[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3178 Introduced in House (IH)]
2d Session
H. R. 3178
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
March 27, 1996
Ms. Slaughter (for herself, Mrs. Morella, Mrs. Lowey, Ms. Eddie Bernice
Johnson of Texas, Ms. Brown of Florida, Mrs. Clayton, Miss Collins of
Michigan, Mrs. Collins of Illinois, Ms. DeLauro, Ms. Eshoo, Ms. Furse,
Ms. Harman, Ms. Jackson-Lee of Texas, Mrs. Johnson of Connecticut, Mrs.
Kelly, Mrs. Kennelly, Ms. Lofgren, Ms. McKinney, Mrs. Maloney, Mrs.
Meek of Florida, Mrs. Meyers of Kansas, Mrs. Mink of Hawaii, Ms.
Norton, Ms. Pelosi, Ms. Rivers, Mrs. Roukema, Ms. Roybal-Allard, Mrs.
Schroeder, Mrs. Thurman, Ms. Velazquez, Ms. Waters, and Ms. Woolsey)
introduced the following bill; which was referred to the Committee on
Commerce, and in addition to the Committees on Ways and Means, the
Judiciary, Agriculture, International Relations, Veterans' Affairs,
Economic and Educational Opportunities, National Security, and Banking
and Financial Services, for a period to be subsequently determined by
the Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
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 1996''.
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
Subtitle A--Breast Cancer Research Extension Act of 1996
Sec. 1101. Short title.
Sec. 1102. Extension of program of research on breast cancer.
Subtitle B--HHS Women Scientists Employment Opportunity Act
Sec. 1151. Short title.
Sec. 1152. Women's scientific employment.
Subtitle C--Women and AIDS Research Initiative Amendments of 1996
Sec. 1191. Short title.
Sec. 1192. Establishment of general program of research regarding women
and acquired immune deficiency syndrome.
Subtitle D--Women's Cardiovascular Diseases Research and Prevention Act
Sec. 1201. Short title.
Sec. 1202. Findings.
Sec. 1203. Expansion and intensification of activities regarding heart
attack, stroke and other cardiovascular
diseases in women.
Subtitle E--Osteoporosis and Related Bone Diseases Research Act of 1996
Sec. 1251. Short title.
Sec. 1252. Findings.
Sec. 1253. Osteoporosis research.
Subtitle F--Lupus Research Amendments of 1996
Sec. 1291. Short title.
Sec. 1292. Findings.
Sec. 1293. Expansion and intensification of activities regarding lupus.
Subtitle G--Ovarian Cancer Research and Information Amendments of 1996
Sec. 1301. Short title.
Sec. 1302. Funding for research on ovarian cancer.
Sec. 1303. Public information and education on ovarian cancer.
Subtitle H--HPV Infection and Cervical Cancer Research Resolution of
1996
Sec. 1351. Short title.
Sec. 1352. Sense of Congress.
Subtitle I--Office for Rare Disease Research Act of 1996
Sec. 1391. Short title.
Sec. 1392. Establishment of Office for Rare Disease Research.
Subtitle J--Federal Risk Assessment in Women's Health Act of 1996
Sec. 1401. Short title.
Sec. 1402. Interagency review.
Sec. 1403. Study of research needs.
Subtitle K--Women's Health Environmental Factors Act of 1996
Sec. 1451. Short title.
Sec. 1452. Report on effect of environmental factors on women's health.
Subtitle L--Consumer Involvement in Breast Cancer Research Act
Sec. 1491. Short title.
Sec. 1492. Increased involvement of advocates in decision making
regarding research on breast cancer.
Subtitle M--Women and Alcohol Research Equity Act of 1996
Sec. 1501. Short title.
Sec. 1502. Findings.
Sec. 1503. Provisions regarding increase in amount of funds expended
for research on alcohol abuse and
alcoholism among women.
TITLE II--SERVICES
Subtitle A--Women's Health Office Act of 1996
Sec. 2101. Short title.
Sec. 2102. Public Health Service Office on Women's Health.
Sec. 2103. Centers for Disease Control and Prevention Office of Women's
Health.
Sec. 2104. Agency for Health Care Policy and Research Office of Women's
Health.
Sec. 2105. Health Resources and Services Administration Office of
Women's Health.
Sec. 2106. Food and Drug Administration Office of Women's Health.
Subtitle B--Genetic Information Nondiscrimination in Health Insurance
Act of 1996
Sec. 2151. Short title.
Sec. 2152. Prohibition of health insurance discrimination on the basis
of genetic information.
Subtitle C--Improved Patient Access to Clinical Studies Act of 1996
Sec. 2191. Short title.
Sec. 2192. Coverage for individuals participating in approved clinical
studies.
Subtitle D--Equitable Health Care for Neurobiological Disorders Act of
1996
Sec. 2201. Short title.
Sec. 2202. Findings.
Sec. 2203. Standards for nondiscriminatory treatment of neurobiological
disorders for employer health benefit
plans.
Sec. 2204. Enforcement through excise tax.
Sec. 2205. Definitions.
Subtitle E--Victims of Abuse Insurance Protection Act
Sec. 2251. Short title.
Sec. 2252. Definitions.
Sec. 2253. Discriminatory acts prohibited.
Sec. 2254. Reasons for adverse actions.
Sec. 2255. Life insurance.
Sec. 2256. Subrogation without consent prohibited.
Sec. 2257. Enforcement.
Subtitle F--Insurance Protection for Victims of Domestic Violence Act
Sec. 2291. Short title.
Sec. 2292. Prohibition of health insurance discrimination with respect
to victims of domestic violence.
Subtitle G--Domestic Violence Victims Insurance Protection Act of 1996
Sec. 2301. Short title.
Sec. 2302. Protection of domestic violence victims from health
insurance discrimination.
Subtitle H--Fairness to Minority Women Health Act
Sec. 2351. Short title.
Sec. 2352. Exception to AFDC income and resources attribution rule for
certain battered aliens.
Sec. 2353. Amendment to the Food Stamp Act of 1977.
Sec. 2354. Requiring certain recipients of Federal financial assistance
to have personnel available who speak
predominant language used in area.
Sec. 2355. Study regarding domestic violence and latina women.
Subtitle I--Adolescent Health Demonstration Projects Act
Sec. 2391. Short title.
Sec. 2392. Establishment or support of demonstration projects.
Sec. 2393. Project requirements.
Sec. 2394. Areas to be served.
Sec. 2395. Abortion restriction.
Sec. 2396. Report.
Subtitle J--Eating Disorders Information and Education Act of 1996
Sec. 2401. Short title.
Sec. 2402. Findings.
Sec. 2403. Public information and education on eating disorders.
Subtitle K--Women's Choice and Reproductive Health Protection Act of
1996
Sec. 2451. Short title.
Sec. 2452. Findings.
Sec. 2453. Sense of Congress with respect to certain reproductive
health issues.
Sec. 2454. Family planning amendments.
Sec. 2455. Freedom of full disclosure.
Sec. 2456. Fairness in evaluation of RU-486.
Sec. 2457. Freedom of choice.
Sec. 2458. Fairness in insurance.
Sec. 2459. Abortions in facilities of the uniformed services not
prohibited if not federally funded.
Subtitle L--Women's Right To Know Act of 1996
Sec. 2491. Short title.
Sec. 2492. First amendment rights.
Subtitle M--International Population Stabilization and Reproductive
Health Act
Sec. 2501. Short title.
Sec. 2502. Authorities relating to United States population assistance.
Sec. 2503. Authorizations of appropriations.
Sec. 2504. Oversight of multilateral development banks.
Sec. 2505. Economic and social development initiatives to stabilize
world population.
Sec. 2506. AIDS prevention and control fund.
Sec. 2507. Support for United Nations forward looking strategies for
the advancement of women.
Sec. 2508. Support for the convention on the elimination of all forms
of discrimination against women.
Subtitle N--Federal Prohibition of Female Genital Mutilation Act of
1996
Sec. 2551. Short title.
Sec. 2552. Title 18 amendment.
Sec. 2553. Information and education regarding female genital
mutilation.
Sec. 2554. Effective dates.
Subtitle O--Women and HIV Outreach and Prevention Act
Sec. 2591. Short title.
Sec. 2592. Preventive health programs regarding women and human
immunodeficiency virus.
Sec. 2593. Treatment of women for substance abuse.
Sec. 2594. Early intervention services for women.
Subtitle P--Smoking Prevention and Cessation in WIC Clinics Act
Sec. 2601. Short title.
Sec. 2602. Smoking cessation demonstration programs for WIC
participants.
Subtitle Q--Comprehensive Fetal Alcohol Syndrome Prevention Act
Sec. 2651. Short title.
Sec. 2652. Prevention of fetal alcohol syndrome; program of National
Institute on Alcohol Abuse and Alcoholism.
Subtitle R--Postreproductive Health Care Act
Sec. 2691. Short title.
Sec. 2692. Establishment of program for postreproductive health care.
Subtitle S--Family Caregiver Support and Protection Act of 1996
Sec. 2701. Short title.
Sec. 2702. Coverage of respite care services under medicare.
Sec. 2703. Treatment of long-term care services as medical care.
Subtitle T--Medicare Mammography Enhancement Act of 1996
Sec. 2751. Short title.
Sec. 2752. Expanding screening mammography under the medicare program.
Subtitle U--Medicare Bone Mass Measurement Standardization Act of 1996
Sec. 2791. Short title.
Sec. 2792. Medicare coverage of bone mass measurements.
Subtitle V--Osteoporosis and Related Bone Disorders Resource Center Act
of 1996
Sec. 2801. Short title.
Sec. 2802. Funding for information clearinghouse on osteoporosis,
Paget's disease, and related bone
disorders.
Subtitle W--Women Veterans Health Improvement Act of 1996
Sec. 2851. Short title.
Sec. 2852. Women's health services.
Sec. 2853. Report on women's health care and research.
Sec. 2854. Expansion of research relating to women veterans.
Sec. 2855. Population study.
Sec. 2856. Outreach services for homeless women veterans.
Sec. 2857. Safe and effective treatment for women psychiatric patients.
Sec. 2858. Mammography quality standards.
TITLE I
Subtitle A--Breast Cancer Research Extension Act of 1996
SEC. 1101. SHORT TITLE.
This subtitle may be cited as the ``Breast Cancer Research
Extension Act of 1996''.
SEC. 1102. EXTENSION OF PROGRAM OF RESEARCH ON BREAST CANCER.
Section 417B(b)(1) of the Public Health Service Act (42 U.S.C.
286a-8(b)(1)) is amended to read as follows:
``(1) Breast cancer.--For the purpose of carrying out
section 417(c), there are authorized to be appropriated
$575,000,000 for fiscal year 1997, and such sums as may be
necessary for each of the fiscal years 1998 through 2001. Such
authorizations of appropriations are in addition to the
authorizations of appropriations established in subsection (a)
with respect to such purpose.''.
Subtitle B--HHS Women Scientists Employment Opportunity Act
SEC. 1151. SHORT TITLE.
This subtitle may be cited as the ``HHS Women Scientist Employment
Opportunity Act''.
SEC. 1152. WOMEN'S SCIENTIFIC EMPLOYMENT.
The Public Health Service Act (42 U.S.C. 281 et seq.) is amended by
adding at the end the following title:
``TITLE XXVII--WOMEN'S SCIENTIFIC EMPLOYMENT WITH DEPARTMENT OF HEALTH
AND HUMAN SERVICES
``SEC. 2701. WOMEN'S SCIENTIFIC EMPLOYMENT.
``(a) In General.--
``(1) In general.--For each agency specified in paragraph
(2), the Secretary, in collaboration with the head of the
agency, shall--
``(A) establish policies for the agency on matters
relating to the employment by the agency of women as
scientists, and periodically review and as appropriate
revise such policies; and
``(B) monitor the extent of compliance with such
policies and take appropriate action in cases in which
the Secretary determines that the policies have been
violated.
``(2) Specified agencies.--The agencies referred to in
paragraph (1) are the National Institutes of Health, the
Centers for Disease Control and Prevention, the Food and Drug
Administration, and such other agencies or offices of the
Department of Health and Human Services as the Secretary
determines to be appropriate.
``(b) Certain Functions.--
``(1) In general.--In carrying out subsection (a) with
respect to a specified agency, the Secretary shall provide for
the following:
``(A) Determining the concerns of women scientists
employed at the agency.
``(B) Developing a policy defining the standard
tenure process for employment at the agency.
``(C) Determining the reason for departure from the
agency by interviewing women and men scientists as they
leave.
``(D) Distributing yearly to all employees of the
agency of the policy of the agency on flexible family
leave.
``(E) Monitoring the number of women, including
minority women, included on the committees, panels, and
other working groups (and in meetings) of the agency.
``(F) Making efforts to recruit minority women,
based on the small numbers of tenured minority women
scientists.
``(G) Developing additional goals related to women
and minority women scientists at the agency.
``(2) Agency-specific provisions.--With respect to the
National Institutes of Health, in carrying out subsection (a),
the Secretary shall (in addition to activities under paragraph
(1)) provide for the implementation of the recommendations of
the group known as the Task Force on the Status of NIH
Intramural Women Scientists.
``(c) Inclusion of Women on Intramural and Extramural Conferences
and Other Groups.--
``(1) In general.--The Secretary shall establish a policy
at each specified agency of requiring inclusion of women
scientists in greater numbers on or in conferences, workshops,
meetings, international congresses, and other groups funded or
sponsored by the agency. Such policy shall provide for the
inclusion of not less than one woman scientist in each such
group, except as provided in paragraph (2). This paragraph
applies whether such groups are held for employees of the
agency headquarters, for employees of field offices, or both.
``(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 Secretary provides a waiver of the
requirement. The Secretary may grant such a waiver only if--
``(A) the individual with the chief responsibility
for the group involved submits to the Secretary a
written request for the waiver and the request provides
an explanation of the reasons underlying the need for
the waiver; and
``(B) the Secretary makes a determination that
extraordinary circumstances justify providing the
waiver.
``(d) Study on Pay Equity.--
``(1) In general.--For each specified agency, the Secretary
shall provide for a study to identify any pay differences among
men and women scientists employed by the agency, 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 HHS Women Scientist Employment Opportunity
Act of 1996, the Secretary shall complete the study required in
paragraph (1) and submit to the Committee on 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) Definitions.--For purposes of this section, the term
`specified agency' means an agency specified in subsection (a)(2).
``(f) 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 1997 through 1999.''.
Subtitle C--Women and AIDS Research Initiative Amendments of 1996
SEC. 1191. SHORT TITLE.
This subtitle may be cited as the ``Women and AIDS Research
Initiative Amendments of 1996''.
SEC. 1192. 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 the following:
``(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 the
following:
``(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.
``(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.
``(5) Behavioral research on the prevention of such cases
and research on model educational programs for such prevention.
``(6) Research leading to an understanding of social,
economic, and legal factors whose impact contributes to an
increased risk of such infection.
``(7) Research leading to an understanding of social,
economic, and legal factors whose impact contributes to--
``(A) low levels of participation by women in
clinical trials; or
``(B) inadequate access to health care services, or
inadequate utilization of such services.
``(c) Clinical Research.--
``(1) Gynecological evaluations.--In clinical trials
regarding the human immunodeficiency virus in which women
participate as subjects, the Secretary shall ensure--
``(A) that the designs of the trials include
adequate evaluation of prospective subjects prior to
enrollment, and adequate evaluation of subjects during
the course of the trials, including evaluation of the
reproductive tract, and appropriate follow-up services
regarding such evaluations; and
``(B) the conduct of studies related to the
propensity for cases of infection with such virus to
cause abnormalities in the reproductive tract, or to
alter the natural history of other reproductive-tract
infections and diseases.
``(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 research
under subsection (a) to determine the effectiveness, on such
cases in women, of approved treatment protocols.
``(4) Support services.--
``(A) In conducting or supporting clinical trials
regarding the human immunodeficiency virus in which
women participate as subjects, the Secretary shall take
into account factors that can facilitate such
participation, including consideration of employment
schedules and the provision of support services. The
Secretary may provide such services accordingly,
including transportation services, child care services,
medical and mental health services, treatment for drug
abuse, social services (including services addressing
domestic violence), and other support services.
``(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 and
other sexually transmitted diseases, the Secretary
shall conduct or support research under subsection (a)
on topical microbicide and physical barrier methods of
prevention that women can use without their sexual
partner's cooperation or knowledge.
