subsection
(a) are as follows:
``(1) The prevention and outpatient treatment of health
conditions--
``(A) unique to, more serious, or more prevalent
for eligible women; or
``(B) for which, in the case of such women, the
factors of medical risk or types of medical
intervention are different.
``(2) Counseling on the conditions described in paragraph
(1).
``(3) The education and training of health professionals
(including allied health professionals) on the prevention and
treatment of such conditions and on the provision of such
counseling.
``(c) Priority in Provision of Services.--The Secretary may make a
grant under subsection (a) only if the applicant involved agrees that,
in expending the grant to provide authorized services to eligible
women, the applicant will give priority to providing the services for
menopausal health conditions.
``(d) Outreach.--The Secretary may make a grant under subsection
(a) only if the applicant involved agrees--
``(1) to conduct outreach services to inform women in the
community involved of the fact that authorized services are
available from the applicant; and
``(2) to give priority to providing the outreach services
to low-income women.
``(e) Limitation on Imposition of Fees for Services.--The Secretary
may make a grant under subsection (a) only if the applicant involved
agrees that, if a charge is imposed for the provision of services or
activities under the grant, such charge--
``(1) will be made according to a schedule of charges that
is made available to the public;
``(2) will be adjusted to reflect the income of the woman
involved; and
``(3) will not be imposed on any woman with an income equal
to or less than 100 percent of the official poverty line, as
established by the Director of the Office of Management and
Budget and revised by the Secretary in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of 1981.
``(f) Reports to Secretary.--The Secretary may make a grant under
subsection (a) only if the applicant involved agrees to submit to the
Secretary, for each fiscal year for which such a grant is made to the
applicant, a report describing the purposes for which the grant has
been expended.
``(g) Requirement of Application.--The Secretary may make a grant
under subsection (a) only if the applicant involved makes an agreement
that the grant will not be expended for any purpose other than the
purpose described in such subsection and for compliance with any other
agreements required in this section. Such a grant may be made only if
an application for the grant is submitted to the Secretary containing
such agreements, and the application is in such form, is made in such
manner, and contains such other agreements, and such assurances and
information, as the Secretary determines to be necessary to carry out
this section.
``(h) Definitions.--For purposes of this section:
``(1) The term `authorized services' means the services
described in subsection (b).
``(2) The term `eligible women' means women described in
subsection (a).
``(3) The term `health conditions' includes diseases and
disorders.
``(4) The term `health' includes mental health.
``(5) The term `menopausal age', with respect to a woman,
includes the age at which the woman is nearing menopause and
includes any age at which the woman experiences menopausal
health conditions.
``(6) The term `menopausal health conditions' means
conditions arising from the diminished or complete cessation of
the functioning of the ovaries, whether occurring naturally or
otherwise.
``(i) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $25,000,000
for fiscal year 1994, and such sums as may be necessary for each of the
fiscal years 1995 and 1996.''.
Subtitle G--Medicare Bone Mass Measurement Coverage Act of 1993
SEC. 231. SHORT TITLE.
This subtitle may be cited as the ``Medicare Bone Mass Measurement
Coverage Act of 1993''.
SEC. 232. MEDICARE COVERAGE OF BONE MASS MEASUREMENTS.
(a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended--
(1) in subsection (s)--
(A) in paragraph (12)(C), by striking ``and'' at
the end,
(B) by striking the period at the end of paragraph
(14) and inserting ``; and'',
(C) by redesignating paragraphs (15) and (16) as
paragraphs (16) and (17), and
(D) by inserting after paragraph (14) the following
new paragraph:
``(15) bone mass measurement (as defined in subsection
(oo));''; and
(2) by inserting after subsection (nn) the following new
subsection:
``Bone Mass Measurement
``(oo)(1) The term `bone mass measurement' means a radiologic or
radioisotopic procedure performed on a qualified individual (as defined
in paragraph (2)) for the purpose of detecting bone loss through the
use of single and dual photon absorptiometry, dual energy X-ray
absorptiometry or similar dual energy techniques, or quantitative
computed tomography, and includes a physician's interpretation of the
results of the procedure.
``(2) For purposes of paragraph (1), the term `qualified
individual' means (in accordance with regulations prescribed by the
Secretary)--
``(A) an estrogen-deficient woman at clinical risk for
osteoporosis;
``(B) an individual with vertebral abnormalities;
``(C) an individual receiving long-term glucocorticoid
steroid therapy; or
``(D) an individual with primary hyperparathyroidism.''.
(b) Conforming Amendments.--The Social Security Act is amended by
striking ``paragraphs (15) and (16)'' each place it appears in sections
1864(a), 1865(a), 1902(a)(9)(C), and 1915(a)(1)(B)(ii)(I) and inserting
``paragraphs (16) and (17)''.
(c) Effective Date.--The amendments made by this section shall
apply to bone mass measurements performed on or after January 1, 1994.
Subtitle H--Mickey Leland Adolescent Pregnancy Prevention and
Parenthood Act of 1993
SEC. 236. SHORT TITLE.
This subtitle may be cited as the ``Mickey Leland Adolescent
Pregnancy Prevention and Parenthood Act of 1993''.
SEC. 237. ADOLESCENT PREGNANCY PREVENTION, CARE, AND RESEARCH GRANTS.
Title XX of the Public Health Service Act (42 U.S.C. 300z et seq.)
is amended to read as follows:
``TITLE XX--ADOLESCENT PREGNANCY PREVENTION, CARE, AND RESEARCH GRANTS
``SEC. 2001. FINDINGS AND PURPOSES.
``(a) Findings.-- The Congress finds that--
``(1) adolescents are at a high risk of unwanted pregnancy;
``(2) in 1988, more than 1,000,000 teenagers became
pregnant, and nearly 500,000 teenagers carried their
pregnancies to term, of which more than 6 out of 10 births were
out of wedlock;
``(3) the birthrate for adolescents between the ages of 15
and 17 increased 23 percent between 1986 and 1989;
``(4) in a high proportion of cases, the pregnant
adolescent is herself the product of an unmarried parenthood
during adolescence and is continuing the pattern in her own
lifestyle;
``(5) pregnancy and childbirth among unmarried adolescents,
particularly young adolescents, often results in severe adverse
health, social, and economic consequences, including--
``(A) higher percentage of pregnancy and childbirth
complications;
``(B) higher incidence of low birth weight babies;
``(C) higher infant mortality and morbidity;
``(D) greater likelihood that an adolescent
marriage will end in divorce;
``(E) decreased likelihood of completing schooling;
and
``(F) higher risks of unemployment and welfare
dependency; and
therefore, education, training, and job research services are
important for adolescent parents; and
``(6) an adolescent who becomes pregnant once is likely to
experience rapid repeat pregnancies and childbearing, with
increased risks;
``(7) research has shown that in cases in which there is a
family involvement in comprehensive values-based projects and
services--
``(A) low birth weight is significantly reduced;
``(B) delays in initiating sexual activity occur;
``(C) there are significant reductions in repeat
pregnancy, welfare costs, and child abuse; and
``(D) teens are more likely to return and complete
their high school education; and
therefore, the family should become a partner in the
development of curriculum and programs that reflect the values
of the community;
``(8) the problems of adolescent pregnancy and parenthood
are multiple and complex and are best approached through a
variety of integrated and essential services, particularly
those that allow the pregnant adolescent and adolescent parent
to stay in school;
``(9) such services, including a wide array of educational
and supportive services, often are not available to the
adolescents who need them, or are available but fragmented and
thus of limited effectiveness in preventing pregnancies and
future welfare dependency; and
``(10) Federal policy therefore should encourage the
development of appropriate health, educational, and social
services where they are now lacking or inadequate, and the
better coordination of existing services where they are
available in order to prevent unwanted early and repeat
pregnancies and to help adolescents become productive,
independent contributors to family and community life.
``(b) Purposes.--It is the purpose of this title--
``(1) to establish better coordination, integration, and
linkages among existing programs in order to expand and improve
the availability of, and access to, needed comprehensive
community services that assist in preventing unwanted initial
and repeat pregnancies among adolescents, enable pregnant
adolescents to obtain proper care and assist pregnant
adolescents, their male partners, and adolescent parents to
become productive independent contributors to family and
community life, with primary emphasis on services to
adolescents who are 17 years of age and under;
``(2) to expand the availability of such services that are
essential to that objective;
``(3) to promote innovative, comprehensive, and integrated
approaches to the delivery of such services;
``(4) to encourage and support research programs concerning
the societal causes and consequences of pregnancy,
childbearing, and child rearing for adolescent females and
males;
``(5) to support evaluative research to identify effective
services that reduce adolescent pregnancy rates and that
improve the outcome of adolescent childbearing for the parents,
the child, and their families; and
``(6) to encourage and provide for the dissemination of
results, findings, and information from programs and research
projects relating to adolescent pregnancy and parenthood.
``SEC. 2002. DEFINITIONS.
``For the purposes of this title:
``(1) Adolescent.--The term `adolescent' means an
individual under the age of 21.
``(2) Care services.--The term `care services' means all
services for the provision of care to adolescents, both male
and female, pregnant adolescents and their male partners, and
adolescent parents. Such term shall include all core services
and may include supplementary services, in accordance with
regulations prescribed by the Secretary.
``(3) Core services.--The term `core services' means those
services that shall be provided by a grantee, as determined by
the Secretary by regulation, which shall include--
``(A) pregnancy testing and maternity counseling,
or referral for such services;
``(B) family planning services, except that such
services for adolescents who are not already parents
may be limited to counseling and referral unless
suitable and appropriate family planning services are
not otherwise available in the community;
``(C) counseling on all options regarding
pregnancy, or referral for such services;
``(D) primary and preventive health services,
including prenatal and postnatal care for mother and
children and arrangements for delivery;
``(E) well-baby care;
``(F) nutrition information and counseling;
``(G) screening, counseling and treatment or
referral for treatment and prevention of sexually
transmitted diseases, including acquired
immunodeficiency syndrome;
``(H) referral to appropriate pediatric care;
``(I) educational services relating to sexuality
and family life, including--
``(i) education on responsible
decisionmaking regarding sexual activity;
``(ii) education on the responsibilities of
parenting;
``(iii) education on a full range of means
for delaying becoming pregnant, including
abstinence, natural family planning, and
contraception;
``(iv) education on the prevention of
sexually transmitted diseases, including
acquired immunodeficiency syndrome; and
``(v) assistance to parents, schools, youth
agencies, and health care providers to educate
adolescents and pre-adolescents concerning
self-discipline and responsibility in human
sexuality;
``(J) referral to appropriate educational,
employment, employment training, and vocational
services;
``(K) mental health services and referral to mental
health services and to other appropriate physical
health and social services; and
``(L) encouragement of parent and family
involvement in each of the core services described in
subparagraphs (A) through (K).
``(4) Eligible grant recipient.--The term `eligible grant
recipient' means a public or nonprofit private organization or
agency that demonstrates, to the satisfaction of the
Secretary--
``(A) in the case of an organization that will
provide care services, the capability of providing all
care services in a single setting or the capability of
creating a network through which all care services
would be provided; or
``(B) in the case of an organization that will
provide prevention services, the capability of
providing such services.
``(5) Eligible person.--The term `eligible person' means--
``(A) with regard to the provision of prevention
services and referral to such other services as may be
appropriate, any adolescent; or
``(B) with regard to the provision of care
services, adolescent parents and (when appropriate)
adolescents who are not parents.
``(6) Prevention services.--The term `prevention services'
means services described in subparagraphs (B) and (I) of
paragraph (3) and referrals to such other services as may be
appropriate, including services to be offered in schools at
local discretion.
``(7) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(8) Supplemental services.--The term `supplemental
services' means those services that may be provided by a
grantee, as determined by the Secretary by regulation, which
may include--
``(A) child care sufficient to enable the
adolescent parent to continue education or to enter
into employment, including services to be provided
within secondary schools at local discretion;
``(B) consumer education and homemaking;
``(C) counseling for the immediate and extended
family members of the eligible person;
``(D) transportation;
``(E) referral to licensed residential care or
maternity home services;
``(F) referral to licensed adoption agencies for
adoption placement services;
``(G) employability training and counseling; and
``(H) such other services as are consistent with
this title as the Secretary may approve in accordance
with regulations promulgated by the Secretary.
