[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 592 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                 S. 592

                   To improve the health of children.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 11, 1999

   Mr. Bond introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
                   To improve the health of children.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Healthy Kids 2000 
Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
 TITLE I--HEALTH CARE ACCESSIBILITY AND ACCOUNTABILITY FOR MOTHERS AND 
                                NEWBORNS

 Subtitle A--Accessibility of Mothers and Newborns to Health Insurance

Sec. 101. Short title; references.
Sec. 102. Optional coverage of low-income, uninsured pregnant women 
                            under a State child health plan.
Sec. 103. Automatic enrollment for children born to women receiving 
                            pregnancy-related assistance.
Sec. 104. Expanded availability of funding for administrative costs 
                            related to outreach and eligibility 
                            determinations.
            Subtitle B--Patient Rights With Respect to Care

Sec. 111. Pa``subpart c--patient rights with respect to care
        ``Sec. 721. Patient access to obstetric and gynecological care.
        ``Sec. 722. Access to pediatric care.
        ``Sec. 723. Accountability through distribution of information.
        ``Sec. 724. Generally applicable provision.
Sec. 112. Grievances and appeals with respect to children.
Sec. 113. Amendments to the Internal Revenue Code of 1986.
Sec. 114. Effective date.
  TITLE II--PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE GME PROGRAMS

Sec. 201. Short title.
Sec. 202. Program of payments to children's hospitals that operate 
                            graduate medical education programs.
              TITLE III--PEDIATRIC PUBLIC HEALTH PROMOTION

 Subtitle A--National Center for Birth Defects Research and Prevention

Sec. 301. National center for birth defects research and prevention.
       Subtitle B--Pregnant Mothers and Infants Health Promotion

Sec. 311. Short title.
Sec. 312. Findings.
Sec. 313. Establishment.
     Subtitle C--Safe Motherhood Monitoring and Prevention Research

Sec. 321. Short title.
Sec. 322. Amendment to Public Health Service Act.
             Subtitle D--Poison Control Center Enhancement

Sec. 331. Short title.
Sec. 332. Findings.
Sec. 333. Definition.
Sec. 334. Establishment of a national toll-free number.
Sec. 335. Establishment of nationwide media campaign.
Sec. 336. Establishment of a grant program.
                      TITLE IV--PEDIATRIC RESEARCH

Sec. 401. Establishment of a pediatric research initiative.
Sec. 402. Investment in tomorrow's pediatric researchers.

 TITLE I--HEALTH CARE ACCESSIBILITY AND ACCOUNTABILITY FOR MOTHERS AND 
                                NEWBORNS

 Subtitle A--Accessibility of Mothers and Newborns to Health Insurance

SEC. 101. SHORT TITLE; REFERENCES.

    (a) Short Title.--This subtitle may be cited as the ``Mothers and 
Newborns Health Insurance Act of 1999''.
    (b) References to Social Security Act.--Except as otherwise 
expressly provided, whenever in this subtitle an amendment or repeal is 
expressed as an amendment to, or repeal of, a section or other 
provision, the reference shall be considered to be made to a section or 
other provision of the Social Security Act.

SEC. 102. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN 
              UNDER A STATE CHILD HEALTH PLAN.

    (a) In General.--Title XXI (42 U.S.C. 1397aa et seq.) is amended by 
adding at the end the following new section:

``SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN.

    ``(a) Optional Coverage.--Notwithstanding any other provision of 
this title, a State child health plan may provide for coverage of 
pregnancy-related assistance for targeted low-income pregnant women in 
accordance with this section.
    ``(b) Definitions.--For purposes of this section:
            ``(1) Pregnancy-related assistance.--The term `pregnancy-
        related assistance' has the meaning given the term `child 
        health assistance' in section 2110(a) as if any reference to 
        targeted low-income children were a reference to targeted low-
        income pregnant women, except that the assistance shall be 
        limited to services related to pregnancy (which include 
        prenatal, delivery, and postpartum services) and to other 
        conditions that may complicate pregnancy and shall not include 
        pre-pregnancy services and supplies.
            ``(2) Targeted low-income pregnant woman.--The term 
        `targeted low-income pregnant woman' has the meaning given the 
        term `targeted low-income child' in section 2110(b) as if any 
        reference to a child were deemed a reference to a woman during 
        pregnancy and through the end of the month in which the 60-day 
period (beginning on the last day of her pregnancy) ends.
    ``(c) References to Terms and Special Rules.--In the case of, and 
with respect to, a State providing for coverage of pregnancy-related 
assistance to targeted low-income pregnant women under subsection (a), 
the following special rules apply:
            ``(1) Any reference in this title (other than subsection 
        (b)) to a targeted low-income child is deemed to include a 
        reference to a targeted low-income pregnant woman.
            ``(2) Any such reference to child health assistance with 
        respect to such women is deemed a reference to pregnancy-
        related assistance.
            ``(3) Any such reference to a child is deemed a reference 
        to a woman during pregnancy and the period described in 
        subsection (b)(2).
            ``(4) The medicaid applicable income level is deemed a 
        reference to the income level established under section 
        1902(l)(2)(A).
            ``(5) Subsection (a) of section 2103 (relating to required 
        scope of health insurance coverage) shall not apply insofar as 
        a State limits coverage to services described in subsection 
        (b)(1) and the reference to such section in section 2105(a)(1) 
        is deemed not to require, in such case, compliance with the 
        requirements of section 2103(a).
            ``(6) There shall be no exclusion of benefits for services 
        described in subsection (b)(1) based on any pre-existing 
        condition, and no waiting period (including a waiting period to 
        carry out section 2102(b)(3)(C)) shall apply.
    ``(d) No Impact on Allotments.--Nothing in this section shall be 
construed as affecting the amount of any initial allotment provided to 
a State under section 2104(b).
    ``(e) Application of Funding Restrictions.--The coverage under this 
section (and the funding of such coverage) is subject to the 
restrictions of section 2105(c).''.
    (b) Conforming Amendment.--Section 2102(b)(1)(B) (42 U.S.C. 
1397bb(b)(1)(B)) is amended--
            (1) by striking ``and'' at the end of clause (i);
            (2) by striking the period at the end of clause (ii) and 
        inserting ``, and''; and
            (3) by adding at the end the following new clause:
                            ``(iii) may not apply a waiting period 
                        (including a waiting period to carry out 
                        paragraph (3)(C)) in the case of a targeted 
                        low-income child who is pregnant.''.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
shall take effect on the date of the enactment of this Act and shall 
apply to allotments for all fiscal years.

