[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 1799 Introduced in Senate (IS)]







104th CONGRESS
  2d Session
                                S. 1799

 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 SENATE OF THE UNITED STATES

                              May 23, 1996

Ms. Snowe (for herself, Ms. Mikulski, Mrs. Feinstein, Mrs. Murray, Ms. 
Moseley-Braun, and Mr. Kerry) introduced the following bill; which was 
 read twice and referred to the Committee on Labor and Human Resources

_______________________________________________________________________

                                 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--RESEARCH

        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.
                  Subtitle N--Breast Cancer Screening

Sec. 1601. Short title.
Sec. 1602. Sense of Congress regarding breast cancer screening.
                           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.
          Subtitle X--Newborns' and Mothers' Health Protection

Sec. 2901. Short title.
Sec. 2902. Finding.
Sec. 2903. Required coverage for minimum hospital stay following birth.
Sec. 2904. Post-delivery follow-up care.
Sec. 2905. Prohibitions.
Sec. 2906. Notice.
Sec. 2907. Applicability.
Sec. 2908. Enforcement.
Sec. 2909. Definitions.
Sec. 2910. Preemption.
Sec. 2911. Effective date.
    Subtitle Y--Obstetrician-Gynecologists as Primary Care Providers

Sec. 2951. Sense of the Senate regarding obstetrician-gynecologists.

                           TITLE I--RESEARCH

        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 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.''.

                  Subtitle N--Breast Cancer Screening

SEC. 1601. SHORT TITLE.

    This subtitle may be cited as the ``Accurate Mammography Guidelines 
Act of 1996''.

SEC. 1602. SENSE OF CONGRESS REGARDING BREAST CANCER SCREENING.

    (a) Findings.--Congress finds that--
            (1) the National Cancer Institute is the lead Federal 
        agency for research on the causes, prevention, diagnosis, and 
        treatment of cancer;
            (2) health professionals and consumers throughout the 
        Nation regard the guidelines of the National Cancer Institute 
        as reliable scientific and medical advice;
            (3) it has been proven that intervention with routine 
        screening for breast cancer through mammography can save 
        women's lives at a time when medical science is unable to 
        prevent this disease;
            (4) there are statistical limitations to evaluating the 
        efficacy of mammography in a 5-10 year age range of women, 
        using existing studies designed to test the efficacy of 
        mammography in a 25-30 year age range of women;
            (5) there were numerous shortcomings identified in a 
        Canadian study designed to address reduction of mortality from 
        breast cancer in the 40-49 age range;
            (6) to date, it is not possible to have the same degree of 
        scientific confidence about the benefit of mammography for 
        women ages 40-49 as exists for women ages 50-69 due to inherent 
        limitations in the studies that have been conducted;
            (7) meta-analysis (combining the results of several 
        studies) is sometimes useful, and the studies used to reach the 
        National Cancer Institute's conclusions were not easily 
        combined because of variations in design, technology, screening 
        interval, the inclusion or exclusion of clinical breast 
        examination, and quality;
            (8) the existing clinical trial data are inadequate to 
        provide a definite answer to the efficacy of early detection in 
        the 40-49 age group and there has been a dramatic change in 
        technology during the 30-year period since the initiation of 
        the first study of breast cancer screening;
            (9) the majority, approximately 80 percent, of women who 
        are diagnosed with breast cancer have no identifiable risk for 
        this disease;
            (10) breast cancer is the leading cause of cancer death 
        among women in the age group 15-54;
            (11) the American Cancer Society and 21 other national 
        medical organizations and health and consumer groups are at 
        variance with the recently rescinded guideline of the National 
        Cancer Institute for mammography for women ages 40-49; and
            (12) the statement of scientific fact on breast cancer 
        screening issued by the National Cancer Institute on December 
        3, 1993, will cause widespread confusion and concern among 
        women and physicians, erode confidence in mammography, and 
        reinforce barriers and negative attitudes that keep women of 
        all ages from being screened
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) adequately designed and conducted studies are needed to 
        determine the benefit of screening women ages 40-49 through 
        mammography and other emerging technologies;
            (2) the National Cancer Institute's statement of scientific 
        fact on breast cancer screening should clearly state that the 
        uncertainty of evidence for women in this age group is due to 
        the limitations of existing studies (as of the date of issuance 
        of the statement); and
            (3) the National Cancer Institute should reissue the 
        recently rescinded guideline for mammography for women ages 40-
        49 or direct the public to consider guidelines issued by other 
        organizations.