``SEC. 2003. AUTHORITY TO MAKE GRANTS FOR SERVICES.
``The Secretary may make grants to provide prevention and care
services to pregnant adolescents and their male partners, adolescent
parents, and nonpregnant adolescents. Grants shall be used to provide,
supplement, or improve the quality of such services.
``SEC. 2004. USE OF GRANTS FOR SERVICES.
``(a) Uses.--A grant made under this title may be used to--
``(1) provide eligible persons--
``(A) prevention services;
``(B) care services; or
``(C) any combination of prevention and care
services;
``(2) coordinate, integrate, and provide linkages among
providers of prevention, care, and other services for eligible
persons in furtherance of the purposes of this title;
``(3) provide supplemental services where such services are
not adequate or not available to eligible persons in the
community and that are essential to the care of eligible
persons and to the prevention of adolescent pregnancy;
``(4) plan, for a period of not more than 1 year, for the
administration and coordination of pregnancy prevention
services and programs of care for eligible persons that will
further the objectives of this title; and
``(5) fulfill assurances required for grant approval by
section 2006.
``(b) Fees.--Grantees shall charge fees for services only pursuant
to a fee schedule, approved by the Secretary as a part of the
application described in section 2006, that bases fees charged by the
grantee on the income of the eligible person and takes into account the
difficulty adolescents face in obtaining resources to pay for services.
In no case may a grantee discriminate with regard to the provision of
services to any individual because of that individual's inability to
provide payment for such services.
``SEC. 2005. PRIORITIES, AMOUNTS, AND DURATION OF GRANTS FOR SERVICES.
``(a) Priorities.--In approving applications for grants for
services under this title, the Secretary shall give priority to
applicants who--
``(1) serve an area where there is a high incidence of
adolescent pregnancy;
``(2) serve an area with a high proportion of low-income
families and where the availability of programs of prevention
and care for eligible persons is low;
``(3) show evidence--
``(A) in the case of an applicant who will provide
prevention services, of having the ability to provide
prevention services for adolescents and their families
that are appropriate for the target population and the
geographic area to be served, including the special
needs of rural areas; or
``(B) in the case of an applicant who will provide
care services, of having the ability to bring together
a wide range of needed core services and, as
appropriate, supplemental services in comprehensive
single-site programs, or to establish a well-integrated
network of such services (appropriate for the target
population and geographic area to be served including
the special needs of rural areas) for eligible persons;
``(4) will utilize to the maximum extent feasible existing
available programs and facilities such as community health
centers, child welfare agencies, children and youth centers,
maternal and infant health centers, regional rural health
facilities, licensed adoption agencies, maternity homes, school
and other educational programs, family planning clinics, mental
health programs, nutrition programs, recreation programs, and
other ongoing pregnancy prevention and pregnancy-related
services;
``(5) make use, to the maximum extent feasible, of other
Federal, State, and local funds, programs, contributions, and
other third-party reimbursements;
``(6) can demonstrate a community commitment to the program
by making available to the program non-Federal funds,
personnel, and facilities;
``(7) have involved the community to be served, including
public and nonprofit private agencies, adolescents, and
families, in the planning and implementation of the program;
and
``(8) will demonstrate innovative and effective approaches
in addressing the problems of adolescent pregnancy or
parenthood, including outreach to adolescent males and
approaches for providing pregnant adolescents with adequate
information about adoption.
``(b) Amounts.--
``(1) In general.--The amount of a grant for a program for
services under this title shall be determined by the Secretary,
based on factors such as the incidence of adolescent pregnancy
in the geographic area to be served, and the adequacy of
pregnancy prevention services and programs of care for eligible
persons in such area.
``(2) Rural areas.--In making grants for services under
this title, the Secretary shall consider the special needs of
rural areas and, to the maximum extent practicable, shall
distribute funds taking into consideration the relative number
of adolescents in such areas in need of such services.
``(c) Federal Share.--
``(1) In general.--Subject to paragraph (3), a grant for
services under this title may not exceed 75 percent of the
costs of the program for any year.
``(2) Form of non-federal contributions.--Non-Federal
contributions required by paragraph (1) may be in cash or in
kind, fairly evaluated, including plant, equipment, or
services.
``(3) Waiver.--The Secretary may waive the limitation
specified in paragraph (1) for any year in accordance with
criteria established by regulation.
``SEC. 2006. REQUIREMENTS FOR APPLICATIONS FOR GRANTS FOR SERVICES.
``(a) In General.--An application for a grant for services under
this title shall be in such form and contain such information as the
Secretary may require, and shall include--
``(1) an identification of the incidence of adolescent
pregnancy and related problems;
``(2) a description of the economic conditions and income
levels in the geographic area to be served;
``(3) a description of existing pregnancy prevention
services and programs of care for eligible persons (including
adoption services), and including where, how, by whom, and to
which population groups such services are provided, and the
extent to which they are coordinated in the geographic area to
be served;
``(4) a description of the major unmet needs for services
for adolescents at risk of initial or recurrent pregnancies and
an estimate of the number of adolescents not being served in
the area;
``(5)(A) in the case of an applicant who will provide
prevention services, a description of the necessary services to
be provided and how the applicant will provide such services;
or
``(B) in the case of an applicant who will provide care
services, a description of how all core services will be
provided in the program using funds under this title or will
otherwise be provided by the grantee in the area to be served,
the population to which such services will be provided, how
such services will be coordinated, integrated, and linked with
other related programs and services and the source or sources
of funding of such core services in the public and private
sectors; or
``(6) a description of the manner in which adolescents
needing services other than the services provided directly by
the applicant will be identified and how access and appropriate
referral to such other services (such as but not limited to
medicaid; licensed adoption agencies; maternity home services;
public assistance; employment services; child care services for
adolescent parents; and other city, county, and State programs
related to adolescent pregnancy) will be provided, including a
description of a plan to coordinate such other services with
the services supported under this title;
``(7) a description of the results expected from the
provision of services, and the procedures to be used for
evaluating those results;
``(8) assurances that the applicant will have an ongoing
quality assurance program;
``(9) assurances that the applicant shall have a system for
maintaining the confidentiality of patient records in
accordance with regulations prescribed by the Secretary;
``(10) assurances that the applicant will demonstrate its
financial responsibility by the use of such accounting
procedures and other requirements as may be prescribed by the
Secretary;
``(11) assurances that the applicant will make maximum use
of other sources of Federal and State funding;
``(12)(A) a description of--
``(i) the schedule of fees to be used in the
provision of services, which shall comply with section
2004(c); and
``(ii) a corresponding schedule of discounts to be
applied to the payment of such fees, which shall--
``(I) comply with section 2004(b);
``(II) be adjusted on the basis of the
ability of the eligible person to pay; and
``(III) provide that no fee will be imposed
on any eligible individual with an income of
less than 100 percent of the official poverty
line;
``(B) assurances that the applicant has made and will
continue to make every reasonable effort--
``(i) to secure from eligible persons payment for
services in accordance with such schedules;
``(ii) to collect reimbursement for health or other
services provided to persons who are entitled to have
payment made on their behalf for such services under
any Federal or other government program or private
insurance program; and
``(iii) to seek such reimbursement on the basis of
the full amount of fees for services without
application of any discount; and
``(C) assurances that the applicant has submitted or will
submit to the Secretary such reports as the Secretary may
require to determine compliance with this paragraph;
``(13) assurances that the applicant will make maximum use
of funds available under title X;
``(14) assurances that the acceptance by any individual of
family planning services or family planning information
(including educational materials) provided through financial
assistance under this title shall be voluntary and shall not be
a prerequisite to eligibility for or receipt of any other
service furnished by the applicant;
``(15) assurances that fees collected by the applicant for
services rendered in accordance with this title shall be used
by the applicant to further the purposes of this title;
``(16) assurances that the applicant, if providing both
prevention and care services, will not exclude or discriminate
against any adolescent who receives prevention services and
subsequently requires care services as a pregnant adolescent;
``(17) a description of how the applicant will ascertain
whether services for which adolescents have been referred have
actually been obtained and develop a plan to ensure that needed
services actually are received;
``(18) assurances that unemancipated minors requesting
services from the applicant will be encouraged to consult with
their parents with respect to such services and that services
shall not be denied to unemancipated minors who decide not to
consult their parents;
``(19) assurances that all pregnant adolescents receiving
services will be informed of the availability of counseling
(either by the entity providing core services or through a
referral agreement with such other entity that provides such
counseling) on all options, regarding the pregnancy;
``(20) assurances that primary emphasis for services
supported under this title shall be given to adolescents 17 and
under who are not able to obtain needed assistance through
other means;
``(21) assurances that funds received under this title
shall not supplant funds received from any other Federal,
State, or local program or any private sources of funds; and
``(22) a plan for the conduct of, and assurances that the
applicant will conduct, evaluations of the effectiveness of the
services supported under this title in accordance with
subsection (b).
``(b) Evaluations.--
``(1) In general.--Each grantee that receives funds for a
grant for services under this title shall expend at least 3
percent but not in excess of 10 percent of the amounts received
under this title for the conduct of evaluations of the services
supported under this title. The Secretary may, for a particular
grantee on good cause shown, waive the preceding sentence with
respect to the amounts to be expended on evaluations, but may
not waive the requirement that such evaluations be conducted.
``(2) Independent evaluation.--Evaluations required by
paragraph (1) shall be conducted by an organization or entity
that is independent of the grantee providing services supported
under this title.
``(c) Reports.--
``(1) In general.--Each grantee that participates in the
program established by this title shall make such reports
concerning its use of Federal funds as the Secretary may
require, including reports on prevention programs and care
programs.
``(2) Contents of reports on prevention programs.--Reports
on prevention programs shall be in a standard format as
prescribed by the Secretary and shall include a description
of--
``(A) the characteristics, educational attainments,
and economic status of clients;
``(B) the clients' previous exposure in home,
school, or other locations to educational efforts
regarding sexuality and family life;
``(C) the types of interventions employed in the
prevention program;
``(D) the before and after outcome measurements on
variables appropriate to the intervention;
``(E) to the extent possible and where appropriate
to program goals, the pregnancy and sexually
transmitted disease rates subsequent to intervention;
and
``(F) the extent of parent or family involvement in
the program.
``(3) Contents of reports on care programs.--Reports on
care programs shall be in standard format as prescribed by the
Secretary and shall include a description of--
``(A) the characteristics, health history,
educational attainments, and economic status of clients
at the time of entry;
``(B) the client prenatal care and pregnancy
outcome, complications of pregnancy and delivery, and
infant birth outcomes;
``(C) the characteristics, educational attainments,
and economic status of clients at time of follow-up and
infant follow-up information;
``(D) the types of services provided to clients;
and
``(E) the extent of parent or family involvement in
the services provided.
``(4) Comparison data.--Reports on prevention programs and
care programs shall include control group data or other
appropriate comparison data to provide comparisons with project
data and to indicate program impact or effectiveness.
``(5) Follow-up data.--Reports on prevention programs and
care programs shall include, to the extent possible, follow-up
data on a random sample of program graduates and dropouts.
``(d) Timing of Services.--No application submitted for a grant for
a program for care services under this title may be approved unless the
Secretary is satisfied that core services shall be available through
the applicant within a reasonable time after such grant is received.
``SEC. 2007. COORDINATION OF FEDERAL AND STATE PROGRAMS.
``(a) Federal Programs.--The Secretary shall coordinate Federal
policies and programs providing services relating to the prevention of
initial and recurrent adolescent pregnancies and providing care
services for eligible persons. In achieving such coordination, the
Secretary shall--
``(1) require grantees who receive grants for services
under this title to report periodically to the Secretary
concerning Federal, State, and local policies and programs that
interfere with the delivery of and coordination of pregnancy
prevention services and other programs of care for pregnant
adolescents and adolescent parents;
``(2) provide technical assistance to facilitate
coordination by State and local recipients of Federal
assistance;
``(3) give priority in the provision of funds, where
appropriate, to applicants using single or coordinated grant
applications for multiple programs; and
``(4) give priority, where appropriate, to the provision of
funds under Federal programs administered by the Secretary
(other than the program established by this title) to programs
providing comprehensive prevention services and comprehensive
programs of care for eligible persons.