``(B) In carrying out subparagraph (A), the
Secretary shall--
``(i) give priority to carrying out the
topical microbicide research agenda of the
National Institutes of Health, including
agendas regarding basic research, product
development, and clinical evaluation of new and
existing products; and
``(ii) give special consideration to
research on topical microbicides that are not
spermicides and that otherwise are methods that
do not pose a threat to the ability of women to
conceive and bear healthy children.
``(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 spermicides and other
contraceptive methods;
``(B) the use of vaginal products, including
douches, tampons, and vaginal medications;
``(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 March 1996, 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 2,500
women with such infection are included in the study, and that
the demographic variability of the cohort is maintained.
``(2) The Secretary shall ensure that the study period is
extended for a minimum of 5 years.
``(3) With respect to markers of human immunodeficiency
virus disease progression and viral activity (including the
cells commonly known as CD4 cells and including quantitative
viral load measures), the Secretary shall ensure that the study
adequately addresses the relationship between such markers and
the development of serious illnesses in such women. 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 research.--In addition to any other
authorizations of appropriations that are available for the
following purposes:
``(A) For the purpose of carrying out subsection
(c)(1), there are authorized to be appropriated
$20,000,000 for fiscal year 1997, and such sums as may
be necessary for each of the fiscal years 1998 through
1999.
``(B) For the purpose of carrying out subsection
(c)(2), there are authorized to be appropriated
$10,000,000 for fiscal year 1997, and such sums as may
be necessary for each of the fiscal years 1998 through
1999.
``(C) For the purpose of carrying out subsection
(c)(3), there are authorized to be appropriated
$10,000,000 for fiscal year 1997, and such sums as may
be necessary for each of the fiscal years 1998 through
1999.
``(D) For the purpose of carrying out subsection
(c)(4), there are authorized to be appropriated
$15,000,000 for fiscal year 1997, and such sums as may
be necessary for each of the fiscal years 1998 and
1999.
``(2) Prevention programs.--In addition to any other
authorizations of appropriations that are available for the
following purposes:
``(A) For the purpose of carrying out subsection
(d)(1), there are authorized to be appropriated
$10,000,000 for fiscal year 1997, and such sums as may
be necessary for each of the fiscal years 1998 through
1999.
``(B) For the purpose of carrying out subsection
(d)(2), there are authorized to be appropriated
$10,000,000 for fiscal year 1997, and such sums as may
be necessary for each of the fiscal years 1998 through
1999.
``(3) Interagency study.--In addition to any other
authorizations of appropriations that are available for the
purpose of carrying out subsection (e), there are authorized to
be appropriated for such purpose $6,000,000 for fiscal year
1997, and such sums as may be necessary for each of the fiscal
years 1998 through 1999.''.
Subtitle D--Women's Cardiovascular Diseases Research and Prevention Act
SEC. 1201. SHORT TITLE.
This subtitle may be cited as the ``Women's Cardiovascular Diseases
Research and Prevention Act''.
SEC. 1202. FINDINGS.
The Congress finds as follows with respect to women in the United
States:
(1) Heart attack, stroke, and other cardiovascular diseases
are the leading causes of death in women.
(2) Heart attacks and strokes are leading causes of
disability in women.
(3) Cardiovascular diseases claim the lives of more women
each year than does cancer. Each year more than 479,000 females
die of cardiovascular diseases, while approximately 246,000
females die of cancer. Heart attack kills more than 5 times as
many females as breast cancer. Stroke kills twice as many
females as breast cancer.
(4) One in 5 females has some form of cardiovascular
disease. Of females under age 65, each year more than 20,000
die of heart attacks. In the case of African-American women,
from ages 35 to 74 the death rate from heart attacks is
approximately twice that of white women and 3 times that of
women of other races.
(5) Each year since 1984, cardiovascular diseases have
claimed the lives of more females than males. In 1992, of the
number of individuals who died of such diseases, 52 percent
were females and 48 percent were males.
(6) The clinical course of cardiovascular diseases is
different in women than in men, and current diagnostic
capabilities are less accurate in women than in men. Once a
woman develops a cardiovascular disease, she is more likely
than a man to have continuing health problems, and she is more
likely to die.
(7) Of women who have had a heart attack, approximately 44
percent die within 1 year of the attack. Of men who have had
such an attack, 27 percent die within 1 year. At older ages,
women who have had a heart attack are twice as likely as men to
die from the attack within a few weeks. Women are more likely
than men to have a stroke during the first 6 years following a
heart attack. More than 60 percent of women who suffer a stroke
die within 8 years. Long-term survivorship of stroke is better
in women than in men. Of individuals who die from a stroke,
each year approximately 61 percent are females. In 1992, 87,124
females died from strokes. Women have unrecognized heart
attacks more frequently than men. Of women who died suddenly
from heart attack, 63 percent had no previous evidence of
disease.
(8) More than half of the annual health care costs that are
related to cardiovascular diseases are attributable to the
occurrence of the diseases in women, each year costing this
nation hundreds of billions of dollars in health care costs and
lost productivity.
SEC. 1203. EXPANSION AND INTENSIFICATION OF ACTIVITIES REGARDING HEART
ATTACK, STROKE AND OTHER CARDIOVASCULAR DISEASES IN
WOMEN.
Subpart 2 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285b et seq.) is amended by inserting after section 424 the
following section:
``heart attack, stroke, and other cardiovascular diseases in women
``Sec. 424A. (a) In General.--The Director of the Institute shall
expand, intensify, and coordinate research and related activities of
the Institute with respect to heart attack, stroke, and other
cardiovascular diseases in women.
``(b) Coordination With Other Institutes.--The Director of the
Institute shall coordinate activities 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 heart
attack, stroke, and other cardiovascular diseases in women.
``(c) Certain Programs.--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 develop methods for
preventing, cardiovascular diseases in women. Activities under such
subsection shall include conducting and supporting the following:
``(1) Research to determine the reasons underlying the
prevalence of heart attack, stroke, and other cardiovascular
diseases in women, including African-American women and other
women who are members of racial or ethnic minority groups.
``(2) Basic research concerning the etiology and causes of
cardiovascular diseases in women.
``(3) Epidemiological studies to address the frequency and
natural history of such diseases and the differences among men
and women, and among racial and ethnic groups, with respect to
such diseases.
``(4) The development of safe, efficient, and cost-
effective diagnostic approaches to evaluating women with
suspected ischemic heart disease.
``(5) Clinical research for the development and evaluation
of new treatments for women, including rehabilitation.
``(6) Studies to gain a better understanding of methods of
preventing cardiovascular diseases in women, including
applications of effective methods for the control of blood
pressure, lipids, and obesity.
``(7) Information and education programs for patients and
health care providers on risk factors associated with heart
attack, stroke, and other cardiovascular diseases in women, and
on the importance of the prevention or control of such risk
factors and timely referral with appropriate diagnosis and
treatment. Such programs shall include information and
education on health-related behaviors that can improve such
important risk factors as smoking, obesity, high blood
cholesterol, and lack of exercise.
``(d) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $140,000,000
for fiscal year 1997, and such sums as may be necessary for each of the
fiscal years 1998 and 1999. The authorization of appropriations
established in the preceding sentence is in addition to any other
authorization of appropriation that is available for such purpose.''.
Subtitle E--Osteoporosis and Related Bone Diseases Research Act of 1996
SEC. 1251. SHORT TITLE.
This subtitle may be cited as the ``Osteoporosis and Related Bone
Diseases Research Act of 1996''.
SEC. 1252. 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) osteoporosis is a threat to an estimated 25,000,000
Americans, 80 percent of whom are women, many of whose cases go
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, hyperparathyroidism, and other related
metabolic bone diseases;
(4) osteoporosis is responsible for 1,500,000 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) 1 of every 2 women and 1 of every 8 men over age 50
will develop fractures associated with osteoporosis;
(6) direct medical costs of osteoporosis are estimated to
be $10,000,000,000 annually 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
diseases is severely constrained at key research institutes,
including the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, the National Institute on
Aging, the National Institute of Diabetes and Digestive and
Kidney Diseases, the National Institute of Dental Research, and
the National Institute of Child Health and Human Development;
(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),
risk factors related to genes that help to control
skeletal metabolism, and risk factors relating to the
relationship of aging processes to the development of
osteoporosis;
(C) bone mass measurement technology, including
more widespread and cost-effective techniques for
making more precise measurements and for interpreting
measurements;
(D) calcium (including bioavailability, intake
requirements, and the role of calcium in building
heavier and denser skeletons), and vitamin D and its
role as an essential vitamin in adults;
(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. 1253. 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 by adding at the end the following
new section:
``SEC. 442A. RESEARCH ON OSTEOPOROSIS AND RELATED DISEASES.
``(a) Expansion of Research.--The Director of the Institute, the
Director of the National Institute on Aging, the Director of the
National Institute of Diabetes and Digestive and Kidney Diseases, the
Director of the National Institute of Dental Research, and the Director
of the National Institute of Child Health and Human Development shall
expand and intensify research on osteoporosis and related bone
diseases. The research shall be in addition to research that is
authorized under any other provision of law.
``(b) Mechanisms for Expansion of Research.--Each of the Directors
specified in subsection (a) shall, in carrying out such subsection,
provide for one or more of the following:
``(1) Investigator-initiated research.
``(2) Funding for investigators beginning their research
careers.
``(3) Mentorship research grants.
``(4) Specialized centers.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $30,000,000 for the National
Institute of Arthritis and Musculoskeletal and Skin Diseases,
$6,500,000 for the National Institute on Aging, $6,500,000 for the
National Institute of Diabetes and Digestive and Kidney Diseases,
$4,000,000 for the National Institute of Dental Research, and
$3,000,000 for the National Institute of Child Health and Human
Development for each of the fiscal years 1997 through 1999, 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 diseases under any
other provision of law.
``(d) Related Bone Diseases Defined.--As used in this section, the
term `related bone diseases' includes--
``(1) Paget's disease, a bone disease characterized by
enlargement and loss of density with bowing and deformity of
the bones;
``(2) osteogenesis imperfecta, a familial disease marked by
extreme brittleness of the long bones;
``(3) 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;
``(4) hypoparathyroidism, a condition characterized by the
absence of parathormone resulting in disturbances of calcium
metabolism;
``(5) renal bone disease, a disease characterized by
metabolic disturbances from dialysis, renal transplants, or
other renal disturbances;
``(6) primary or postmenopausal osteoporosis and secondary
osteoporosis, such as that induced by corticosteroids; and
``(7) other general diseases of bone and mineral metabolism
including abnormalities of vitamin D.''.
Subtitle F--Lupus Research Amendments of 1996
SEC. 1291. SHORT TITLE.
This subtitle may be cited as the ``Lupus Research Amendments of
1996''.
SEC. 1292. 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. 1293. 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 conducting and
supporting the following:
``(1) Research to determine the reasons underlying the
elevated prevalence of lupus in women, including African-
American women.
``(2) Basic research concerning the etiology and causes of
the disease.
``(3) 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.
``(4) The development of improved screening techniques.
``(5) Clinical research for the development and evaluation
of new treatments, including new biological agents.
``(6) 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 1997, and such sums as may be necessary for each of the
fiscal years 1998 and 1999. 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 G--Ovarian Cancer Research and Information Amendments of 1996
SEC. 1301. SHORT TITLE.
This subtitle may be cited as the ``Ovarian Cancer Research and
Information Amendments of 1996''.
SEC. 1302. FUNDING FOR RESEARCH ON OVARIAN CANCER.
Section 417B(b)(2) of the Public Health Service Act 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 1997, and such sums as may be necessary for each
of the fiscal years 1998 and 1999. 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. 1303. PUBLIC INFORMATION AND EDUCATION ON OVARIAN CANCER.
Section 417(d)(4) of the Public Health Service Act 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 H--HPV Infection and Cervical Cancer Research Resolution of
1996
SEC. 1351. SHORT TITLE.
This subtitle may be cited as the ``HPV Infection and Cervical
Cancer Research Resolution of 1996''.
SEC. 1352. SENSE OF CONGRESS.
It is the sense of the Congress that in conducting research
relating to the prevention and detection of cervical cancer, the
Director of the National Cancer Institute and the Director of the
National Institute of Allergy and Infectious Diseases should
collaborate in sponsoring basic and clinical research on human
papillomavirus diagnosis and prevention as a risk of cervical cancer,
and as applicable, develop screening techniques accordingly.
Subtitle I--Office for Rare Disease Research Act of 1996
SEC. 1391. SHORT TITLE.
This subtitle may be cited as the ``Office for Rare Disease
Research Act of 1996''.
SEC. 1392. ESTABLISHMENT OF OFFICE FOR RARE DISEASE RESEARCH.
Part A of title IV of the Public Health Service Act (42 U.S.C. 281
et seq.) is amended by adding at the end thereof the following new
section:
``SEC. 404F. OFFICE FOR RARE DISEASE RESEARCH.
``(a) Establishment.--There is established within the Office of the
Director of the National Institutes of Health an office to be known as
the Office for Rare Disease Research (in this section referred to as
the `Office'). The Office shall be headed by a director, who shall be
appointed by the Director of the National Institutes of Health.
``(b) Purpose.--The purpose of the Office is to promote and
coordinate the conduct of research on rare diseases through a strategic
research plan and to establish and manage a rare disease research
clinical database.
``(c) Advisory Council.--The Secretary shall establish an advisory
council for the purpose of providing advice to the director of the
Office concerning carrying out the strategic research plan and other
duties under this section. Section 222 shall apply to such council to
the same extent and in the same manner as such section applies to
committees or councils established under such section.
``(d) Duties.--In carrying out subsection (b), the director of the
Office shall--
``(1) develop a comprehensive plan for the conduct and
support of research on rare diseases;
``(2) coordinate and disseminate information among the
institutes and the public on rare diseases;
``(3) support research training and encourage the
participation of a diversity of individuals in the conduct of
rare disease research;
``(4) identify projects or research on rare diseases that
should be conducted or supported by the National Institutes of
Health;
``(5) develop and maintain a central database on current
government sponsored clinical research projects for rare
diseases;
``(6) determine the need for registries of research
subjects and epidemiological studies of rare disease
populations; and
``(7) prepare biennial reports on the activities carried
out or to be carried out by the Office and submit such reports
to the Secretary and the Congress.''.
Subtitle J--Federal Risk Assessment in Women's Health Act of 1996
SEC. 1401. SHORT TITLE.
This subtitle may be cited as the ``Federal Risk Assessment in
Women's Health Act of 1996''.
SEC. 1402. 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 Women's Health of the Public Health
Service and 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. 1403. 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 Women's Health of the Public Health
Service and 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 K--Women's Health Environmental Factors Act of 1996
SEC. 1451. SHORT TITLE.
This subtitle may be cited as the ``Women's Health Environmental
Factors Act of 1996''.
SEC. 1452. REPORT ON EFFECT OF ENVIRONMENTAL FACTORS ON WOMEN'S HEALTH.
(a) In General.--The Secretary of Health and Human Services, acting
through the Director of the National Institute of Environmental Health
Sciences, shall submit to the Congress a report in accordance with the
following:
(1) The report shall summarize the body of scientific
knowledge on the effects that environmental factors have on
women's health. The report shall include descriptions of the
known effects of environmental factors on breast cancer, on
immune dysfunction, and on compounds that mimic human estrogen.
(2) The report shall specify an agenda for the conduct and
support of research by such Director on the effects that
environmental factors have on women's health. The agenda shall
specify the categories of research that should receive
priority. In the development of the agenda, the summary
prepared under paragraph (1) shall be considered, including
consideration of areas of research identified by the summary as
having received insufficient study.
(b) Date for Submission of Report.--The report under subsection (a)
shall be submitted to the Congress not later than one year after the
date of the enactment of this Act.
Subtitle L--Consumer Involvement in Breast Cancer Research Act
SEC. 1491. SHORT TITLE.
This subtitle may be cited as the ``Consumer Involvement in Breast
Cancer Research Act''.
SEC. 1492. INCREASED INVOLVEMENT OF ADVOCATES IN DECISION MAKING
REGARDING RESEARCH ON BREAST CANCER.
Section 417(c) of the Public Health Service Act (42 U.S.C. 285a-
6(c)) is amended by adding at the end the following paragraph:
``(3) Involvement of advocates in decision making.--
``(A) The Director of the Institute shall, to the
extent practicable, provide for the increased
involvement (relative to fiscal year 1996) of advocates
in decision making at the Institute regarding research
on breast cancer.