                           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 counseling.
            (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 Institutes 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 minora, or the labia majora.

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.

          Subtitle X--Newborns' and Mothers' Health Protection

SEC. 2901. SHORT TITLE.

    This subtitle may be cited as the ``Newborns' and Mothers' Health 
Protection Act of 1996''.

SEC. 2902. FINDING.

    Congress finds that--
            (1) the length of post-delivery inpatient care should be 
        based on the unique characteristics of each mother and her 
        newborn child, taking into consideration the health of the 
        mother, the health and stability of the infant, the ability and 
        confidence of the mother to care for her infant, the adequacy 
        of support systems at home, and the access of the mother and 
        infant to appropriate follow-up health care; and
            (2) the timing of the discharge of a mother and her newborn 
        child from the hospital should be made by the attending 
        provider in consultation with the mother.

SEC. 2903. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOLLOWING BIRTH.

    (a) In General.--Except as provided in subsection (b), a health 
plan or an employee health benefit plan that provides maternity 
benefits, including benefits for childbirth, shall ensure that coverage 
is provided with respect to a mother who is a participant, beneficiary, 
or policyholder under such plan and her newborn child for a minimum of 
48 hours of in-patient care following a normal vaginal delivery, and a 
minimum of 96 hours of in-patient care following a caesarean section, 
without requiring the attending provider to obtain authorization from 
the health plan or employee health benefit plan in order to keep a 
mother and her newborn child in the inpatient setting for such period 
of time.
    (b) Exception.--Notwithstanding subsection (a), a health plan or an 
employee health benefit plan shall not be required to provide coverage 
for post-delivery in-patient care for a mother who is a participant, 
beneficiary, or policyholder under such plan and her newborn child 
during the period referred to in subsection (a) if--
            (1) a decision to discharge the mother and her newborn 
        child prior to the expiration of such period is made by the 
attending provider in consultation with the mother; and
            (2) the health plan or employee health benefit plan 
        provides coverage for post-delivery follow-up care as described 
        in section 2904.

SEC. 2904. POST-DELIVERY FOLLOW-UP CARE.

    (a) In General.--In the case of a decision to discharge a mother 
and her newborn child from the inpatient setting prior to the 
expiration of 48 hours in the case of a normal vaginal delivery or 96 
hours in the case of a caesarean section, the health plan or employee 
health benefit plan shall provide coverage for timely post-delivery 
care. Such health care shall be provided to a mother and her newborn 
child by a registered nurse, physician, nurse practitioner, nurse 
midwife or physician assistant experienced in maternal and child health 
in--
            (1) the home, a provider's office, a hospital, a federally 
        qualified health center, a federally qualified rural health 
        clinic, or a State health department maternity clinic; or
            (2) another setting determined appropriate under 
        regulations promulgated by the Secretary, in consultation with 
        the Secretary of Health and Human Services, (including a 
        birthing center or an intermediate care facility);
except that such coverage shall ensure that the mother has the option 
to be provided with such care in the home.
    (b) Timely Care.--As used in subsection (a), the term ``timely 
post-delivery care'' means health care that is provided--
            (1) following the discharge of a mother and her newborn 
        child from the inpatient setting; and
            (2) in a manner that meets the health care needs of the 
        mother and her newborn child, that provides for the appropriate 
        monitoring of the conditions of the mother and child, and that 
        occurs within the 24- to 72-hour period immediately following 
        discharge.
    (c) Consistency With State Law.--The Secretary shall, with respect 
to regulations promulgated under subsection (a) concerning appropriate 
post-delivery care settings, ensure that, to the extent practicable, 
such regulations are consistent with State licensing and practice laws.

SEC. 2905. PROHIBITIONS.