``(b) Other Recipients.--Any recipient of a grant for services
under this title shall coordinate its activities with any other
recipient of such a grant that is located in the same locality.
``SEC. 2008. GRANTS FOR RESEARCH.
``(a) In General.--
``(1) Authorization.--The Secretary may make grants to
public agencies or nonprofit private organizations or
institutions of higher education to support the research and
dissemination activities described in paragraphs (4), (5), and
(6) of section 2001(b).
``(2) Duration.--The Secretary may make grants or enter
into contracts under this section for a period of 1 year. A
grant or contract under this section for a program may be
renewed for 4 additional 1-year periods, which need not be
consecutive.
``(3) Amount limitation.--A grant or contract for any 1-
year period under this section may not exceed $100,000 for the
direct costs of conducting research or dissemination activities
under this section and may include such additional amounts for
the indirect costs of conducting such activities as the
Secretary determines appropriate. The Secretary may waive the
preceding sentence with respect to a specific program if the
Secretary determines that--
``(A) exceptional circumstances warrant such waiver
and that the program will have national impact;
``(B) additional amounts are necessary for the
direct costs of conducting limited programs for the
provision of necessary services in order to provide
data for research carried out under this title; or
``(C) several grantees together require more than
$100,000 to evaluate the effectiveness of different
combinations of services, and if such grantees
demonstrate evidence of reasonable progress in the
first year, such multisite evaluation studies shall
receive preference for funding renewal.
``(4) Carryover for report.--The amount of any grant or
contract made under this section may remain available for
obligation or expenditure after the close of the 1-year period
for which such grant or contract is made in order to assist the
recipient in preparing the report required by subsection
(f)(1).
``(b) Use of Funds.--
``(1) In general.--Funds provided for research under this
section may be used for descriptive or explanatory surveys,
evaluation studies, longitudinal studies, or limited programs
for services that are for the purpose of increasing knowledge
and understanding of the matters described in paragraphs (4)
and (5) of section 2001(b).
``(2) Limitations.--Funds provided under this section may
not be used for the purchase or improvement of land, or the
purchase, construction, or permanent improvement (other than
minor remodeling) of any building or facility.
``(c) Prerequisites.--The Secretary may not make any grant or enter
into any contract to support research or dissemination activities under
this section unless--
``(1) the Secretary has received an application for such
grant or contract that is in such form and that contains such
information as the Secretary may by regulation require;
``(2) the applicant has demonstrated that the applicant is
capable of conducting one or more of the types of research or
dissemination activities described in paragraph (4), (5), or
(6) of section 2001(b); and
``(3) in the case of an application for a research program,
the panel established by subsection (e)(2) has determined that
the program is of scientific merit.
``(d) Coordination.--The Secretary shall coordinate research and
dissemination activities carried out under this section with research
and dissemination activities carried out by the National Institutes of
Health.
``(e) Review of Applications.--
``(1) System.--The Secretary shall establish a system for
the review of applications for grants and contracts under this
section. Such system shall be substantially similar to the
system for scientific peer review of the National Institutes of
Health and shall meet the requirements of paragraphs (2) and
(3).
``(2) Panel.--
``(A) Establishment.--In establishing the system
required by paragraph (1), the Secretary shall
establish a panel to review applications under this
section.
``(B) Expertise.--Panel members should have
expertise in research and evaluation and should
represent disciplines relevant to the study of
adolescent pregnancy and parenting.
``(C) Limit on physicians.--Not more than 25
percent of the members of the panel shall be
physicians.
``(D) Meetings.--The panel shall meet as often as
may be necessary to facilitate the expeditious review
of applications under this section, but not less than
once each year.
``(E) Review.--The panel shall review each program
for which an application is made under this section,
evaluate the scientific merit of the program, determine
whether the program is of scientific merit, and make
recommendations to the Secretary concerning whether the
application for the program should be approved.
``(3) Grant determination.--The Secretary shall make grants
under this section from among the programs that the panel
established by paragraph (2) has determined to be of scientific
merit and may only approve an application for a program if the
panel has made such determination with respect to such a
program. The Secretary shall make a determination with respect
to an application within 1 month after receiving the
determinations and recommendations of such panel with respect
to the application.
``(f) Reports.--
``(1) Research reports.--
``(A) In general.--The recipient of a grant or
contract for a research program under this section
shall prepare and transmit to the Secretary a report
describing the results and conclusions of such
research. Except as provided in subparagraph (B), such
report shall be transmitted to the Secretary not later
than 12 months after the end of the year for which
funds are provided under this section. The recipient
may utilize reprints of articles published or accepted
for publication in professional journals to supplement
or replace such report if the research contained in
such articles was supported under this section during
the year for which the report is required.
``(B) Multiyear programs.--In the case of any
research program for which assistance is provided under
this section for 2 or more consecutive 1-year periods,
the recipient of such assistance shall prepare and
transmit the report required by subparagraph (A) to the
Secretary not later than 12 months after the end of
each 1-year period for which such funding is provided.
``(2) Other reports.--Recipients of grants and contracts
for dissemination under this section shall submit to the
Secretary such reports as the Secretary determines appropriate.
``SEC. 2009. EVALUATION.
``Of the funds appropriated under this title, the Secretary shall
reserve not less than 1 percent and not more than 3 percent for the
evaluation of activities carried out under this title. The Secretary
shall submit to the appropriate committees of Congress a summary of
each evaluation conducted under this section and a summary of the data
reported by grantees under section 2006(c).
``SEC. 2010. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out this title,
there are authorized to be appropriated $60,000,000 for each of the
fiscal years 1995 through 1997.
``(b) Grants for Services.--At least two-thirds of the amounts
appropriated to carry out this title shall be used to make grants for
services.
``(c) Prevention Services.--Two-thirds of the amounts specified
under subsection (b) for use for grants for services shall be used for
grants for prevention services.
``SEC. 2011. FUND RESTRICTION.
``No funds for grants made under this title may be used for payment
for the performance of an abortion.''.
Subtitle I--Adolescent Health Demonstrations Projects Act of 1993
SEC. 241. SHORT TITLE.
This subtitle may be cited as the ``Adolescent Health
Demonstrations Projects Act of 1993''.
SEC. 242. ESTABLISHMENT OR SUPPORT OF DEMONSTRATION PROJECTS.
The Secretary of Health and Human Services (hereinafter in this
subtitle referred to as the ``Secretary'') shall make grants in fiscal
years 1994 through 1998 to public and nonprofit private entities to
establish or support adolescent health demonstration projects in
secondary schools or entities associated with secondary schools for the
purpose of demonstrating how such projects may be established
throughout the United States.
SEC. 243. PROJECT REQUIREMENTS.
An adolescent health demonstration project established or supported
under section 242 shall (1) provide nutrition and hygiene counseling,
health care related to sports, family planning information and
services, prenatal and postpartum care, family life and parenting
counseling, and alcohol and drug abuse education and treatment, (2)
serve adolescents before their graduation from high school, (3)
encourage family participation, to the extent practical, (4) obtain the
approval of the school board in the locality to be served by the
project before the project is implemented, (5) furnish such reports and
data as the Secretary may require, including, at a minimum, the number
and characteristics of individuals served, the services provided, and
the results achieved, and (6) establish a community advisory committee
to oversee the establishment and implementation of such project. Such
community advisory committee shall include students, parents, school
personnel, physicians, religious and business leaders, and other
community representatives and shall establish policies for the project
with respect to the services to be provided under the project, the
populations to be served, the personnel who will provide services, fees
to be charged, and other policy issues.
SEC. 244. AREAS TO BE SERVED.
In making grants under section 242, the Secretary shall give
priority to applications for projects which will serve areas with low-
income residents or minority populations.
SEC. 245. ABORTION RESTRICTION.
None of the funds provided under a grant under section 242 may be
used to perform or pay for abortions.
SEC. 245A. REPORT.
The Secretary shall, in each fiscal year, set aside not more than 5
percent of the amount appropriated for grants under section 242 to
evaluate the operations of the projects for which grants were made
under such section. Not later than December 1, 1999, the Secretary
shall report to the Congress the result of such evaluation together
with such recommendations as the Secretary may have respecting the
extension of the grant authority under section 242 or the establishment
of a continuing service program.
Subtitle J--Eating Disorders Information and Education Act of 1993
SEC. 246. SHORT TITLE.
This subtitle may be cited as the ``Eating Disorders Information
and Education Act of 1993''.
SEC. 247. FINDINGS.
The Congress finds the following:
(1) Eating disorders include anorexia nervosa and bulimia
nervosa, as well as eating disorders not otherwise defined.
(2) Anorexia nervosa and bulimia each can result in death,
cardiac impairments, depression, substance abuse, osteoporosis,
infertility, amenorrhea, anemia, and other medical conditions.
(3) Medical authorities are uncertain to what extent eating
disorders are caused by physiological factors, by psychosocial
factors, or by both.
(4) Such disorders primarily affect women. As many as 6
percent of women may be experiencing eating disorders, and the
rate of new cases is increasing. As many as 30 percent of women
in institutions of higher education may be displaying symptoms
of eating disorders.
(5) There are effective treatments for some eating
disorders.
SEC. 248. PUBLIC INFORMATION AND EDUCATION ON EATING DISORDERS.
Subpart 3 of part B of title V of the Public Health Service Act (42
U.S.C. 290bb-31 et seq.), as added by section 115 of Public Law 102-321
(106 Stat. 346), is amended by adding at the end the following section:
``eating disorders
``Sec. 520C. (a) Information and Education.--The Secretary, acting
through the Director of the Center for Mental Health Services, shall
carry out a program to provide information and education to the public
on the prevention and treatment of eating disorders.
``(b) Toll-Free Telephone Communications.--In carrying out
subsection (a), the Secretary shall provide for the operation of toll-
free telephone communications to provide information to the public on
eating disorders, including referrals for services for the prevention
and treatment of such disorders. Such communications shall be available
on a 24-hour, 7-day basis.
``(c) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $2,000,000
for fiscal year 1994, and such sums as may be necessary for each of the
fiscal years 1994 through 1996.''.
Subtitle K--Women and HIV Outreach and Prevention Act
SEC. 251. SHORT TITLE.
This subtitle may be cited as the ``Women and HIV Outreach and
Prevention Act''.
SEC. 252. PREVENTIVE HEALTH PROGRAMS REGARDING WOMEN AND HUMAN
IMMUNODEFICIENCY VIRUS.
Title XXV of the Public Health Service Act (42 U.S.C. 300ee et
seq.) is amended by adding at the end the following part:
``Part C--Programs for Women
``SEC. 2531. PREVENTIVE HEALTH SERVICES.
``(a) In General.--The Secretary may make grants for the following
purposes:
``(1) Providing to women preventive health services that
are related to acquired immune deficiency syndrome, including--
``(A) counseling on the prevention of infection
with, and the transmission of, the etiologic agent for
such syndrome; and
``(B) screening women for infection with such
agent.
``(2) Providing appropriate referrals regarding the
provision of other services to women who are receiving services
pursuant to paragraph (1), including, as appropriate, referrals
for treatment for such infection, referrals for treatment for
substance abuse, referrals for mental health services,
referrals regarding pregnancy, childbirth, and pediatric care,
and referrals for housing services.
``(3) Providing follow-up services regarding such
referrals, to the extent practicable.
``(4) Improving referral arrangements for purposes of
paragraph (2).
``(5) In the case of a woman receiving services pursuant to
any of paragraphs (1) through (3), providing to the partner of
the woman the services described in such paragraphs, as
appropriate.
``(6) With respect to the services specified in paragraphs
(1) through (5)--
``(A) providing outreach services to inform women
of the availability of such services; and
``(B) providing training regarding the effective
provision of such services.
``(b) Minimum Qualifications of Grantees.--The Secretary may make a
grant under subsection (a) only if the applicant for the grant is a
grantee under section 329, section 330, or section 1001, or is another
public or nonprofit private entity that provides health or voluntary
family planning services to a significant number of low-income women in
a culturally sensitive and language-appropriate manner.