``(B) For purposes of this paragraph, the term
`advocate' means an individual who is accountable to,
represents, and reports back to organizations that
represent those affected by breast cancer.
``(C) The Director of the Institute shall prepare a
report on the manner in which subparagraph (A) has been
carried out. The report shall be included in the first
report under section 407 that the Director submits
after the expiration of the one-year period beginning
on the date of the enactment of the Consumer
Involvement in Breast Cancer Research Act.''.
Subtitle M--Women and Alcohol Research Equity Act of 1996
SEC. 1501. SHORT TITLE.
This subtitle may be cited as the ``Women and Alcohol Research
Equity Act of 1996''.
SEC. 1502. FINDINGS.
The Congress finds as follows with respect to the United States:
(1) One of every 4 alcoholics receiving treatment is a
woman.
(2) In fiscal year 1995, the National Institute on Alcohol
Abuse and Alcoholism had a total research budget of
$191,186,000, and $43,997,080 of the budget (approximately 23
percent) was available for research on alcohol abuse and
alcoholism among women. There are selected areas where alcohol
contributes to a more rapid and severe development of disease
in women than in men, and research on women exclusively in
these areas is important.
(3) According to data collected during the years 1980
through 1993 (in the survey known as the National Drug and
Alcoholism Treatment Unit Survey), women represent
approximately 30 percent of the clients presenting for alcohol
problems in traditional public treatment facilities. A recent
study has shown that women are more likely than men to use
nontraditional health care systems for alcohol-related
problems. No data exists to count women in nontraditional
treatment settings; therefore, it is not possible to know
whether women are overrepresented or underrepresented in all
treatment settings in proportion to their numbers (30 percent).
(4) Alcohol use by pregnant women is the leading known
cause of mental retardation in newborns. Fetal alcohol syndrome
(FAS), 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, depending upon the
national birth-rate. The incidence of less severe fetal alcohol
effects (FAE) is at least 3 times that of fetal alcohol
syndrome. For Black Americans, the risk of FAS remains about
sevenfold higher than for whites, even after adjustment for the
frequency of maternal alcohol intake, occurrence of chronic
alcohol problems, and parity. Among Native Americans, the
incidence of FAS varies among different cultures; some are
similar to the overall U.S. population, while a much higher
prevalence is reported for others. Research is also needed on
the male contribution to birth abnormalities related to
alcohol.
(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. Proportionately more
alcoholic women die of cirrhosis of the liver than do alcoholic
men. Additionally, the combined effects of estrogen and alcohol
may impact not only liver damage but osteoporosis as well.
(7) The interval between onset of drinking-related problems
and entry into treatment appears to be shorter for women than
for men. Further, studies of women alcoholics in treatment
suggest that they often experience greater physiological
impairment earlier in their drinking careers, despite having
consumed less alcohol than men. These findings suggest that the
development of consequences associated with heavy drinking may
be accelerated or ``telescoped'' in women.
(8) Women become intoxicated faster than men. This may be
due to a different enzyme and hormonal activity in women than
in men.
(9) Chronic, heavy drinking contributes to menstrual
disorders, fertility problems, and premature menopause.
(10) 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.
(11) The National Institute on Alcohol Abuse and Alcoholism
has identified areas for future research on alcohol abuse and
alcoholism among women. As a result of stimulating research
applications during the years 1993 through 1995, such
Institute's portfolio on women and children has increased by
$17,997,000, or more than 69 percent, over the fiscal year 1992
base of $26,000,000.
SEC. 1503. PROVISIONS REGARDING INCREASE IN AMOUNT OF FUNDS EXPENDED
FOR RESEARCH ON ALCOHOL ABUSE AND ALCOHOLISM AMONG WOMEN.
Section 464H(d) of the Public Health Service Act (42 U.S.C.
285n(d)) is amended by adding at the end the following paragraph:
``(3) Women's health.--
``(A) For fiscal year 1997, of the first
$191,186,000 appropriated under paragraph (1), the
Director of the Institute shall obligate not less than
$43,997,080 for the purpose of carrying out under this
subpart projects of research on alcohol abuse and
alcoholism among women.
``(B) In addition to the authorization of
appropriations established in paragraph (1), there are
authorized to be appropriated for carrying out the
purpose specified in subparagraph (A) $25,000,000 for
fiscal year 1997, and such sums as may be necessary for
each of the fiscal years 1998 and 1999.''.
TITLE II--SERVICES
Subtitle A--Women's Health Office Act of 1996
SEC. 2101. SHORT TITLE.
This subtitle may be cited as the ``Women's Health Office Act of
1996''.
SEC. 2102. PUBLIC HEALTH SERVICE OFFICE ON WOMEN'S HEALTH.
Title XVII of the Public Health Service Act (42 U.S.C. 300u et
seq.) is amended by adding at the end the following section:
``office on women's health
``Sec. 1710. (a) Establishment of Office.--There is established an
Office on 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 women's health conditions--
``(1) advise the Assistant Secretary for Health concerning
scientific, legal, ethical, and policy issues relating to
women's health;
``(2) 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;
``(3) enter into interagency agreements with other agencies
of the Service to increase the participation of women in health
service and promotion programs;
``(4) support research, demonstrations and evaluations to
test new and innovative models, to increase knowledge and
understanding of health risk factors, to develop mechanisms
that support better information dissemination, education,
prevention, and service delivery for women, and to support
initiatives for the promotion of women with respect to careers
in the health professions and research;
``(5) monitor Public Health Service agency and regional
activities regarding women's health, and coordinate activities
of such agency Offices of Women's Health;
``(6) 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
``(7) coordinate efforts to promote women's health programs
and policies in the voluntary and corporate sectors.
``(d) Coordinating Committee.--The Secretary shall provide for the
operation of a committee composed of the heads of the agencies of the
Public Health Service (or the designees of the agency heads), which
committee shall be chaired by the Deputy Assistant Secretary for
Women's Health. With respect to women's health conditions, such
committee shall assist the Deputy Assistant Secretary in identifying
the needs for programs regarding the conditions, and in making an
estimate each fiscal year of the funds needed to adequately support the
programs; identifying needs regarding the coordination of programs; and
encouraging the agencies of the Public Health Service to conduct and
support programs.
``(e) Advisory Committee.--The Secretary shall provide for the
operation of an advisory committee regarding the duties of the Office.
Such committee shall be composed of 15 voting members, appointed from
among individuals who have expertise in women's health and who are not
officers or employees of the Federal Government, and the term of office
for such members shall be four years. The membership of the committee
shall include as nonvoting members each of the individuals serving as
nonvoting members of the Coordinating Committee under subsection (d),
and shall include such other Federal officials or employees as the
Secretary determines to be appropriate. The committee shall be chaired
by the Deputy Assistant Secretary for Women's Health, and shall meet at
the call of the Chair, but not less than once each fiscal year.
``(f) Reports.--Not later than January 31, 1997, 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.
``(g) Definition.--For purposes of 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.
``(h) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $6,000,000
for fiscal year 1997, and such sums as may be necessary for each of the
fiscal years 1998 and 1999.''.
SEC. 2103. CENTERS FOR DISEASE CONTROL AND PREVENTION OFFICE OF WOMEN'S
HEALTH.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317F the following
section:
``centers for disease control and prevention office of women's health
``Sec. 317G. (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 on Women's Health established
under section 1710.
``(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, 1997, 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. 2104. 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 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 on Women's Health established
under section 1710.
``(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, 1997, 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. 2105. HEALTH RESOURCES AND SERVICES ADMINISTRATION OFFICE OF
WOMEN'S HEALTH.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended--
(1) by redesignating section 340D as section 340E; and
(2) by inserting before section 340E (as so redesignated)
the following:
``Subpart IX--Miscellaneous Provisions
``office of women's health
``Sec. 340D. (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 on Women's Health established
under section 1710.
``(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, 1997, 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. 2106. 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 the following 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 on Women's Health
established under section 1710 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, 1997, 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 B--Genetic Information Nondiscrimination in Health Insurance
Act of 1996
SEC. 2151. SHORT TITLE.
This subtitle may be cited as the ``Genetic Information
Nondiscrimination in Health Insurance Act of 1996''.
SEC. 2152. PROHIBITION OF HEALTH INSURANCE DISCRIMINATION ON THE BASIS
OF GENETIC INFORMATION.
(a) In General.--An insurance provider may not deny or cancel
health insurance coverage, or vary the premiums, terms, or conditions
for health insurance coverage, for an individual or a family member of
an individual--
(1) on the basis of genetic information; or
(2) on the basis that the individual or family member of an
individual has requested or received genetic services.
(b) Limitation on Collection and Disclosure of Information.--
(1) In general.--An insurance provider may not request or
require an individual to whom the provider provides health
insurance coverage, or an individual who desires the provider
to provide health insurance coverage, to disclose to the
provider genetic information about the individual or family
member of the individual.
(2) Requirement of prior authorization.--An insurance
provider may not disclose genetic information about an
individual without the prior written authorization of the
individual or legal representative of the individual. Such
authorization is required for each disclosure and shall include
an identification of the person to whom the disclosure would be
made.
(c) Enforcement.--
(1) Plans other than employee health benefit plans.--The
requirements established under subsections (a) and (b) shall be
enforced by the State insurance commissioner for the State
involved or the official or officials designated by the State,
except that in no case shall a State enforce such requirements
as they relate to employee health benefit plans.
(2) Employee health benefit plans.--With respect to
employee health benefit plans, the Secretary shall enforce the
requirements established under subsections (a) and (b) in the
same manner as provided for under sections 502, 504, 506, and
510 of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1132, 1134, 1136, and 1140).
(3) Private right of action.--A person may bring a civil
action--
(A) to enjoin any act or practice which violates
subsection (a) or (b),
(B) to obtain other appropriate equitable relief
(i) to redress such violations, or (ii) to enforce any
such subsections, or
(C) to obtain other legal relief, including
monetary damages.
(4) Jurisdiction.--State courts of competent jurisdiction
and district courts of the United States have concurrent
jurisdiction of actions under this subsection. The district
courts of the United States shall have jurisdiction, without
respect to the amount in controversy or the citizenship of the
parties, to grant the relief provided for in paragraph (3) in
any action.
(5) Venue.--For purposes of this subsection the venue
provisions of section 1391 of title 28, United States Code,
shall apply.
(6) Regulations.--The Secretary may promulgate such
regulations as may be necessary or appropriate to carry out
this section.
(d) Applicability.--
(1) Preemption of state law.--A State may establish or
enforce requirements for insurance providers or health
insurance coverage with respect to the subject matter of this
section, but only if such requirements are more restrictive
than the requirements established under subsections (a) and
(b).
(2) Rule of construction.--Nothing in this section shall be
construed to affect or modify the provisions of section 514 of
the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1144).
(3) Continuation.--Nothing in this section shall be
construed as requiring a group health plan or an employee
health benefit plan to provide benefits to a particular
participant or beneficiary.
(e) Definitions.--For purposes of this subtitle:
(1) Employee health benefit plan.--The term ``employee
health benefit plan'' means any employee welfare benefit plan,
governmental plan, or church plan (as defined under paragraphs
(1), (32), and (33) of section 3 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1002)) that provides or
pays for health insurance coverage (such as provider and
hospital benefits) whether--
(A) directly;
(B) through a group health plan; or
(C) otherwise.
(2) Family member.--The term ``family member'' means, with
respect to an individual, another individual related by blood
to that individual.
(3) Genetic information.--The term ``genetic information''
means information about genes, gene products, or inherited
characteristics.
(4) Genetic services.--The term ``genetic services'' means
health services to obtain, assess, and interpret genetic
information for diagnostic and therapeutic purposes, and for
genetic education and counselling.
(5) Group health plan.--The term ``group health plan'' has
the meaning given such term in section 607 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1167), and
includes a multiple employer welfare arrangement (as defined in
section 3(40) of such Act) that provides health insurance
coverage.
(6) Health insurance coverage.--The term ``health insurance
coverage'' means a contractual arrangement for the provision of
a payment for health care, including--
(A) a group health plan; and
(B) any other health insurance arrangement,
including any arrangement consisting of a hospital or
medical expense incurred policy or certificate,
hospital or medical service plan contract, or health
maintenance organization subscriber contract.
(7) Individual health plan.--The term ``individual health
plan'' means any health insurance coverage offered to
individuals that is not a group health plan.
(8) Insurance provider.--The term ``insurance provider''
means an insurer or other entity providing health insurance
coverage.
(9) Person.--The term ``person'' includes corporations,
companies, associations, firms, partnerships, societies, and
joint stock companies, as well as individuals.
(10) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(11) State.--The term ``State'' means any of the 50 States,
the District of Columbia, Puerto Rico, the Northern Mariana
Islands, the Virgin Islands, American Samoa, and Guam.
(f) Technical Amendment.--Section 508 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1138) is amended by inserting
``and under the Genetic Insurance Nondiscrimination in Health Insurance
Act of 1995'' before the period.
(g) Effective Date.--This section shall apply to health insurance
coverage offered or renewed on or after the end of the 90-day period
beginning on the date of the enactment of this Act.
Subtitle C--Improved Patient Access to Clinical Studies Act of 1996
SEC. 2191. SHORT TITLE.
This subtitle may be cited as the ``Improved Patient Access to
Clinical Studies Act of 1996''.
SEC. 2192. COVERAGE FOR INDIVIDUALS PARTICIPATING IN APPROVED CLINICAL
STUDIES.
(a) Permitting Participation in Approved Clinical Studies.--A
health plan may not deny (or limit or impose additional conditions on)
coverage of items and services furnished to an enrollee if--
(1) the enrollee is participating in an approved clinical
study,
(2) the items and services are furnished according to the
design of the study or to treat conditions resulting from
participation in the study, and
(3) the items and services would otherwise be covered under
the plan except for the fact that they are provided in
connection with participation in such a study.
A health plan may not discriminate against an enrollee on the basis of
the enrollee's participation in such a study.
(b) Construction.--Nothing in subsection (a) shall be construed as
requiring a health plan to provide for payment for items and services
normally paid for as part of an approved clinical study.
(c) Approved Clinical Study Defined.--In this section, the term
``approved clinical study'' means--
(1) a research study approved by the Secretary of Health
and Human Services, the Director of the National Institutes of
Health, the Commissioner of the Food and Drug Administration,
the Secretary of Veterans Affairs, the Secretary of Defense, or
a qualified nongovernmental research entity (as defined in
guidelines of the National Institute of Health), or
(2) a peer-reviewed and approved research program, as
defined by the Secretary of Health and Human Services,
conducted for the primary purpose of determining whether or not
a treatment is safe, efficacious, or having any other
characteristic of a treatment which must be demonstrated in
order for the treatment to be medically necessary or
appropriate.
Subtitle D--Equitable Health Care for Neurobiological Disorders Act of
1996
SEC. 2201. SHORT TITLE.
This subtitle may be cited as the ``Equitable Health Care for
Neurobiological Disorders Act of 1996''.
SEC. 2202. FINDINGS.
Congress finds that--
(1) there are sufficient neuroscientific data to document
that many severe ``mental'' illnesses are actually physical
illnesses known as neurobiological disorders that are
characterized by significant neuroanatomical and neurochemical
abnormalities;
(2) American families should have adequate health insurance
protection for the costs of treating neurobiological disorders
that is commensurate with the protections provided for other
illnesses;
(3) currently, many public and private health insurance
programs discriminate against persons with neurobiological
disorders by providing more restrictive coverage for treatments
of those illnesses in comparison to coverage provided for
treatments of other medical problems;
(4) unequal health insurance coverage contributes to the
destructive and unfair stigmatization of persons with
neurobiological disorders that are as beyond the control of the
individuals as are cancer, diabetes, and other serious physical
health problems;
(5) about 95 percent of what is known about both normal and
abnormal structure and function of the brain has been learned
in the last 10 years, but millions of severely mentally ill
people have yet to benefit from these startling research
advances in clinical and basic neuroscience; and
(6) according to the National Institutes of Mental Health,
equitable insurance coverage for severe mental disorders will
yield $2.2 billion annually in net savings through decreased
use of general medical services and a substantial decrease in
social costs.
SEC. 2203. STANDARDS FOR NONDISCRIMINATORY TREATMENT OF NEUROBIOLOGICAL
DISORDERS FOR EMPLOYER HEALTH BENEFIT PLANS.