    (a) Terms and Conditions.--In implementing the requirements of this 
subtitle, a health plan or an employee health benefit plan may not--
            (1) deny enrollment, renewal, or continued coverage to a 
        mother and her newborn child who are participants, 
        beneficiaries or policyholders based on compliance with this 
        subtitle;
            (2) provide monetary incentives to mothers to encourage 
        such mothers to request less than the minimum coverage required 
        under this subtitle; or
            (3) provide incentives (monetary or otherwise) to an 
        attending provider to induce such provider to provide treatment 
        in a manner inconsistent with this subtitle.
    (b) Providers.--In implementing the requirements of this section, a 
health plan or an employee health benefit plan may not penalize or 
otherwise reduce or limit the reimbursement of an attending provider 
because such provider provided treatment in accordance with this 
subtitle.
    (c) Rule of Construction.--Nothing in this subtitle shall be 
construed to require that a mother who is a participant, beneficiary, 
or policyholder covered under this subtitle--
            (1) give birth in a hospital; or
            (2) stay in the hospital for a fixed period of time 
        following the birth of her child.

SEC. 2906. NOTICE.

    (a) Employee Health Benefit Plan.--An employee health benefit plan 
shall provide notice to each participant regarding coverage required 
under this subtitle in accordance with regulations promulgated by the 
Secretary.
    (b) Health Plan.--A health plan shall provide notice to each 
policyholder regarding coverage required under this subtitle.
    (c) Requirements.--Notice required under this section shall be in 
writing, prominently positioned in, and be transmitted--
            (1) in a mailing made within 120 days of the date of 
        enactment of this Act by such plan to the participant or 
        policyholder; and
            (2) as part of the annual informational packet sent to the 
        participant or policyholder.

SEC. 2907. APPLICABILITY.

    (a) Construction.--
            (1) In general.--A requirement or standard imposed under 
        this subtitle on a health plan shall be deemed to be a 
        requirement or standard imposed on the health plan issuer. Such 
        requirements or standards shall be enforced by the State 
        insurance commissioner for the State involved or the official 
        or officials designated by the State to enforce the 
        requirements of this subtitle. In the case of a health plan 
        offered by a health plan issuer in connection with an employee 
        health benefit plan, the requirements or standards imposed 
        under this subtitle shall be enforced with respect to the 
        health plan issuer by the State insurance commissioner for the 
        State involved or the official or officials designated by the 
        State to enforce the requirements of this subtitle.
            (2) Limitation.--Except as provided in section 2908(c), the 
        Secretary shall not enforce the requirements or standards of 
        this subtitle as they relate to health plan issuers or health 
        plans. In no case shall a State enforce the requirements or 
        standards of this subtitle as they relate to employee health 
        benefit plans.
    (b) Rule of Construction.--Nothing in this subtitle 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).

SEC. 2908. ENFORCEMENT.

    (a) Health Plan Issuers.--Each State shall require that each health 
plan issued, sold, renewed, offered for sale or operated in such State 
by a health plan issuer meet the standards established under this 
subtitle. A State shall submit such information as required by the 
Secretary demonstrating effective implementation of the requirements of 
this subtitle.
    (b) Employee Health Benefit Plans.--With respect to employee health 
benefit plans, the standards established under this subtitle shall be 
enforced 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). The civil penalties contained in 
paragraphs (1) and (2) of section 502(c) of such Act (29 U.S.C. 1132(c) 
(1) and (2)) shall apply to any information required by the Secretary 
to be disclosed and reported under this section.
    (c) Failure To Enforce.--In the case of the failure of a State to 
substantially enforce the standards and requirements set forth in this 
subtitle with respect to health plans, the Secretary, in consultation 
with the Secretary of Health and Human Services, shall enforce the 
standards of this subtitle in such State. In the case of a State that 
fails to substantially enforce the standards set forth in this 
subtitle, each health plan issuer operating in such State shall be 
subject to civil enforcement 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). The civil penalties contained in 
paragraphs (1) and (2) of section 502(c) of such Act (29 U.S.C. 1132(c) 
(1) and (2)) shall apply to any information required by the Secretary 
to be disclosed and reported under this section.
    (d) Regulations.--The Secretary, in consultation with the Secretary 
of Health and Human Services, may promulgate such regulations as may be 
necessary or appropriate to carry out this subtitle.

SEC. 2909. DEFINITIONS.