``(c) Confidentiality.--The Secretary may make a grant under
subsection (a) only if the applicant for the grant agrees to maintain
the confidentiality of information on individuals regarding screenings
pursuant to subsection (a), subject to complying with applicable law.
``(d) Application for Grant.--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 such subsection.
``(e) Evaluations and Reports.--
``(1) Evaluations.--The Secretary shall, directly or
through contracts with public or private entities, provide for
evaluations of projects carried out pursuant to subsection (a).
``(2) Reports.--Not later than 1 year after the date on
which amounts are first appropriated under subsection (f), and
annually thereafter, the Secretary shall submit to the Congress
a report summarizing evaluations carried out under paragraph
(1) during the preceding fiscal year.
``(f) Authorizations of Appropriations.--
``(1) Title x clinics.--For the purpose of making grants
under subsection (a) to entities that are grantees under
section 1001, and for the purpose of otherwise carrying out
this section with respect to such grants, there are authorized
to be appropriated $30,000,000 for fiscal year 1994, and such
sums as may be necessary for each of the fiscal years 1995 and
1996.
``(2) Community and migrant health centers; other
providers.--For the purpose of making grants under subsection
(a) to entities that are grantees under section 329 or 330, and
to other entities described in subsection (b) that are not
grantees under section 1001, and for the purpose of otherwise
carrying out this section with respect to such grants, there
are authorized to be appropriated $20,000,000 for fiscal year
1994, and such sums as may be necessary for each of the fiscal
years 1995 and 1996.
``SEC. 2532. PUBLIC EDUCATION.
``(a) In General.--The Secretary may make grants for the purpose of
developing and carrying out programs to educate women on the prevention
of infection with, and the transmission of, the etiologic agent for
acquired immune deficiency syndrome.
``(b) Minimum Qualifications of Grantees.--The Secretary may make a
grant under subsection (a) only if the applicant involved is a public
or nonprofit private entity that is experienced in carrying out health-
related activities for women, with a priority given to such entities
that have successfully targeted women of color.
``(c) Application for Grant.--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 such subsection.
``(d) Evaluations and Reports.--
``(1) Evaluations.--The Secretary shall, directly or
through contracts with public or private entities, provide for
evaluations of projects carried out pursuant to subsection (a).
``(2) Reports.--Not later than 1 year after the date on
which amounts are first appropriated under subsection (e), and
annually thereafter, the Secretary shall submit to the Congress
a report summarizing evaluations carried out under paragraph
(1) during the preceding fiscal year.
``(e) Authorizations of Appropriations.--For the purpose of
carrying out this section, there are authorized to be appropriated
$30,000,000 for fiscal year 1994, and such sums as may be necessary for
each of the fiscal years 1995 and 1996.''.
SEC. 253. TREATMENT OF WOMEN FOR SUBSTANCE ABUSE.
Subpart 1 of part B of title V of the Public Health Service Act (42
U.S.C. 290bb et seq.), as amended by section 108 of Public Law 102-321
(106 Stat. 336), is amended by inserting after section 509 the
following section:
``treatment of women for substance abuse
``Sec. 509A. (a) In General.--The Director of the Center for
Substance Abuse Treatment may make awards of grants, cooperative
agreements, and contracts for the purpose of carrying out programs--
``(1) to provide treatment for substance abuse to women,
including but not limited to, women with dependent children;
``(2) to provide to women who engage in such abuse
counseling on the prevention of infection with, and the
transmission of, the etiologic agent for acquired immune
deficiency syndrome; and
``(3) to provide such counseling to women who are the
partners of individuals who engage in such abuse.
``(b) Authorization of Appropriations.--For the purpose of carrying
out subsection (a), there are authorized to be appropriated $20,000,000
for fiscal year 1994, and such sums as may be necessary for each of the
fiscal years 1995 and 1996.''.
SEC. 254. EARLY INTERVENTION SERVICES FOR WOMEN.
Section 2655 of the Public Health Service Act (42 U.S.C. 300ff-55)
is amended--
(1) by striking ``For the purpose of'' and inserting ``(a)
In General.--For the purpose of''; and
(2) by adding at the end the following subsection:
``(b) Programs for Women.--For the purpose of making grants under
section 2651 to provide to women early intervention services described
in such section, and for the purpose of providing technical assistance
under section 2654(b) with respect to such grants, there are authorized
to be appropriated $20,000,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995 and 1996.''.
Subtitle L--Standby Guardianship Act
SEC. 256. SHORT TITLE.
This subtitle may be cited as the ``Standby Guardianship Act''.
SEC. 257. STATES REQUIRED TO HAVE STANDBY GUARDIANSHIP LAW AS A
CONDITION OF ELIGIBILITY FOR FEDERAL FUNDS FOR FOSTER
CARE AND ADOPTION ASSISTANCE.
(a) In General.--Part E of title IV of the Social Security Act (42
U.S.C. 670-679) is amended by inserting after section 477 the
following:
``SEC. 478. STANDBY GUARDIANSHIP LAWS AND PROCEDURES.
``To be eligible for payments under this part, a State must have in
effect laws and procedures that permit any parent who is chronically
ill or near death, without surrendering parental rights, to designate a
standby guardian for the parent's minor children, whose authority would
take effect upon--
``(1) the death of the parent;
``(2) the mental incapacity of the parent; or
``(3) the physical debilitation and consent of the
parent.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect at the end of the first calendar quarter that begins 60 or
more months after the date of the enactment of this Act, and shall
apply to payments under part E of title IV of the Social Security Act
for the quarter and payments made under such part for any succeeding
quarter.
Subtitle M--Federal Prohibition of Female Genital Mutilation Act of
1993
SEC. 261. SHORT TITLE.
This subtitle may be cited as the ``Federal Prohibition of Female
Genital Mutilation Act of 1993''.
SEC. 262. TITLE 18 AMENDMENT.
(a) In General.--Chapter 7 of title 18, United States Code, is
amended by adding at the end the following new section:
``Sec. 116. Female genital mutilation
``(a) Except as provided in subsection (b), whoever knowingly
circumcises, excises, or infibulates the whole or any part of the labia
majora or labia minora or clitoris of another person who has not
attained the age of 18 years shall be fined under this title or
imprisoned not more than 5 years, or both.
``(b) A surgical operation is not a violation of this section if
the operation is--
``(1) necessary to the health of the person on whom it is
performed, and is performed by a person licensed in the place
of its performance as a medical practitioner; or
``(2) performed on a person in labor or who has just given
birth and is performed for medical purposes connected with that
labor or birth by a person licensed in the place it is
performed as a medical practitioner, midwife, or person in
training to become such a practitioner or midwife.
``(c) In applying subsection (b)(1), no account shall be taken of
the effect on the person on whom the operation is to be performed of
any belief on the part of that or any other person that the operation
is required as a matter of custom or ritual.
``(d) Whoever knowingly denies to any person medical care or
services or otherwise discriminates against any person in the provision
of medical care or services, because--
``(1) that person has undergone female circumcision,
excision, or infibulation; or
``(2) that person has requested that female circumcision,
excision, or infibuation be performed on any person;
shall be fined under this title or imprisoned not more than one year,
or both.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 7 of title 18, United States Code, is amended by adding at the
end the following new item:
``116. Female genital mutilation.''.
SEC. 263. EDUCATION AND OUTREACH.
The Secretary of Health and Human Services shall carry our
appropriate education, preventive, and outreach activities in
communities that traditionally practice female circumcision, excision,
or infibulation, to inform people in those communities about the health
risks and emotional trauma inflicted by those practices, and to inform
them and the medical community about the provisions of section 262.
SEC. 264. EFFECTIVE DATES.
Section 263 shall take effect immediately, and the Secretary of
Health and Human Services shall commence carrying it out not later than
90 days after the date of the enactment of this Act. Section 262 shall
take effect 180 days after the date of the enactment of this Act.
Subtitle N--Smoking Prevention and Cessation in WIC Clinics Act
SEC. 266. SHORT TITLE.
This subtitle may be cited as the ``Smoking Prevention and
Cessation in WIC Clinics Act''.
SEC. 267. SMOKING CESSATION DEMONSTRATION PROGRAMS FOR WIC
PARTICIPANTS.
Section 17(e) of the Child Nutrition Act of 1966 (42 U.S.C.
1786(e)) is amended--
(1) by redesignating paragraphs (3) (the second place it
appears), (4), and (5) as paragraphs (4) through (6),
respectively; and
(2) by adding at the end the following new paragraph:
``(7)(A) The State agency shall ensure that each local agency
operating the program under this section--
``(i) establishes and carries out an on-site smoking
cessation demonstration program for pregnant participants on a
voluntary basis; and
``(ii) educates all participants about the adverse health
effects of cigarette smoking.
``(B) The program described in subparagraph (A)(i) shall--
``(i) be provided to participants during regular visits to
the clinic;
``(ii) be incorporated into the program under this section;
``(iii) include a public information and education
component, which shall include the dissemination of risk
information and materials relating to the adverse health
effects of cigarette smoking during pregnancy; and
``(iv) include a self-monitoring component, which shall
include--
``(I) one-on-one counseling designed to help
participants quit smoking; and
``(II) the utilization of a process whereby the
participant develops and signs, and a representative
from the local agency and an individual chosen by the
participant also sign, a written statement containing a
promise by the participant to quit smoking beginning on
a certain date.
``(C)(i) The State agency shall ensure that each local agency
operating the program under this section submits to such State agency
an annual report containing a description and evaluation of the program
established and carried out by such local agency, including a
description of the total number of participants receiving services
under such program and the success rate of such participants in
quitting smoking. The State agency shall compile such reports into 1
annual report and submit such report to the Secretary.
``(ii) The Secretary shall submit to the Congress an annual report
containing--
``(I) a compilation of the information contained in the
reports received by the Secretary from each State agency under
clause (i); and
``(II) an evaluation of the effectiveness of the smoking
cessation demonstration programs.''.
Subtitle O--Family and Medical Leave Health Care Reform Resolution of
1993
SEC. 271. SHORT TITLE.
This subtitle may be cited as the ``Family and Medical Leave Health
Care Reform Resolution of 1993''.
SEC. 272. FINDINGS.
The Congress finds that--
(1) the number of single-parent and 2-parent households in which
the single parent or both parents work is increasing significantly;
(2) it is important for the development of children and the
family unit that fathers and mothers be able to participate in
early childrearing and the care of family members who have
serious health conditions;
(3) the lack of employment policies to accommodate working
parents can force individuals to choose between job security
and parenting;
(4) there is inadequate job security for employees who have
serious health conditions that prevent them from working for
temporary periods;
(5) due to the nature of the roles of men and women in the
society of the United States, the primary responsibility for
family caretaking often falls on women, and such responsibility
affects the working lives of women more than it affects the
working lives of men;
(6) more than 70 percent of women with school-aged children
and 56 percent of women with preschool-aged children work
outside the home;
(7) employment standards that apply only to 1 gender have
serious potential for encouraging employers to discriminate
against employees and applicants for employment who are of the
gender;
(8) numerous bills to reform the health insurance system in
the United States have been introduced in the Senate and the
House of Representatives;
(9) several of the bills, if they were enacted, would
significantly alter the existing health insurance system; and
(10) granting employees family and temporary medical leave
as part of a reform of the health insurance system promises to
improve both the prevention and cure of serious health
conditions by averting undue stress on the part of employees
and permitting them personally to attend to family members who
have such conditions.
SEC. 273. SENSE OF CONGRESS.
It is the sense of the Congress that any bill to address the
ongoing and unmet health insurance needs of the people of the United
States that is enacted should require that paid or unpaid leave, as
detailed in the Family and Medical Leave Act of 1993, be incorporated
as a basic or elective option for plan participants for 1 or more of
the following:
(1) Because of the birth of a son or daughter of an
employee and in order to care for the son or daughter.
(2) Because of the placement of a son or daughter with an
employee for adoption or foster care.
(3) In order to care for the spouse, or a son, daughter, or
parent, of an employee, if the spouse, son, daughter, or parent
has a serious health condition.
