[Congressional Record Volume 144, Number 33 (Monday, March 23, 1998)]
[Senate]
[Pages S2424-S2433]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. ROCKEFELLER (for himself, Ms. Snowe, Mr. Kerry, Mr. 
        Kennedy, Mr. Dodd, Mr. Jeffords, and Mr. Chafee):
  S. 1809. A bill to improve the performance outcomes of the child 
support enforcement program in order to increase the financial 
stability and well-being of children and families, and to require the 
Secretary of Health and Human Services and the Secretary of Labor to 
jointly develop a National Standardized Medical Support Notice and 
establish a working group to eliminate existing barriers to the 
effective establishment and enforcement of medical child support; to 
the Committee on Finance.


         the child support performance improvement act of 1998

  Mr. ROCKEFELLER. Mr. President, I am pleased to join with my 
colleagues to introduce the Child Support Performance Improvement Act 
of 1998. I believe this legislation, with its special emphasis on the 
enforcement of medical child support orders, will improve the financial 
security and health of thousands of American children. This bill also 
takes careful steps to ensure that vital Federal health programs such 
as Medicaid and the new Children's Health Insurance Program are not 
misused by parents who are able but unwilling to live up to their 
health care responsibilities. I want to take this opportunity to share 
my special thanks with Senator Snowe, who has shown a long-standing 
commitment to this important issue. I would also like to thank Senators 
Kerry, Kennedy, Dodd, Jeffords, and Chafee for their work on the issue 
of child support.
  As a nation, our most fundamental measure of success is how 
effectively we provide for our children. We have a collective 
responsibility to ensure that our children have the financial resources 
they need to live happy, healthy and stable lives. At the same time, 
the responsibility for addressing many of children's daily needs fall 
squarely at the feet of their parents. In my state of West Virginia and 
elsewhere, too many parents neglect their financial responsibilities, 
maintaining that because they are no longer living in the same house as 
their children, they no longer have to support them. With so many 
parents refusing to provide their children with adequate financial 
support and health care, between $15 and $25 billion dollars in child 
support remains uncollected each year.
  The Child Support Performance Improvement Act of 1998 takes several 
steps to make child support a dependable part of the continuum of 
private and public benefits available to American children. Since the 
child support enforcement system was created in 1975

[[Page S2425]]

to centralize state government collections, Congress has authorized 
Federal funding to improve and broaden state child support programs. In 
addition to general financial support, the Federal government also 
makes annual incentive payments to the states based on the cost 
effectiveness of their child support collections. That is, dollar for 
dollar, do the states show a significant return for the money they 
spend on child support collections.
  For several years, there has been a consensus among both state child 
support agencies and child advocates that basing incentive payments on 
cost effectiveness alone does no justice to the many other areas of 
state performance. Two years ago, the welfare reform law took a 
positive step forward by commissioning a task force composed of child 
support experts from the Department of Health and Human Services and 
state agencies to come up with a new set of incentives that would keep 
states on the road to more effective child support collections in a 
variety of areas. The Child Support Performance Improvement Act of 1998 
incorporates the consensus findings of this work group. For the first 
time, the new incentives structure takes into account not only a 
state's cost effectiveness but its ability to establish paternity and 
child support orders and to collect current and back child support 
payments.
  This legislation also increases the emphasis on a State's collection 
of medical child support and eliminates some of the barriers the States 
face in their efforts to enforce medical child support orders. With one 
out of seven American children unable to access basic health coverage, 
medical child support or ``medical support'' has become a vital part of 
child support enforcement. Medical support can take many forms 
including an order to a non-custodial parent to provide health 
insurance, to cover a portion of an insurance co-payment or a 
deductible, or to pay past medical bills. Since 1984, federal law has 
required state child support enforcement agencies to petition for and 
collect medical support as part of any general child support order if 
health care coverage is available to the non-custodial parent at a 
reasonable cost. Unfortunately, however, medical child support is still 
only collected in about 30% of all child support cases. If we fail to 
use this prime opportunity to re-establish medical support as a 
priority, enforcement of medical support might be even more dismal in 
the future.
  The Child Support Performance Improvement Act of 1998 will improve 
the collection of medical support in two significant ways. First, it 
requires the Secretary of Health and Human Services to create a sixth 
medical support criterion upon which Federal incentives payments will 
be based. This sixth medical support incentives factor will not only 
ensure that States do their best to collect medical support, but it 
will also send a message to the States that when creating and improving 
their overall collections systems, medical support is a top priority.
  Many of us have worked hard to make sure that all American children 
receive appropriate health care coverage through both public and 
private programs such as the newly-created Children's Health Insurance 
(or ``CHIPS'') Program. Although this and other Federal programs are 
vital, they were never intended and should not be used as a parachute 
for parents who could afford to cover their own children, but refuse to 
do so.
  This bill also helps improve medical support collections by 
eliminating some of the procedural barriers that the states face when 
they try to enforce medical support orders through health plans 
governed by the Employment Retirement Income Security Act of 1974 
(ERISA). Once a court issues a medical support order, the state child 
support enforcement agencies sends a notice of that order to the non-
custodial parent's health plan. Over 50 percent of American employers 
offer health plans that are governed by ERISA. As a result, there are 
over 700,000 children who are dependent on a medical support order 
through an ERISA-governed plan. Currently, there is a lack of 
uniformity in the way that state child support enforcement agency and 
the health plan administrators communicate with one another. Despite 
the fact that ERISA already defines the elements a medical support 
order must contain in order to be valid under federal law, there is 
still a lot of confusion by the state agencies and the plan 
administrators about what is required.
  After consultation with dozens of ERISA plan administrators, state 
agencies, and child advocates, this bill removes this procedural 
barrier by requiring the Secretaries of the Department of Health and 
Human Services and the Department of Labor to create and implement a 
standardized national medical support notice that states would be 
required to use and employers would be required to accept under ERISA. 
This standardized form will take into account the respective 
administrative needs of both states and employers. Second, the bill 
requires the Secretary of the Department of Labor, in consultation with 
the Department of Health and Human Services, to submit recommendations 
for any other necessary improvements to the medical child support 
provisions of ERISA. Finally, the bill commissions a work group 
composed of medical support experts from state agencies, employers, 
plan administrators and child advocates to identify and make 
recommendations for the elimination of any remaining medical support 
barriers.
  The Child Support Performance Improvement Act of 1998 is designed to 
improve States' overall child support collections with a special 
emphasis on the effective enforcement of medical support orders, so 
that all qualified children receive the health coverage that they 
deserve.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1809

       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 ``Child Support Performance 
     Improvement Act of 1998''.

     SEC. 2. INCENTIVE PAYMENTS TO STATES.

       (a) In General.--Part D of title IV of the Social Security 
     Act (42 U.S.C. 651-669) is amended by inserting after section 
     458 the following:

     ``SEC. 458A. INCENTIVE PAYMENTS TO STATES.

       ``(a) In General.--In addition to any other payment under 
     this part, the Secretary shall, subject to subsection (f), 
     make an incentive payment to each State for each fiscal year 
     in an amount determined under subsection (b).
       ``(b) Amount of Incentive Payment.--
       ``(1) In general.--The incentive payment for a State for a 
     fiscal year is equal to the incentive payment pool for the 
     fiscal year, multiplied by the State incentive payment share 
     for the fiscal year.
       ``(2) Incentive payment pool.--
       ``(A) In general.--In paragraph (1), the term `incentive 
     payment pool' means--
       ``(i) $422,000,000 for fiscal year 2000;
       ``(ii) $429,000,000 for fiscal year 2001;
       ``(iii) $450,000,000 for fiscal year 2002;
       ``(iv) $461,000,000 for fiscal year 2003;
       ``(v) $454,000,000 for fiscal year 2004;
       ``(vi) $446,000,000 for fiscal year 2005;
       ``(vii) $458,000,000 for fiscal year 2006;
       ``(viii) $471,000,000 for fiscal year 2007;
       ``(ix) $483,000,000 for fiscal year 2008; and
       ``(x) for any succeeding fiscal year, the amount of the 
     incentive payment pool for the fiscal year that precedes such 
     succeeding fiscal year, multiplied by the percentage (if any) 
     by which the CPI for such preceding fiscal year exceeds the 
     CPI for the 2nd preceding fiscal year.
       ``(B) CPI.--For purposes of subparagraph (A), the CPI for a 
     fiscal year is the average of the Consumer Price Index for 
     the 12-month period ending on September 30 of the fiscal 
     year. As used in the preceding sentence, the term `Consumer 
     Price Index' means the last Consumer Price Index for all-
     urban consumers published by the Department of Labor.
       ``(3) State incentive payment share.--In paragraph (1), the 
     term `State incentive payment share' means, with respect to a 
     fiscal year--
       ``(A) the incentive base amount for the State for the 
     fiscal year; divided by
       ``(B) the sum of the incentive base amounts for all of the 
     States for the fiscal year.
       ``(4) Incentive base amount.--In paragraph (3), the term 
     `incentive base amount' means, with respect to a State and a 
     fiscal year, the sum of the applicable percentages 
     (determined in accordance with paragraph (6)) multiplied by 
     the corresponding maximum incentive base amounts for the 
     State for the fiscal year, with respect to each of the 
     following measures of State performance for the fiscal year:
       ``(A) The paternity establishment performance level.
       ``(B) The support order performance level.
       ``(C) The current payment performance level.