SEC. 103. AUTOMATIC ENROLLMENT FOR CHILDREN BORN TO WOMEN RECEIVING 
              PREGNANCY-RELATED ASSISTANCE.

    (a) In General.--Section 2111, as added by section 102, is amended 
by adding at the end the following new subsection:
    ``(f) Automatic Enrollment for Children Born to Women Receiving 
Pregnancy-Related Assistance.--Notwithstanding any other provision of 
this title, if a child is born to a targeted low-income pregnant woman 
who was receiving pregnancy-related assistance under this section on 
the date of the child's birth, the child shall be deemed to have 
applied for child health assistance under the State child health plan 
on the date of such birth, to have been found eligible for such 
assistance on such date, and to remain eligible for such assistance 
until the child attains 1 year of age.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act and shall apply to 
allotments for all fiscal years.

SEC. 104. EXPANDED AVAILABILITY OF FUNDING FOR ADMINISTRATIVE COSTS 
              RELATED TO OUTREACH AND ELIGIBILITY DETERMINATIONS.

    Section 1931(h) (42 U.S.C. 1396u-1(h)) is amended--
            (1) by striking the subsection heading and inserting 
        ``Increased Federal Matching Rate for Administrative Costs 
        Related to Outreach and Eligibility Determinations'';
            (2) in paragraph (2), by striking ``eligibility 
        determinations'' and all that follows and inserting 
        ``determinations of the eligibility of children and pregnant 
        women for benefits under the State plan under this title or 
        title XXI, outreach to children and pregnant women likely to be 
        eligible for such benefits, and such other outreach- and 
        eligibility-related activities as the Secretary may approve.'';
            (3) in paragraph (3), by striking ``and ending with fiscal 
        year 2000''; and
            (4) by striking paragraph (4) and inserting the following:
            ``(4) Encouraging use of local and community-based 
        organizations in outreach and enrollment activities.--The 
        Secretary shall establish a procedure under which, if a State 
        does not otherwise obligate the amounts made available under 
        this subsection, local and community-based public or nonprofit 
        private organizations (including local and county governments, 
        public health departments, community health centers, children's 
        hospitals, and disproportionate share hospitals) may seek to 
        have administrative costs relating to outreach and enrollment 
        of children and pregnant women under this title and title XXI 
        treated as administrative costs of a State described in section 
        1903(a)(7), if such organizations have the permission of the 
        State involved. A State may require such an organization to 
        provide payment of such amounts as the State would otherwise be 
        responsible for in order to obtain payment under this 
        paragraph.''.

            Subtitle B--Patient Rights With Respect to Care

SEC. 111. PATIENT RIGHTS WITH RESPECT TO CARE.

    (a) In General.--Part 7 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1181 et seq.) is 
amended--
            (1) by redesignating subpart C as subpart D; and
            (2) by inserting after subpart B the following:

            ``Subpart C--Patient Rights With Respect to Care

``SEC. 721. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.

    ``(a) In General.--In any case in which a group health plan (other 
than a fully insured group health plan)--
            ``(1) provides coverage for benefits consisting of--
                    ``(A) gynecological care (such as preventive 
                women's health examinations); or
                    ``(B) obstetric care (such as pregnancy-related 
                services);
        provided by a participating physician who specializes in such 
        care; and
            ``(2) requires or provides for the designation by a 
        participant or beneficiary of a participating primary care 
        provider;
if the primary care provider designated by such participant or 
beneficiary is not such a physician as described in paragraph (1), then 
the plan shall meet the requirements of subsection (b).
    ``(b) Requirements.--A group health plan (other than a fully 
insured group health plan) that meets the requirements of this 
subsection, in connection with the coverage of benefits described in 
subsection (a) consisting of care described in subparagraph (A) or (B) 
of subsection (a)(1), if the plan--
            ``(1) does not require authorization or a referral by the 
        primary care provider in order to obtain coverage for such 
        benefits; and
            ``(2) treats the ordering of other routine care related to 
        the care described in subparagraph (A) or (B) of subsection 
        (a)(1), by the participating physician providing the care 
        described in either such subparagraph, as the authorization of 
        the primary care provider with respect to such care.
    ``(c) Rule of Construction.--Nothing in subsection (b)(2) shall be 
construed as waiving any requirements of coverage relating to medical 
necessity or appropriateness with respect to the coverage of the 
gynecological or obstetric care so ordered. Nothing in subsection (b) 
shall be construed to preclude the health plan from requiring that the 
obstetrician or gynecologist notify the primary care provider or the 
plan of treatment decisions.

``SEC. 722. ACCESS TO PEDIATRIC CARE.