(a) In General.--The standards for the nondiscriminatory and
equitable treatment by employer health benefit plans of individuals
with neurobiological disorders are requirements that such plans (and
carriers offering such plans) provide for coverage of services that are
essential to the effective treatment of neurobiological disorders in a
manner that--
(1) is not more restrictive than coverage provided for
other major physical illnesses;
(2) provides adequate financial protection to the person
requiring the medical treatment for a neurobiological disorder;
and
(3) is consistent with effective and common methods of
controlling health care costs for other major physical
illnesses.
(b) Plan Deemed to Meet Standards.--An employer health benefit plan
shall be deemed to meet the standards described in subsection (a) if
the plan provides for the following:
(1) Stop-loss protection for catastrophic expenses.
(2) Coverage of facility-based care.
(3) Coverage of outpatient medical management on a par with
other medical procedures to encourage the use of cost-effective
ambulatory treatment, including treatment in non-traditional
settings.
(4) Coverage of visits for psychological supportive,
therapeutic, and rehabilitative services, with coinsurance and
fees set to ensure effective cost control of high demand
services.
(5) Coverage of prescription drugs essential to the cost
effective treatment of neurobiological disorders.
(6) Coverage of medically necessary services for
comorbidity of other disorders.
SEC. 2204. ENFORCEMENT THROUGH EXCISE TAX.
(a) In General.--Chapter 43 of the Internal Revenue Code of 1986
(relating to qualified pension, etc., plans) is amended by adding at
the end thereof the following new section:
``SEC. 4980C. FAILURE TO COMPLY WITH EMPLOYER HEALTH BENEFIT PLAN
STANDARDS FOR NONDISCRIMINATORY TREATMENT FOR
NEUROBIOLOGICAL DISORDERS.
``(a) Imposition of Tax.--There is hereby imposed a tax on the
failure of a carrier or an employer health benefit plan to comply with
the standards relating to the nondiscriminatory treatment of
neurobiological disorders under section 3 of the Equitable Health Care
for Neurobiological Disorders Act of 1996.
``(b) Amount of Tax.--
``(1) In general.--Subject to paragraph (2), the tax
imposed by subsection (a) shall be an amount not to exceed 25
percent of the amounts received by the carrier or under the
plan for coverage during the period such failure persists.
``(2) Limitation in case of individual failures.--In the
case of a failure that only relates to specified individuals or
employers (and not to the plan generally), the amount of the
tax imposed by subsection (a) shall not exceed the aggregate of
$100 for each day during which such failure persists for each
individual to which such failure relates. A rule similar to the
rule of section 4980B(b)(3) shall apply for purposes of this
section.
``(c) Liability for Tax.--The tax imposed by this section shall be
paid by the carrier.
``(d) Exceptions.--
``(1) Corrections within 30 days.--No tax shall be imposed
by subsection (a) by reason of any failure if--
``(A) such failure was due to reasonable cause and
not to willful neglect, and
``(B) such failure is corrected within the 30-day
period beginning on earliest date the carrier knew, or
exercising reasonable diligence would have known, that
such failure existed.
``(2) Waiver by secretary.--In the case of a failure which
is due to reasonable cause and not to willful neglect, the
Secretary may waive part or all of the tax imposed by
subsection (a) to the extent that payment of such tax would be
excessive relative to the failure involved.
``(e) Definitions.--For purposes of this section, the terms
`carrier' and `employer health benefit plan' have the respective
meanings given such terms in section 5 of the Equitable Health Care for
Neurobiological Disorders Act of 1996.''
(b) Clerical Amendment.--The table of sections for chapter 43 of
such Code is amended by adding at the end thereof the following new
item:
``Sec. 4980C. Failure to comply with
employer health benefit plan
standards for nondiscriminatory
treatment for neurobiological
disorders.''.
(c) Effective Date.--The amendments made by this subsection shall
apply to plan years beginning after December 31, 1996.
SEC. 2205. DEFINITIONS.
In this subtitle, the following definitions shall apply:
(1) Carrier.--The term ``carrier'' means any entity which
provides health insurance or health benefits in a State, and
includes a licensed insurance company, a prepaid hospital or
medical service plan, a health maintenance organization, the
plan sponsor of a multiple employer welfare arrangement or an
employee benefit plan (as defined under the Employee Retirement
Income Security Act of 1974), or any other entity providing a
plan of health insurance subject to State insurance regulation.
(2) Employer health benefit plan.--The term ``employer
health benefit plan'' means a health benefit plan (including an
employee welfare benefit plan, as defined in section 3(1) of
the Employee Retirement Income Security Act of 1974) which is
offered to employees through an employer and for which the
employer provides for any contribution to such plan or any
premium for such plan are deducted by the employer from
compensation to the employee.
(3) Health benefit plan.--The term ``health benefit plan''
means any hospital or medical expense incurred policy or
certificate, hospital or medical service plan contract, or
health maintenance subscriber contract, or a multiple employer
welfare arrangement or employee benefit plan (as defined under
the Employee Retirement Income Security Act of 1974) which
provides benefits with respect to health care services, but
does not include--
(A) coverage only for accident, dental, vision,
disability income, or long-term care insurance, or any
combination thereof,
(B) medicare supplemental health insurance,
(C) coverage issued as a supplement to liability
insurance,
(D) worker's compensation or similar insurance, or
(E) automobile medical-payment insurance,
or any combination thereof.
(4) Neurobiological disorder.--
(A) In general.--An individual with a
``neurobiological disorder'' is an individual diagnosed
with one or more of the following conditions:
(i) Affective disorders, including bipolar
disorder and major depressive disorder.
(ii) Anxiety disorders, including
obsessive-compulsive disorder and panic
disorder.
(iii) Attention deficit disorders.
(iv) Autism and other pervasive
developmental disorders.
(v) Psychotic disorders, including
schizophrenia spectrum disorders.
(vi) Tourette's disorder.
(B) Periodic review of definition.--
(i) In general.--Not later than 6 months
after the date of the enactment of this
subtitle, the Secretary of Health and Human
Services shall promulgate regulations directing
the National Institute of Mental Health to
conduct a biannual review of the definition of
neurobiological disorders under subparagraph
(A). In conducting such review, the National
Institute of Mental Health shall consult with
extramural researchers to review such
definition and make recommendations for
necessary revisions.
(ii) Review by advisory council required.--
The Secretary may not promulgate any regulation
modifying the definition of neurobiological
disorders under subsection (a) until the
recommendations of the National Institute of
Mental Health under clause (i) have been
reviewed by the National Advisory Mental Health
Council.
Subtitle E--Victims of Abuse Insurance Protection Act
SEC. 2251. SHORT TITLE.
This subtitle may be cited as the ``Victims of Abuse Insurance
Protection Act''.
SEC. 2252. DEFINITIONS.
As used in this subtitle:
(1) The term ``abuse'' means the occurrence of one or more
of the following acts between household or family (including
in-laws or extended family) members, spouses or former spouses,
or individuals engaged in or formerly engaged in a sexually
intimate relationship:
(A) Attempting to cause or intentionally,
knowingly, or recklessly causing another person bodily
injury, physical harm, substantial emotional distress,
psychological trauma, rape, sexual assault, or
involuntary sexual intercourse.
(B) Engaging in a course of conduct or repeatedly
committing acts toward another person, including
following the person without proper authority and under
circumstances that place the person in reasonable fear
of bodily injury or physical harm.
(C) Subjecting another person to false imprisonment
or kidnapping.
(D) Attempting to cause or intentionally,
knowingly, or recklessly causing damage to property so
as to intimidate or attempt to control the behavior of
another person.
(2) The term ``abuse-related medical condition'' means a
medical condition which arises in whole or in part out of an
action or pattern of abuse.
(3) The term ``abuse status'' means the fact or perception
that a person is, has been, or may be a subject of abuse,
irrespective of whether the person has sustained abuse-related
medical conditions or has incurred abuse-related claims.
(4) The term ``health benefit plan'' means any public or
private entity or program that provides for payments for health
care, including--
(A) a group health plan (as defined in section 607
of the Employee Retirement Income Security Act of 1974)
or a multiple employer welfare arrangement (as defined in section 3(40)
of such Act) that provides health benefits;
(B) any other health insurance arrangement,
including any arrangement consisting of a hospital or
medical expense incurred policy or certificate,
hospital or medical service plan contract, or health
maintenance organization subscriber contract;
(C) workers' compensation or similar insurance to
the extent that it relates to workers' compensation
medical benefits (as defined by the Federal Trade
Commission); and
(D) automobile medical insurance to the extent that
it relates to medical benefits (as defined by the
Federal Trade Commission).
(5) The term ``health carrier'' means a person that
contracts or offers to contract on a risk-assuming basis to
provide, deliver, arrange for, pay for or reimburse any of the
cost of health care services unless the person assuming the
risk is accepting the risk from a duly licensed health carrier.
(6) The term ``insured'' means a party named on a policy,
certificate, or health benefit plan as the person with legal
rights to the benefits provided by the policy, certificate, or
health benefit plan. For group insurance, such term includes a
person who is a beneficiary covered by a group policy,
certificate, or health benefit plan.
(7) The term ``insurer'' means any person, reciprocal
exchange, interinsurer, Lloyds insurer, fraternal benefit
society, or other legal entity engaged in the business of
insurance, including agents, brokers, adjusters, and third
party administrators. The term also includes health carriers,
health benefit plans, and life, disability, and property and
casualty insurers.
(8) The term ``policy'' means a contract of insurance,
certificate, indemnity, suretyship, or annuity issued, proposed
for issuance or intended for issuance by an insurer, including
endorsements or riders to an insurance policy or contract.
(9) The term ``subject of abuse'' means a person to whom an
act of abuse is directed, a person who has had prior or current
injuries, illnesses, or disorders that resulted from abuse, or
a person who seeks, may have sought, or should have sought
medical or psychological treatment for abuse, protection,
court-ordered protection, or shelter from abuse.
SEC. 2253. DISCRIMINATORY ACTS PROHIBITED.
(a) In General.--No insurer or health carrier may, directly or
indirectly, engage in any of the following acts or practices on the
basis that the applicant or insured, or any person employed by the
applicant or insured or with whom the applicant or insured is known to
have a relationship or association, is, has been, or may be the subject
of abuse:
(1) Denying, refusing to issue, renew or reissue, or
canceling or otherwise terminating an insurance policy or
health benefit plan.
(2) Restricting, excluding, or limiting insurance or health
benefit plan coverage for losses as a result of abuse or
denying a claim incurred by an insured as a result of abuse,
except as otherwise permitted or required by State laws
relating to life insurance beneficiaries.
(3) Adding a premium differential to any insurance policy
or health benefit plan.
(4) Terminating health coverage for a subject of abuse
because coverage was originally issued in the name of the
abuser and the abuser has divorced, separated from, or lost
custody of the subject of abuse or the abuser's coverage has
terminated voluntarily or involuntarily and the subject of
abuse does not qualify for extension of coverage under part 6
of subtitle B of title I or the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1161 et seq.) or 4980B of the
Internal Revenue Code of 1986. Nothing in this paragraph
prohibits the insurer from requiring the subject of abuse to
pay the full premium for the subject's coverage under the
health plan. The insurer may terminate group coverage after the
continuation coverage required by this paragraph has been in
force for 18 months if it offers conversion to an equivalent
individual plan. The continuation of health coverage required
by this paragraph shall be satisfied by any extension of
coverage under part 6 of subtitle B of title I or the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.)
or 4980B of the Internal Revenue Code of 1986 provided to a
subject of abuse and is not intended to be in addition to any
extension of coverage provided under part 6 of subtitle B of
title I or the Employee Retirement Income Security Act of 1974
(29 U.S.C. 1161 et seq.) or 4980B of the Internal Revenue Code
of 1986.
(b) Use of Information.--
(1) In general.--No insurer may use, disclose, or transfer
information relating to an applicant's or insured's abuse
status or abuse-related medical condition or the applicant's or
insured's status as a family member, employer or associate, person in a
relationship with a subject of abuse for any purpose unrelated to the
direct provision of health care services unless such use, disclosure,
or transfer is required by an order of an entity with authority to
regulate insurance or an order of a court of competent jurisdiction or
by abuse reporting laws. Nothing in this paragraph shall be construed
as limiting or precluding a subject of abuse from obtaining the
subject's own medical records from an insurer.
(2) Authority of subject of abuse.--A subject of abuse, at
the absolute discretion of the subject of abuse, may provide
evidence of abuse to an insurer for the limited purpose of
facilitating treatment of an abuse-related condition or
demonstrating that a condition is abuse-related. Nothing in
this paragraph shall be construed as authorizing an insurer or
health carrier to disregard such provided evidence.
SEC. 2254. REASONS FOR ADVERSE ACTIONS.
An insurer that takes any adverse action relating to any plan or
policy of a subject of abuse, shall advise the subject of abuse
applicant or insured of the specific reasons for the action in writing.
Reference to general underwriting practices or guidelines does not
constitute a specific reason.
SEC. 2255. LIFE INSURANCE.
Nothing in this subtitle shall be construed to prohibit a life
insurer from declining to issue a life insurance policy if the
applicant or prospective owner of the policy is or would be designated
as a beneficiary of the policy, and if--
(1) the applicant or prospective owner of the policy lacks
an insurable interest in the insured; or
(2) the applicant or prospective owner of the policy is
known, on the basis of police or court records, to have
committed an act of abuse.
SEC. 2256. SUBROGATION WITHOUT CONSENT PROHIBITED.
Except where the subject of abuse has already recovered damages,
subrogation of claims resulting from abuse is prohibited with the
informed consent of the subject of abuse.
SEC. 2257. ENFORCEMENT.
(a) Federal Trade Commission.--The Federal Trade Commission shall
have the power to examine and investigate any insurer to determine
whether such insurer has been or is engaged in any act or practice
prohibited by this subtitle. If the Federal Trade Commission determines
an insurer has been or is engaged in any act or practice prohibited by
this subtitle, the Commission may take action against such insurer by
the issuance of a cease and desist order as if the insurer was in
violation of section 5 of the Federal Trade Commission Act. Such cease
and desist order may include any individual relief warranted under the
circumstances, including temporary, preliminary, and permanent
injunctive and compensatory relief.
(b) Private Cause of Action.--An applicant or insured claiming to
be adversely affected by an act or practice of an insurer in violation
of this subtitle may maintain an action against the insurer in a
Federal or State court of original jurisdiction. Upon proof of such
conduct by a preponderance of the evidence, the court may award
appropriate relief, including temporary, preliminary, and permanent
injunctive relief and compensatory and punitive damages, as well as the
costs of suit and reasonable fees for the aggrieved individual's
attorneys and expert witnesses. With respect to compensatory damages,
the aggrieved individual may elect, at any time prior to the rendering
of final judgment, to recover in lieu of actual damages, an award of
statutory damages in the amount of $5,000 for each violation.
Subtitle F--Insurance Protection for Victims of Domestic Violence Act
SEC. 2291. SHORT TITLE.
This subtitle may be cited as the ``Insurance Protection for
Victims of Domestic Violence Act''.
SEC. 2292. PROHIBITION OF HEALTH INSURANCE DISCRIMINATION WITH RESPECT
TO VICTIMS OF DOMESTIC VIOLENCE.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following new title:
``TITLE XXVII--PROHIBITION OF HEALTH INSURANCE DISCRIMINATION WITH
RESPECT TO VICTIMS OF DOMESTIC VIOLENCE
``SEC. 2701. LIMITATIONS ON UNDERWRITING.
``No insurer may engage in a practice that has the effect of
denying, canceling, or not renewing health insurance coverage or health
benefits, or establishing, increasing, or varying the premium charged
for the coverage or benefits or excluding health coverage with respect
to health care items or services related to treatment of a condition--
``(1) to an individual on the basis that the individual or
family member is, has been, or may be the subject of abuse, has
had prior injuries that resulted from abuse, or seeks, has
sought, or should have sought medical or psychological
treatment for protection against abuse, or shelter from abuse;
or
``(2) to or for a group or employer on the basis that the
group includes or the employer employs, or provides or
subsidizes insurance for, an individual described in paragraph
(1).
``SEC. 2702. ESTABLISHMENT OF STANDARDS.
``(a) Role of National Association of Insurance Commissioners.--
``(1) In general.--The Secretary shall request the National
Association of Insurance Commissioners to develop, in
consultation with nonprofit domestic violence victim advocacy
organizations, within 9 months after the date of the enactment
of this title, model standards that incorporate the limitations
on underwriting set forth in section 2701, and provide
procedures for enforcement for such provisions, including a
private right of action.