(4) Because of a serious health condition that makes an
employee unable to perform the functions of the position of the
employee.
Subtitle P--Veteran Women's Health Improvement Act of 1993
SEC. 276. SHORT TITLE.
This subtitle may be cited as the ``Veteran Women's Health
Improvement Act of 1993''.
SEC. 277. WOMEN'S HEALTH SERVICES.
(a) Women's Health Services.--Section 1701 of title 38, United
States Code, is amended--
(1) in paragraph (6)(A)(i), by inserting ``women's health
services,'' after ``preventive health services,''; and
(2) by adding at the end the following:
``(10) The term `women's health services' means health care
services provided to women, including counseling and services relating
to the following:
``(A) Papanicolaou tests (pap smear).
``(B) Breast examinations and mammography.
``(C) Comprehensive reproductive health care, including
pregnancy-related care.
``(D) The management of infertility.
``(E) The management and prevention of sexually-transmitted
diseases.
``(F) Menopause, osteoporosis, and other conditions
relating to aging.
``(G) Physical or psychological conditions arising out of
acts of sexual violence.''.
(b) Contracts for Women's Health Services.--Section 1703(a) of such
title is amended by adding at the end the following:
``(9) Women's health services for veterans on an ambulatory
or outpatient basis.''.
(c) Repeal of Superseded Authority.--Section 106 of the Veterans
Health Care Act of 1992 (Public Law 102-585; 38 U.S.C. 1710 note) is
amended--
(1) by striking out subsection (a); and
(2) by striking out ``(b) Responsibilities of Directors of
Facilities.--'' before ``The Secretary''.
(d) Report on Health Care and Research.--Section 107(b) of such Act
(38 U.S.C. 1710 note) is amended--
(1) in paragraph (1), by inserting ``and women's health
services (as such term is defined in section 1701(10) of title
38, United States Code)'' after ``section 106 of this Act'';
(2) in paragraph (2), by striking out ``and (B)'' and
inserting in lieu thereof ``(B) the type and amount of services
provided by such personnel, including information on the
numbers of inpatient stays and the number of outpatient visits
through which such services were provided, and (C)'';
(3) by redesignating paragraph (4) as paragraph (7);
(4) by adding after paragraph (3) the following new
paragraphs:
``(4) A description of the personnel of the Department who
provided such services to women veterans, including the number
of employees (including both the number of individual employees
and the number of full-time employee equivalents) and the
professional qualifications or specialty training of such
employees and the Department facilities to which such personnel
were assigned.
``(5) A description of any actions taken by the Secretary
to ensure the retention of the personnel described in paragraph
(4) and any actions undertaken to recruit additional such
personnel or personnel to replace such personnel.
``(6) An assessment by the Secretary of any difficulties
experienced by the Secretary in the furnishing of such services
and the actions taken by the Secretary to resolve such
difficulties.''; and
(5) by adding after paragraph (7), as redesignated by
paragraph (3) of this subsection, the following:
``(8) A description of the actions taken by the Secretary
to foster and encourage the expansion of such research.''.
SEC. 278. EXPANSION OF RESEARCH RELATING TO WOMEN VETERANS.
(a) Health Research.--Section 109(a) of the Veterans Health Care
Act of 1992 (Public Law 102-585; 38 U.S.C. 7303 note) is amended--
(1) by inserting ``(1)'' before ``The Secretary'';
(2) in paragraph (1), as so designated, by striking out
``veterans who are women'' and inserting in lieu thereof
``women veterans''; and
(3) by adding at the end the following:
``(2) In carrying out this section, the Secretary shall consult
with the following:
``(A) The Director of the Nursing Service.
``(B) Officials of the Central Office assigned
responsibility for women's health programs and sexual trauma
services.
``(C) The members of the Advisory Committee on Women
Veterans established under section 542 of title 38, United
States Code.
``(D) Members of appropriate task forces and working groups
within the Department of Veterans Affairs (including the Women
Veterans Working Group and the Task Force on Treatment of Women
Who Suffer Sexual Abuse).
``(3) The Secretary shall foster and encourage research under this
section on the following matters as they relate to women:
``(A) Breast cancer.
``(B) Gynecological and reproductive health, including
gynecological cancer, infertility, sexually-transmitted
diseases, and pregnancy.
``(C) Human Immunodeficiency Virus and Acquired Immune
Deficiency Syndrome.
``(D) Mental health, including post-traumatic stress
disorder, depression, combat related stress, and trauma.
``(E) Diseases related to aging, including menopause,
osteoporosis, and Alzheimer's Disease.
``(F) Substance abuse.
``(G) Sexual violence and related trauma.
``(H) Exposure to toxic chemicals and other environmental
hazards.
``(4) The Secretary shall, to the maximum extent practicable,
ensure that personnel of the Department of Veterans Affairs engaged in
the research referred to in paragraph (1) include the following:
``(A) Personnel of the geriatric research, education, and
clinical centers designated pursuant to section 7314 of title
38, United States Code.
``(B) Personnel of the National Center for Post-Traumatic
Stress Disorder established pursuant to section 110(c) of the
Veterans Health Care Act of 1984 (Public Law 98-528; 98 Stat.
2692).
``(5) The Secretary shall ensure that personnel of the Department
engaged in research relating to the health of women veterans are
advised and informed of such research engaged in by other personnel of
the Department.''.
(b) Inclusion of Women and Minorities in Clinical Research
Projects.--(1) In conducting or supporting clinical research, the
Secretary of Veterans Affairs shall ensure that--
(A) women who are veterans are included as subjects in each
project of such research; and
(B) members of minority groups who are veterans are
included as subjects of such research.
(2) The requirement in paragraph (1) regarding women and members of
minority groups who are veterans may be waived by the Secretary of
Veterans Affairs with respect to a project of clinical research if the
Secretary determines that the inclusion, as subjects in the project, of
women and members of minority groups, respectively--
(A) is inappropriate with respect to the health of the
subjects;
(B) is inappropriate with respect to the purpose of the
research; or
(C) is inappropriate under such other circumstances as the
Secretary of Veterans Affairs may designate.
(3) In the case of a project of clinical research in which women or
members of minority groups will under paragraph (1) be included as
subjects of the research, the Secretary of Veterans Affairs shall
ensure that the project is designed and carried out so as to provide
for a valid analysis of whether the variables being tested in the
research affect women or members of minority groups, as the case may
be, differently than other persons who are subjects of the research.
(c) Population Study.--Section 110(a) of such Act (38 U.S.C. 1710
note) is amended--
(1) in paragraph (1), by striking out the second sentence;
and
(2) by amending paragraph (3) to read as follows:
``(3)(A) Subject to subparagraph (B), the study shall be based on--
``(i) an appropriate sample of veterans who are women; and
``(ii) an examination of the medical and demographic
histories of the women comprising such sample.
``(B) The sample referred to in subparagraph (A) shall constitute a
representative sampling (as determined by the Secretary) of the ages,
the ethnic, social and economic backgrounds, the enlisted and officer
grades, and the branches of service of all veterans who are women.
``(C) In carrying out the examination referred to in subparagraph
(A)(ii), the Secretary shall determine the number of women of the
sample who have used medical facilities of the Department, nursing home
facilities of or under the jurisdiction of the Department, and
outpatient care facilities of or under the jurisdiction of the
Department.''.
SEC. 279. MAMMOGRAPHY QUALITY STANDARDS.
(a) Applicability to Department of Veterans Affairs of Mammography
Quality Standards Act of 1992.--Subsections (a) through (k) of section
354 of the Public Health Service Act (42 U.S.C. 263b) shall apply with
respect to facilities of the Department of Veterans Affairs without
regard to the last sentence of subparagraph (A) of subsection (a)(3) of
such section.
(b) Extension of Deadlines.--Any deadline for the completion of any
action prescribed under any provision referred to in subsection (a)
shall be applied with respect to facilities of the Department of
Veterans Affairs by extending such deadline so as to be two years after
the date of the enactment of this Act or two years after the date which
would otherwise be applicable under such provision, whichever is later.
(c) Interagency Cooperation.--The Secretary of Veterans Affairs
shall take appropriate steps to cooperate with the Secretary of Health
and Human Services in the implementation of this section.
Subtitle Q--Defense Women's Health Improvement Act of 1993
SEC. 281. SHORT TITLE.
This subtitle may be cited as the ``Defense Women's Health
Improvement Act of 1993''.
PART I--WOMEN'S HEALTH CARE
SEC. 282. PRIMARY AND PREVENTIVE HEALTH-CARE SERVICES FOR WOMEN.
(a) Female Members and Retirees of the Uniformed Services.--(1)
Chapter 55 of title 10, United States Code, is amended by inserting
after section 1074c the following new section:
``Sec. 1074d. Primary and preventive health-care services for women
``Female members and former members of the uniformed services who
are entitled to medical care under section 1074 or 1074a of this part
shall be furnished with primary and preventive health-care services for
women as part of such medical care.''.
(2) The table of sections at the beginning of such chapter is
amended by inserting after the item relating to section 1074c the
following new item:
``1074d. Primary and preventive health-care services for women.''.
(b) Female Dependents.--Section 1077(a) of such title is amended by
adding at the end the following new paragraph:
``(13) Primary and preventive health-care services for
women.''.
(c) Definition.--Section 1072 of such title is amended by adding at
the end the following new paragraph:
``(6) The term `primary and preventive health-care services
for women' means health-care services provided to women,
including counseling, relating to the following:
``(A) Papanicolaou tests (pap smear).
``(B) Breast examinations and mammography.
``(C) Comprehensive reproductive health care,
including care related to pregnancy.
``(D) Infertility and sexually transmitted
diseases, including prevention.
``(E) Menopause.
``(F) Physical or psychological conditions arising
out of acts of sexual violence.''.
SEC. 283. REPORT ON THE PROVISION OF HEALTH-CARE SERVICES TO WOMEN.
(a) Report Required.--The Secretary of Defense shall prepare a
report evaluating the provision of health-care services through
military medical treatment facilities and the Civilian Health and
Medical Program of the Uniformed Services to female members of the
uniformed services and female covered beneficiaries eligible for health
care under chapter 55 of title 10, United States Code.
(b) Contents.--The report required by subsection (a) shall contain
the following:
(1) A description of the medical personnel of the
Department of Defense who provided health-care services during
fiscal year 1993 to female members and covered beneficiaries,
including--
(A) the number of such personnel (including both
the number of individual employees and the number of
full-time employee equivalents);
(B) the professional qualifications or specialty
training of such personnel; and
(C) the medical facilities to which such personnel
were assigned.
(2) A description of any actions, including the use of
special pays and incentives, taken by the Secretary during
fiscal year 1993--
(A) to ensure the retention of the medical
personnel described in paragraph (1);
(B) to recruit additional personnel to provide
health-care services to female members and female
covered beneficiaries; and
(C) to replace departing personnel who provided
such services.
(3) A description of any existing or proposed programs to
encourage specialization of health care professionals in fields
related to primary and preventive health-care services for
women.
(4) An assessment of any difficulties experienced by
military medical treatment facilities or the Civilian Health
and Medical Program of the Uniformed Services in furnishing
primary and preventive health-care services for women and a
description of those actions taken by the Secretary to resolve
such difficulties.
(5) An assessment of the extent to which gender-related
factors impede or complicate diagnoses (such as inappropriate
psychiatric referrals and admissions) made by medical personnel
described in paragraph (1).
(6) A description of the actions taken by the Secretary to
foster and encourage the expansion of research relating to
health care issues of concern to female members of the
uniformed services and female covered beneficiaries.
(c) Population Study of the Need of Female Members and Female
Covered Beneficiaries for Health-Care Services.--(1) As part of the
report required by subsection (a), the Secretary shall conduct a study
to determine the needs of female members of the uniformed services and
female covered beneficiaries for health-care services, including
primary and preventive health-care services for women.
(2) The study shall examine the health needs of current members and
covered beneficiaries and future members and covered beneficiaries
based upon the anticipated size and composition of the Armed Forces in
the year 2000 and should be based on the demographics of society as a
whole.
(d) Submission and Revision.--The Secretary of Defense shall submit
the report required by subsection (a) to Congress not later than April
1, 1994. The Secretary shall revise and resubmit the report to Congress
not later than April 1, 1999.