[[Page S2426]]

       ``(D) The arrearage payment performance level.
       ``(E) The cost-effectiveness performance level.
       ``(5) Maximum incentive base amount.--
       ``(A) In general.--For purposes of paragraph (4), the 
     maximum incentive base amount for a State for a fiscal year 
     is--
       ``(i) with respect to the performance measures described in 
     subparagraphs (A), (B), and (C) of paragraph (4), 100 percent 
     of the State collections base for the fiscal year; and
       ``(ii) with respect to the performance measures described 
     in subparagraphs (D) and (E) of paragraph (4), 75 percent of 
     the State collections base for the fiscal year.
       ``(B) Data required to be complete and reliable.--
     Notwithstanding subparagraph (A), the maximum incentive base 
     amount for a State for a fiscal year with respect to a 
     performance measure described in paragraph (4) is zero, 
     unless the Secretary determines, on the basis of an audit 
     performed under section 452(a)(4)(C)(i), that the data which 
     the State submitted pursuant to section 454(15)(B) for the 
     fiscal year and which is used to determine the performance 
     level involved is complete and reliable.
       ``(C) State collections base.--For purposes of subparagraph 
     (A), the State collections base for a fiscal year is equal to 
     the sum of--
       ``(i) 2 times the sum of--

       ``(I) the total amount of support collected during the 
     fiscal year under the State plan approved under this part in 
     cases in which the support obligation involved is required to 
     be assigned to the State pursuant to part A or E of this 
     title or title XIX; and
       ``(II) the total amount of support collected during the 
     fiscal year under the State plan approved under this part in 
     cases in which the support obligation involved was so 
     assigned but, at the time of collection, is not required to 
     be so assigned; and

       ``(ii) the total amount of support collected during the 
     fiscal year under the State plan approved under this part in 
     all other cases.
       ``(6) Determination of applicable percentages based on 
     performance levels.--
       ``(A) Paternity establishment.--
       ``(i) Determination of paternity establishment performance 
     level.--The paternity establishment performance level for a 
     State for a fiscal year is, at the option of the State, the 
     IV-D paternity establishment percentage determined under 
     section 452(g)(2)(A) or the statewide paternity establishment 
     percentage determined under section 452(g)(2)(B).
       ``(ii) Determination of applicable percentage.--The 
     applicable percentage with respect to a State's paternity 
     establishment performance level is as follows:
       

------------------------------------------------------------------------
``If the paternity establishment performance level is:                  
-------------------------------------------------------  The applicable 
            At least:                 But less than:     percentage is: 
------------------------------------------------------------------------
80%..............................  ...................         100      
79%..............................  80%................         98       
78%..............................  79%................         96       
77%..............................  78%................         94       
76%..............................  77%................         92       
75%..............................  76%................         90       
74%..............................  75%................         88       
73%..............................  74%................         86       
72%..............................  73%................         84       
71%..............................  72%................         82       
70%..............................  71%................         80       
69%..............................  70%................         79       
68%..............................  69%................         78       
67%..............................  68%................         77       
66%..............................  67%................         76       
65%..............................  66%................         75       
64%..............................  65%................         74       
63%..............................  64%................         73       
62%..............................  63%................         72       
61%..............................  62%................         71       
60%..............................  61%................         70       
59%..............................  60%................         69       
58%..............................  59%................         68       
57%..............................  58%................         67       
56%..............................  57%................         66       
55%..............................  56%................         65       
54%..............................  55%................         64       
53%..............................  54%................         63       
52%..............................  53%................         62       
51%..............................  52%................         61       
50%..............................  51%................         60       
0%...............................  50%................         0.       
------------------------------------------------------------------------

     Notwithstanding the preceding sentence, if the paternity 
     establishment performance level of a State for a fiscal year 
     is less than 50 percent but exceeds by at least 10 percentage 
     points the paternity establishment performance level of the 
     State for the immediately preceding fiscal year, then the 
     applicable percentage with respect to the State's paternity 
     establishment performance level is 50 percent.
       ``(B) Establishment of child support orders.--
       ``(i) Determination of support order performance level.--
     The support order performance level for a State for a fiscal 
     year is the percentage of the total number of cases under the 
     State plan approved under this part in which there is a 
     support order during the fiscal year.
       ``(ii) Determination of applicable percentage.--The 
     applicable percentage with respect to a State's support order 
     performance level is as follows:
       

------------------------------------------------------------------------
     ``If the support order performance level is:                       
-------------------------------------------------------  The applicable 
            At least:                 But less than:     percentage is: 
------------------------------------------------------------------------
80%..............................  ...................         100      
79%..............................  80%................         98       
78%..............................  79%................         96       
77%..............................  78%................         94       
76%..............................  77%................         92       
75%..............................  76%................         90       
74%..............................  75%................         88       
73%..............................  74%................         86       
72%..............................  73%................         84       
71%..............................  72%................         82       
70%..............................  71%................         80       
69%..............................  70%................         79       
68%..............................  69%................         78       
67%..............................  68%................         77       
66%..............................  67%................         76       
65%..............................  66%................         75       
64%..............................  65%................         74       
63%..............................  64%................         73       
62%..............................  63%................         72       
61%..............................  62%................         71       
60%..............................  61%................         70       
59%..............................  60%................         69       
58%..............................  59%................         68       
57%..............................  58%................         67       
56%..............................  57%................         66       
55%..............................  56%................         65       
54%..............................  55%................         64       
53%..............................  54%................         63       
52%..............................  53%................         62       
51%..............................  52%................         61       
50%..............................  51%................         60       
0%...............................  50%................         0.       
------------------------------------------------------------------------

     Notwithstanding the preceding sentence, if the support order 
     performance level of a State for a fiscal year is less than 
     50 percent but exceeds by at least 5 percentage points the 
     support order performance level of the State for the 
     immediately preceding fiscal year, then the applicable 
     percentage with respect to the State's support order 
     performance level is 50 percent.
       ``(C) Collections on current child support due.--
       ``(i) Determination of current payment performance level.--
     The current payment performance level for a State for a 
     fiscal year is equal to the total amount of current support 
     collected during the fiscal year under the State plan 
     approved under this part divided by the total amount of 
     current support owed during the fiscal year in all cases 
     under the State plan, expressed as a percentage.
       ``(ii) Determination of applicable percentage.--The 
     applicable percentage with respect to a State's current 
     payment performance level is as follows:
       

------------------------------------------------------------------------
    ``If the current payment performance level is:                      
-------------------------------------------------------  The applicable 
            At least:                 But less than:     percentage is: 
------------------------------------------------------------------------
80%..............................  ...................         100      
79%..............................  80%................         98       
78%..............................  79%................         96       
77%..............................  78%................         94       
76%..............................  77%................         92       
75%..............................  76%................         90       
74%..............................  75%................         88       
73%..............................  74%................         86       
72%..............................  73%................         84       
71%..............................  72%................         82       
70%..............................  71%................         80       
69%..............................  70%................         79       
68%..............................  69%................         78       
67%..............................  68%................         77       
66%..............................  67%................         76       
65%..............................  66%................         75       
64%..............................  65%................         74       
63%..............................  64%................         73       
62%..............................  63%................         72       
61%..............................  62%................         71       
60%..............................  61%................         70       
59%..............................  60%................         69       
58%..............................  59%................         68       
57%..............................  58%................         67       
56%..............................  57%................         66       
55%..............................  56%................         65       
54%..............................  55%................         64       
53%..............................  54%................         63       
52%..............................  53%................         62       
51%..............................  52%................         61       
50%..............................  51%................         60       
49%..............................  50%................         59       
48%..............................  49%................         58       
47%..............................  48%................         57       
46%..............................  47%................         56       
45%..............................  46%................         55       
44%..............................  45%................         54       
43%..............................  44%................         53       
42%..............................  43%................         52       
41%..............................  42%................         51       
40%..............................  41%................         50       
0%...............................  40%................         0.       
------------------------------------------------------------------------