``(2) Review of standards.--If the Association develops
recommended regulations specifying the standards within the
period, the Secretary shall review the standards. The review
shall be completed within 90 days after the date the regulations are
developed. Unless the Secretary determines within the period that such
standards do not meet the requirements, such standards shall serve as
the standards under this title, with such amendments as the Secretary
determines to be necessary.
``(b) Contingency.--If the Association does not develop the model
regulations within the 9 month period beginning on the date of the
enactment of this title, or the Secretary determines that the
regulations do not specify standards that meet the requirements
described in subsection (a), the Secretary shall specify, within 15
months after the date of the enactment of this title, standards to
carry out the requirements.
``(c) Application of Standards.--
``(1) In general.--Each State shall submit to the
Secretary, by the deadline specified in paragraph (2), a report
on actions the State is taking to implement and enforce the
standards established under this section with respect to
insurers and health insurance coverage offered or renewed not
later than such deadline.
``(2) Deadline for report.--Each State shall file the
report described in paragraph (1) not later than 1 year after
the date that standards are established under subsection (a)
or, in the event of the failure of the Association to develop
timely model regulations, under subsection (b).
``(d) Federal Role.--
``(1) Notice of deficiency.--If the Secretary determines
that a State has failed to submit a report by the deadline
specified by subsection (c), or finds that the State has not
implemented and provided adequate enforcement of the standards
established under subsection (a) or (b), the Secretary shall
notify the State and provide the State a period of 60 days in
which to submit the report.
``(2) Implementation of alternative enforcement
mechanism.--
``(A) In general.--If, after the 60-day period, the
Secretary finds that such a failure has not been
corrected, the Secretary shall within 30 days provide
for a mechanism for the implementation and enforcement
of such standards in the State as the Secretary
determines to be appropriate.
``(B) Civil penalty.--Under any implementation and
enforcement mechanism established by the Secretary
pursuant to this paragraph, the Secretary shall have
the authority to impose on an insurer a civil monetary
penalty in the amount of $10,000 for each day during
which such insurer violates the requirements described
in section 2701, or the standards developed under this
section. Liability for such penalty shall begin to
accrue on the 30th day after the Secretary has provided
such insurer with notice of its noncompliance, if the
insurer has failed to correct the deficiency by such
date.
``(C) Effective period.--Any such implementation
and enforcement mechanism established by the Secretary
shall take effect with respect to insurers, and health
insurance coverage offered or renewed, on or after 3
months after the date of the Secretary's finding under
paragraph (1), and until the date the Secretary finds
that such a failure has been corrected.
``(3) Federal civil right of action.--
``(A) In general.--Any individual aggrieved
as a result of conduct prohibited by section
2701 may bring a civil action in the
appropriate United States district court
against the insurer.
``(B) Relief.--Upon proof of such conduct
by a preponderance of the evidence, the insurer
shall be subject to a civil penalty that may
include temporary, preliminary, or permanent
injunctive relief and compensatory and punitive
damages, as well as the costs of suit and
reasonable fees for the aggrieved individual's
attorneys. With respect to compensatory
damages, the aggrieved individual may elect, at
any time prior to the rendering of final
judgment, to recover in lieu of actual damages,
an award of statutory damages in the amount of
$5,000 for each violation.
``SEC. 2703. APPLICATION TO GROUP HEALTH PLANS AND ENFORCEMENT.
``(a) Application.--Subject to subsection (b), the prohibitions in
section 2701 and the standards developed under section 2702 shall apply
to group health plans providing health coverage in the same manner as
they apply to insurers providing health insurance coverage. The penalty
described in section 2702(d)(2)(B) may be imposed by the Secretary of
Labor on group health plans that are not in compliance with the
requirements of sections 2701 and 2702.
``(b) Substitution of Federal Officials.--For purposes of
subsection (a), any reference in section 2702 to--
``(1) a State or the Secretary of Health and Human Services
is deemed to be a reference to the Secretary of Labor; and
``(2) an insurer or health insurance coverage is deemed to
be a reference to a group health plan and health coverage,
respectively.
``(c) Enforcement.--For purposes of part 5 of subtitle B of title I
of the Employee Retirement Income Security Act of 1974 (29 U.S.C 1131
et seq.) the provisions of this title insofar as they relate to group
health plans shall be deemed to be provisions of title I of such Act
irrespective of exclusions under section 4(b) of such Act.
``(d) Regulatory Authority.--With respect to the regulatory
authority of the Secretary of Labor under this title pursuant to
subsection (c), section 505 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1135) shall apply.
``SEC. 2704. DEFINITIONS.
``For purposes of this title:
``(1) Association.--The term `Association' means the
National Association of Insurance Commissioners.
``(2) Insurer.--
``(A) In general.--The term `insurer' means a
health benefit plan or a health care provider that
conducts activities related to the protection of public
health.
``(B) Health benefit plan.--The term `health
benefit plan' means any public or private entity or
program that provides for payments for health care,
including--
``(i) a group health plan (as defined in
section 607 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1167)) or a
multiple employer welfare arrangement (as
defined in section 3(40) of such Act) that
provides health benefits; and
``(ii) any other health insurance
arrangement, including any arrangement
consisting of a hospital or medical expense
incurred policy or certificate, hospital or
medical service plan contract, or health
maintenance organization subscriber contract.
``(C) Health care provider.--The term `health care
provider' means a provider of services (as defined in
section 1861(u) of the Social Security Act (42 U.S.C.
1395u)), a physician, a supplier, or any other person
furnishing health care, including a Federal or State
program that provides directly for the provision of
health care to beneficiaries.
``(3) Victim of abuse.--The term `victim of abuse' means
the occurrence of one or more of the following acts between
family or household members, current or former sexual or
intimate partners, or persons sharing biological parenthood--
``(A) attempting to cause or intentionally,
knowingly, or recklessly causing bodily injury, rape,
or sexual abuse as such term is defined in section 2242
of title 18, United States Code.
``(B) placing, by physical menace, another
individual in reasonable fear of imminent serious
bodily injury;
``(C) infliction of false imprisonment; or
``(D) physically or sexually abusing minor
children.''.
Subtitle G--Domestic Violence Victims Insurance Protection Act of 1996
SEC. 2301. SHORT TITLE.
This subtitle may be cited as the ``Domestic Violence Victims
Insurance Protection Act of 1996''.
SEC. 2302. PROTECTION OF DOMESTIC VIOLENCE VICTIMS FROM HEALTH
INSURANCE DISCRIMINATION.
(a) In General.--An insurer may not deny or cancel health insurance
coverage for an individual solely on the basis that the individual is
or has been the subject of an act of domestic violence.
(b) Interpretation.-- Nothing in this section shall prevent an
insurer from underwriting, issuing, or renewing health insurance
coverage on the basis of the physical or mental history of an
individual so long as the insurer does not take into consideration
whether such individual's condition was caused by an act of domestic
violence.
(c) Standards.--
(1) In general.--The Secretary of Health and Human Services
shall request the National Association of Insurance
Commissioners to develop, within 9 months after the date of the
enactment of the Act, model regulations that specify standards
with respect to the requirements of this subtitle as applicable
to carriers and health insurance coverage.
(2) Review of standards.--If the National Association of
Insurance Commissioners develops recommended regulations
specifying such standards within such period, the Secretary
shall review the standards. Such review shall be completed
within 60 days after the date the regulations are developed.
Unless the Secretary determines within such period that the
standards do not meet the requirements, such standards shall
serve as the standards under this section, with such amendments
as the Secretary deems necessary.
(3) Application of standards.--Each State shall submit to
the Secretary a report on steps the State is taking to
implement and enforce the standards established under paragraph
(1) with respect to carriers and health insurance coverage
offered or renewed.
(d) Definitions.--For purposes of this section:
(1) Act of domestic violence.--The term ``act of domestic
violence'' means, with respect to an individual, the occurrence
of one or more acts of harassment, menacing, reckless
endangerment, kidnapping, assault, attempted assault, or
attempted murder, in violation of Federal or State law, between
household or family members (including in-laws or extended family),
spouses or former spouses, or individuals engaged in or formerly
engaged in a sexually intimate relationship, where such an act has
resulted in actual physical or emotional injury, or has created a
substantial risk of physical or emotional harm to such individual or
such individual's child.
(2) Health insurance coverage.--
(A) In general.--Except as provided in subparagraph
(B), the term ``health insurance coverage'' means any
hospital or medical service policy or certificate,
hospital or medical service plan contract, or health
maintenance organization contract offered by an
insurer.
(B) Exception.--Such term does not include any of
the following:
(i) Coverage for accident only, dental
only, vision only, disability income, or long-
term care insurance.
(ii) Medical supplemental health insurance.
(iii) Coverage issued as a supplement to
liability insurance.
(iv) Liability insurance, including general
liability insurance and automobile liability
insurance.
(v) Worker's compensation or similar
insurance.
(vi) Automobile medical-payment insurance.
(vii) Coverage for a specified disease or
illness.
(3) Insurer.--The term ``insurer'' means an insurance
company, insurance service, or insurance organization licensed
to engage in the business of insurance in a State, and health
maintenance organization.
(4) State.--The term ``State'' means any State, the
District of Columbia, Puerto Rico, the Northern Mariana
Islands, the Virgin Islands, American Samoa, and Guam.
Subtitle H--Fairness to Minority Women Health Act
SEC. 2351. SHORT TITLE.
This subtitle may be cited as the ``Fairness to Minority Women
Health Act''.
SEC. 2352. EXCEPTION TO AFDC INCOME AND RESOURCES ATTRIBUTION RULE FOR
CERTAIN BATTERED ALIENS.
(a) In General.--Section 415(f) of the Social Security Act (42
U.S.C. 615(f)) is amended--
(1) in the matter preceding paragraph (1), by striking
``who is--'' and inserting ``who--'';
(2) in each of paragraphs (1) and (2), by inserting ``is''
before ``admitted'';
(3) in paragraph (3), by inserting ``is'' before
``paroled'';
(4) in paragraph (4)--
(A) by inserting ``is'' before ``granted''; and
(B) by striking ``or'' at the end;
(5) in paragraph (5)--
(A) by inserting ``is'' before ``a Cuban''; and
(B) by striking the period at the end and inserting
a semicolon; and
(6) by adding at the end the following:
``(6) is battered by, or is the subject of extreme cruelty
(including physical acts resulting in physical injury or a
threat of physical injury, sexual abuse, rape, or mental abuse)
perpetrated by, the spouse or other person who executed the
affidavit of support or similar agreement referred to in
subsection (a) with respect to the alien, but only after the
first day on which the battery or cruelty occurs after the
alien enters into the United States; or
``(7) is a dependent child, and a relative with whom the
child is living is battered by, or is the subject of extreme
cruelty (including physical acts resulting in physical injury
or a threat of physical injury, sexual abuse, rape, or mental
abuse) perpetrated by, the parent or other person who executed
the affidavit of support or similar agreement referred to in
subsection (a) with respect to the alien, but only after the
first day on which the battery or cruelty occurs after the
alien enters into the United States.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect 90 days after the date of the enactment of this Act.
SEC. 2353. AMENDMENT TO THE FOOD STAMP ACT OF 1977.
(a) In General.--Section 5(i) of the Food Stamp Act of 1977 (7
U.S.C. 2014(i)) is amended by adding at the end the following:
``(F) If an alien is battered by the alien's sponsor, or is the
subject of extreme cruelty perpetrated by the sponsor, after such alien
enters the United States, then after the date the battery or cruelty
occurs, this subsection (other than subparagraph (E) of paragraph (2))
shall not apply with respect to such alien and to any child of such
alien less than 18 years of age and residing with such alien.''.
(b) The amendment made by subsection (a) shall take effect 90 days
after the date of the enactment of this Act.
SEC. 2354. REQUIRING CERTAIN RECIPIENTS OF FEDERAL FINANCIAL ASSISTANCE
TO HAVE PERSONNEL AVAILABLE WHO SPEAK PREDOMINANT
LANGUAGE USED IN AREA.
(a) Providers of Obstetrical and Gynecological Services.--
(1) Medicaid.--Section 1903(i) of the Social Security Act
(42 U.S.C. 1396b(i)) is amended--
(A) by striking ``or'' at the end of paragraph
(14);
(B) by striking the period at the end of paragraph
(15) and inserting ``; or''; and
(C) by inserting after paragraph (15) the following
new paragraph:
``(16) with respect to any amount expended for obstetrical
or gynecological services furnished by or through a hospital,
clinic, or other institutional provider, unless the hospital,
clinic, or provider has available at least one individual who
is able to communicate in the predominant language used by residents of
the area in which the hospital, clinic, or provider is located (as
determined by the Secretary on the basis of information provided by the
Secretary of Commerce pursuant to the most recent decennial census).''.
(2) Family planning services.--Section 1001 of the Public
Health Service Act (42 U.S.C. 300) is amended--
(A) by redesignating subsections (c) and (d) as
subsections (d) and (e), respectively; and
(B) by inserting after subsection (b) the following
subsection:
``(c) The Secretary may make a grant under this section only if the
applicant involved agrees to ensure that, of the individuals providing
services under the grant, at least one will be an individual who is
able to communicate in the predominant language used by residents of
the area in which the family planning project involved is located (as
determined by the Secretary on the basis of information provided by the
Secretary of Commerce pursuant to the most recent decennial census).''.
(3) Effective date.--The amendments made by this subsection
shall apply to services furnished on or after October 1, 1996.
(b) Domestic Violence Shelters.--
(1) In general.--The Family Violence Prevention and
Services Act (42 U.S.C. 10401 et seq.) is amended by adding at
the end the following new section:
``SEC. 319. AVAILABILITY OF BILINGUAL SERVICES.
``No funds may be made available under this title for any provider
of shelter or related assistance unless the provider has available at
least one individual who is able to communicate in the predominant
language used by residents of the area in which the provider is located
(as determined by the Secretary on the basis of information provided by
the Secretary of Commerce pursuant to the most recent decennial
census).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to funds made available on or after October 1,
1996.
SEC. 2355. STUDY REGARDING DOMESTIC VIOLENCE AND LATINA WOMEN.
(a) In General.--With respect to cases of domestic violence in
which Latina women are the victims, the Secretary of Health and Human
Services, in consultation with the Attorney General of the United
States, shall conduct a study for the following purposes:
(1) To determine the incidence of such cases, and to
provide a comparison of such estimate with the relevant
incidence for other populations of women (utilizing existing
data regarding such other populations).
(2) To determine whether and to what extent the causes and
effects for such cases are different than for cases of domestic
violence in which other populations of women are the victims
(utilizing existing data regarding such other populations).
(b) Report.--Not later than 3 years after the date of the enactment
of this Act, the Secretary of Health and Human Services shall submit to
the Congress a report describing the findings made in the study under
subsection (a).
Subtitle I--Adolescent Health Demonstration Projects Act
SEC. 2391. SHORT TITLE.
This subtitle may be cited as the ``Adolescent Health Demonstration
Projects Act''.
SEC. 2392. 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 1997 through 2001 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. 2393. PROJECT REQUIREMENTS.
An adolescent health demonstration project established or supported
under section 2392 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. 2394. AREAS TO BE SERVED.
In making grants under section 2392, the Secretary shall give
priority to applications for projects which will serve areas with low-
income residents or minority populations.
SEC. 2395. ABORTION RESTRICTION.
None of the funds provided under a grant under section 2392 may be
used to perform or pay for abortions.
SEC. 2396. REPORT.
The Secretary shall, in each fiscal year, set aside not more than 5
percent of the amount appropriated for grants under section 2392 to
evaluate the operations of the projects for which grants were made
under such section. Not later than December 1, 2002, 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 2392 or the
establishment of a continuing service program.
Subtitle J--Eating Disorders Information and Education Act of 1996
SEC. 2401. SHORT TITLE.
This subtitle may be cited as the ``Eating Disorders Information
and Education Act of 1996''.
SEC. 2402. FINDINGS.
The Congress finds the following:
(1) Eating disorders include anorexia nervosa, bulimia
nervosa, and binge eating disorder, 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 7
percent of women may be experiencing eating disorders, and the
rate of new cases is increasing. As many as 80 percent of women
may during their lifetimes display symptoms of eating
disorders.
(5) There are effective treatments for some eating
disorders.
SEC. 2403. 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.) 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 1997, and such sums as may be necessary for each of the
fiscal years 1998 and 1999.''.