    ``(a) Access to Appropriate Pediatric Primary Care Providers.--
            ``(1) In general.--If a group health plan (other than a 
        fully insured group health plan) requires or provides for a 
        participant to designate a participating pediatric primary care 
        provider for a child of such participant--
                    ``(A) the plan or issuer shall permit the 
                participant to designate a pediatric primary care 
                provider who specializes in pediatrics as the child's 
                primary care provider; and
                    ``(B) if such a participant has not designated such 
                a provider for the child, the plan or issuer shall 
                consider appropriate pediatric expertise in mandatorily 
                assigning such a participant to a pediatric primary 
                care provider.
            ``(2) Construction.--Nothing in paragraph (1) shall be 
        construed to--
                    ``(A) waive any requirements of coverage relating 
                to medical necessity or appropriateness with respect to 
                coverage of services; or
                    ``(B) preclude the group health plan involved from 
                requiring that the pediatric provider notify the 
                primary care provider or the plan of treatment 
                decisions.
    ``(b) Referral to Speciality Care for Children Requiring Treatment 
by Specialists.--
            ``(1) In general.--In the case of a child who is covered 
        under a group health plan (other than a fully insured group 
        health plan) and who has a mental or physical condition, 
        disability, or disease of sufficient seriousness and complexity 
        to require diagnosis, evaluation or treatment by a specialist, 
        the plan shall make or provide for a referral to a specialist 
        who has extensive experience or training, and is available and 
        accessible to provide the treatment for such condition or 
        disease, including the choice of a nonprimary care specialist 
        participating in the plan or a referral to a nonparticipating 
        provider as provided for under paragraph (4) if such a provider 
        is not available within the plan.
            ``(2) Specialist defined.--For purposes of this subsection, 
        the term `specialist' means, with respect to a condition, 
        disability, or disease, a health care practitioner, facility 
        (such as a children hospital), or center (such as a center of 
        excellence) that has extensive pediatric expertise through 
        appropriate training or experience to provide high quality care 
        in treating the condition, disability, or disease.
            ``(3) Referrals to participating providers.--A group health 
        plan (other than a fully insured group health plan) is not 
        required under paragraph (1) to provide for a referral to a 
        specialist that is not a participating provider, unless the 
        plan does not have an appropriate specialist that is available 
and accessible to treat the participant's or beneficiary's condition 
and that is a participating provider with respect to such treatment.
            ``(4) Treatment of nonparticipating providers.--If a group 
        health plan (other than a fully insured group health plan) 
        refers a child beneficiary to a nonparticipating specialist, 
        services provided pursuant to the referral shall be provided at 
        no additional cost to the participant beyond what the 
        participant would otherwise pay for services received by such a 
        specialist who is a participating provider.
    ``(c) Definition.--In this subpart, the term `child' means an 
individual who is under 19 years of age.

``SEC. 723. ACCOUNTABILITY THROUGH DISTRIBUTION OF INFORMATION.

    ``(a) In General.--A group health plan (other than a fully insured 
group health plan) shall, with respect to the coverage of children, 
submit to participants (and prospective participants), and make 
available to the public, in writing the health-related information 
described in subsection (b).
    ``(b) Information.--The information to be provided under subsection 
(a) shall include information on the structures, processes, and 
outcomes regarding each health insurance product offered to 
participants and beneficiaries in a manner that is separate for both 
the adult and child participants and beneficiaries, using measures that 
are specific to each group.

``SEC. 724. GENERALLY APPLICABLE PROVISION.

    ``In the case of a group health plan that provides benefits under 2 
or more coverage options, the requirements of this subpart shall apply 
separately with respect to each coverage option.''.
    (b) Definition.--Section 733(a) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1191b(a)) is amended by adding at the 
end the following:
            ``(3) Fully insured group health plan.--The term `fully 
        insured group health plan' means a group health plan where 
        benefits are provided pursuant to the terms of an arrangement 
        between a group health plan and a health insurance issuer and 
        are guaranteed by the health insurance issuer under a contract 
        or policy of insurance.''.
    (c) Conforming Amendment.--The table of contents in section 1 of 
the Employee Retirement Income Security Act of 1974 is amended--
            (1) in the item relating to subpart C, by striking 
        ``Subpart C'' and inserting ``Subpart D''; and
            (2) by adding at the end of the items relating to subpart B 
        of part 7 of subtitle B of title I of such Act the following 
        new items:

            ``subpart c--patient rights with respect to care
``Sec. 721. Patient access to obstetric and gynecological care.
``Sec. 722. Access to pediatric care.
``Sec. 723. Accountability through distribution of information.
``Sec. 724. Generally applicable provision.''.

SEC. 112. GRIEVANCES AND APPEALS WITH RESPECT TO CHILDREN.

    (a) In General.--Section 503 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1133) is amended to read as follows:

``SEC. 503. CLAIMS PROCEDURE, AND GRIEVANCES AND APPEALS WITH RESPECT 
              TO CHILDREN.