     Notwithstanding the preceding sentence, if the current 
     payment performance level of a State for a fiscal year is 
     less than 40 percent but exceeds by at least 5 percentage 
     points the current payment performance level of the State for 
     the immediately preceding fiscal year, then the applicable 
     percentage with respect to the State's current payment 
     performance level is 50 percent.
       ``(D) Collections on child support arrearages.--
       ``(i) Determination of arrearage payment performance 
     level.--The arrearage payment performance level for a State 
     for a fiscal year is equal to the total number of cases under 
     the State plan approved under this part in which payments of 
     past-due child support were received during the fiscal year 
     and part or all of the payments were

[[Page S2427]]

     distributed to the family to whom the past-due child support 
     was owed (or, if all past-due child support owed to the 
     family was, at the time of receipt, subject to an assignment 
     to the State, part or all of the payments were retained by 
     the State) divided by the total number of cases under the 
     State plan in which there is past-due child support, 
     expressed as a percentage.
       ``(ii) Determination of applicable percentage.--The 
     applicable percentage with respect to a State's arrearage 
     payment performance level is as follows:
       

------------------------------------------------------------------------
   ``If the arrearage payment performance level is:                     
-------------------------------------------------------  The applicable 
            At least:                 But less than:     percentage is: 
------------------------------------------------------------------------
80%..............................  ...................         100      
79%..............................  80%................         98       
78%..............................  79%................         96       
77%..............................  78%................         94       
76%..............................  77%................         92       
75%..............................  76%................         90       
74%..............................  75%................         88       
73%..............................  74%................         86       
72%..............................  73%................         84       
71%..............................  72%................         82       
70%..............................  71%................         80       
69%..............................  70%................         79       
68%..............................  69%................         78       
67%..............................  68%................         77       
66%..............................  67%................         76       
65%..............................  66%................         75       
64%..............................  65%................         74       
63%..............................  64%................         73       
62%..............................  63%................         72       
61%..............................  62%................         71       
60%..............................  61%................         70       
59%..............................  60%................         69       
58%..............................  59%................         68       
57%..............................  58%................         67       
56%..............................  57%................         66       
55%..............................  56%................         65       
54%..............................  55%................         64       
53%..............................  54%................         63       
52%..............................  53%................         62       
51%..............................  52%................         61       
50%..............................  51%................         60       
49%..............................  50%................         59       
48%..............................  49%................         58       
47%..............................  48%................         57       
46%..............................  47%................         56       
45%..............................  46%................         55       
44%..............................  45%................         54       
43%..............................  44%................         53       
42%..............................  43%................         52       
41%..............................  42%................         51       
40%..............................  41%................         50       
0%...............................  40%................         0.       
------------------------------------------------------------------------

     Notwithstanding the preceding sentence, if the arrearage 
     payment performance level of a State for a fiscal year is 
     less than 40 percent but exceeds by at least 5 percentage 
     points the arrearage payment performance level of the State 
     for the immediately preceding fiscal year, then the 
     applicable percentage with respect to the State's arrearage 
     payment performance level is 50 percent.
       ``(E) Cost-effectiveness.--
       ``(i) Determination of cost-effectiveness performance 
     level.--The cost-effectiveness performance level for a State 
     for a fiscal year is equal to the total amount collected 
     during the fiscal year under the State plan approved under 
     this part divided by the total amount expended during the 
     fiscal year under the State plan, expressed as a ratio.
       ``(ii) Determination of applicable percentage.--The 
     applicable percentage with respect to a State's cost-
     effectiveness performance level is as follows:
       

------------------------------------------------------------------------
   ``If the cost-effectiveness performance level is:                    
-------------------------------------------------------  The applicable 
            At least:                 But less than:     percentage is: 
------------------------------------------------------------------------
5.00.............................  ...................         100      
4.50.............................  4.99...............         90       
4.00.............................  4.50...............         80       
3.50.............................  4.00...............         70       
3.00.............................  3.50...............         60       
2.50.............................  3.00...............         50       
2.00.............................  2.50...............         40       
0.00.............................  2.00...............         0.       
------------------------------------------------------------------------

       ``(F) Medical support.--Subject to section 2(d)(2)(C) of 
     the Child Support Performance Improvement Act of 1998, the 
     medical support performance level for a State for a fiscal 
     year, and the applicable percentage for a State with respect 
     to such level, shall be determined in accordance with 
     regulations implementing the recommendations required to be 
     included in the report submitted under section 2(d)(2)(B) of 
     such Act.
       ``(c) Treatment of Interstate Collections.--In computing 
     incentive payments under this section, support which is 
     collected by a State at the request of another State shall be 
     treated as having been collected in full by both States, and 
     any amounts expended by a State in carrying out a special 
     project assisted under section 455(e) shall be excluded.
       ``(d) Administrative Provisions.--The amounts of the 
     incentive payments to be made to the States under this 
     section for a fiscal year shall be estimated by the Secretary 
     at or before the beginning of the fiscal year on the basis of 
     the best information available, as obtained in accordance 
     with section 452(a)(12). The Secretary shall make the 
     payments for the fiscal year, on a quarterly basis (with each 
     quarterly payment being made not later than the beginning of 
     the quarter involved), in the amounts so estimated, reduced, 
     or increased to the extent of any overpayments or 
     underpayments which the Secretary determines were made under 
     this section to the States involved for prior periods and 
     with respect to which adjustment has not already been made 
     under this subsection. Upon the making of any estimate by the 
     Secretary under the preceding sentence, any appropriations 
     available for payments under this section are deemed 
     obligated.
       ``(e) Regulations.--
       ``(1) In general.--The Secretary shall prescribe such 
     regulations as may be necessary governing the calculation of 
     incentive payments under this section, including directions 
     for excluding from the calculations certain closed cases and 
     cases over which the States do not have jurisdiction, and 
     regulations excluding from the calculations of the current 
     payment performance level and the arrearage payment 
     performance level any case in which the State used State 
     funds to make such payments for the primary purpose of 
     increasing the State's performance levels in such areas.
       ``(2) Regulations implementing the medical support 
     performance level.--Subject to section 2(d)(2)(C) of the 
     Child Support Performance Improvement Act of 1998, the 
     Secretary shall prescribe regulations implementing the 
     recommendations required to be included in the report 
     submitted under section 2(d)(2)(B) of such Act. To the extent 
     necessary to ensure that the implementation of such 
     recommendations does not result in total Federal expenditures 
     under this section in excess of the amount of such 
     expenditures in the absence of such implementation, such 
     regulations may increase or decrease the percentages 
     specified in clauses (i) and (ii) of subsection (b)(5)(A).
       ``(f) Reinvestment.--
       ``(1) In general.--Until such time as the State qualifies 
     for the maximum incentive amount possible, as determined 
     under subsection (b)(5), payments under this section and 
     section 458 shall supplement, not supplant, State child 
     support expenditures under the State program under this part 
     to the extent that such expenditures were funded by the State 
     in fiscal year 1997.
       ``(2) Penalty.--Failure to satisfy the requirement of 
     paragraph (1) shall result in a proportionate reduction, 
     determined by the Secretary, of future payments to the State 
     under this section and section 458.''.
       (b) Payments During Transition Period.--Notwithstanding 
     section 458A of the Social Security Act (42 U.S.C. 658A), as 
     added by subsection (a), the amount of an incentive payment 
     for a State under such section shall not be--
       (1) in the case of fiscal year 2000, less than 80 percent 
     or greater than 120 percent of the incentive payment for the 
     State determined under section 458 of the Social Security Act 
     (42 U.S.C. 658) for fiscal year 1999 (as such section was in 
     effect for such fiscal year);
       (2) in the case of fiscal year 2001, less than 60 percent 
     or greater than 140 percent of the incentive payment for the 
     State (as so determined);
       (3) in the case of fiscal year 2002, less than 40 percent 
     or greater than 160 percent of the incentive payment for the 
     State (as so determined); and
       (4) in the case of fiscal year 2003, less than 20 percent 
     or greater than 180 percent of the incentive payment for the 
     State (as so determined).
       (c) Regulations.--Within 9 months after the date of 
     enactment of this section, the Secretary of Health and Human 
     Services shall, in addition to the regulations required under 
     section 458A(e) of the Social Security Act, issue regulations 
     governing the implementation of section 458A of the Social 
     Security Act, when such section takes effect, and the 
     implementation of subsection (b) of this section.
       (d) Studies.--
       (1) General review of new incentive payment system.--
       (A) In general.--The Secretary of Health and Human Services 
     (in this subsection referred to as the ``Secretary'') shall 
     conduct a study of the implementation of the incentive 
     payment system established by section 458A of the Social 
     Security Act, in order to identify the problems and successes 
     of the system.
       (B) Reports to congress.--
       (i) Report on variations in state performance attributable 
     to demographic variables.--Not later than October 1, 2000, 
     the Secretary shall submit to Congress a report that 
     identifies any demographic or economic variables that account 
     for differences in the performance levels achieved by the 
     States with respect to the performance measures used in the 
     system, and contains the recommendations of the Secretary for 
     such adjustments to the system as may be necessary to ensure 
     that the relative performance of States is measured from a 
     baseline that takes account of any such variables.
       (ii) Interim report.--Not later than March 1, 2001, the 
     Secretary shall submit to Congress an interim report that 
     contains the findings of the study required by subparagraph 
     (A).
       (iii) Final report.--Not later than October 1, 2003, the 
     Secretary shall submit to Congress a final report that 
     contains the final findings of the study required by 
     subparagraph (A). The report shall include any 
     recommendations for changes in the system