Subtitle K--Women's Choice and Reproductive Health Protection Act of
1996
SEC. 2451. SHORT TITLE.
This subtitle may be cited as the ``Women's Choice and Reproductive
Health Protection Act of 1996''.
SEC. 2452. FINDINGS.
The Congress finds that--
(1) reproductive rights are central to women's ability to
exercise full enjoyment of rights secured to them by Federal
and State law;
(2) abortion has been a legal and constitutionally
protected medical procedure throughout the United States since
1973 and has become part of mainstream medical practice as is
evidenced by the positions of medical institutions including
the American Medical Association, the American College of
Obstetricians and Gynecologists, and the American Medical
Women's Association;
(3) the availability of abortion services is diminishing
throughout the United States: 84 percent of counties have no
abortion provider and between 1982 and 1992 the number of
providers decreased in 45 States; and
(4) at a minimum, Congress must retain the following
policies, which currently preserve women's choice and
reproductive health:
(A) Funding for abortion services for victims of
rape and incest.
(B) Protection from clinic violence.
(C) The implementation of breast cancer, cervical
cancer and chlamydia screening programs in all 50
States.
(D) Full implementation of legislation to establish
contraceptive and infertility research programs.
(E) Authorization of family planning programs.
(F) The prohibition of a ``gag'' rule on
information pertaining to reproductive medical
services.
(G) The evaluation of RU-486.
(H) The fundamental right to choose, as stated by
the Supreme Court in Roe v. Wade.
(I) Fairness in insurance.
(J) The ability of military personnel overseas to
purchase abortion services at military facilities with
private funds.
SEC. 2453. SENSE OF CONGRESS WITH RESPECT TO CERTAIN REPRODUCTIVE
HEALTH ISSUES.
(a) Rape and Incest Victim Protection.--It is the sense of Congress
that the current provisions requiring funding of abortion services in
cases of life endangerment, rape or incest for women eligible for
medical assistance are essential to their health and well-being and
therefore Federal and State governments must provide funding in these
cases.
(b) Clinic Violence.--It is the sense of Congress that--
(1) Federal resources are necessary to ensure that women
have safe access to reproductive health facilities and that
health professionals can deliver services in a secure
environment free from violence and threats of force; and
(2) it is necessary and appropriate to use Federal
resources to combat the nationwide campaign of violence and
harassment against reproductive health centers.
(c) Preventive Health Measures Regarding Breast and Cervical
Cancer.--It is the sense of the Congress that the program of grants
under title XV of the Public Health Service Act should receive a level
of funding that is adequate for all States to receive grants under such
title.
(d) Programs Regarding Contraception and Infertility.--
(1) Research centers.--It is the sense of the Congress that
the program of research centers under section 452A of the
Public Health Service Act should receive a level of funding
that is adequate for a reasonable number of research centers to
be operated under the program.
(2) Loan repayment program regarding conduct of research.--
It is the sense of the Congress that the program of loan-
repayment contracts under section 487B of the Public Health
Service Act should receive a level of funding that is adequate
for a reasonable number of individuals to conduct research
under the program.
(3) Screenings for infertility-related sexually transmitted
diseases.--It is the sense of the Congress that the program of
grants under section 318A of the Public Health Service Act
should receive a level of funding that is adequate for
screenings under such section to be available in all States.
SEC. 2454. FAMILY PLANNING AMENDMENTS.
Section 1001(d) of the Public Health Service Act (42 U.S.C. 300(d))
is amended to read as follows:
``(d) For the purpose of grants and contracts under this section,
there are authorized to be appropriated $220,000,000 for fiscal year
1997, $250,000,000 for fiscal year 1998, and such sums as may be
necessary for each of the fiscal years 1999 through 2001.''.
SEC. 2455. FREEDOM OF FULL DISCLOSURE.
Title XI of the Civil Rights Act of 1964 is amended by adding at
the end the following:
``Sec. 1107. (a) Notwithstanding any other provision of law, no
governmental authority shall, in or through any program or activity
that provides health care services or information, administered or
assisted by such authority, limit the right of any person to provide,
or the right of any person to receive, nonfraudulent information about
the availability of reproductive health care services, including family
planning, prenatal care, adoption, and abortion services.
``(b) As used in this section the term `governmental authority'
means any authority of the United States.''.
SEC. 2456. FAIRNESS IN EVALUATION OF RU-486.
The Secretary of Health and Human Services shall--
(1) assure that the Food and Drug Administration evaluates
the drug called Mifepristone or RU-486 only on the basis
provided by law; and
(2) assess initiatives by which the Department of Health
and Human Services can promote the testing, licensing, and
manufacturing in the United States of this drug or other
antiprogestins.
SEC. 2457. FREEDOM OF CHOICE.
(a) Findings.--Congress finds the following:
(1) The 1973 Supreme Court decision in Roe v. Wade
established constitutionally based limits on the power of
States to restrict the right of a woman to choose to terminate
a pregnancy. Under the strict scrutiny standard enunciated in
Roe v. Wade, States were required to demonstrate that laws
restricting the right of a woman to choose to terminate a
pregnancy were the least restrictive means available to achieve
a compelling State interest. Since 1989, the Supreme Court has
no longer applied the strict scrutiny standard in reviewing
challenges to the constitutionality of State laws restricting
such rights.
(2) As a result of the Supreme Court's recent modification
of the strict scrutiny standard enunciated in Roe v. Wade,
certain States have restricted the right of women to choose to
terminate a pregnancy or to utilize some forms of
contraception, and these restrictions operate cumulatively to--
(A)(i) increase the number of illegal or medically
less safe abortions, often resulting in physical
impairment, loss of reproductive capacity or death to
the women involved;
(ii) burden interstate commerce by forcing women to
travel from States in which legal barriers render
contraception or abortion unavailable or unsafe to
other States or foreign nations;
(iii) interfere with freedom of travel between and
among the various States;
(iv) burden the medical and economic resources of
States that continue to provide women with access to
safe and legal abortion; and
(v) interfere with the ability of medical
professionals to provide health services;
(B) obstruct access to and use of contraceptive and
other medical techniques that are part of interstate
and international commerce;
(C) discriminate between women who are able to
afford interstate and international travel and women
who are not, a disproportionate number of whom belong to racial or
ethnic minorities; and
(D) infringe upon women's ability to exercise full
enjoyment of rights secured to them by Federal and
State law, both statutory and constitutional.
(3) Although Congress may not by legislation create
constitutional rights, it may, where authorized by its
enumerated powers and not prohibited by a constitutional
provision, enact legislation to create and secure statutory
rights in areas of legitimate national concern.
(4) Congress has the affirmative power both under section 8
of article I of the Constitution of the United States and under
section 5 of the Fourteenth Amendment of the Constitution to
enact legislation to prohibit State interference with
interstate commerce, liberty or equal protection of the laws.
(b) Purpose.--It is the purpose of this section to establish, as a
statutory matter, limitations upon the power of States to restrict the
freedom of a woman to terminate a pregnancy in order to achieve the
same limitations as provided, as a constitutional matter, under the
strict scrutiny standard of review enunciated in Roe v. Wade and
applied in subsequent cases from 1973 to 1988.
(c) In General.--A State--
(1) may not restrict the freedom of a woman to choose
whether or not to terminate a pregnancy before fetal viability;
(2) may restrict the freedom of a woman to choose whether
or not to terminate a pregnancy after fetal viability unless
such a termination is necessary to preserve the life or health
of the woman; and
(3) may impose requirements on the performance of abortion
procedures if such requirements are medically necessary to
protect the health of women undergoing such procedures.
(d) Definition.--As used in this section, the term ``State''
includes the District of Columbia, the Commonwealth of Puerto Rico, and
each other territory or possession of the United States.
SEC. 2458. FAIRNESS IN INSURANCE.
Notwithstanding any other provision of law no Federal law shall be
construed to prohibit a provider of health insurance from offering
coverage for the full range of reproductive health care, including
abortion services.
SEC. 2459. ABORTIONS IN FACILITIES OF THE UNIFORMED SERVICES NOT
PROHIBITED IF NOT FEDERALLY FUNDED.
Section 1093 of title 10, United States Code, is amended--
(1) by inserting ``(a) Limitation.--'' before ``Funds'';
and
(2) by adding at the end the following:
``(b) Abortions in Facilities Overseas.--Subsection (a) does not
limit the performing of an abortion in a facility of the uniformed
services located outside the 48 contiguous States of the United States
if--
``(1) the cost of performing the abortion is fully paid
from a source or sources other than funds available to the
Department of Defense;
``(2) abortions are not prohibited by the laws of the
jurisdiction where the facility is located; and
``(3) the abortion would otherwise be permitted under the
laws applicable to the provision of health care to members and
former members of the uniformed services and their dependents
in such facility.''.
Subtitle L--Women's Right To Know Act of 1996
SEC. 2491. SHORT TITLE.
This subtitle may be cited as the ``Women's Right To Know Act of
1996''.
SEC. 2492. FIRST AMENDMENT RIGHTS.
Title XI of the Civil Rights Act of 1964 is amended by adding at
the end the following:
``Sec. 1107. (a) Notwithstanding any other provision of law, no
governmental authority shall in or through any program or activity,
administered or assisted by such authority, that provides health care
services or information, limit the right of any person to provide, or
the right of any person to receive, nonfraudulent information about the
availability of reproductive health care services, including family
planning, prenatal care, adoption, and abortion services.
``(b) As used in this section--
``(1) the term `governmental authority' means any authority
of any State or of the United States; and
``(2) the term `State' includes the District of Columbia,
Puerto Rico, and any other territory or possession of the
United States.''.
Subtitle M--International Population Stabilization and Reproductive
Health Act
SEC. 2501. SHORT TITLE.
This subtitle may be cited as the ``International Population
Stabilization and Reproductive Health Act''.
SEC. 2502. 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 developing world, the
inability of women and couples to exercise choice over
childbearing undermines the role of women in economic
development, contributes to death and suffering among women and
their children, puts pressure on the environment and the
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 more than one
billion of the world's 5.6 billion people live.
``(2) Through 2015, the world's population will continue to
grow, with annual population increments predicted to be above
86 million. This will lead to a tripling of the world's
population before stabilization can occur.
``(3) As the population within individual countries grows,
cities grow rapidly, movement in and between countries
increases, and regional distributions of population become
unbalanced.
``(4) After more than a quarter century of experience and
research, a global consensus is emerging on the need for
increased international cooperation in regard to population in
the context of sustainable development.
``(5) To act effectively on this consensus, the ability to
exercise reproductive choice should be expanded through broader
dissemination of fertility regulation services that involve
women, couples, and the community and which are competent in
meeting individual, family, and community needs and values.
``(6) Although a number of barriers to family planning
remain, in many countries a large and growing unmet desire
exists for fertility regulation among women and men who are too
poor to pay the full cost of services or for whom services are
otherwise inaccessible. Worldwide, estimates are that more than 350
million couples want to space or prevent another pregnancy, but lack
access to family planning methods.
``(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 fertility regulation methods
and services and increased access to quality reproductive
health care can help prevent many of these tragedies.
``(8) In addition to the personal toll on families, the
impact of human population growth and widespread poverty 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.
``declaration of policy
``Sec. 499B. (a) In General.--Congress declares that to reduce
population growth and stabilize world population at the lowest level
feasible and thereby improve the health and well-being of the world's
families, to ensure the role of women in the development process, and
to protect the global environment, an important objective of the
foreign policy of the United States shall be to assist the
international community to achieve universal availability of quality
fertility regulation services through a wide choice of safe and
effective means of family planning, including programs of public
education and other health and development efforts in support of
smaller families.
``(b) Financial Targets.--The Congress endorses a target for global
expenditures in developing countries of at least $17,000,000,000 by the
year 2000 for population programs described in section 499C, and
establishes a goal for United States population assistance by the year
2000 of $1,850,000,000 in constant 1993 dollars.
``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 fertility
regulation methods and closely related reproductive health care
services, including the prevention and control of HIV-AIDS,
sexually transmitted diseases, and reproductive tract
infections;
``(2) support for adequate and regular supplies of quality
contraceptives, quality family planning counseling,
information, education, communication, and services emphasizing
the use of the mass media to improve public knowledge of
fertility regulation 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
fertility regulation 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 allow 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, nonuse, and unsafe or ineffective use of
various fertility regulation 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 prevention of unsafe abortions and
management of complications of unsafe abortions, including
research and public information dissemination on the health and
welfare consequences;
``(8) support for special programs to reach adolescents and
young adults 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;
``(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 remove all major remaining barriers to
family planning use, including unnecessary legal,
medical, clinical, and regulatory barriers to
information and methods, and to make family planning an
established community norm;
``(10) support for programs and strategies that actively
discourage harmful practices such as female genital mutilation;
and
``(11) support for prenatal, safe delivery programs and
postnatal care programs that include breastfeeding as a child
survival strategy and means for enhancing birth spacing.
``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
fertility regulation 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 high quality 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) In each recipient country, programs supported by
United States population assistance shall, to the extent
possible, support 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.
``(4) Family planning services and related reproductive
health care services supported by United States population
assistance shall ensure--
``(A) privacy and confidentiality and maintain the
highest medical standards possible under local
conditions; and
``(B) regular oversight of the quality of medical
care and other services offered, including followup
care such as care for the side effects of contraceptive
use.
``(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) Family planning services supported by United States
population assistance shall be designed to take into account
the needs of the family planning user, including the
constraints on women's time, by involving members of the
community, including both men and women, in the design,
management, and ongoing evaluation of the services through
appropriate training and recruitment efforts. The design of
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.
Related services shall be included, either on site or through
referral.
``(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)(A) Programs supported by United States population
assistance shall--
``(i) support the prevention of the spread of HIV-
AIDS infection;
``(ii) raise awareness regarding HIV-AIDS
prevention and consequences; and
``(iii) provide quality counselling, medical care
and support services to HIV-AIDS infected individuals
in a manner which respects individual rights and
confidentiality.
``(B) Responsible sexual behavior, including voluntary
abstinence, for the prevention of HIV infection should be
promoted and included in education and information programs.
``(9) 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 regulation.
``eligibility for population assistance
``Sec. 499E. (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 fertility
regulation and requires foreign assistance to implement,
expand, or sustain quality family planning services for all its
people.
``(3) The country demonstrates a strong policy commitment
to population stabilization through the expansion of
reproductive choice.
``(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.
``participation in multilateral organizations
``Sec. 499F. (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 1996 and 1997 an amount
commensurate with the contributions of the other donor countries for
the purpose of furthering international cooperation in the development
and evaluation of fertility regulation technology.
``support for nongovernmental organizations
``Sec. 499G. (a) Finding.--Congress finds that 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.
``(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 effective population and
family planning activities which encourage significant
involvement by private health practitioners, employer-based
health services, unions, and cooperative health organizations;
and
``(2) a commitment to quality 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 fertility regulation 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 environment 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. 2503. 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) $635,000,000 for fiscal year 1997 and $695,000,000
for fiscal year 1998 to carry out subsection (b) of this
section; and''.
SEC. 2504. OVERSIGHT OF MULTILATERAL DEVELOPMENT BANKS.
(a) Findings.--The Congress finds that--
(1) multilateral development banks have an important role
to play in global population efforts;
(2) although the increased commitment by multilateral
development banks to population-related activities is
encouraging, together the banks provided less than $200,000,000
in 1994 in assistance for core population programs, and their
overall lending for population, health, and nutrition decreased
by more than one-half between 1993 and 1994; and
(3) the banks themselves have recognized a need to improve
oversight of programs, strengthen the technical skills of their
personnel, and improve their capacity to work with borrowers,
other donors, and nongovernmental organizations in formulating
creative population projects to meet diverse borrower needs.
(b) Sense of Congress.--It is the sense of the Congress that the
multilateral development banks should increase their annual support for
the population activities described in section 499C of the Foreign
Assistance Act of 1961, as added by this Act, to not less than a total
of $1,000,000,000 by December 31, 2001.
(c) Report Required.--Not later than July 31 of each year, the
Secretary of the Treasury shall prepare and transmit to Congress a
report which includes, with respect to the preceding calendar year--
(1) information on the resources made available by each
multilateral development bank for the population activities
described in section 499C of the Foreign Assistance Act of
1961, as added by this Act;
(2) if such resources total less than $1,000,000,000, any
specific actions taken by the United States executive directors
to the banks to encourage increases in such resources and in
policy-level discussions with donor and developing country
governments; and
(3) an analysis of the progress made by the banks towards--
(A) meeting the objectives of the population
activities which are supported by the banks;
(B) increasing their in-country management staff;
(C) improving the technical skills of their
personnel; and
(D) assuring their responsiveness to borrower
needs.