    ``(a) Claims Procedure.--In accordance with regulations of the 
Secretary, every employee benefit plan shall--
            ``(1) provide adequate notice in writing to any participant 
        or beneficiary whose claim for benefits under the plan has been 
        denied, setting forth the specific reasons for such denial, 
        written in a manner calculated to be understood by the 
        participant, and
            ``(2) afford a reasonable opportunity to any participant 
        whose claim for benefits has been denied for a full and fair 
        review by the appropriate named fiduciary of the decision 
        denying the claim.
    ``(b) Internal Appeals Process.--A group health plan, or health 
insurance issuer in connection with the provisions of health insurance 
coverage, shall, with respect to the coverage of children, establish 
and maintain a system to provide for the resolution of complaints and 
appeals regarding all aspects of such coverage. Such a system shall 
include an expedited procedure for appeals where a standard appeal 
would jeopardize the life, health, or development of the child.
    ``(c) External Appeals Process.--A group health plan, or health 
insurance issuer in connection with the provision of health insurance 
coverage, shall, with respect to the coverage of children, provide for 
an independent external review process that meets the following 
requirements:
            ``(1) External appeal activities shall be conducted through 
        clinical peers, including a physician or other health care 
        professional who is appropriately credentialed in pediatrics 
        who has the same or similar specialty as the speciality 
        involved in the appeal and who has experience managing the 
        condition, procedure, or treatment under review or appeal.
            ``(2) External appeal activities shall be conducted through 
        an entity that has sufficient pediatric expertise, including 
        subspeciality expertise, and staffing to conduct external 
        appeal activities on a timely basis.
            ``(3) Such a review process shall include an expedited 
        procedure for appeals on behalf of a child enrollee in which 
        the time frame of a standard appeal would jeopardize the life, 
        health, or development of the child.''.
    (b) Conforming Amendment.--The table of contents in section 1 of 
the Employee Retirement Income Security Act of 1974 is amended by 
striking the item relating to section 503 and inserting the following 
new item:

``Sec. 503. Claims procedures and grievances and appeals with respect 
                            to children.''.

SEC. 113. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

    Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is 
amended--
            (1) in the table of sections, by inserting after the item 
        relating to section 9812 the following new item:

                              ``Sec. 9813. Standard relating to 
                                        Patients' bill of rights.''; 
                                        and
            (2) by inserting after section 9812 the following:

``SEC. 9813. STANDARD RELATING TO PATIENTS' RIGHTS.

    ``A group health plan shall comply with the requirements of subpart 
C of part 7 of subtitle B of title I of the Employee Retirement Income 
Security Act of 1974 (as in effect as of the date of the enactment of 
the Healthy Kids 2000 Act), and such requirements shall be deemed to be 
incorporated into this section.''.

SEC. 114. EFFECTIVE DATE.

    (a) In General.--The amendments made by this subtitle shall apply 
with respect to plan years beginning on or after January 1 of the 
second calendar year following the date of the enactment of this Act. 
The Secretary shall issue all regulations necessary to carry out the 
amendments made by this section before the effective date thereof.
    (b) Limitation on Enforcement Actions.--No enforcement action shall 
be taken, pursuant to the amendments made by this subtitle, against a 
group health plan with respect to a violation of a requirement imposed 
by such amendments before the date of issuance of regulations issued in 
connection with such requirement.

  TITLE II--PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE GME PROGRAMS

SEC. 201. SHORT TITLE.

    This title may be cited as the ``Pediatric Medical Education, 
Training, and Research Act of 1999''.

SEC. 202. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE 
              GRADUATE MEDICAL EDUCATION PROGRAMS.