(e) Definitions.--For purposes of this section:
(1) The term ``primary and preventive health care services
for women'' has the meaning given such term in paragraph (6) of
section 1072 of title 10, United States Code, as added by
section 101(c)).
(2) The term ``covered beneficiary'' has the meaning given
such term in paragraph (5) of such section.
PART II--WOMEN'S HEALTH RESEARCH
SEC. 284. DEFENSE WOMEN'S HEALTH RESEARCH CENTER.
(a) Establishment of the Center.--The Secretary of Defense shall
establish a Defense Women's Health Research Center (hereinafter in this
section referred to as the ``Center'') in the Department of the Army.
The Center shall be under the authority of the Army Health Services
Command.
(b) Purposes.--(1) The Center shall be the coordinating agent for
multidisciplinary and multiinstitutional research within the Department
of Defense on women's health issues related to service in the Armed
Forces. The Center shall be dedicated to development and application of
new knowledge, procedures, techniques, training, and equipment for the
improvement of the health of women in the Armed Forces.
(2) In carrying out or sponsoring research studies, the Center
shall provide that the cohort of women in the Armed Forces shall be
considered as a control group.
(3) The Center shall support the goals and objectives recognized by
the Department of Defense under the plan of the Department of Health
and Human Services designated as ``Healthy People 2000''.
(4) The Center shall support initiation and expansion of research
into matters relating to women's health in the military, including the
following matters as they relate to women in the military:
(A) Combat stress and trauma.
(B) Exposure to toxins and other environmental hazards
associated with military hardware.
(C) Psychology related stresses in warfare situations.
(D) Breast cancer.
(E) Reproductive health, including pregnancy.
(F) Gynecological cancers.
(G) Infertility and sexually transmitted diseases.
(H) HIV and AIDS.
(I) Mental health, including post-traumatic stress disorder
and depression.
(J) Menopause, osteoporosis, Alzheimer's disease, and other
conditions and diseases related to aging.
(K) Substance abuse.
(L) Sexual violence and related trauma.
(M) Human factor studies related to women in combat.
(c) Preparation of a Plan.--The Secretary of Defense, acting
through the Secretary of the Army and in coordination with the other
military departments, shall prepare a plan for the implementation of
this section. The plan shall be submitted to the Committees on Armed
Services of the Senate and House of Representatives before May 1, 1994.
(d) Requirements Relating to Establishment of Center.--(1) The
Secretary shall provide for the establishment of the Center at an
existing Army facility.
(2) The Center may be established only at a facility having the
following characteristics:
(A) A physical plant immediately available to serve as
headquarters for the medical activities to be carried out by
the Center.
(B) Ongoing fellowship and residency programs colocated
with ongoing collaborative health-related and interdisciplinary
research of (i) a facility of the Department of Veterans
Affairs, (ii) an accredited university with specialties in
medical research and clinical diagnostics, and (iii) a hospital
owned and operated by a municipality.
(C) A technologically modern laboratory capability at the
site and at the affiliated sites referred to in subparagraph
(B), with the capability to include state-of-the-art clinical
diagnostic instrumentation, data processing, telecommunication,
and data storage systems.
(D) Compatibility with and capability to effectively expand
its existing mission in accordance with the mission of the
Center under this section.
(E) Maximum multi-State geographic jurisdiction to permit
regional health-related issues to be researched and integrated
into national military databases.
(F) An existing relationship for the provision of services
to Native Americans through the Indian Health Service.
(e) Activities for Fiscal Year 1994.--During fiscal year 1994, the
Center shall address the following:
(1) Program planning, infrastructure development, baseline
information gathering, technology infusion, and connectivity.
(2) Management and technical staffing.
(3) Data base development of health issues related to
service on active duty as compared to service in the National
Guard or Reserves.
(4) Research protocols, cohort development, health
surveillance and epidemiologic studies.
SEC. 285. CONTINUATION OF ARMY BREAST CANCER RESEARCH PROGRAM.
During fiscal year 1994, the Secretary of the Army shall continue
the breast cancer research program established in the second and third
provisos in the paragraph in title IV of the Department of Defense
Appropriations Act, 1993 (Public Law 102-396; 106 Stat. 1890) under the
heading ``Research, Development, Test, and Evaluation, Army'' .
SEC. 286. INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH
PROJECTS.
(a) General Rule.--In conducting or supporting clinical research,
the Secretary of Defense shall ensure that--
(1) women who are members of the Armed Forces are included
as subjects in each project of such research; and
(2) members of minority groups who are members of the Armed
Forces are included as subjects of such research.
(b) Waiver Authority.--The requirement in subsection (a) regarding
women and members of minority groups who are members of the Armed
Forces may be waived by the Secretary of Defense with respect to a
project of clinical research if the Secretary determines that the
inclusion, as subjects in the project, of women and members of minority
groups, respectively--
(1) is inappropriate with respect to the health of the
subjects;
(2) is inappropriate with respect to the purpose of the
research; or
(3) is inappropriate under such other circumstances as the
Secretary of Defense may designate.
(c) Requirement for Analysis of Research.--In the case of a project
of clinical research in which women or members of minority groups will
under subsection (a) be included as subjects of the research, the
Secretary of Defense shall ensure that the project is designed and
carried out so as to provide for a valid analysis of whether the
variables being tested in the research affect women or members of
minority groups, as the case may be, differently than other persons who
are subjects of the research.
SEC. 287. REPORT ON RESEARCH RELATING TO FEMALE MEMBERS OF THE
UNIFORMED SERVICES AND FEMALE COVERED BENEFICIARIES.
Not later than July 1 of each of 1995, 1996, and 1997, the
Secretary of Defense shall submit to Congress a report containing--
(1) a description (as of May 31 of the year in which the
report is submitted) of the status of any health research that
is being carried out by or under the jurisdiction of the
Secretary relating to female members of the uniformed services
and female covered beneficiaries under chapter 55 of title 10,
United States Code; and
(2) recommendations of the Secretary as to future health
research (including a proposal for any legislation relating to
such research) relating to such female members and covered
beneficiaries.
PART III--WOMEN'S HEALTH EDUCATION
SEC. 288. WOMEN'S HEALTH CURRICULUM ADVISORY COMMITTEE.
The Secretary of Defense shall establish at the F. Edward Hebert
School of Medicine of the Uniformed Services University of the Health
Sciences a women's health curriculum advisory committee to promote the
comprehensive integration of women's health issues into the curriculum
at the University. The committee shall include the surgeon general of
each of the military departments and the dean of the School of
Medicine. The committee shall be established by April 1, 1994.
Subtitle R--International Population Stabilization and Reproductive
Health Act
SEC. 291. SHORT TITLE.
This subtitle may be cited as the ``International Population
Stabilization and Reproductive Health Act''.
SEC. 292. AUTHORITIES RELATING TO UNITED STATES POPULATION ASSISTANCE.
Part I of the Foreign Assistance Act of 1961 is amended--
(1) in section 104(b), by striking ``on such terms and
conditions as he may determine'' and inserting ``in accordance
with the provisions of chapter 12''; and
(2) by adding at the end the following new chapter:
``CHAPTER 12--UNITED STATES POPULATION ASSISTANCE
``SEC. 499. DEFINITION.
``For purposes of this chapter, the term `United States population
assistance' means assistance provided under section 104(b) of this Act.
``SEC. 499A. CONGRESSIONAL FINDINGS.
``The Congress makes the following findings:
``(1) Throughout much of the world, the lack of access of
women, particularly poor women, to basic reproductive health
services and information undermines women's struggle for self-
determination, contributes to death and suffering among women
and their children, puts pressure on the land, forests, and
other natural resources on which many poor families depend for
their survival, and in other ways vitiates the efforts of
families to lift themselves out of the poverty in which over
1,000,000,000 of the world's more than 5,000,000,000 people
live.
``(2) During the 1980s, nearly 800,000,000 people, a number
three times greater than the population of the United States,
were added to the world's population.
``(3) Birthrates in many developing countries are declining
too slowly to prevent a near tripling of the world's population
before stabilization can occur, and although birthrates in some
countries have declined faster in recent years than
anticipated, world progress toward stabilization was noticeably
slower in the 1980s than in the 1970s.
``(4) After more than a quarter century of experience and
research, the actions needed to bring about a rapid decline in
birthrates are well documented. The ability to exercise
reproductive choice must be expanded, and such expansion should
occur through broader dissemination and choice of contraceptive
services that involve the community and are sufficient to meet
the needs and values of those who use them.
``(5) Although a number of religious and cultural barriers
to family planning remain, attitudes toward modern
contraception have changed over the last decade, and in many
countries a large and growing unmet desire exists for deferring
or preventing pregnancy among women and men who are too poor to
pay the full cost of services.
``(6) Although many social and economic factors affect
desired family size, organized, accessible, and affordable
family planning programs have the most rapid and strongest
effect on birthrate because they enable women and their
families to determine the timing and number of their children.
Widespread voluntary adoption of modern family planning methods
and their successful long-term use depend on the quality of
reproductive health care services offered and their
responsiveness to individual and community needs and values.
``(7) Millions of women, most of them mothers, are killed
or injured each year as a result of unsafe abortions. The
availability of safe and effective family planning methods and
services can help prevent many of these tragedies.
``(8) The impact of human population growth, combined with
widespread poverty and unsustainable patterns of natural
resource consumption, is evident in mounting signs of stress on
the world's environment, particularly in tropical
deforestation, erosion of arable land and watersheds,
extinction of plant and animal species, global climate change,
waste management, and air and water pollution.
``(9) Traditionally, United States population assistance
has not focused on achieving specific goals with respect to
international population stabilization or the expansion of
reproductive choice. The absence of clear goals in those areas
has led to a lack of criteria for allocating funds and
evaluating program success.
``SEC. 499B. DECLARATION OF POLICY.
``(a) In General.--The Congress declares that to reduce population
growth and stabilize world population at the lowest level feasible and
thereby protect the global environment, to provide greater self-
determination for women, and to improve the health and well-being of
the world's families, a principal objective of the foreign policy of
the United States shall be to assist the international community to--
``(1) achieve universal availability of high quality family
planning services through a wide choice of safe and effective
means of contraception, including programs of public education
and other health and development efforts that enable
individuals to choose smaller families;
``(2) ensure that all individuals and couples, regardless
of age or marital status, are able to exercise their right to
decide whether and how many children to have and their right to
reproductive health by improving the quality and accessibility
of accountable family planning and reproductive health
programs;
``(3) improve reproductive health, especially of women and
young people, through maternal and child health and nutrition
services, and through sexuality and gender education services,
especially for young people; and
``(4) achieve population stabilization at a level
consistent with the maintenance of the natural resource base
and with investment in human resources, within a broad strategy
to adjust consumption levels and patterns in all countries.
``(b) Financial Targets.--The Congress establishes a target for
global expenditures in developing countries from all domestic and
international sources by the year 2000 of at least $11,000,000,000 for
population programs described in section 499C, and establishes a goal
for United States population assistance by the year 2000 of
$1,400,000,000 in constant 1990 dollars, not including funds available
for other reproductive health programs.
``SEC. 499C. AUTHORIZED ACTIVITIES.