[[Page S2428]]

     that the Secretary determines would improve the operation of 
     the child support enforcement program.
       (2) Development of medical support incentive.--
       (A) In general.--The Secretary, in consultation with State 
     directors of programs operated under part D of title IV of 
     the Social Security Act and representatives of children 
     potentially eligible for medical support, such as child 
     advocacy organizations, shall develop a new medical support 
     performance measure based on the effectiveness of States in 
     establishing and enforcing medical support obligations, and 
     shall make recommendations for the incorporation of the 
     measure, in a revenue neutral manner, into the incentive 
     payment system established by section 458A of the Social 
     Security Act.
       (B) Report.--Not later than October 1, 1999, the Secretary 
     shall submit to the Committee on Ways and Means of the House 
     of Representatives and the Committee on Finance of the 
     Senate, a report that describes the performance measure and 
     contains the recommendations required under subparagraph (A).
       (C) Congressional disapproval required.--
       (i) In general.--The Secretary shall, by regulation, 
     implement the recommendations required to be included in the 
     report submitted under subparagraph (B) unless a joint 
     resolution is enacted, in accordance with subparagraph (D), 
     disapproving such recommendations before the end of the 1-
     year period that begins on the date on which the Secretary 
     submits such report.
       (ii) Exclusion of certain days.--For purposes of clause (i) 
     and subparagraph (D), the days on which either House of 
     Congress is not in session because of an adjournment of more 
     than 3 days to a day certain shall be excluded from the 
     computation of the period.
       (D) Congressional consideration.--
       (i) Terms of the resolution.--For purposes of subparagraph 
     (C)(i), the term ``joint resolution'' means only a joint 
     resolution that is introduced within the 1-year period 
     described in such subparagraph and--

       (I) that does not have a preamble;
       (II) the matter after the resolving clause of which is as 
     follows: ``That Congress disapproves the recommendations of 
     the Secretary of Health and Human Services regarding the 
     implementation of a medical support performance measure 
     submitted on ________'', the blank space being filled in with 
     the appropriate date; and
       (III) the title of which is as follows: ``Joint resolution 
     disapproving the recommendations of the Secretary of Health 
     and Human Services regarding the implementation of a medical 
     support performance measure.''.

       (ii) Referral.--A resolution described in clause (i) that 
     is introduced--

       (I) in the House of Representatives, shall be referred to 
     the Committee on Ways and Means; and
       (II) in the Senate, shall be referred to the Committee on 
     Finance.

       (iii) Discharge.--If a committee to which a resolution 
     described in clause (i) is referred has not reported such 
     resolution by the end of the 20-day period beginning on the 
     date on which the Secretary submits the report required under 
     subparagraph (B), such committee shall be, at the end of such 
     period, discharged from further consideration of such 
     resolution, and such resolution shall be placed on the 
     appropriate calendar of the House involved.
       (iv) Consideration.--On or after the third day after the 
     date on which the committee to which a resolution described 
     in clause (i) has reported, or has been discharged from 
     further consideration of such resolution, such resolution 
     shall be considered in the same manner as a resolution is 
     considered under subsections (d), (e), and (f) of section 
     2908 of the Defense Base Closure and Realignment Act of 1990 
     (10 U.S.C. 2687 note).
       (e) Technical Amendments.--
       (1) In general.--Section 341 of the Personal Responsibility 
     and Work Opportunity Reconciliation Act of 1996 (42 U.S.C. 
     658 note) is amended--
       (A) by striking subsection (a) and redesignating 
     subsections (b), (c), and (d) as subsections (a), (b), and 
     (c), respectively; and
       (B) in subsection (c) (as so redesignated)--
       (i) by striking paragraph (1) and inserting the following:
       ``(1) Conforming amendments to present system.--The 
     amendments made by subsection (a) of this section shall 
     become effective with respect to a State as of the date the 
     amendments made by section 103(a) (without regard to section 
     116(a)(2)) first apply to the State.''; and
       (ii) in paragraph (2), by striking ``(c)'' and inserting 
     ``(b)''.
       (2) Effective date.--The amendments made by this subsection 
     shall take effect as if included in the enactment of section 
     341 of the Personal Responsibility and Work Opportunity 
     Reconciliation Act of 1996.
       (f) Elimination of Predecessor Incentive Payment System.--
       (1) Repeal.--Section 458 of the Social Security Act (42 
     U.S.C. 658) is repealed.
       (2) Conforming amendments.--
       (A) Section 458A of the Social Security Act (42 U.S.C. 
     658a) is redesignated as section 458.
       (B) Paragraphs (1) and (2) of section 458(f) (as so 
     redesignated) are each amended by striking ``and section 
     458''.
       (C) Subsections (c) and (d) of this section are each 
     amended by striking ``458A'' each place it appears and 
     inserting ``458''.
       (3) Effective date.--The amendments made by this subsection 
     shall take effect on October 1, 2003.
       (g) General Effective Date.--Except as otherwise provided 
     in this section, the amendments made by this section shall 
     take effect on October 1, 1999.

     SEC. 3. DATA INTEGRITY.

       (a) Duty of the Secretary To Ensure Reliable Data.--Section 
     452(a) of the Social Security Act (42 U.S.C. 652(a)) is 
     amended--
       (1) in paragraph (10), by striking ``and'' at the end;
       (2) in paragraph (11), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following:
       ``(12) ensure that data required for the operation of State 
     programs under this part is complete and reliable by 
     providing Federal guidance, technical assistance, and 
     monitoring.''.
       (b) Effective date.--The amendments made by subsection (a) 
     shall take effect on the date of enactment of this Act.

     SEC. 4. ELIMINATION OF BARRIERS TO THE EFFECTIVE 
                   ESTABLISHMENT AND ENFORCEMENT OF MEDICAL CHILD 
                   SUPPORT.