    (a) Payments.--
            (1) In general.--The Secretary shall make payment under 
        this section to each children's hospital for each hospital cost 
        reporting period beginning after fiscal year 1999 and before 
        fiscal year 2004 for the direct and indirect expenses 
        associated with operating approved medical residency training 
        programs.
            (2) Payment amount.--Subject to paragraph (3), the amount 
        payable under this section to a children's hospital for direct 
        and indirect expenses relating to approved medical residency 
        training programs for a cost reporting period ending in a 
        fiscal year is equal to the sum of the amount determined under 
        subsection (b) and the amount determined under subsection (c) 
        for such hospital for such fiscal year.
            (3) Capped amount.--
                    (A) In general.--The payments to children's 
                hospitals established in this subsection for cost 
                reporting periods ending in any fiscal year shall not 
                exceed the funds appropriated under subsection (e) for 
                that fiscal year.
                    (B) Pro rata reductions.--If the Secretary 
                determines that the amount of funds appropriated under 
                subsection (e) for cost reporting periods ending in any 
                fiscal year is insufficient to provide the total amount 
                of payments otherwise due for such periods, the 
                Secretary shall reduce each of the amounts payable 
                under this section for such period on a pro rata basis 
                to reflect such shortfall.
    (b) Amount of Payment for Direct Medical Education.--
            (1) In general.--The amount determined under this 
        subsection for payments to a children's hospital for direct 
        expenses relating to approved medical residency training 
        programs for a cost reporting period ending in fiscal years 
        2000 through 2003 is equal to the product of--
                    (A) the per resident rate for direct medical 
                education, as determined under paragraph (2), for the 
                cost reporting period; and
                    (B) the weighted average number of full-time 
                equivalent residents in the hospital's approved medical 
                residency training programs (as determined under 
                section 1886(h)(4) of the Social Security Act (42 
                U.S.C. 1395ww(h)(4))) for the cost reporting period.
            (2) Per resident rate for direct medical education.--
                    (A) In general.--The per resident rate for direct 
                medical education for a hospital for a cost reporting 
                period is the updated rate determined under 
                subparagraph (B).
                    (B) Computation updated rate.--The updated rate 
                determined under this subparagraph is equal to the 
                lesser of--
                            (i) a rate equal to the weighted average of 
                        the per resident rates computed under section 
                        1886(h)(2) of the Social Security Act (42 
                        U.S.C. 1395ww(h)(2)) for cost reporting periods 
                        ending during fiscal year 1999 for all 
                        hospitals located in the Metropolitan 
Statistical Area in which the hospital involved is located; or
                            (ii) the per resident rate for cost 
                        reporting periods ending during fiscal year 
                        1999 for the hospital involved (as determined 
                        by the Secretary using the methodology 
                        described in section 1886(h)(2)(E)) of such Act 
                        (42 U.S.C. 1395ww(h)(2)(E)));
                each such rate updated by the hospital market basket 
                increase percentage from fiscal year 1999 through the 
                fiscal year involved.
    (c) Amount of Payment for Indirect Medical Education.--
            (1) In general.--The amount determined under this 
        subsection for payments to a children's hospital for indirect 
        expenses relating to approved medical residency training 
        programs for a cost reporting period ending in fiscal years 
        2000 through 2003 is equal to an amount determined appropriate 
        by the Secretary.
            (2) Factors.--In determining the amount under paragraph 
        (1), the Secretary shall--
                    (A) take into account variations in case mix among 
                children's hospitals and the weighted average number of 
                full-time equivalent residents in the hospitals' 
                approved medical residency training programs (as 
                determined under section 1886(h)(4) of the Social 
                Security Act (42 U.S.C. 1395ww(h)(4))) for the cost 
                reporting period; and
                    (B) assure that the aggregate of the payments for 
                indirect expenses relating to approved medical 
                residency training programs under this section in a 
                fiscal year are equal to the amount appropriated for 
                such expenses in such year under subsection (e)(2).
    (d) Making of Payments.--
            (1) Interim payments.--The Secretary shall estimate, before 
        the beginning of each cost reporting period for a hospital for 
        which a payment may be made under this section, the amount of 
        the payment for such period and shall (subject to paragraph 
        (2)) make payment of such amount in 26 equal interim 
        installments during such period.
            (2) Withholding.--The Secretary shall withhold up to 25 
        percent from each interim installment paid under paragraph (1).
            (3) Reconciliation.--At the end of each such period, the 
        hospital shall submit to the Secretary such information as the 
        Secretary determines to be necessary to determine the percent 
        (if any) of the amount withheld under paragraph (2) that is due 
        under this section for the hospital for the period. Based on 
        such determination, the Secretary shall recoup any overpayments 
        made, or pay any balance due. The amount so determined shall be 
        considered a final intermediary determination for purposes of 
        applying section 1878 of the Social Security Act (42 U.S.C. 
        1395oo) and shall be subject to review under that section in 
        the same manner as the amount of payment under section 1886(d) 
        of such Act (42 U.S.C. 1395ww(d)) is subject to review under 
        such section.
    (e) Limitation on Expenditures.--
            (1) Payment for direct medical education expenses 
        representing medicare's share of such expenses.--
                    (A) In general.--Subject to subparagraph (B), there 
                are hereby appropriated, out of any money in the 
                Treasury not otherwise appropriated, for payments under 
                this section for direct expenses relating to approved 
                medical residency training programs for a cost 
                reporting period for cost reporting periods beginning 
                in--
                            (i) fiscal year 2000, $35,000,000;
                            (ii) fiscal year 2001, $95,000,000;
                            (iii) fiscal year 2002, $95,000,000; and
                            (iv) fiscal year 2003, $95,000,000.
                    (B) Carryover of excess.--If the amount of payments 
                under this section for cost reporting periods ending in 
                fiscal year 2000, 2001, or 2002 is less than the amount 
                provided under this paragraph for such payments for 
                such periods, then the amount available under this 
                paragraph for cost reporting periods ending in the 
                following fiscal year shall be increased by the amount 
                of such difference.
            (2) Payment for indirect medical education expenses 
        representing medicare's share of such expenses.--There are 
        hereby appropriated, out of any money in the Treasury not 
        otherwise appropriated, for payments under this section for 
        indirect expenses relating to approved medical residency 
        training programs for a cost reporting period for cost 
        reporting periods beginning in--
                    (A) fiscal year 2000, $65,000,000;
                    (B) fiscal year 2001, $190,000,000;
                    (C) fiscal year 2002, $190,000,000; and
                    (D) fiscal year 2003, $190,000,000.
    (f) Relation to Medicare and Medicaid Payments.--Notwithstanding 
any other provision of law, payments under this section to a hospital 
for a cost reporting period--
            (1) are in lieu of any amounts otherwise payable to the 
        hospital under section 1886(h) or 1886(d)(5)(B) of the Social 
        Security Act (42 U.S.C. 1395ww(h); 1395ww(d)(5)B)) to the 
        hospital for such cost reporting period, but
            (2) shall not affect the amounts otherwise payable to such 
        hospitals under a State Medicaid plan under title XIX of the 
        Social Security Act (42 U.S.C. 1396 et seq.).
    (g) Definitions.--In this section:
            (1) Approved medical residency training program.--The term 
        ``approved medical residency training program'' has the meaning 
        given such term in section 1886(h)(5)(A) of the Social Security 
        Act (42 U.S.C. 1395ww(h)(5)(A)).
            (2) Children's hospital.--The term ``children's hospital'' 
        means a hospital described in section 1886(d)(1)(B)(iii) of the 
        Social Security Act (42 U.S.C. 1395ww(d)(1)(B)(iii)).
            (3) Direct graduate medical education costs.--The term 
        ``direct graduate medical education costs'' has the meaning 
        given such term in section 1886(h)(5)(C) of the Social Security 
        Act (42 U.S.C. 1395ww(h)(5)(C)).
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

              TITLE III--PEDIATRIC PUBLIC HEALTH PROMOTION

 Subtitle A--National Center for Birth Defects Research and Prevention

SEC. 301. NATIONAL CENTER FOR BIRTH DEFECTS RESEARCH AND PREVENTION.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following:

              ``PART Q--PEDIATRIC PUBLIC HEALTH PROMOTION

``SEC. 399L. NATIONAL CENTER FOR BIRTH DEFECTS RESEARCH AND PREVENTION.