``United States population assistance is authorized to provide--
``(1) support for the expansion of quality, affordable,
voluntary family planning services, which emphasize informed
choice among a variety of safe and effective family planning
methods and closely related reproductive health care services,
including the prevention and control of sexually transmitted
diseases and reproductive tract infections;
``(2) support for adequate and regular supplies of quality
contraceptive and other commodities, comprehensive counseling,
appropriate followup, and support for programs that emphasize
the use of the mass media to improve public knowledge of
contraceptive methods and related disease prevention methods
and where they may be obtained and to promote the benefits of
family planning and reproductive health to individuals,
families, and communities;
``(3) support to United States and foreign research
institutions and other appropriate entities for biomedical
research to develop and evaluate improved methods of safe and
effective contraception and related disease control, with
particular emphasis on methods which--
``(A) are likely to be safer, easier to use, easier
to make available in developing country settings, and
less expensive than current methods;
``(B) are controlled by women, including barrier
methods and vaginal microbicides;
``(C) are likely to prevent the spread of sexually
transmitted diseases; and
``(D) encourage and enable men to take greater
responsibility for their own fertility;
``(4) support for field research on the characteristics of
programs most likely to result in sustained use of effective
family planning in meeting each individual's lifetime
reproductive goals, with particular emphasis on the
perspectives of family planning users, including support for
relevant social and behavioral research focusing on such
factors as the use, non-use, and unsafe or ineffective use of
various contraceptive and related-disease control methods;
``(5) support for the development of new evaluation
techniques and performance criteria for family planning
programs, emphasizing the family planning user's perspective
and reproductive goals;
``(6) support for research and research dissemination
related to population policy development, including demographic
and health surveys to assess population trends, measure unmet
needs, and evaluate program impact, and support for policy-
relevant research on the relationships between population
trends, poverty, and environmental management, including
implications for sustainable agriculture, agroforestry,
biodiversity, water resources, energy use, and local and global
climate change;
``(7) support for research and public information
dissemination on the health and welfare consequences of unsafe
abortions and for the equipment and training necessary for the
medical treatment of the complications of unsafe abortions;
``(8) support for special programs to reach adolescents and
young adults, regardless of marital status, before they begin
childbearing, including health education programs which stress
responsible parenthood and the health risks of unprotected
sexual intercourse, as well as service programs designed to
meet the information and contraception needs of adolescents and
young adults; and
``(9) support for a broad array of governmental and
nongovernmental communication strategies designed--
``(A) to create public awareness worldwide;
``(B) to generate a consensus on the need to
address reproductive health issues and the problems
associated with continued world population growth;
``(C) to emphasize the need to educate men as well
as women and mobilize their support for reproductive
rights and responsibilities; and
``(D) to make family planning an established
community norm.
``SEC. 499D. TERMS AND CONDITIONS.
``United States population assistance is authorized to be provided
subject to the following conditions:
``(1) Such assistance may only support, directly or through
referral, those activities which provide a broad range of
contraceptive methods permitted by individual country policy
and a broad choice of public and private family planning
services, including networks for community-based and subsidized
commercial distribution of contraceptives.
``(2) No program supported by United States population
assistance may deny an individual family planning services
because of such individual's inability to pay all or part of
the cost of such services.
``(3) Family planning services and related reproductive
health care services supported by United States population
assistance shall maintain the highest medical standards
possible under local conditions and shall ensure regular
oversight of the quality of medical care and other services
offered.
``(4) United States-supported reproductive health programs
shall in each recipient country support to the extent possible
an integrated approach, consistent with respect for the rights
of women as decisionmakers in matters of reproduction and
sexuality, for the provision of public and private reproductive
health services.
``(5) United States population assistance programs shall
furnish only those contraceptive drugs and devices which have
received approval for marketing in the United States by the
Food and Drug Administration or which have been tested and
determined to be safe and effective under research protocols
comparable to those required by the Food and Drug
Administration or have been determined to be safe by an
appropriate international organization or the relevant health
authority in the country to which they are provided.
``(6) Reproductive health services supported by the United
States shall be designed to take into account the needs of
individuals and couples, including the constraints on women's
time, by involving communities, particularly representatives of
women, through appropriate training and recruitment efforts, in
the design, management, and ongoing evaluation of services. The
design of such services shall stress easy accessibility, by
locating services as close as possible to potential users, by
keeping hours of service convenient, and by improving
communications between users and providers through community
outreach and involvement. The evaluation of reproductive health
services also shall not use as a measure of program success the
degree of longevity or permanency of any contraceptive method.
``(7) United States population assistance to adolescent
fertility programs shall be provided in the context of
prevailing norms and customs in the recipient country.
``(8) None of the funds made available by the United States
Government to foreign governments, international organizations,
or nongovernmental organizations may be used to coerce any
person to undergo contraceptive sterilization or involuntary
abortion or to accept any other method of fertility control.
``SEC. 499E. ELIGIBILITY FOR POPULATION ASSISTANCE.
``(a) Eligible Countries.--Notwithstanding any other provision of
law, United States population assistance shall be available, directly
or through intermediary organizations, to any country which the
President determines has met one or more of the following criteria:
``(1) The country accounts for a significant proportion of
the world's annual population increment.
``(2) The country has significant unmet needs for methods
of contraception, prevention and treatment of sexually
transmitted diseases and acquired immune deficiency syndrome
(AIDS), and obstetric and gynecological care, and requires
foreign assistance to directly implement, expand, or sustain
quality reproductive health services for all its people.
``(3) The country demonstrates a strong commitment to
population stabilization and to comprehensive reproductive
health care strategies through policies, programs and the
commitment of domestic funds to improve service and make
services more widely available.
``(b) Eligibility of Nongovernmental and Multilateral
Organizations.--In determining eligibility for United States population
assistance, the President shall not subject nongovernmental and
multilateral organizations to requirements which are more restrictive
than requirements applicable to foreign governments for such
assistance.
``SEC. 499F. PARTICIPATION IN MULTILATERAL ORGANIZATIONS.
``(a) Finding.--The Congress recognizes that the recent attention
in government policies toward population stabilization owes much to the
efforts of the United Nations and its specialized agencies and
organizations, particularly the United Nations Population Fund.
``(b) Availability of Funds.--United States population assistance
shall be available for contributions to the United Nations Population
Fund in such amounts as the President determines would be commensurate
with United States contributions to other multilateral organizations
and with the contributions of other donor countries.
``(c) Prohibitions.--(1) The prohibitions contained in section
104(f) of this Act shall apply to the funds made available for the
United Nations Population Fund.
``(2) No United States population assistance may be available to
the United Nations Population Fund unless such assistance is held in a
separate account and not commingled with any other funds.
``(3) No funds may be available for the United Nations Population
Fund unless the Fund agrees to prohibit the use of those funds to carry
out any program, project, or activity that involves the use of coerced
abortion or involuntary sterilization.
``(d) Allocation of Funds.--Of the funds made available for United
States population assistance, the President shall make available for
the Special Programme of Research, Development and Research Training in
Human Reproduction for each of the fiscal years 1994 and 1995 an amount
commensurate with the contributions of the other donor countries for
the purpose of furthering international cooperation in the development
and evaluation of contraceptive technology.
``SEC. 499G. SUPPORT FOR NONGOVERNMENTAL ORGANIZATIONS.
``(a) Findings.--The Congress finds that--
``(1) in many developing countries, nongovernmental
entities, including private and voluntary organizations and
private sector entities, such as the International Planned
Parenthood Federation and the Planned Parenthood Federation of
America, are the most appropriate and effective providers of
United States assistance to population and family planning
activities; and
``(2) in particular, organizations and groups founded by
women or in which women have significant and meaningful
participation, and which are committed to promoting women's
reproductive health rights through client-oriented programs and
activities, have proven the most effective of all.
``(b) Procedures.--The President shall establish simplified
procedures for the development and approval of programs to be carried
out by nongovernmental organizations that have demonstrated--
``(1) a capacity to undertake quality, effective, client-
oriented reproductive health and population activities which
encourage significant involvement by private health
practitioners, employer-based health services, unions, and
cooperative health organizations; and
``(2) a commitment to quality, client-oriented reproductive
health care for women.
``(c) Priority for Nongovernmental Organizations.--The largest
share of United States population assistance made available for any
fiscal year shall be made available through United States and foreign
nongovernmental organizations.
``SEC. 499H. REPORTS TO CONGRESS.
``The President shall prepare and submit to the Congress, as part
of the annual presentation materials on foreign assistance, a report on
world progress toward population stabilization and universal
reproductive choice. The report shall include--
``(1) estimates of expenditures on the population
activities described in section 499C by national governments,
donor agencies, and private sector entities;
``(2) an assessment by country of the availability and use
of all methods of contraception and abortion, whether lawful or
unlawful in that country;
``(3) an analysis by country and region of the impact of
population trends on a set of key social, economic, political,
and environmental indicators, which shall be identified by the
President in the first report submitted pursuant to this
section and analyzed in that report and each subsequent report;
and
``(4) a detailed statement of prior year and proposed
direct and indirect allocations of population assistance, by
country, which describes how each country allocation meets the
criteria set forth in this section.''.
SEC. 293. AUTHORIZATIONS OF APPROPRIATIONS.
Section 104(g)(1) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b(g)(1) is amended by amending subparagraph (A) to read as follows:
``(A) $725,000,000 for fiscal year 1994 and $800,000,000
for fiscal year 1995 to carry out subsection (b) of this
section; and''.
SEC. 294. ECONOMIC AND SOCIAL DEVELOPMENT INITIATIVES TO STABILIZE
WORLD POPULATION.
(a) Congressional Findings.--The Congress makes the following
findings:
(1) Women represent 50 percent of the world's human
resource potential. Therefore, improving the health, social,
and economic status of women and increasing their productivity
are essential for economic progress in all countries.
(2) Throughout the world, women who participate in the
social, economic, and political affairs of their communities
are more likely to exercise their choice about childbearing
than women who do not participate in such activities.
(3) Effective economic development strategies address
issues such as infant and child survival rates, educational
opportunities, especially literacy programs, for girls and
women, and gender equality in development.
(4) Comprehensive population stabilization efforts which
include both family planning services and economic development
activities achieve lower birth rates and stimulate more
development than those which pursue these objectives
independently.
(5) The most powerful, long-term influence on birthrates is
education, especially educational attainment among women. The
education of women also has a strong influence on other aspects
of family welfare, including child survival. World-wide
statistics, however, indicate that the number of school-age
children, especially girls, not attending school is growing
annually.
(6) Each year, nearly 15,000,000 children under the age of
5 die, most from preventable causes. Wider availability of
vaccines, simple treatments for diarrheal disease and
respiratory infections, and improved nutrition could prevent
many of these deaths.
(7) Each year, 500,000 or more women worldwide die from
complications related to pregnancy, childbirth, or illegal
abortion. Another 10 million women annually suffer long-term
illness or permanent physical impairment from such causes.
(8) In many countries, high levels of mortality and
morbidity among women of childbearing age are directly related
to inadequate or inaccessible reproductive health care
services.
(9) Many women are their family's principal caregiver and
chief source of economic support. The death of a mother
substantially increases the risk of neglect, abandonment, or
death for her young children.
(10) Malnutrition and anemia are widespread among poor
women in their childbearing years, yet the worldwide campaign
to encourage breastfeeding has devoted little attention to the
nutritional needs of nursing mothers, or in the improvement of
nutritional and health levels of women in general.
(11) During the 1990s, women, especially in Africa, face
substantially increased risks of death or disability from
sexually transmitted diseases. During the 1990s, more than
3,000,000 women in Africa will die of the acquired immune
deficiency syndrome (AIDS), leaving more than 5,000,000
orphans.
(b) Declaration of Policy.--Congress declares that, in order to
further the United States foreign policy objective of assisting the
international community in achieving universal availability of quality
family planning services and stabilizing world population, additional
objectives of the foreign policy of the United States shall be--
(1) to expand basic education opportunities for girls and
women;
(2) to reduce the gap between male and female levels of
literacy and between male and female levels of primary and
secondary school enrollment;
(3) to help ensure that women worldwide have the
opportunity to become equal partners with men in the
development of their societies;
(4) to reduce global maternal and infant mortality rates;
and
(5) to improve worldwide overall reproductive health,
maternal and child health status, and quality of life.
(c) Authorized Activities.--United States development assistance
shall be available, on a priority basis, for--
(1) countries which either have adopted and implemented, or
have agreed to adopt and implement, strategies to help ensure,
by the year 2000--
(A) the completion of primary school education by
no less than 80 percent of the country's primary
school-age children;
(B) the reduction of adult illiteracy by at least
one-half the country's 1990 level; and
(C) the elimination of the gap between male and
female levels of literacy and between male and female
levels of primary and secondary school enrollment;
(2) governmental and nongovernmental programs which, with
respect to a targeted country, are intended--
(A) to reduce significantly malnutrition among the
country's children under 5 years of age;
(B) to maintain immunizations against childhood
diseases for significant segments of the country's
children; and
(C) to reduce the number of childhood deaths in the
country which result from diarrheal disease and acute
respiratory infections;
(3) governmental and nongovernmental programs which are
intended to increase women's productivity through improved
access to appropriate labor-saving technology, vocational
training, and extension services and access to credit and child
care; and
(4) governmental and nongovernmental programs which are
intended to increase the access of girls and women to
comprehensive reproductive health care services pursuant to
subsection (d).