(d) Definition.--As used in this section, the term ``multilateral
development banks'' means the International Bank for Reconstruction and
Development, the International Development Association, the African
Development Bank, the Asian Development Bank, the Inter-American
Development Bank, and the European Bank for Reconstruction and
Development.
SEC. 2505. 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. Improving
the status of women also enhances their decisionmaking capacity
at all levels in all spheres of life, including in the area of
reproductive health.
(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 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.
Education is one of the most important means of empowering
women with the knowledge, skills and self confidence necessary
to participate in their communities.
(6) In most societies, men traditionally have exercised
preponderant power in nearly all spheres of life. Therefore,
improving communication between men and women on reproductive
health issues and increasing their understanding of joint
responsibilities are essential to ensuring that men and women
are equal partners in public and private life.
(7) In addition to enabling women to participate in the
development of their societies, educational attainment has a
strong influence on all other aspects of family welfare,
including child survival. However, of the world's 130 million
children who are not enrolled in primary school, 70 percent are
girls.
(8) In a number of countries, lower rates of school
enrollment among girls, the practice of prenatal sex selection,
and higher rates of mortality among very young girls suggest
that ``son preference'' is curtailing the access of girl
children to food, health care, and education.
(9) Each year, nearly 15 million 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.
(10) Each year, 500,000 or more women worldwide die from
complications related to pregnancy, childbirth, illegal
abortion, or inadequate or inaccessible reproductive health
care services. Another 10 million women annually suffer long-
term illness or permanent physical impairment from such causes.
(11) 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.
(12) By mid-1993, the cumulative number of AIDS cases since
the pandemic began was estimated at 2.5 million, and an
estimated 14 million people had been infected with HIV. By year
2000, estimates are that 40 million people will be HIV
infected.
(13) As of mid-1993, four-fifths of all persons ever
infected with HIV lived in developing countries. Women are the
fastest growing group of new cases.
(b) Declaration of Policy.--Congress declares that, to further the
United States foreign policy objective of assisting the international
community in achieving universal availability of quality fertility
regulation services and stabilizing world population, additional
objectives of the foreign policy of the United States shall be--
(1) to help achieve universal access to basic education for
women and men, with particular priority being given to primary
and technical education and job training;
(2) to increase understanding of the consequences of
population growth through effective education strategies that
begin in primary school and continue through all levels of
formal and nonformal education and which take into account the
rights and responsibilities of parents and the needs of children and
adolescents;
(3) to reduce the gap between male and female levels of
literacy and between male and female levels of primary and
secondary school enrollment;
(4) to help ensure that women worldwide have the
opportunity to become equal partners with men in the
development of their societies;
(5) to help eliminate all forms of discrimination against
girl children and the root causes of son preference, which
result in harmful and unethical practice such as female
infanticide and prenatal sex selection;
(6) to increase public awareness of the value of girl
children through public education that promotes equal treatment
of girls and boys in health, nutrition, education,
socioeconomic and political activity, and equitable inheritance
rights;
(7) to promote gender equality in all spheres of life,
including family and community life, and to encourage and
enable men to take responsibility for their sexual and
reproductive behavior and their social and family roles;
(8) to help ensure that women and men have the information
and means needed to achieve good reproductive health and to
exercise their reproductive rights through responsible sexual
behavior and equity in gender relations;
(9) to reduce global maternal and infant mortality rates;
and
(10) to improve worldwide 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--
(A) before 2015, the achievement of the goal of
universal primary education for girls and boys in all
countries and access to secondary and higher levels of
education, including vocational education and technical
training, for girls and women;
(B) by 2005, the reduction of adult illiteracy by
at least one-half the country's 1990 level;
(C) by 2005, the elimination of the gap between
male and female levels of literacy and between male and
female levels of primary and secondary school
enrollment; and
(D) the establishment of programs designed to meet
adolescent health needs, which include services and
information on responsible sexual behavior, family
planning practice, reproductive health and sexually
transmitted diseases, and HIV-AIDS prevention;
(2) governmental and nongovernmental programs which, with
respect to a targeted country, are intended--
(A) by 2005, to increase life expectancy at birth
to greater than 70 years of age and by 2015, to 75
years of age;
(B) by 2005, to reduce by one-third the country's
mortality rates for infants and children under 5 years
of age, or to 50 per 1,000 live births for infants and
70 per 1,000 for children under 5 years of age,
whichever is less; and by 2015, to reduce the country's
infant mortality rate below 35 per 1,000 births and the
under-5 mortality rate below 45 per 1,000;
(C) by 2005, to reduce maternal mortality by one-
half of the 1990 level and by a further one-half by
2015;
(D) by 2005, to reduce significantly malnutrition
among the country's children under 5 years of age;
(E) to maintain immunizations against childhood
diseases for significant segments of the country's
children; and
(F) 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 and ensure equal
participation and equitable representation at all levels of the
political process and public life in each community and society
through--
(A) improved access to appropriate labor-saving
technology, vocational training, and extension services
and access to credit and child care;
(B) equal participation of women and men in all
areas of family and household responsibilities,
including family planning, financial support, child
rearing, children's education, and maternal and child
health and nutrition;
(C) fulfillment of the potential of women through
education, skill development and employment, with the
elimination of poverty, illiteracy and poor health
among women being of paramount importance; and
(D) recognition and promotion of the equal value of
children of both sexes;
(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); and
(5) governmental and nongovernmental programs which are
intended to eliminate all forms of exploitation, abuse,
harassment, and violence against women, adolescents, and
children.
(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, as added by this Act.
(2) Comprehensive reproductive health care programs which are
eligible for assistance under this section include--
(A) fertility regulation 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) child survival and other programs that promote birth
spacing through breastfeeding;
(E) expanded and coordinated programs that support
responsible sexual behavior, including voluntary abstinence,
and which prevent, detect, and treat sexually transmitted
diseases, including HIV-AIDS, reproductive tract infections,
and other chronic reproductive health problems;
(F) programs intended to eliminate traditional practices
injurious to women's health, including female genital
mutilation;
(G) improvements in the practice of midwifery, including
outreach to traditional birth attendants; and
(H) expanded and coordinated programs to prevent, detect,
and treat cancers of the reproductive system.
(e) Reports to Congress.--(1) Not later than December 31, 1996, the
President shall prepare and submit to Congress a report which
includes--
(A) estimates of the total financial resources needed to
achieve, by the year 2005, 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 nongovernmental 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 2005,
world maternal mortality by one-half of the worldwide
1990 level and a further one-half by 2015; 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 18 years of age.
(f) Authorization of Appropriations.--(1) Of the aggregate amounts
available for United States development and economic assistance
programs for education activities, $165,000,000 for fiscal year 1997
and $200,000,000 for fiscal year 1998 shall be available only for
programs in support of increasing primary and secondary school
enrollment and equalizing levels of male and female enrollment.
(2) There are authorized to be appropriated $330,000,000 for fiscal
year 1997 and $380,000,000 for fiscal year 1998 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 1996 and 1997.
(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. 2506. 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) $125,000,000 for fiscal year 1997 and
$145,000,000 for fiscal year 1998 to carry out
subsection (c)(4) of this section.''.
(c) Effective Date.--The amendments made by this section shall take
effect October 1, 1996.
SEC. 2507. 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, 1996,
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. 2508. 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.
Subtitle N--Federal Prohibition of Female Genital Mutilation Act of
1996
SEC. 2551. SHORT TITLE.
This subtitle may be cited as the ``Federal Prohibition of Female
Genital Mutilation Act of 1996''.
SEC. 2552. 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 infibulation 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. 2553. INFORMATION AND EDUCATION REGARDING FEMALE GENITAL
MUTILATION.
(a) In General.--The Secretary of Health and Human Services shall
do the following:
(1) Compile data on the number of females living in the
United States who have been subjected to female genital
mutilation (whether in the United States or in their countries
of origin), including a specification of the number of girls
under the age of 18 who have been subjected to such mutilation.
(2) Identify communities in the United States that practice
female genital mutilation, and design and carry out outreach
activities to educate individuals in the communities on the
physical and psychological health effects of such practice.
Such outreach activities shall be designed and implemented in
collaboration with representatives of the ethnic groups
practicing such mutilation and with representatives of
organizations with expertise in preventing such practice.
(3) Develop recommendations for the education of students
of schools of medicine and osteopathic medicine regarding
female genital mutilation and complications arising from such
mutilation. Such recommendations shall be disseminated to such
schools.
(b) Definition.--For purposes of this section, the term ``female
genital mutilation'' means the removal or infibulation (or both) of the
whole or part of the clitoris, the labia minor, or the labia major.
SEC. 2554. EFFECTIVE DATES.
Section 2553 of this Act 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 2552 of this Act shall take effect 180 days after the date of
the enactment of this Act.
Subtitle O--Women and HIV Outreach and Prevention Act
SEC. 2591. SHORT TITLE.
This subtitle may be cited as the ``Women and HIV Outreach and
Prevention Act''.
SEC. 2592. 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) providing prevention education on the human
immunodeficiency virus (in this part referred to as
`HIV'), including counseling on all modes of
transmission between individuals, including sexual
contact, the use of IV drugs, and maternal-fetal
transmission;
``(B) making available voluntary HIV testing
services to women; and
``(C) providing effective and close linkages
between testing and care services for women.
``(2) Providing appropriate referrals regarding the
provision of other services to women who are receiving services
pursuant to paragraph (1), including, as appropriate, referrals
regarding the following: treatment for HIV infection; treatment
for substance abuse; mental health services; pregnancy and
childbirth; pediatric care; housing services; public
assistance; job training; child care; respite care;
reproductive health care; and domestic violence.
``(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 1997, and such
sums as may be necessary for each of the fiscal years 1998 and
1999.
``(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
1997, and such sums as may be necessary for each of the fiscal
years 1998 and 1999.
``SEC. 2532. PUBLIC EDUCATION.
``(a) In General.--The Secretary may make grants for the purpose of
developing and carrying out programs to provide HIV prevention
education to women, including education on all modes of transmission
between individuals, including sexual contact, the use of IV drugs, and
maternal-fetal transmission.
``(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) Provisions Regarding Planning Councils.--In carrying out the
mission of the Community HIV Planning Process, the Secretary shall
ensure that women who represent women's interests and have expertise on
women's health, HIV positive women, and their advocates are included on
the Planning Councils, that financial resources are allocated to ensure
such representation, and that Planning Councils use qualitative data
based on women's experiences.
``(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 (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.
``(f) Authorizations of Appropriations.--For the purpose of
carrying out this section, there are authorized to be appropriated
$30,000,000 for fiscal year 1997, and such sums as may be necessary for
each of the fiscal years 1998 and 1999.''.
SEC. 2593. 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 1997, and such sums as may be necessary for each of the
fiscal years 1998 and 1999.''.
SEC. 2594. 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 1997, and such sums as
may be necessary for each of the fiscal years 1998 and 1999.''.
Subtitle P--Smoking Prevention and Cessation in WIC Clinics Act
SEC. 2601. SHORT TITLE.
This subtitle may be cited as the ``Smoking Prevention and
Cessation in WIC Clinics Act''.
SEC. 2602. 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 Q--Comprehensive Fetal Alcohol Syndrome Prevention Act
SEC. 2651. SHORT TITLE.
This subtitle may be cited as the ``Comprehensive Fetal Alcohol
Syndrome Prevention Act''.
SEC. 2652. PREVENTION OF FETAL ALCOHOL SYNDROME; PROGRAM OF NATIONAL
INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM.
Subpart 14 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285n et seq.) is amended by adding at the end the following
section:
``fetal alcohol syndrome
``Sec. 464K. (a) In General.--The Director of the Institute shall
establish a program for the conduct and support of research and
training, the dissemination of health information, and other programs
with respect to the cause, diagnosis, prevention, and treatment of
fetal alcohol syndrome and the related condition known as fetal alcohol
effects (which syndrome and effects are referred to collectively in
this section as `fetal alcohol conditions').
``(b) Interagency Coordinating Committee.--
``(1) In general.--Subject to paragraph (6), the Secretary
shall establish a committee to be known as the Interagency
Coordinating Committee on Fetal Alcohol Syndrome (in this
subsection referred to as the `Coordinating Committee').
``(2) Duties.--With respect to fetal alcohol conditions,
the Coordinating Committee shall--
``(A) coordinate the activities of the National
Institutes of Health; and
``(B) coordinate the aspects of all Federal health
programs and activities relating to such conditions in
order to assure the adequacy and technical soundness of
such programs and activities, and in order to provide
for the full communication and exchange of information
necessary to maintain adequate coordination of such
programs and activities.
``(3) Composition.--The Coordinating Committee shall be
composed of--
``(A) the directors of each of the national
research institutes, and the heads of other agencies of
the National Institutes of Health, that are involved in
research on fetal alcohol conditions; and
``(B) representatives of all other Federal
departments and agencies whose programs involve health
functions or responsibilities relevant to such
conditions.
``(4) Chair.--The Secretary shall designate a member of the
Coordinating Committee to serve as the chair of the Committee.
The Committee shall meet at the call of the Chair, but not less
than four times a year.
``(5) Annual report.--
``(A) In carrying out paragraph (2), the
Coordinating Committee shall comply with the following:
``(i) Identify and monitor all activities
regarding fetal alcohol conditions that are
conducted or supported by the Department of
Health and Human Services and other Federal
departments or agencies.
``(ii) Identify the goals expected to be
achieved through the activities.
``(iii) Conduct evaluations of the extent
to which the activities have been effective in
achieving such goals.
``(iv) Determine the extent to which the
activities have been coordinated with each
other.
``(v) Make recommendations on the
activities that should be carried out, on
priorities among the activities, and on the
coordination of the activities.
``(B) Subject to paragraph (6)(B), the Coordinating
Committee shall, for each fiscal year, prepare and
submit to the Congress a report detailing the
activities of the Committee in carrying out the duties
of the Committee for the fiscal year. The Coordinating
Committee shall submit copies of each such report to
the Secretary, the Director of NIH, the officials
specified in paragraph (3)(A), and the advisory council
for the Institute. Except as provided in paragraph
(6)(B), each such report shall be submitted not later
than February 1 of the fiscal year following the fiscal
year for which the report is prepared.
``(6) Initial intradepartmental status of committee.--
``(A) During fiscal years 1997 and 1998, the
Secretary shall ensure that individuals appointed to
the Coordinating Committee under paragraph (3)(B)
include only officers or employees of the Department of
Health and Human Services, and that the duties of the
Coordinating Committee are carried out only with
respect to such Department.
``(B) The first report under subparagraph (B) of
paragraph (5) shall concern fiscal years 1997 and 1998,
and shall consist of the findings and recommendations
made by the Coordinating Committee in applying
subparagraph (A) of such paragraph to the Department of
Health and Human Services. Such report shall be
submitted not later than February 1, 1999.
``(7) Prevention activities.--With respect to activities
for the prevention of fetal alcohol conditions--
``(A) the Coordinating Committee shall, as soon as
is practicable after the date on which this section
takes effect, develop recommendations under paragraph
(5)(A) regarding the Department of Health and Human
Services; and
``(B) such Committee shall, as soon as is
practicable after October 1, 1998, develop
recommendations under such paragraph regarding other
departments and agencies of the Federal Government.
``(c) Certain Activities.--
``(1) In general.--Activities under subsection (a)
regarding fetal alcohol conditions shall include conducting and
supporting basic and applied research, including
epidemiological research; demonstrations; the training of
health professionals, including the development of professional
practice standards for detecting and preventing such conditions
in pregnant women and for counseling such women; the evaluation
of programs, including training programs; and the dissemination
of diagnostic criteria. Activities under such subsection shall
include the provision of technical assistance to public and
nonprofit private entities that carry out such programs.
``(2) Prevention; public awareness.--
``(A) With respect to the prevention of fetal
alcohol conditions, each of the requirements of
paragraph (1) regarding the conduct and support of
various types of activities shall be carried out,
except to the extent inapplicable to prevention
activities. Activities conducted or supported pursuant
to the preceding sentence shall include carrying out a
comprehensive program to educate health professionals
and the general public, and shall include programs
directed toward at-risk populations. Programs under
this paragraph that are directed toward particular
populations shall be provided in the language and
cultural context most appropriate for the population
involved.