    ``(a) Establishment.--There is established within the Centers for 
Disease Control and Prevention a center to be known as the National 
Center for Birth Defects Research and Prevention.
    ``(b) Purpose.--The general purpose of the National Center 
established under subsection (a) shall be to--
            ``(1) collect, analyze, and make available data on birth 
        defects, including data on the causes of such defects and on 
        the incidence and prevalence of such defects;
            ``(2) conduct applied epidemiological research on the 
        prevention of such defects; and
            ``(3) provide information and education to the public on 
        the prevention of such defects.
    ``(c) Director.--The National Center established under subsection 
(a) shall be headed by a director to be appointed by the Secretary.
    ``(d) Transfers.--There shall be transferred to the National Center 
established under subsection (a) all activities, budgets and personnel 
of the National Center for Environmental Health that relate to birth 
defects, folic acid, cerebral palsy, mental retardation, child 
development, newborn screening, autism, fragile X syndrome, fetal 
alcohol syndrome, pediatric genetics, and disability prevention.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.

       Subtitle B--Pregnant Mothers and Infants Health Promotion

SEC. 311. SHORT TITLE.

    This subtitle may be cited as the ``Pregnant Mothers and Infants 
Health Protection Act''.

SEC. 312. FINDINGS.

    Congress makes the following findings:
            (1) Alcohol consumption by a woman during her pregnancy can 
        cause the woman to have a miscarriage and otherwise cause 
        serious harm to her baby, including low birth weight, birth 
        defects, and behavioral problems.
            (2) Illegal drug usage can cause problems such as 
        miscarriage, early birth, or high or low blood pressure for the 
        mother.
            (3) Exposure to illegal drugs often causes babies to die 
        before or after they are born. If a baby is born alive, the 
        newborn might be addicted to drugs and have painful withdrawal. 
        Drug exposure may also cause severe damage to the newborn's 
        organs, such as the brain, eyes, ears, heart, kidneys, or 
        genitals.
            (4) Smoking tobacco products during pregnancy significantly 
        increases maternal and fetal risk and accounts for 20 to 30 
        percent of the low birth weight rate and 10 percent of the 
        fetal and infant death rate in the United States.
            (5) Infants of mothers who smoke during and after pregnancy 
        have nearly a 3 fold increase in the risk of Sudden Infant 
        Death Syndrome (referred to in this section as ``SIDS'') as 
        compared to infants of mothers who do not smoke.
            (6) Smoking during pregnancy has been associated with 
        certain childhood cancers and birth defects, and it increases 
        the risk of spontaneous abortion, premature rupture of 
        membranes, and delivery of a stillborn infant.
            (7) Smoking during pregnancy may impede the growth of the 
        fetus and increase the likelihood of mental retardation by 50 
        percent.
            (8) The proportion of women who quit smoking during 
        pregnancy but relapse within 6 months is nearly 63 percent, 
        thereby exposing their infants to passive smoke and increasing 
        their risk of SIDS and other health related problems.
            (9) Effective prenatal smoking, alcohol, and illegal drug 
        cessation methods increase the rate of cessation during 
        pregnancy.

SEC. 313. ESTABLISHMENT.

    Part Q of title III of the Public Health Service Act (as added by 
section 301) is amended by adding at the end the following:

``SEC. 399M. PROGRAMS REGARDING PRENATAL AND POSTNATAL HEALTH.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall carry out 
programs--
            ``(1) to collect, analyze, and make available data on 
        prenatal smoking, alcohol and illegal drug usage, including 
        data on the implications of such activities and on the 
        incidence and prevalence of such activities and their 
        implications;
            ``(2) to conduct applied epidemiological research on the 
        prevention of prenatal and postnatal smoking, alcohol and 
        illegal drug usage;
            ``(3) to support, conduct, and evaluate the effectiveness 
        of educational and cessation programs; and
            ``(4) to provide information and education to the public on 
        the prevention and implications of prenatal and postnatal 
        smoking, alcohol and illegal drug usage.
    ``(b) Grants.--In carrying out subsection (a), the Secretary may 
award grants to and enter into contracts with States, local 
governments, scientific and academic institutions, Federally qualified 
health centers, and other public and nonprofit entities, and may 
provide technical and consultative assistance to such entities.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $15,000,000 for each of the 
fiscal years 2000 and 2001, and such sums as may be necessary for each 
of the fiscal years 2002 and 2003.''.

     Subtitle C--Safe Motherhood Monitoring and Prevention Research

SEC. 321. SHORT TITLE.

    This Act may be cited as the ``Safe Motherhood Monitoring and 
Prevention Research Act''.

SEC. 322. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.

    Part Q of title III of the Public Health Service Act (as added by 
section 301 and amended by section 311) is further amended by adding at 
the end the following:

``SEC. 399N. SAFE MOTHERHOOD MONITORING.

    ``(a) Purpose.--It is the purpose of this section to develop 
monitoring systems at the local, State, and national level to better 
understand the burden of maternal complications and mortality and to 
decrease the disparities among population at risk of death and 
complications from pregnancy.
    ``(b) Activities.--For the purpose described in subsection (a), the 
Secretary may carry out the following activities:
            ``(1) The Secretary, acting through the Centers for Disease 
        Control and Prevention, may establish and implement a national 
        monitoring and surveillance program to identify and promote the 
        investigation of deaths and severe complications that occur 
        during pregnancy.
            ``(2) The Secretary, acting through the Centers for Disease 
        Control and Prevention, may expand the Pregnancy Risk 
        Assessment Monitoring System to provide surveillance and 
        collect data in each of the 50 States.
            ``(3) The Secretary, acting through the Centers for Disease 
        Control and Prevention, may expand the Maternal and Child 
        Health Epidemiology Program to provide technical support, 
        financial assistance, or the time-limited assignment of senior 
        epidemiologists to maternal and child health programs in each 
        of the 50 States.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $25,000,000 for each fiscal 
year.''.