    As used in this subtitle:
            (1) Attending provider.--The term ``attending provider'' 
        shall include the obstetrician-gynecologists, pediatrician, 
        family physician, or other physician attending the mother or 
        newly born child. Such term shall also include any other health 
        care provider who, in accordance with applicable State law, may 
        be primarily responsible for the care of a mother and her 
        newborn child (including nurse midwives and nurse 
        practitioners).
            (2) Beneficiary.--The term ``beneficiary'' has the meaning 
        given such term under section 3(8) of the Employee Retirement 
        Income Security Act of 1974 (29 U.S.C. 1002(8)).
            (3) Employee health benefit plan.--
                    (A) In general.--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 (1), (32), and (33))) that provides or pays 
                for health benefits (such as provider and hospital 
                benefits) for participants and beneficiaries whether--
                            (i) directly;
                            (ii) through a health plan offered by a 
                        health plan issuer as defined in paragraph (4); 
                        or
                            (iii) otherwise.
                    (B) Rule of construction.--An employee health 
                benefit plan shall not be construed to be a health plan 
                or a health plan issuer.
                    (C) Arrangements not included.--Such term does not 
                include the following, or any combination thereof:
                            (i) Coverage only for accident, or 
                        disability income insurance, or any combination 
                        thereof.
                            (ii) Medicare supplemental health insurance 
                        (as defined under section 1882(g)(1) of the 
                        Social Security Act).
                            (iii) Coverage issued as a supplement to 
                        liability insurance.
                            (iv) Liability insurance, including general 
                        liability insurance and automobile liability 
                        insurance.
                            (v) Workers compensation or similar 
                        insurance.
                            (vi) Automobile medical payment insurance.
                            (vii) Coverage for a specified disease or 
                        illness.
                            (viii) Hospital or fixed indemnity 
                        insurance.
                            (ix) Short-term limited duration insurance.
                            (x) Credit-only, dental-only, or vision-
                        only insurance.
                            (xi) A health insurance policy providing 
                        benefits only for long-term care, nursing home 
                        care, home health care, community-based care, 
                        or any combination thereof.
            (4) Group purchaser.--The term ``group purchaser'' means 
        any person (as defined under paragraph (9) of section 3 of the 
        Employee Retirement Income Security Act of 1974 (29 U.S.C. 
        1002(9)) or entity that purchases or pays for health benefits 
        (such as provider or hospital benefits) on behalf of 
        participants or beneficiaries in connection with an employee 
        health benefit plan.
            (5) Health plan.--
                    (A) In general.--The term ``health plan'' means any 
                group health plan or individual health plan.
                    (B) Group health plan.--The term ``group health 
                plan'' means any contract, policy, certificate or other 
                arrangement offered by a health plan issuer to a group 
                purchaser that provides or pays for health benefits 
                (such as provider and hospital benefits) in connection 
                with an employee health benefit plan.
                    (C) Individual health plan.--The term ``individual 
                health plan'' means any contract, policy, certificate 
                or other arrangement offered to individuals by a health 
                plan issuer that provides or pays for health benefits 
                (such as provider and hospital benefits) and that is 
                not a group health plan.
                    (D) Arrangements not included.--Such term does not 
                include the following, or any combination thereof:
                            (i) Coverage only for accident, or 
                        disability income insurance, or any combination 
                        thereof.
                            (ii) Medicare supplemental health insurance 
                        (as defined under section 1882(g)(1) of the 
                        Social Security Act).
                            (iii) Coverage issued as a supplement to 
                        liability insurance.
                            (iv) Liability insurance, including general 
                        liability insurance and automobile liability 
                        insurance.
                            (v) Workers compensation or similar 
                        insurance.
                            (vi) Automobile medical payment insurance.
                            (vii) Coverage for a specified disease or 
                        illness.
                            (viii) Hospital or fixed indemnity 
                        insurance.
                            (ix) Short-term limited duration insurance.
                            (x) Credit-only, dental-only, or vision-
                        only insurance.
                            (xi) A health insurance policy providing 
                        benefits only for long-term care, nursing home 
                        care, home health care, community-based care, 
                        or any combination thereof.
                    (E) Certain plans included.--Such term includes any 
                plan or arrangement not described in any clause of 
                subparagraph (D) which provides for benefit payments, 
                on a periodic basis, for--
                            (i) a specified disease or illness, or
                            (ii) a period of hospitalization,
                without regard to the costs incurred or services 
                rendered during the period to which the payments 
                relate.
            (6) Health plan issuer.--The term ``health plan issuer'' 
        means any entity that is licensed (prior to or after the date 
        of enactment of this Act) by a State to offer a health plan.
            (7) Participant.--The term ``participant'' has the meaning 
        given such term under section 3(7) of the Employee Retirement 
        Income Security Act of 1974 (29 U.S.C. 1002(7)).
            (8) Secretary.--The term ``Secretary'' unless otherwise 
        specified means the Secretary of Labor.