``(B) In the conduct and support of activities
under subparagraph (A), special emphasis shall be
placed upon the utilization of collaborative efforts
with both the public and private sectors for the
purpose of--
``(i) increasing the awareness and
knowledge of health professionals and the
public regarding the prevention of fetal
alcohol conditions; and
``(ii) developing and disseminating to
health professionals, patients and patient
families, and the public information designed
to encourage individuals to adopt healthful
practices concerning the prevention of such
conditions.
``(d) Uniform Criteria for Collection and Reporting of Data.--In
order to provide for the comparability of data on fetal alcohol
conditions, the Secretary shall, to the extent practicable, develop
uniform criteria for the collection and reporting of such data by or
through the National Institutes of Health and the other agencies of the
Department of Health and Human Services. The Secretary shall encourage
the States to utilize such criteria.
``(e) Collaborative Activities.--The Secretary may require that an
activity under this section be carried out in collaboration with or
through one or more of the other agencies of the Department of Health
and Human Services, and amounts made available under subsection (f) are
available to the Secretary for such purpose.
``(f) 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 1997 through 2001.''.
Subtitle R--Postreproductive Health Care Act
SEC. 2691. SHORT TITLE.
This subtitle may be cited as the ``Postreproductive Health Care
Act''.
SEC. 2692. 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 1997, and such sums as may be necessary for each of the
fiscal years 1998 and 1999.''.
Subtitle S--Family Caregiver Support and Protection Act of 1996
SEC. 2701. SHORT TITLE.
This subtitle may be cited as the ``Family Caregiver Support and
Protection Act of 1996''.
SEC. 2702. COVERAGE OF RESPITE CARE SERVICES UNDER MEDICARE.
(a) In General.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) by striking ``and'' at the end of subparagraph (N);
(2) by striking ``and'' at the end of subparagraph (O); and
(3) by inserting after subparagraph (O) the following new
subparagraph:
``(P) respite care services (as defined in subsection
(oo)); and''.
(b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x)
is amended by adding at the end the following new subsection:
``Respite Care Services
``(oo)(1)(A) Subject to subparagraph (C), the term `respite care
services' means any of the services described in subparagraph (B) which
are furnished to an eligible individual (as described in paragraph (2))
for the support of a caregiver described in paragraph (2) at the
individual's home or in the community on a short-term, intermittent, or
emergency basis by an individual or entity who meets such standards as
the Secretary may establish.
``(B) The services described in this subparagraph are as follows:
``(i) Companion services.
``(ii) Homemaker services.
``(iii) Personal assistance.
``(iv) Community day services.
``(v) Temporary care in an accredited or licensed
residential facility.
``(C) In establishing standards pursuant to subparagraph (A) for
individuals and entities providing respite care services, the Secretary
shall consult with organizations representing providers of the services
described in such paragraph and organizations representing individuals
who typically receive such services.
``(D) The term `respite care services' does not include any
services furnished to an individual during a 12-month period after the
individual has been furnished 120 hours of such services during such
period.
``(2) An `eligible individual' described in this paragraph is an
individual with functional limitations (as described in paragraph (3))
who is dependent on a daily basis on a caregiver who--
``(A) has primary responsibility for providing care to the
individual;
``(B) does not receive financial remuneration for providing
such care; and
``(C) has provided such care for a period of not less than
3 consecutive months.
``(3)(A) In paragraph (2), an `individual with functional
limitations' is an individual who is certified (in accordance with such
criteria as the Secretary may establish consistent with subparagraph
(C)) as--
``(i) being unable to perform without substantial
assistance from another individual (including assistance
involving verbal reminding or physical cueing) at least 2 of
the activities of daily living described in subparagraph (B)
for a period of at least 90 days due to a loss of functional
capacity or to cognitive or other mental impairment;
``(ii) requiring substantial supervision to protect the
individual from threats to the individual's health or safety
due to substantial cognitive or other mental impairment; or
``(iii) having a level of disability similar (as determined
by the Secretary) to the level of disability described in
clause (i) or (ii).
``(B) The activities of daily living described in this subparagraph
are as follows:
``(i) Eating.
``(ii) Toileting.
``(iii) Transferring.
``(iv) Bathing.
``(v) Dressing.
``(vi) Continence.
``(C) In establishing criteria pursuant to subparagraph (A) for the
certification of individuals with functional limitations, the Secretary
may not require that such certification be performed only by a
physician.''.
(c) Payment on Hourly Basis.--Section 1833 of such Act (42 U.S.C.
1395l) is amended by inserting after subsection (o) the following new
subsection:
``(p) Payment for respite care services shall be paid on the basis
of an hour of such services provided.''.
(d) Conforming Amendment.--Section 1862(a) of such Act (42 U.S.C.
1395y(a)) is amended--
(1) by striking ``or'' at the end of paragraph (14);
(2) by striking the period at the end of paragraph (15) and
inserting ``; or''; and
(3) by inserting after paragraph (15) the following new
paragraph:
``(16) in the case of respite care services, which are
furnished to an individual during a 12-month period after the
individual has been furnished 120 hours of such services during
such period.''.
(e) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 1997.
SEC. 2703. TREATMENT OF LONG-TERM CARE SERVICES AS MEDICAL CARE.
(a) General Rule.--Paragraph (1) of section 213(d) (defining
medical care) is amended by striking ``or'' at the end of subparagraph
(B), by striking the period at the end of subparagraph (C) and
inserting ``, or'', and by adding at the end the following new
subparagraph:
``(D) for qualified long-term care services (as
defined in subsection (f)).''
(b) Definition of Qualified Long-Term Care Services.--Section 213
of such Code is amended by adding at the end the following new
subsection:
``(f) Qualified Long-Term Care Services.--For purposes of this
section--
``(1) In general.--The term `qualified long-term care
services' means necessary diagnostic, preventive, therapeutic,
curing, treating, mitigating, and rehabilitative services, and
maintenance or personal care services, which--
``(A) are required by a chronically ill individual,
and
``(B) are provided pursuant to a plan of care
prescribed by a licensed health care practitioner.
``(2) Chronically ill individual.--
``(A) In general.--The term `chronically ill
individual' means any individual who has been certified
by a licensed health care practitioner as--
``(i) being unable to perform (without
substantial assistance from another individual)
at least 2 activities of daily living for a
period of at least 90 days due to a loss of
functional capacity or to cognitive impairment,
``(ii) requiring substantial supervision to
protect such individual from threats to health
or safety due to substantial cognitive
impairment, or
``(iii) having a level of disability
similar (as determined by the Secretary in
consultation with the Secretary of Health and
Human Services) to the level of disability
described in clause (i) or (ii).
Such term shall not include any individual otherwise
meeting the requirements of the preceding sentence
unless within the preceding 12-month period a licensed
health care practitioner has certified that such
individual meets such requirements.
``(B) Activities of daily living.--For purposes of
subparagraph (A), each of the following is an activity
of daily living:
``(i) Eating.
``(ii) Toileting.
``(iii) Transferring.
``(iv) Bathing.
``(v) Dressing.
``(vi) Continence.
``(C) Substantial assistance.--For purposes of
subparagraph (A)(i), the term `substantial assistance'
includes verbal reminding or physical cuing.
``(3) Maintenance or personal care services.--The term
`maintenance or personal care services' means any care the
primary purpose of which is the provision of needed assistance
with any of the disabilities as a result of which the
individual is a chronically ill individual (including the
protection from threats to health and safety due to severe
cognitive impairment).
``(4) Licensed health care practitioner.--The term
`licensed health care practitioner' means any physician (as
defined in section 1861(r)(1) of the Social Security Act) and
any registered professional nurse, licensed social worker, or
other individual who meets such requirements as may be
prescribed by the Secretary.''
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 1995.
Subtitle T--Medicare Mammography Enhancement Act of 1996
SEC. 2751. SHORT TITLE.
This subtitle may be cited as the ``Medicare Mammography
Enhancement Act of 1996''.
SEC. 2752. EXPANDING SCREENING MAMMOGRAPHY UNDER THE MEDICARE PROGRAM.
(a) Providing Annual Screening Mammography for Women Over Age 49.--
Section 1834(c)(2)(A) of the Social Security Act (42 U.S.C.
1395m(c)(2)(A)) is amended--
(1) in clause (iv), by striking ``but under 65 years of
age,'', and
(2) by striking clause (v).
(b) Waiver of Deductible.--
(1) In general.--The first sentence of section 1833(b) of
such Act (42 U.S.C. 1395l(b)) is amended--
(A) by striking ``and (4)'' and inserting ``(4)'',
and
(B) by striking the period at the end and inserting
the following: ``, and (5) such deductible shall not
apply with respect to screening mammography (as
described in section 1861(jj)).''.
(2) Conforming amendment.--Section 1834(c)(1)(C) of such
Act (42 U.S.C. 1395m(c)(1)(C)) is amended by striking ``,
subject to the deductible established under section 1833(b),''.
(c) Waiver of Coinsurance.--
(1) In general.--Section 1834(c)(1)(C) of such Act (42
U.S.C. 1395m(c)(1)(C)) is amended by striking ``80 percent
of''.
(2) Waiver of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) of such
Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by inserting after
``1861(s)(10)(A)'' the following: ``, with respect to screening
mammography (as defined in section 1861(jj)),''.
(d) Effective Date.--The amendments made by this section shall
apply to screening mammography performed on or after January 1, 1997.
Subtitle U--Medicare Bone Mass Measurement Standardization Act of 1996
SEC. 2791. SHORT TITLE.
This subtitle may be cited as the ``Medicare Bone Mass Measurement
Standardization Act of 1996''.
SEC. 2792. MEDICARE COVERAGE OF BONE MASS MEASUREMENTS.
(a) In General.--
(1) Coverage.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)), as amended by section
147(f)(6)(B)(iii) of the Social Security Act Amendments of
1994, is amended--
(A) in subparagraph (N), by striking ``and'' at the
end;
(B) in subparagraph (O), by striking ``and'' at the
end; and
(C) by inserting after subparagraph (O) the
following new subparagraph:
``(P) bone mass measurement (as defined in subsection
(oo)); and''.
(2) Bone mass measurements described.--Section 1861 of such
Act (42 U.S.C. 1395x), as amended by section 146(a) of the
Social Security Act Amendments of 1994, is amended by adding at
the end the following new subsection:
``Bone Mass Measurement
``(oo)(1) The term `bone mass measurement' means a radiologic or
radioisotopic procedure or other scientifically proven technology
performed on a qualified individual (as defined in paragraph (2)) for
the purpose of identifying bone mass or detecting bone loss, 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;
``(D) an individual with primary hyperparathyroidism; or
``(E) an individual who is monitored to assess the
individual's response to or the efficacy of approved
osteoporosis drug therapies.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to bone mass measurements performed on or after January 1, 1997.
Subtitle V--Osteoporosis and Related Bone Disorders Resource Center Act
of 1996
SEC. 2801. SHORT TITLE.
This subtitle may be cited as the ``Osteoporosis and Related Bone
Disorders Resource Center Act of 1996''.
SEC. 2802. FUNDING FOR INFORMATION CLEARINGHOUSE ON OSTEOPOROSIS,
PAGET'S DISEASE, AND RELATED BONE DISORDERS.
Section 409A(d) of the Public Health Service Act (42 U.S.C.
284e(d)) is amended by adding at the end the following sentence: ``In
addition to other authorizations of appropriations available for the
purpose of the establishment and operation of the information
clearinghouse under subsection (c), there are authorized to be
appropriated for such purpose $500,000 for fiscal year 1997, and such
sums as may be necessary for each of the fiscal years 1998 and 1999.''.
Subtitle W--Women Veterans Health Improvement Act of 1996
SEC. 2851. SHORT TITLE.
This subtitle may be cited as the ``Women Veterans Health
Improvement Act of 1996''.
SEC. 2852. 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) The management and prevention of sexually transmitted
diseases.
``(D) Menopause, osteoporosis, and other conditions
relating to aging.
``(E) Cardiac care.
``(F) Physical and psychological conditions arising out of
acts of sexual violence.
``(G) Physical and psychological conditions that result
from homelessness.''.
(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''.
SEC. 2853. REPORT ON WOMEN'S HEALTH CARE AND RESEARCH.
(a) In General.--Not later than January 1, 1999, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans' Affairs of
the Senate and House of Representatives a report on the provision of
health care services and the conduct of research carried out by, or
under the jurisdiction of, the Secretary relating to women veterans.
The report shall be prepared through the Center for Women Veterans
established under section 318 of title 38, United States Code, which
shall prepare the report in consultation with the Advisory Committee on
Women Veterans established under section 542 of that title.
(b) Contents.--The report under subsection (a) shall include the
following information:
(1) The number of women veterans who have received women's
health services (as such term is defined in section 1701(10) of
title 38, United States Code) in facilities under the
jurisdiction of the Secretary (or the Secretary of Defense),
shown by reference to the Department facility which provided
(or, in the case of Department of Defense facilities, arranged
for) those services.
(2) A description of--
(A) the services provided at each such facility;
(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) the extent to which each such facility relies
on contractual arrangements under section 1703 or 8153
of title 38, United States Code, to furnish care to
women veterans in facilities which are not under the
jurisdiction of the Secretary where the provision of
such care is not furnished in a medical emergency.
(3) The steps taken by each such facility to expand the
provision of services at such facility (or under arrangements
with the Department of Defense facility) to women veterans.
(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.
(7) A description (as of October 1 of the year preceding
the year in which the report is submitted) of the status of any
research relating to women veterans being carried out by or
under the jurisdiction of the Secretary.
(8) A description of the actions taken by the Secretary to
foster and encourage the expansion of such research.
SEC. 2854. EXPANSION OF RESEARCH RELATING TO WOMEN VETERANS.
(a) Inclusion of Women and Minorities in Health Research.--Section
7303(c) of title 38, United States Code, is amended--
(1) in paragraph (1), by striking out ``that, whenever
possible and appropriate--'' and inserting in lieu thereof
``that--''; and
(2) by adding at the end the following new paragraph:
``(3) 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 may designate.''.
(b) Health Research Relating to Women.--Section 7303(d) of such
title is amended by adding at the end the following new paragraphs:
``(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.
``(I) Cardiac care.
``(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 this
title.
``(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.''.
SEC. 2855. POPULATION STUDY.
(a) Study.--The Secretary of Veterans Affairs, subject to
subsection (f), shall conduct a study to determine the needs of
veterans who are women for health-care services. The study shall be
carried out through the Center for Women Veterans.
(b) Consultation.--Before carrying out the study, the Secretary
shall request the advice of the Advisory Committee on Women Veterans on
the conduct of the study.
(c) Persons To Be Included in Sample of Veterans Studied.--(1)
Subject to paragraph (2), the study shall be based on--
(A) an appropriate sample of veterans who are women; and
(B) an examination of the medical and demographic histories
of the women comprising such sample.
(2) The sample referred to in paragraph (1) 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. The
Secretary shall ensure that homeless Women Veterans are included in the
sample.
(3) In carrying out the examination referred to in paragraph
(1)(B), 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.
(d) Reports.--The Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives reports
relating to the study as follows:
(1) Not later than nine months after the date of the
enactment of this Act, an interim report describing (A) the
information and advice obtained by the Secretary from the
Advisory Committee on Women Veterans, and (B) the status of the
study.
(2) Not later than December 31, 1999, a final report
describing the results of the study.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to the General Operating Expenses account of the
Department of Veterans Affairs $2,000,000 to carry out the purposes of
this section. Amounts appropriated pursuant to this authorization of
appropriations shall be available for obligation without fiscal year
limitation.
(f) Limitation.--No funds may be used to conduct the study
described in subsection (a) unless expressly provided for in an
appropriation Act.
SEC. 2856. OUTREACH SERVICES FOR HOMELESS WOMEN VETERANS.
Section 7722(e) of title 38, United States Code, is amended by
adding at the end the following new sentence: ``In carrying out this
subsection, the Secretary shall take such steps as may be necessary to
ensure that homeless women veterans are included in such outreach
programs and outreach services.''.
SEC. 2857. SAFE AND EFFECTIVE TREATMENT FOR WOMEN PSYCHIATRIC PATIENTS.
The Secretary of Veterans Affairs shall ensure that women veterans
who are receiving psychiatric treatment from the Secretary,
particularly in the case of women who are sexually traumatized, receive
such treatment (on both an inpatient and outpatient basis) in a safe
and effective manner that recognizes the privacy needs of such women.
SEC. 2858. 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.
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