``SEC. 399O. PREVENTION RESEARCH TO ENSURE SAFE MOTHERHOOD.

    ``(a) Purpose.--It is the purpose of this section to provide the 
Centers for Disease Control and Prevention with the authority to 
further expand research concerning risk factors, prevention strategies, 
and the roles of the family, health care providers and the community in 
safe motherhood.
    ``(b) Research.--The Secretary, acting through the Centers for 
Disease Control and Prevention, may carry out activities to expand 
research relating to--
            ``(1) encouraging preconception counseling, especially for 
        at risk populations such as diabetics;
            ``(2) the identification of critical components of prenatal 
        delivery and postpartum care;
            ``(3) the identification of outreach and support services, 
        such as folic acid education, that are available for pregnant 
        women;
            ``(4) the identification of women who are at high risk for 
        complications;
            ``(5) preventing preterm delivery;
            ``(6) preventing urinary tract infections;
            ``(7) preventing unnecessary caesarean sections;
            ``(8) an examination of the higher rates of maternal 
        mortality among African American women;
            ``(9) an examination of the relationship between domestic 
        violence and maternal complications and mortality;
            ``(10) preventing smoking, alcohol and illegal drug usage 
        before, during and after pregnancy;
            ``(11) preventing infections that cause maternal and infant 
        complications; and
            ``(12) other areas determined appropriate by the Secretary.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $20,000,000 for each fiscal 
year.

``SEC. 399P. PREVENTION PROGRAMS TO ENSURE SAFE MOTHERHOOD.

    ``(a) In General.--The Secretary, acting through the Centers for 
Disease Control and Prevention may carry out activities to promote safe 
motherhood, including--
            ``(1) public education campaigns on healthy pregnancies and 
        the building of partnerships with outside organizations 
        concerned about safe motherhood;
            ``(2) education programs for physicians, nurses and other 
        health care providers; and
            ``(3) activities to promote community support services for 
        pregnant women.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $20,000,000 for each fiscal 
year.''.

             Subtitle D--Poison Control Center Enhancement

SEC. 331. SHORT TITLE.

    This subtitle may be cited as the ``Poison Control Center 
Enhancement and Awareness Act''.

SEC. 332. FINDINGS.

    Congress makes the following findings:
            (1) Each year more than 2,000,000 poisonings are reported 
        to poison control centers throughout the United States. More 
        than 90 percent of these poisonings happen in the home. Fifty-
        three percent of poisoning victims are children younger than 6 
        years of age.
            (2) Poison centers are life-saving and cost-effective 
        public health services. For every dollar spent on poison 
        control centers, $7 in medical costs are saved. The average 
        cost of a poisoning exposure call is $31.28, while the average 
        cost if other parts of the medical system are involved is $932. 
        Over the last 2 decades, the instability and lack of funding 
        has resulted in a steady decline in the number of poison 
        control centers in the United States. Currently, there are 75 
        such centers.
            (3) Stabilizing the funding structure and increasing 
        accessibility to poison control centers will increase the 
        number of United States residents who have access to a 
        certified poison control center, and reduce the inappropriate 
        use of emergency medical services and other more costly health 
        care services.

SEC. 333. DEFINITION.

    In this subtitle, the term ``Secretary'' means the Secretary of 
Health and Human Services.

SEC. 334. ESTABLISHMENT OF A NATIONAL TOLL-FREE NUMBER.

    (a) In General.--The Secretary shall provide coordination and 
assistance to regional poison control centers for the establishment of 
a nationwide toll-free phone number to be used to access such centers.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $2,000,000 for each of the 
fiscal years 2000 through 2004.

SEC. 335. ESTABLISHMENT OF NATIONWIDE MEDIA CAMPAIGN.

    (a) In General.--The Secretary shall establish a national media 
campaign to educate the public and health care providers about poison 
prevention and the availability of poison control resources in local 
communities and to conduct advertising campaigns concerning the 
nationwide toll-free number established under section 334.
    (b) Contract With Entity.--The Secretary may carry out subsection 
(a) by entering into contracts with 1 or more nationally recognized 
media firms for the development and distribution of monthly television, 
radio, and newspaper public service announcements.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $600,000 for each of the fiscal 
years 2000 through 2004.

SEC. 336. ESTABLISHMENT OF A GRANT PROGRAM.

    (a) Regional Poison Control Centers.--The Secretary shall award 
grants to certified regional poison control centers for the purposes of 
achieving the financial stability of such centers, and for preventing 
and providing treatment recommendations for poisonings.
    (b) Other Improvements.--The Secretary shall also use amounts 
received under this section to--
            (1) develop standard education programs;
            (2) develop standard patient management protocols for 
        commonly encountered toxic exposures;
            (3) improve and expand the poison control data collection 
        systems; and
            (4) improve national toxic exposure surveillance.
    (c) Certification.--Except as provided in subsection (d), the 
Secretary may make a grant to a center under subsection (a) only if the 
center has been certified by a professional organization in the field 
of poison control, and the Secretary has approved the organization as 
having in effect standards for certification that reasonably provide 
for the protection of the public health with respect to poisoning.
    (d) Waiver of Certification Requirements.--
            (1) In general.--The Secretary may grant a waiver of the 
        certification requirement of subsection (a) with respect to a 
        noncertified poison control center that applies for a grant 
        under this section if such center can reasonably demonstrate 
        that the center will obtain such a certification within a 
        reasonable period of time as determined appropriate by the 
        Secretary.
            (2) Renewal.--The Secretary may only renew a waiver under 
        paragraph (1) for a period of 3 years.
    (e) Supplement not Supplant.--Amounts made available to a poison 
control center under this section shall be used to supplement and not 
supplant other Federal, State, local or private funds provided for such 
center.
    (f) Maintenance of Effort.--A poison control center, in utilizing 
the proceeds of a grant under this section, shall maintain the 
expenditures of the center for activities of the center at a level that 
is equal to not less than the level of such expenditures maintained by 
the center for the fiscal year preceding the fiscal year for which the 
grant is received.
    (g) Matching Requirement.--The Secretary may impose a matching 
requirement with respect to amounts provided under a grant under this 
section if the Secretary determines appropriate.
    (h) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $25,000,000 for each of the 
fiscal years 2000 through 2004.