SEC. 2910. PREEMPTION.

    The provisions of this subtitle shall not preempt those provisions 
of State law that require health plans to provide a minimum of 48 hours 
of in-patient care in the case of a normal vaginal delivery, and 96 
hours of in-patient care in the case of a caesarean section, or that 
require health plans to provide for maternity and pediatric care that 
is in accordance with guidelines established by the American College of 
Obstetricians and Gynecologists and the American Academy of Pediatrics, 
and to provide follow-up care consistent with this subtitle.

SEC. 2911. EFFECTIVE DATE.

    Except as otherwise provided for in this subtitle, the provisions 
of this subtitle shall apply as follows:
            (1) With respect to health plans, such provisions shall 
        apply to plans offered, sold, issued, renewed, in effect, or 
        operated on or after January 1, 1997.
            (2) With respect to employee health benefit plans, such 
        provisions shall apply to such plans on the first day of the 
        first plan year beginning on or after January 1, 1997.

    Subtitle Y--Obstetrician-Gynecologists as Primary Care Providers

SEC. 2951. SENSE OF THE SENATE REGARDING OBSTETRICIAN-GYNECOLOGISTS

    (a) Findings.--Congress finds that--
            (1) women constitute more than 50 percent of the population 
        of the United States;
            (2) because women's health historically has received little 
        attention in terms of Federal funding and in terms of research 
        priorities, there should be an increased emphasis on the needs 
        and preferences of women in such areas;
            (3) the Federal Government should increase its support for 
        women's health and can make a significant difference in 
        improving the status of women's health;
            (4) increased funding for research is insignificant if 
        women's health care services are restricted;
            (5) many women view their obstetrician-gynecologist as 
        their primary or sole physician;
            (6) approximately 70 percent of women would be unwilling to 
        change their obstetrician-gynecologist to save money;
            (7) an obstetrician-gynecologist improves the access to 
        health care of a woman by providing primary and preventive 
        health care throughout the woman's lifetime, encompassing care 
        of the whole patient in addition to focusing on the processes 
        of the female reproductive system;
            (8) preventive and primary care provided by an 
        obstetrician-gynecologist includes instruction in breast self-
        examination, cervical cancer screening, health education, 
        instruction in health promotion, hypertension and 
        cardiovascular surveillance, osteoporosis counseling, sexually 
        transmitted diseases counseling, and identification of victims 
        of domestic violence;
            (9) the most effective way to treat health problems is to 
        prevent such problems from occurring or to catch such problems 
        in the early stages, when such problems are most treatable;
            (10) 60 percent of all office visits to obstetrician-
        gynecologists are for preventive care;
            (11) obstetrician-gynecologists refer their patients to 
        other physicians less frequently than other primary care 
        providers, thus avoiding costly and time-consuming referrals;
            (12) more than two-thirds of all visits to obstetrician-
        gynecologists were by established patients of the physician who 
        were returning for care of a medical condition;
            (13) obstetrician-gynecologists manage the health of women 
        beyond the reproductive system, and are uniquely qualified on 
        the basis of education and experience to provide such health 
        care services to women;
            (14) obstetrician-gynecologists provide health care to 
        women with an awareness of the relationship of disease to 
        family history;
            (15) over two-thirds of general family practice physicians 
        do not deliver newborns and will not be able to address this 
        need of women; and
            (16) 80 percent of maternity care services in the United 
        States are provided by obstetrician-gynecologists.
    (b) Sense of the Senate.--It is the sense of the Senate that--
            (1) obstetrician-gynecologists should be included as 
        primary care providers for women in Federal laws relating to 
        the provision of health care; and
            (2) legislative proposals that define primary care should 
        include primary care services performed by obstetrician-
        gynecologists in such definition.
                                 <all>