       (a) Promulgation of National Standardized Medical Support 
     Notice.--Section 452(a) of the Social Security Act (42 U.S.C. 
     652(a)), as amended by section 3(a), is amended--
       (1) in paragraph (11), by striking ``and'' at the end;
       (2) in paragraph (12), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following:
       ``(13)(A) develop jointly with the Secretary of Labor--
       ``(i) a National Standardized Medical Support Notice that 
     satisfies the requirements of section 609(a)(3) of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1169(a)(3)) and the requirements of this part and shall be 
     used by States to enforce medical support orders; and
       ``(ii) appropriate procedures for the transmission of such 
     Notice to employers by State agencies administering the 
     program established under this part;
       ``(B) not later than 90 days after the date of enactment of 
     this paragraph, establish with the Secretary of Labor, a 
     medical support working group, not to exceed 20 individuals, 
     that shall--
       ``(i) identify the impediments to the effective enforcement 
     of medical support by State agencies administering the 
     program established under this part; and
       ``(ii) be composed of representatives of--
       ``(I) the Department of Labor;
       ``(II) the Department of Health and Human Services;
       ``(III) State directors of programs under this part;
       ``(IV) State directors of the medicaid program under title 
     XIX;
       ``(V) employers, including owners of small businesses;
       ``(VI) plan administrators and plan sponsors of group 
     health plans (as defined in section 607(1) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1167(1));
       ``(VII) children potentially eligible for medical support, 
     such as child advocacy organizations; and
       ``(VIII) State public welfare programs;
       ``(C) require the working group established in accordance 
     with subparagraph (B) to--
       ``(i) not later than 18 months after the date of enactment 
     of this paragraph, submit to the Secretary and Congress a 
     report containing recommendations for appropriate measures to 
     address the impediments to the effective enforcement of 
     medical support by State agencies administering the program 
     established under this part identified by the working group, 
     including--
       ``(I) appropriate measures that establish the priority of 
     withholding of child support obligations, medical support 
     obligations, arrearages in such obligations, and, in the case 
     of a medical support obligation, the employee's portion of 
     any health care coverage premium, by the State agency 
     administering the program established under this part in 
     light of the restrictions on garnishment provided under title 
     III of the Consumer Credit Protection Act (15 U.S.C. 1671-
     1677);
       ``(II) appropriate procedures for coordinating the 
     provision, enforcement, and transition of health care 
     coverage under the State programs established under this 
     part, title XIX, and title XXI;
       ``(III) appropriate measures to improve the enforcement of 
     alternate types of medical support that are aside from health 
     coverage offered through the noncustodial parent's health 
     plan and unrelated to the noncustodial parent's employer, 
     including measures that establish a noncustodial parent's 
     responsibility to share the cost of a copayment, deductible, 
     or a payment for services not covered under a child's 
     existing health coverage; and
       ``(IV) appropriate measures for eliminating any other 
     impediments to the effective enforcement of medical support 
     orders that the working group deems necessary; and
       ``(D) issue, under the authority of the Secretary--
       ``(i) not later than 180 days after the date of enactment 
     of this paragraph, a proposed regulation that specifies that 
     the National Standardized Medical Support Notice shall be 
     used by State agencies administering the program under this 
     part to enforce medical support orders, and that includes 
     such procedures for transmission of the Notice to employers 
     that the Secretary determines are appropriate; and

[[Page S2429]]

       ``(ii) not later than 1 year after the date of enactment of 
     this paragraph, a final regulation that specifies that the 
     National Standardized Medical Support Notice shall be used by 
     State agencies administering the program under this part to 
     enforce medical support orders and the procedures for the 
     transmission of that Notice to employers.''.
       (b) Required Use of Notice by States.--
       (1) State procedures.--Section 466(a)(19) of the Social 
     Security Act (42 U.S.C. 466(a)(19)) is amended to read as 
     follows:
       ``(19) Health care coverage.--Procedures under which--
       ``(A) all child support orders enforced pursuant to this 
     part include a provision for the health care coverage of the 
     child that, not later than October 1, 2000, is enforced, 
     where appropriate, through the use of the National 
     Standardized Medical Support Notice promulgated pursuant to 
     section 452(a)(13);
       ``(B) in any case in which a noncustodial parent is 
     required to provide such health care coverage and the 
     employer of such noncustodial parent is known to the State 
     agency, the State agency shall use the National Standardized 
     Medical Support Notice to transfer notice of the provision 
     for the health care coverage of the child to the employer in 
     conjunction, where appropriate, with an income withholding 
     notice within 2 days of the date that information regarding a 
     newly hired employee is entered in the State Directory of New 
     Hires pursuant to section 453A(e), and to any subsequent 
     employer if the parent changes employment or obtains 
     additional employment and the subsequent employer of such 
     noncustodial parent is known to the State agency;
       ``(C) not later than 7 business days after the date the 
     National Standardized Medical Support Notice is issued, the 
     Notice shall operate to enroll the child in the noncustodial 
     parent's employer's health plan, and to authorize the 
     collection of any employee contributions required for such 
     enrollment, unless the noncustodial parent contests 
     enforcement of the health care coverage provision of the 
     child support order pursuant to the Notice to the State 
     agency based on mistake of fact; and
       ``(D) the employer shall, within 21 days after the date the 
     Notice is issued, notify the State agency administering the 
     program under this part whether such health care coverage is 
     available and, if so, whether the child has been enrolled in 
     such coverage and the effective date of the enrollment, and 
     provide to the custodial parent any necessary documentation 
     to provide the child with coverage.''.
       (2) Conforming amendments.--Section 452(f) of the Social 
     Security Act (42 U.S.C. 652(f)) is amended in the first 
     sentence--
       (A) by striking ``petition for the inclusion of'' and 
     inserting ``include''; and
       (B) by inserting ``and enforce medical support'' before 
     ``whenever''.
       (c) National Standardized Medical Support Notice Deemed a 
     Qualified Medical Child Support Order.--
       (1) Amendment to erisa.--Section 609(a)(5) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1169(a)(5)) 
     is amended by adding at the end the following:
       ``(C) National standardized medical support notice deemed 
     to be a qualified medical child support order.--If a group 
     health plan administrator receives a completed National 
     Standardized Medical Support Notice promulgated pursuant to 
     section 452(a)(13) of the Social Security Act (42 U.S.C. 
     652(a)(13)), and the notice meets the requirements of 
     paragraphs (3) and (4), the notice shall, not later than 7 
     business days after the date the National Standardized 
     Medical Support Notice is issued, be deemed to be a qualified 
     medical child support order and the plan administrator shall 
     comply with the notice.''.
       (2) Rule of construction.--The amendment made by paragraph 
     (1) shall not be construed as requiring an employer to 
     provide or expand any health benefits coverage provided by 
     the employer that the employer is not, as of the date of 
     enactment of this section, required to provide, or to modify 
     or change the eligibility rules applicable to a group health 
     plan (as defined in section 607(1) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1167(1))).
       (d) Report and Recommendations Regarding the Enforcement of 
     Qualified Medical Support Orders Under ERISA.--Not later than 
     1 year after the date of enactment of this Act, the Secretary 
     of Labor, in consultation with the Secretary of Health and 
     Human Services, shall submit to the Committee on Labor and 
     Human Resources and the Committee on Finance of the Senate, 
     and the Committee on Education and the Workforce and the 
     Committee on Ways and Means of the House of Representatives, 
     a report containing recommendations for appropriate 
     legislation to improve the effectiveness of, and enforcement 
     of, qualified medical child support orders under the 
     provisions of section 609 of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1169).

  Mr. KERRY. Mr. President, I am pleased to join the distinguished 
Senators from West Virginia and Maine as a co-sponsor of this very 
important legislation on behalf of America's children. Senators 
Rockefeller and Snowe have long been leaders in the effort to crack 
down on delinquent parents who would deny their children the much-
needed financial support to which they are entitled. I commend their 
dedication to this worthy cause.
  Each year, as much as $15 to $25 billion in child support remains 
uncollected. Of the 5.4 million single mothers who were owed child 
support in 1994, slightly more than half received the full amount due, 
while one quarter received partial payment and one quarter received not 
a penny. The delinquency of deadbeat parents is not only a disgrace, 
but also an emergency, as it primarily impacts the neediest children of 
this nation. One of every four children in America lives in a single 
parent family, 18.7 million children in all. Half of these children 
live at or below the poverty level, compared with only slightly more 
than one out of every ten children in two-parent families.
  The Rockefeller-Snowe-Kerry Child Support Performance Act of 1997 
aims to restructure and improve the federal performance incentive 
system for state collection of child support. It does so by replacing 
the system's current emphasis on the cost effectiveness of state 
programs with one that recognizes substantive achievements. Moreover, 
the bill requires states to use federal incentives payments to 
supplement, not supplant, existing state expenditures to enforce child 
support orders.
  I am particularly committed to working toward the goal of passing the 
medical support component of the Rockefeller-Snowe-Kerry bill. Although 
federal law requires state child support enforcement agencies to pursue 
medical support--particularly, health insurance coverage--when it is 
available to non-custodial parents at a reasonable cost, only 60 
percent of established child support orders included medical support in 
1995. Moreover, the General Accounting Office has reported that as many 
as 20 states were not enforcing existing medical support orders. This 
legislation addresses the inability of children of single parents to 
receive this crucial form of support by requiring the Secretary of 
Health and Human Services to develop and implement a medical support 
performance factor. Enabling child support agencies to enforce the 
requirement for medical support through ERISA-protected plans would 
shift many of the 700,000 children who currently receive public health 
coverage to private health insurance, thereby reducing significantly 
the cost to the public.
  Mr. President, my colleagues and I are determined to ensure that the 
millions of American children who are being short-changed by the non-
payment of child support, and medical support particularly, get help in 
the form of stricter enforcement. We are confident that the 
Rockefeller-Snowe-Kerry approach will make great strides toward this 
end and urge all of our colleagues to support this important 
legislation.
                                 ______
                                 