                      TITLE IV--PEDIATRIC RESEARCH

SEC. 401. ESTABLISHMENT OF A PEDIATRIC RESEARCH INITIATIVE.

    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 the following:

``SEC. 404F. PEDIATRIC RESEARCH INITIATIVE.

    ``(a) Establishment.--The Secretary shall establish within the 
Office of the Director of NIH a Pediatric Research Initiative 
(hereafter in this section referred to as the `Initiative'). The 
Initiative shall be headed by the Director of NIH.
    ``(b) Purpose.--The purpose of the Initiative is to provide funds 
to enable the Director of NIH to encourage--
            ``(1) increased support for pediatric biomedical research 
        within the National Institutes of Health to ensure that the 
        expanding opportunities for advancement in scientific 
        investigations and care for children are realized;
            ``(2) expanded clinical pharmacology and experimental 
        therapeutics research, to--
                    ``(A) better understand maturational changes in 
                drug metabolism and drug actions from birth through 
                puberty;
                    ``(B) apply the insights gained to address specific 
                therapeutic and drug toxicity problems relevant to 
                children;
                    ``(C) conduct pediatric clinical trials which will 
                lead to approval of important therapeutic drugs for use 
                by children; and
                    ``(D) serve as an educational resource for 
                patients, practitioners and students;
            ``(3) enhanced collaborative efforts among the Institutes 
        to support multidisciplinary research in the areas that the 
        Director deems most promising;
            ``(4) increased support for pediatric outcomes and medical 
        effectiveness research to demonstrate how to improve the 
        quality of children's health care while reducing cost; and
            ``(5) recognition of the special attention pediatric 
        research deserves.
    ``(c) Duties.--In carrying out subsection (b), the Director of NIH 
shall--
            ``(1) consult with the Institutes and other advisors as the 
        Director determines appropriate in the allocation of Initiative 
        funds, including the Institute for Child Health and Human 
        Development;
            ``(2) have broad discretion in the allocation of any 
        Initiative assistance among the Institutes, among types of 
        grants, and between basic and clinical research so long as 
        the--
                    ``(A) assistance is directly related to the 
                illnesses and diseases of children; and
                    ``(B) assistance is extramural in nature; and
            ``(3) be responsible for the oversight of any newly 
        appropriated Initiative funds and be accountable with respect 
        to such funds to Congress and to the public.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $100,000,000 for each of the 
fiscal years 2000 and 2001, and such sums as may be necessary for each 
fiscal year thereafter.
    ``(e) Transfer of Funds.--The Director of NIH may transfer amounts 
appropriated under this section to any of the Institutes for a fiscal 
year to carry out the purposes of the Initiative under this section.''.

SEC. 402. INVESTMENT IN TOMORROW'S PEDIATRIC RESEARCHERS.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the National Institute of Child Health and Human Development, 
shall provide enhanced support for extramural activities relating to 
the training and career development of pediatric researchers.
    (b) Purpose.--In carrying out subsection (a), the Secretary of 
Health and Human Services shall ensure that enhanced support is 
designed to ensure the future supply of researchers who are dedicated 
to the care and research needs of children by providing for--
            (1) an increase in the number and size of institutional 
        training grants to medical school pediatric departments and 
        children's hospitals; and
            (2) an increase in the number of career development awards 
        for pediatric providers building careers in pediatric clinical 
        research.
    (c) Pediatric Research Loan Repayment Program.--
            (1) In general.--The Secretary of Health and Human 
        Services, in consultation with the Director of the National 
        Institute of Child Health and Human Development, may establish 
        a pediatric research loan repayment program. Through such 
        program--
                    (A) the Secretary shall enter into contracts with 
                qualified pediatricians under which such pediatricians 
                will agree to conduct pediatric research in 
                consideration of the Federal Government agreeing to 
                repay, for each year of such service, not more than 
                $35,000 of the principal and interest of the 
                educational loans of such pediatricians; and
                    (B) the Secretary shall, for the purpose of 
                providing reimbursements for tax liability resulting 
                from payments made under paragraph (1) on behalf of an 
                individual, make payments, in addition to payments 
                under such paragraph, to the individual in an amount 
                equal to 39 percent of the total amount of loan 
                repayments made for the taxable year involved.
            (2) Application of other provisions.--The provisions of 
        sections 338B, 338C, and 338E of the Public Health Service Act 
        (42 U.S.C. 254l-1, 254m, and 254o) shall, except as 
        inconsistent with paragraph (1), apply to the program 
        established under such paragraph to the same extent and in the 
        same manner as such provisions apply to the National Health 
        Service Corps Loan Repayment Program established under subpart 
        III of part D of title III of such Act (42 U.S.C. 245l et 
        seq.).
            (3) Availability of funds.--Amounts made available to carry 
        out this subsection shall remain available until the expiration 
        of the second fiscal year beginning after the fiscal year for 
        which such amounts were made available.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $20,000,000 for fiscal year 
2000, $25,000,000 for fiscal year 2001, $30,000,000 for fiscal year 
2002, and such sums as may be necessary for each fiscal year 
thereafter.
                                 <all>