(d) Safe Motherhood Initiative.--(1)(A) The President is authorized
to establish a grant program, to be known as the Safe Motherhood
Initiative, to help improve the access of girls and women worldwide to
comprehensive reproductive health care services.
(B) Such program shall be carried out in accordance with this
section and shall be subject to the same terms, conditions,
prohibitions, and restrictions as are applicable to assistance made
available under sections 499D, 499E, and 499F of the Foreign Assistance
Act of 1961.
(2) Eligible for assistance under this section are comprehensive
reproductive health programs which emphasize--
(A) contraceptive services;
(B) prenatal care and screening for high risk pregnancies,
and improved access to safe delivery services for women with
high risk pregnancies;
(C) supplemental food programs for pregnant and nursing
women;
(D) expanded and coordinated programs to prevent, detect,
and treat sexually transmitted diseases, including acquired
immune deficiency syndrome (AIDS), reproductive tract
infections, and other chronic reproductive health problems;
(E) programs to eliminate traditional practices injurious
to women's health, including female genital mutilation; and
(F) improvements in the practice of midwifery, including
outreach to traditional birth attendants.
(e) Reports to Congress.--(1) Not later than December 31, 1994, the
President shall prepare and submit to the Congress a report which
includes--
(A) estimates of the total financial resources needed to
achieve, by the year 2000, the specific objectives set forth in
subsection (c) with respect to education, rates of illiteracy,
malnutrition, immunization, maternal and child mortality and
morbidity, and improvements in the economic productivity of
women;
(B) an analysis of such estimates which separately lists
the total financial resources needed from the United States,
other donor nations, and non-governmental organizations;
(C) an analysis, by country, which--
(i) identifies the legal, social, economic, and
cultural barriers to women's self-determination and to
improvements in the economic productivity of women in
traditional and modern labor sectors; and
(ii) describes initiatives needed to develop
appropriate technologies for use by women, credit
programs for low-income women, expanded child care,
vocational training, and extension services for women;
and
(D) a comprehensive description of--
(i) new and expanded initiatives to ensure safe
motherhood worldwide;
(ii) findings on the major causes of mortality and
morbidity among women of childbearing age in various
regions of the world;
(iii) actions needed to reduce, by the year 2000,
world maternal mortality by one-half of the worldwide
1990 level; and
(iv) the financial resources needed to meet this
goal from the United States, other donor nations, and
nongovernmental organizations.
(2) In each annual country human rights report, the Secretary of
State shall include--
(A) information on any patterns within the country
of discrimination against women in inheritance laws,
property rights, family law, access to credit and
technology, hiring practices, formal education, and
vocational training; and
(B) an assessment which makes reference to all
significant forms of violence against women, including
rape, domestic violence, and female genital mutilation,
the extent of involuntary marriage and childbearing,
and the prevalence of marriage among women under the
age of 18 years.
(f) Authorization of Appropriations.--(1) Of the aggregate amounts
available for United States development and economic assistance
programs for education activities, $350,000,000 for fiscal year 1994
and $350,000,000 for fiscal year 1995 shall be available only for
programs in support of equalizing male and female levels of primary and
secondary school enrollment.
(2) There are authorized to be appropriated $405,000,000 for fiscal
year 1994 and $490,000,000 for fiscal year 1995 to the Child Survival
Fund under section 104(c)(2) of the Foreign Assistance Act of 1961,
which amounts shall be available for child survival activities only,
including the Children's Vaccine Initiative, the worldwide immunization
effort, and oral rehydration programs.
(3) There are authorized to be appropriated $100,000,000 for the
Safe Motherhood Initiative for each of fiscal years 1994 and 1995.
(g) Definitions.--For purposes of this section--
(1) the term ``annual country human rights report'' refers
to the report required to be submitted pursuant to section
502B(b) of the Foreign Assistance Act of 1961 (22 U.S.C.
2304(b)); and
(2) the term ``United States development and economic
assistance'' means assistance made available under chapter 1 of
part I and chapter 4 of part II of the Foreign Assistance Act
of 1961.
SEC. 295. AIDS PREVENTION AND CONTROL FUND.
(a) In General.--Section 104(c) of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b(c)) is amended by adding at the end the following
new paragraph:
``(4)(A)(i) The President is authorized to provide assistance,
under such terms and conditions as he may determine, with respect to
activities relating to research on, and the treatment and control of,
acquired immune deficiency syndrome (AIDS) in developing countries.
``(ii) Assistance provided under clause (i) shall include--
``(I) funds made available directly to the World Health
Organization for its use in financing the Global Program on
AIDS (including activities implemented by the Pan American
Health Organization); and
``(II) funds made available to the United Nations
Children's Fund (UNICEF) for AIDS-related activities.
``(B) Appropriations pursuant to subparagraph (A) may be referred
to as the `AIDS Prevention and Control Fund'.''.
(b) Authorization of Appropriations.--Section 104(g)(1) of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151b(g)) is amended--
(1) by striking ``and'' at the end of subparagraph (A);
(2) in subparagraph (B), by striking ``subsection (c) of
this section.'' and inserting ``subsection (c) of this section
(other than paragraph (4) thereof); and''; and
(3) by adding at the end thereof the following new
subparagraph:
``(C) $100,000,000 for fiscal year 1994 and
$165,000,000 for fiscal year 1995 to carry out
subsection (c)(4) of this section.''.
(c) Effective Date.--The amendments made by this section shall take
effect October 1, 1993.
SEC. 296. OVERSIGHT OF MULTILATERAL DEVELOPMENT BANKS.
(a) Finding.--The Congress considers insufficient the role
currently played in global population efforts by the International Bank
for Reconstruction and Development, the Asian Development Bank, the
Inter-American Development Bank and the African Development Bank.
Although these multilateral development banks are singularly important
sources of support for development activities, together they provided
less than $200,000,000 in 1990 in assistance for core population
programs. Nor have these institutions consistently encouraged
appropriate population and reproductive health care policies.
(b) Report Required.--(1) The Congress believes that the
multilateral development banks should together increase their support
for the population activities described in section 499C of the Foreign
Assistance Act of 1961 to no less than $1,000,000,000 by the end of
1999.
(2) Not later than July 31 of each year, the United States
Executive Directors of the International Bank for Reconstruction and
Development, the Asian Development Bank, the Inter-American Development
Bank and the African Development Bank shall prepare and transmit to
Congress a report which sets forth information on allocations by each
of these institutions to the population activities described in section
499C of the Foreign Assistance Act of 1961 and, if such allocations
total less than $1,000,000,000, set forth any specific actions taken by
the Executive Directors to encourage increases in such allocations and
in policy level discussions with donor and developing country
governments.
SEC. 297. COMMISSION ON WORLD POPULATION STABILIZATION AND REPRODUCTIVE
HEALTH.
(a) Establishment of Commission.--There is established the
Commission on World Population Stabilization and Reproductive Health
for the purpose of coordinating United States preparation for, and
participation in, the 1994 International Conference on Population and
Development and for other purposes.
(b) Composition of Commission.--The Commission shall be composed
of--
(1) the Under Secretary of State for Global Population,
Environment and National Resources;
(2) the Administrator of the Agency for International
Development;
(3) the Deputy Assistant Secretary for Population Affairs
of the Department of Health and Human Services;
(4) the Assistant Administrator for International
Activities of the Environmental Protection Agency;
(5) the Director of the Congressional Office of Technology
Assessment; and
(6) three individuals appointed by the President, by and
with the advice and consent of the Senate, one of whom the
President shall designate as Chairman.
(c) Period of Appointment; Vacancies.--Members shall be appointed
for the life of the Commission. Any vacancy in the Commission shall not
affect its powers, but shall be filled in the same manner as the
original appointment.
(d) Quorum.--A majority of the members of the Commission shall
constitute a quorum, but a lesser number of members may hold hearings.
(e) Hearings.--The Commission may hold such hearings, sit and act
at such times and places, take such testimony, and receive such
evidence as the Commission considers advisable to carry out the
purposes of this section.
(f) Information From Federal Agencies.--The Commission may secure
directly from any Federal department or agency such information as the
Commission considers necessary to carry out the provisions of this
subtitle. Upon request of the Chairman of the Commission, the head of
such department or agency shall furnish such information to the
Commission.
(g) Postal Services.--The Commission may use the United States
mails in the same manner and under the same conditions as other
departments and agencies of the Federal Government.
(h) Gifts.--The Commission may accept, use, and dispose of gifts or
donations of services or property.
(i) Compensation of Members.--Each member of the Commission who is
not an officer or employee of the Federal Government shall be
compensated at a rate equal to the daily equivalent of the annual rate
of basic pay prescribed for level IV of the Executive Schedule under
section 5315 of title 5, United States Code, for each day (including
travel time) during which such member is engaged in the performance of
the duties of the Commission. All members of the Commission who are
officers or employees of the United States shall serve without
compensation in addition to that received for their services as
officers or employees of the United States.
(j) Travel Expenses.--The members of the Commission shall be
allowed travel expenses, including per diem in lieu of subsistence, at
rates authorized for employees of agencies under subchapter I of
chapter 57 of title 5, United States Code, while away from their homes
or regular places of business in the performance of services for the
Commission.
(k) Staff Compensation.--The Chairman of the Commission may fix the
compensation of personnel without regard to the provisions of chapter
51 and subchapter III of chapter 53 of title 5, United States Code,
relating to classification of positions and General Schedule pay rates,
except that the rate of pay for the executive director and other
personnel may not exceed the rate payable for level V of the Executive
Schedule under section 5316 of such title.
(l) Detail of Government Employees.--Any Federal Government
employee may be detailed to the Commission without reimbursement, and
such detail shall be without interruption or loss of civil service
status or privilege.
(m) Procurement of Temporary and Intermittent Services.--The
Chairman of the Commission may procure temporary and intermittent
services under section 3109(b) of title 5, United States Code, at rates
for individuals which do not exceed the daily equivalent of the annual
rate of basic pay prescribed for level V of the Executive Schedule
under section 5316 of such title.
(n) Report.--Not later than June 30, 1994, the Commission shall
submit to the President a public report on national and international
population trends and the probable impact of such trends on efforts to
alleviate poverty and protect the environment. The report, which should
be made available for consideration at the 1994 International
Conference on Population and Development, shall specify, among other
things, modifications in policy and financial commitments required by
foreign governments to achieve universal reproductive choice and early
population stabilization.
(o) Termination of the Commission.--The Commission shall terminate
90 days after the date on which the Commission submits its report under
subsection (n).
(p) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated to the Commission $1,000,000
for fiscal year 1994.
SEC. 298. SUPPORT FOR UNITED NATIONS FORWARD LOOKING STRATEGIES FOR THE
ADVANCEMENT OF WOMEN.
(a) In General.--The President shall direct the United States
representatives to the United Nations Commission on the Status of Women
to take all actions necessary to ensure the rapid implementation of the
United Nations Forward Looking Strategies for the Advancement of Women,
as adopted in 1985 at the United Nations Conference ending the Decade
for Women.
(b) Review and Annual Reports.--Not later than December 31, 1993,
the Secretary of State shall submit the 5-year review of the status of
United States women, as called for at the conference, and shall submit
such annual reports as are requested by the United Nations Commission
on the Status of Women.
SEC. 299. SUPPORT FOR THE CONVENTION ON THE ELIMINATION OF ALL FORMS OF
DISCRIMINATION AGAINST WOMEN.
The President shall promptly complete the review of the United
Nations Convention on the Elimination of All Forms of Discrimination
Against Women, which was signed by the United States on July 17, 1980,
and submit to the Senate any reservations, understandings, or
declarations that the President considers necessary in order that the
Senate may give its advice and consent to ratification, or report to
the Congress why he is unable or unwilling to do so.
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