      By Mr. ROTH:
  S. 1810. A bill to suspend temporarily the duty on a certain anti-HIV 
and anti-AIDS drug; to the Committee on finance.


                      duty suspension legislation

  Mr. ROTH. Mr. President, I rise today to introduce temporary duty 
suspension legislation for the active ingredient used in producing 
Sustiva, a breakthrough drug for treating people with HIV and AIDS.
  I am pleased to introduce this bill on the active ingredients in a 
drug that could simplify treatment for HIV patients and could possibly 
reduce the level of this virus in the bloodstream. By temporarily 
suspending the imposition of duties, this bill will help DuPont Merck, 
a company located in Wilmington, Delaware, lower its cost of production 
and improve its competitiveness.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1810

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

     SECTION 1. TEMPORARY SUSPENSION OF DUTY.

       (a) In General.--Subchapter II of chapter 99 of the 
     Harmonized Tariff Schedule of the United States is amended by 
     inserting in numerical sequence the following new heading:

       

[[Page S2430]]



``9902.32.5  6-Chloro-4-                                                
 6.           (cyclopropylethyny                                        
              l)-1, 4-Dihydro-4-                                        
              (trifluro-methyl)-                                        
              2H-3, 1-benzoxazin-                                       
              2-one (CAS No.                                            
              154598-52-4)                                              
              (provided for in                                          
              subheading                                                
              2934.90.30).......  Free    No                            
                                           change   No                  
                                                     change   On or     
                                                               before 12/
                                                               31/      
                                                               2000''.  
                                                                        

       (b) Effective Date.--The amendment made by this section 
     applies with respect to goods entered, or withdrawn from 
     warehouse for consumption, on or after the 15th day after the 
     date of enactment of this Act.
                                 ______
                                 
      By Mr. FAIRCLOTH:
  S. 1811. A bill to prohibit the Secretary of Health and Human 
Services from promulgating any regulation, rule, or other order if the 
effect of such regulation, rule, or order is to eliminate or modify any 
requirement under the medicare program under title XVIII of the Social 
Security Act for physician supervision of anesthesia services, as such 
requirement was in effect on December 31, 1997; to the Committee on 
Finance.


               The Safe Seniors Medical Care Act of 1998

  Mr. FAIRCLOTH. Mr. President, I come before you today to introduce 
legislation that should be of interest to all senior citizens in the 
U.S.
  Mr. President, I must share with you my shock and outrage when I 
learned of a recently proposed rule by the Clinton Administration that 
eliminates the requirement of a real anesthesiologist during surgery 
for Medicare and Medicaid patients.
  The legislation I am introducing today would stop the Administration 
from imposing such on rule on our nation's senior population.
  At a time when President Clinton is seeking to expand Medicare 
coverage for more Americans, why is he quietly moving to lessen the 
standard of care for our senior citizens? This Administration is 
proposing a change that will permit non-physicians to evaluate patient 
health and administer anesthesia to a population at the greatest risk 
for complications.
  Not long ago, the President stood before Congress and stated that 
``Medical decisions should be made by medical doctors'' and that 
``every American deserves quality care.'' I totally agree with the 
President on these important points.
  But it's not good enough to simply say this--actions have to speak 
louder than words. This is one of the reasons I am introducing this 
bill.
  Mr. President, our elderly are our most vulnerable population. We 
established Medicare because of the cost of health care for the 
elderly. But Medicare doesn't have to be second class care. I think it 
is sinful to lower the quality of care for our seniors.
  Furthermore, this Administration won't even allow seniors that want 
to pay for their own health costs to do so--without forcing the doctor 
out of Medicare. So our seniors have little choice, but to be treated 
under the guidelines of Medicare.
  Now I am 70 years old, but to other Senators this will involve their 
mothers and fathers. To the younger generation, this will involve the 
treatment of their grandparents.
  I have to ask, do you really want to send your mother or father, or 
grandparents in for a critical operation and have the anesthesia 
administered by a non-doctor?
  Does the same standard apply to senior government officials? I would 
assume the President had a doctor administer his anesthesia. When I 
asked HHS Secretary Shalala whether she would choose a nurse or doctor 
to administer the anesthesia, when pressed she said she would ask her 
doctor!
  Here we go again, one standard for Washington officials--another for 
everyone else. I think that is wrong.
  Mr. President, I want to make an important point. This is not about 
diminishing the important role that nurses play an important role in 
the health care system. They play a valuable, great role. But on this 
one issue, I feel that the practice of Anesthesiology is simply too 
important to the any medical procedure to be left to those that are not 
trained extensively in this field. Anesthesia is the most important 
part of any operation, particularly for the elderly.
  Nurse anesthetists are non-physician providers who normally complete 
a two or three-year training technique-oriented training program after 
nursing school. Anesthesiologists are physicians who, after taking a 
pre-med curriculum in college, complete four years of medical school 
and a four-year anesthesiology residency program.
  We value the need for greater education in society, and here we are 
ignoring the importance of extensive education. All the rhetoric in 
Washington these days is about the importance of education. But if the 
Administration has its way, further education in the field will be 
deemed worthless.
  Mr. President, for three decades, Medicare and Medicaid patients have 
benefitted from an attending anesthesiologist. To my knowledge, there 
is no clinical study that can provide justification for eliminating the 
physician supervision requirement. 81% of senior citizens oppose the 
President's rule. And you can count me in that group.
  It is my understanding that there is no difference in cost if this 
rule is implemented. The reimbursement is the same to the doctor or the 
nurse. Furthermore, the number of patient deaths involving anesthesia 
has dramatically declined since the 1950's because we have a greater 
number of anesthesiologists in practice. We have made great strides in 
this field. Why would it make sense to radically change the rules at a 
time when we are so successful? It just doesn't make any sense.
  Mr. President, the bottom line is that senior citizens don't want 
this rule, there is no difference in cost and there is no evidence that 
warrants such a change. I simply cannot stand by and watch the 
President put the lives of senior citizens all across this country in a 
potentially dangerous situation. Thank you, Mr. President. I urge all 
the members to support this legislation.
                                 ______
                                 
      By Mr. LAUTENBERG:
  S. 1818. A bill to suspend temporarily the duty on organic 
luminescent pigments, dyes, and fibers for security applications; to 
the Committee on Finance.
  S. 1819. A bill to suspend temporarily the duty on fluorozirconium 
compounds; to the Committee on Finance.
  S. 1820. A bill to suspend temporarily the duty on 4-Hexylresorcinol; 
to the Committee on Finance.
  S. 1821. A bill to suspend temporarily the duty on polymethine 
sensitizing dyes for imaging applications; to the Committee on Finance.


                      DUTY SUSPENSION LEGISLATION

  Mr. LAUTENBERG. Mr. President, I rise today to introduce legislation 
to suspend temporarily the rate of duty on four products produced by a 
constituent, AlliedSignal Inc. I am introducing a separate bill for 
each of the four products. The first is organic luminescent pigments, 
dyes, and fibers that are used in products requiring security and anti-
counterfeiting technology. Unlike other pigments and dyes, these 
luminescent compounds are designed on a proprietary basis for one 
specific anti-counterfeiting application. The current duty is 5.9%. The 
second product, 4-Hexylresorcinol, has a variety of applications, 
including in throat lozenges, topical antiseptics, and other 
pharmaceutical and cosmetic applications. The current duty is 5.8%. 
Potassium hexafluorozirconate and hexafluorozirconium acid are used in 
the treatment of aluminum alloys in a variety of applications, 
including aerospace. The current duties are 3.1% and 4.2%. Finally, 
polymethine sensitizing dyes are used to improve the spectral response 
of photo-sensitive emulsions on photographic films. These dyes are 
complex organic molecules, and each one is typically designed on a 
proprietary basis to the customer's specifications. The current duty is 
6.8%.
  I have received assurances from AlliedSignal that there is no 
commercial US manufacturer for any of these products. Furthermore, each 
of the products was included in the United States Trade 
Representative's ``zero list'' of chemicals whose U.S. tariffs it tried 
to eliminate, in exchange for concessions from trading partners, during 
the November 1997 APEC Ministerial meeting. In a chemical industry-wide 
review of the zero list, no U.S. company objected to the proposed 
elimination of these products' duties.
  Suspending the duties of products that are not produced in the United 
States helps our companies maintain their global competitiveness. This 
benefits our manufacturers as well as American workers and consumers. I

[[Page S2431]]

ask my colleagues to support this legislation. I ask unanimous consent 
text of the bills be printed in the Record.
  There being no objection, the bills were ordered to be printed in the 
Record, as follows:

                                S. 1818

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

     SECTION 1. TEMPORARY SUSPENSION OF DUTY ON CERTAIN ORGANIC 
                   PIGMENTS, DYES, AND FIBERS.

       (a) In General.--Subchapter II of chapter 99 of the 
     Harmonized Tariff Schedule of the United States is amended by 
     inserting in numerical sequence the following new heading:
         

``9902.32.0  Organic luminescent                                        
 4.           pigments, dyes,                                           
              and fibers for                                            
              security                                                  
              applications                                              
              (provided for in                                          
              subheading                                                
              3204.90.00).......  Free    No                            
                                           change   No                  
                                                     change   On or     
                                                               before 12/
                                                               31/      
                                                               2001''.  
                                                                        

       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply with respect to goods entered, or withdrawn from 
     warehouse for consumption, on or after the date that is 15 
     days after the date of enactment of this Act.
                                                                    ____


                                S. 1819

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

     SECTION 1. TEMPORARY SUSPENSION OF DUTY ON CERTAIN 
                   FLUOROZIRCONIUM COMPOUNDS.

       (a) In General.--Subchapter II of chapter 99 of the 
     Harmonized Tariff Schedule of the United States is amended by 
     inserting in numerical sequence the following new heading:
         

  ``9902.28  Potassium                                                  
 .11.         hexafluorozirconat                                        
              e (CAS No. 16923-                                         
              95-8) (provided                                           
              for in subheading                                         
              2826.90.00) and                                           
              hexafluorozirconiu                                        
              m acid (CAS No.                                           
              12021-95-3)                                               
              (provided for in                                          
              subheading                                                
              2811.19.60).......  Free    No                            
                                           change   No                  
                                                     change   On or     
                                                               before 12/
                                                               31/      
                                                               2001''.  
                                                                        

       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply with respect to goods entered, or withdrawn from 
     warehouse for consumption, on or after the date that is 15 
     days after the date of enactment of this Act.
                                                                    ____


                                S. 1820

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

     SECTION 1. TEMPORARY SUSPENSION OF DUTY ON 4-HEXYLRESORCINOL.

       (a) In General.--Subchapter II of chapter 99 of the 
     Harmonized Tariff Schedule of the United States is amended by 
     inserting in numerical sequence the following new heading:
         

  ``9902.29  4-Hexylresorcinol    Free    No        No        On or     
 .07.         (CAS No. 136-77-6)           change    change    before 12/
              (provided for in                                 31/      
              subheading                                       2001''.  
              2907.29.90)                                               
                                                                        

       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply with respect to goods entered, or withdrawn from 
     warehouse for consumption, on or after the date that is 15 
     days after the date of enactment of this Act.
                                                                    ____


                                S. 1821

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

     SECTION 1. TEMPORARY SUSPENSION OF DUTY ON CERTAIN 
                   SENSITIZING DYES.

       (a) In General.--Subchapter II of chapter 99 of the 
     Harmonized Tariff Schedule of the United States is amended by 
     inserting in numerical sequence the following new heading:
         

  ``9902.29  Polymethine photo-                                         
 .34.         sensitizing dyes                                          
              (provided for in                                          
              subheadings                                               
              2934.90.90 and                                            
              2933.19.90).......  Free    No                            
                                           change   No                  
                                                     change   On or     
                                                               before 12/
                                                               31/      
                                                               2001''.  
                                                                        

       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply with respect to goods entered, or withdrawn from 
     warehouse for consumption, on or after the date that is 15 
     days after the date of enactment of this Act.
                                 ______
                                 
      By Mr. SPECTER (for himself, Mr. Thurmond, Mr. Jeffords, Mr. 
        Murkowski, Mr. Rockefeller, Mr. Akaka, Mr. Wellstone, Mr. 
        Lieberman, and Mrs. Murray):
  S. 1822. A bill to amend title 38, United States Code, to authorize 
provision of care to veterans treated with nasopharyngeal radium 
irradiation; to the Committee on Veterans' Affairs.


                  medical care to veterans legislation

  Mr. SPECTER. Mr. President, as Chairman of the Committee on Veterans' 
Affairs, I have today introduced, at the request of the Secretary of 
Veterans Affairs, S. 1822, a proposed bill to authorize the provision 
of medical care to veterans who were treated with nasopharyngeal radium 
irradiation. The Acting Secretary of Veterans Affairs submitted this 
proposed legislation to the President of the Senate by letter dated 
August 11, 1997.
  Mr. President, it is my usual practice, as Chairman of the Committee 
on Veterans Affairs, to introduce Administration-requested legislation 
that is referred to the Committee without commenting on the substance 
of the introduced bills, without committing myself to either support or 
oppose the legislation in question, and without seeking co-sponsors. In 
this case, I have departed from my usual practice due to the unusual 
nature of this legislation, which is long overdue. I am pleased that 
Senator Jay Rockefeller, the Ranking Minority Member of the Committee 
on Veterans Affairs, has joined me as a cosponsor.
  A medical treatment known as nasopharyngeal radium irradiation --the 
inserting of a radium-tipped metal rod through the nose--began in 1924 
at the Johns Hopkins University as a means to treat middle ear 
obstructions and deafness. It was also commonly used to treat children 
with chronic ear infections. Even until the mid 1960's, medical 
textbooks recommended this treatment to shrink adenoid tissue in 
children. It is estimated that from 500,000 to 2 million persons may 
have received nasopharyngeal radium irradiation treatments over the 
years.
  During the 1940's and 1950's--and perhaps later--the military treated 
submariners and air crew members with nasopharyngeal radium irradiation 
to prevent ear injury caused by severe pressure changes encountered in 
submarine and flight duty. The Final Report of the Advisory Committee 
on Human Radiation Experiments issued in 1995 cites one case where the 
Navy in the early 1940's treated 732 submariners with nasopharyngeal 
radium irradiation to equalize middle ear pressure with a 90 percent 
success rate.
  Unfortunately, scientific research now suggests that individuals who 
received this then-accepted medical treatment may be at increased risk 
for developing head and neck cancers and other types of diseases and 
disorders. When nasopharyngeal irradiation was administered, radiation 
targeted to lymph tissue also affected the brain and other tissues in 
the head and neck, including the paranasal sinuses, salivary glands, 
thyroid and parathyroid glands.
  Mr. President, the Committee on Veterans Affairs will fully develop 
the scientific record on this legislation. I will not now, therefore, 
discuss at length the evidence to support the proposition that veterans 
who received such therapy should now be eligible for VA care to treat 
the previously unknown medical consequences of nasopharyngeal radium 
irradiation. Suffice it to say now that the quantum of radiation to 
which people were routinely exposed as a consequence of nasopharyngeal 
radium irradiation far exceeded levels that would be judged acceptable 
today. Our colleague from Connecticut, Senator Lieberman, stated it 
well when he commented in August 1994, at a hearing of the Environment 
and Public Works Subcommittee on Clean Air and Nuclear Radiation: ``. . 
. the best evidence of the danger of this radium treatment is the fact 
that no doctor in his right mind would think of performing such a 
procedure today.''
  VA has proposed that veterans who received such treatment in the past 
be deemed eligible for treatment of cancers and other diseases and 
disorders that might be associated with this well-intentioned, but 
seemingly misguided, exposure to radiation. This legislation, if 
enacted, would authorize VA to treat such veterans on the same priority 
basis as it treats veterans who may have been exposed to ionizing 
radiation during weapons testing or during the occupation of Japan 
following World War II. It would also authorize VA to examine any 
veteran who was subjected to nasopharyngeal irradiation and include any 
findings in the VA's radiation registry.
  As Chairman of the Veteran's Affairs Committee, I urge my colleagues 
in the Senate to join me in supporting this legislation.

[[Page S2432]]

  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1822

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled, That 
     except as otherwise expressly provided, whenever in this Act 
     an amendment is expressed in terms of an amendment to a 
     section or other provision, the reference shall be considered 
     to be made to a section or other provision of title 38, 
     United States Code.
       Sec. 2. (a) The Secretary may examine, and include in the 
     Department's Ionizing Radiation Registry Program, any veteran 
     who received nasopharyngeal radium irradiation treatments 
     while serving in the active military, naval, or air service.
       (b) Section 1710 is amended--
       (1) in subsection (a)(2)(F), by inserting ``or who received 
     nasopharyngeal radium irradiation treatments,'' after 
     ``environmental hazard,''; and
       (2) in subsection (e)(1)(B) by inserting ``, or a veteran 
     who received nasopharyngeal radium irradiation treatments 
     while serving in the active military, naval, or air 
     service,'' after ``radiation-exposed veteran''.

  Mr. ROCKEFELLER. Mr. President, I am pleased to cosponsor legislation 
that will authorize provision of care to veterans treated with 
nasopharyngeal radium irradiation. This bill, requested by the 
Department of Veterans Affairs, will provide priority health care to a 
group of veterans that have so far been excluded from access to VA 
services. I urge all of my colleagues to support this bill.
  Let me take you back over 40 years, to the 1940's and 50's, when 
thousands of military personnel (primarily Navy submariners and Army 
Air Corps pilots) received nasopharyngeal radium treatments to treat 
and prevent inner ear problems that developed due to the inadequate 
pressurization of their respective vessels. These treatments were 
considered the standard in the medical community at the time for 
children with severe middle ear obstructions and infections, often with 
accompanying deafness. To adapt the treatments to healthy adults, the 
Navy and Army conducted experiments on small groups of submariners and 
pilots. Subsequently, between 8,000 and 12,000 servicemen were 
irradiated for military purposes. The treatments were halted in the 
early 1960's as a result of two developments: pressurized planes and 
submarines became available (thus obviating the need for the 
treatments), and the clinical dangers associated with radiation were 
becoming apparent.
  Looking back, we now know just how dangerous these treatments can be. 
The Centers for Disease Control and Prevention estimate that tissues at 
the exact site of radium placement were exposed to 2000 rem of 
radiation. That is 400 times greater than the maximum ``safe'' level of 
radiation exposure established by the Atomic Energy Commission many 
years ago. Parts of the brain received 24 rem, five times the accepted 
limit of exposure. Studies that have analyzed the health effects of 
external irradiation of the head and neck conclude that there is an 
increased risk of tumors of the brain, and of the thyroid, salivary, 
and parathyroid glands. One study done on individuals who had received 
nasopharyngeal radium treatments concluded there was an increased risk 
of developing head and neck tumors associated with the childhood 
treatments.
  Unfortunately, the health effects of the treatments that were given 
to our veterans is unknown. Careful scientific studies cannot be done 
because the records documenting the treatments are incomplete or 
nonexistent. However, when such high levels of exposure are sustained, 
we must be concerned about long-term health effects, and thus, we have 
a responsibility to ensure access to health care by these veterans. 
Simply put, it is the right thing to do.
  This legislation is a step in the right direction in helping these 
individuals. As Ranking Minority Member of the Senate Committee on 
Veterans' Affairs, I am well acquainted with the difficulties 
experienced by veterans who were exposed to radiation during service to 
their country and later sought help from the VA. The willingness of the 
VA to include this group of veterans is clearly demonstrated by the 
fact that VA initiated this legislation, and that is good.
  In summary, this legislation grants veterans who received 
nasopharyngeal radium treatments the same status as other atomic 
veterans who served in the occupational forces in Nagasaki and 
Hiroshima, or who were present at the atmospheric test sites in Nevada 
and the Pacific. These veterans will now be able to enroll in the 
ionizing radiation registry, which entitles them to a full and complete 
physical examination. They will also gain access to medical care, to 
treat cancerous conditions detected during this examination that are 
associated with exposure to ionizing radiation.
  It is especially important to provide physical examinations and 
health care to these veterans because documentation of the 
nasopharyngeal radium treatments was poorly done, if it was done at 
all. Thus, the relevant clinical information is not in their civilian 
or military medical records to alert a physician to potential problems. 
The appalling lack of documentation has proved to be a constant problem 
in ongoing efforts to grant benefits to atomic veterans of all types, 
and continues to plague us in this effort as well.
  We will continue to study the plight of all atomic veterans, but this 
legislation offers eligible health care to a group of atomic veterans 
that have up to now been closed out of the VA. It is reasonable, 
compassionate, and long overdue.
  Mr. LIEBERMAN. Mr. President, I am very pleased today to join with my 
colleagues, including Senators Specter and Rockefeller, the Chairman 
and Ranking Member of the Veterans Affairs Committee, and the Chairman 
of the Armed Services Committee, Senator Thurmond, as an original 
cosponsor of this legislation which would authorize access to priority 
medical care for veterans treated with nasopharyngeal radium 
irradiation. Enactment of this legislation would be a major step 
forward for our veterans who received this treatment for inner-air 
problems between l940 and l960. I applaud the Clinton Administration 
for submitting this legislation.
  Mr. President, nasal radium irradiation was the largest scale 
radiation experiment in the United States and the consequences of 
exposing so many people to ionizing radiation has not been adequately 
addressed. It was used to alleviate pressure changes associated with 
submarine and flying duties for our soldiers and to treat children with 
inner ear problems. We have a moral obligation to do everything we can 
to help these veterans and civilians. This legislation is especially 
important to me because veterans who received this treatment included 
Navy submariners trained in Connecticut. I've been working for the last 
four years to get similar legislation enacted.
  Under this bill, veterans who received nasopharyngeal radium 
treatments will receive the same status as other atomic veterans who 
served in the occupational forces in Nagasaki and Hiroshima or were 
present at the test sites in Nevada and the Pacific. What this means is 
that these veterans will be able to enroll in the ionizing radiation 
registry which entitles them to a full and complete physical 
examination. They will also gain access to medical care to treat 
cancerous conditions detected during this examination that are 
associated with exposure to ionizing radiation.
  Studies that have analyzed the health effects of external irradiation 
of the head and neck indicate that there is an increased risk of 
tumours of the brain and of the thyroid, salivary and parathyroid 
glands.
  Mr. President, I've been working on many aspects of this problem for 
a number of years. I've been very concerned about notifying veterans 
who received this treatment so that they are aware of the concerns 
about the long term effects of such treatment and can take appropriate 
actions. Last September, the Veterans Administration agreed to provide 
such notification where they had the information available. The 
Veterans Administration is also considering performing a health 
surveillance involving about 400 veterans whose names were discovered 
in a logbook in April l996 at the Submarine School Museum in 
Connecticut. This would also be a significant step forward.
  I also remain very concerned about our civilians who have been 
exposed to this treatment. The Center for Disease

[[Page S2433]]

 Control and Prevention estimates that between 500,000 and two million 
civilians received this treatment between 1945 and l960. I was very 
pleased that CDC hosted a video conference on the treatment at Yale in 
September l995 and has published notices in medical bulletins about the 
treatment, including fact sheets for the general public.
  My number one priority on the civilian side now is attempting to 
ensure that civilians who received the treatment are notified. I have 
written to Secretary Shalala asking her to undertake a feasibility 
study about providing notice. People need to know that they had this 
treatment so that they can determine appropriate next steps, and our 
government should do everything possible to ensure that notice is 
provided.
  Mr. President, many challenges remain as the government seeks to 
fulfill its moral obligation to our veterans. But enactment of this 
legislation would be an extremely important step forward.

                          ____________________