[Congressional Record Volume 144, Number 99 (Wednesday, July 22, 1998)]
[Senate]
[Pages S8779-S8786]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. HARKIN (for himself and Ms. Mikulski):
  S. 2340. A bill to amend title XVIII of the Social Security Act to 
provide for coverage of qualified acupuncturist services under part B 
of the medicare program, and to amend title 5, United States Code, to 
provide for coverage of such services under the Federal Employees 
Health Benefits Program; to the Committee on Finance.


         The Patient Access to Acupuncture Services Act of 1998

  Mr. HARKIN. Mr. President, I am pleased today to introduce the 
Patient Access to Acupuncture Services Act of 1998, to provide limited 
coverage for acupuncture under Medicare and the Federal Employees 
Health Benefits Program. This is an important bill that reflects an 
appropriate and needed response to both progress in science, and to the 
demand for complementary and alternative treatments of pain and 
illness.

  I would like to acknowledge Senator Mikulski, who is cosponsoring 
this bill with me. Senator Mikulski has been a strong supporter of 
effective alternative therapies and has long realized and appreciated 
the importance and significance of such therapies to our health care 
system.
  Mr. President, approximately 90 million Americans suffer from chronic 
illnesses, which, each year, cost society roughly $659 billion in 
health care expenditures, lost productivity and premature death. 
Despite the high costs of this care, studies published in the Journal 
of the American Medical Association reveal that the health care 
delivery system is not meeting the needs of the chronically ill in the 
United States.
  Many of these Americans are looking desperately for effective, less 
costly alternative therapies to relieve the debilitating pain they 
suffer. In 1990 alone, Americans spent nearly $14 billion out-of-pocket 
on alternative therapies. Harvard University researchers have found 
that fully one-third of Americans regularly use complementary and 
alternative medicine, making an estimated 425 million visits to 
complementary and alternative practitioners of these therapies--
surpassing those made to conventional primary care practitioners!
  And with good reason. Last November, a consensus conference of the 
National Institutes of Health approved the use of acupuncture in 
standard U.S. medical care. It was the first time that the NIH had 
endorsed as effective a major alternative therapy, and it was just the 
type of medical breakthrough that I had hoped for and envisioned when I 
worked to establish the Office of Alternative Medicine at NIH.
  The NIH experts cited data showing that acupuncture can effectively 
relieve certain conditions, such as nausea, vomiting and pain, and 
shows promise in treating chronic conditions such as lower back pain, 
substance addictions, osteoarthritis and asthma.
  In 1993, the FDA reported that Americans spent $500 million for up to 
12 million acupuncture visits. In 1996, after reviewing the science, 
the FDA removed acupuncture needles from the category of ``experimental 
medical devices'' and now regulates them just as it does other devices, 
such as surgical scalpels and hypodermic syringes. Acupuncture is 
effectively used by practitioners around the world. The World Health 
Organization has approved its use to treat a variety of medical 
conditions, including pulmonary problems and rehabilitation from 
neurological damage.
  It has been reported that more than 1 million Americans currently 
receive acupuncture each year. Access to qualified acupuncture 
professionals for appropriate conditions should be ensured. Including 
this important therapy under Medicare and FEHBP coverage will promote a 
progressive health system that integrates treatment from both 
acupuncturists and physicians. It will expand patient care options. I 
also believe it will reduce health care costs because of the relatively 
low cost of acupuncture compared to conventional pain management 
therapies.
  Research is still needed to demonstrate the effectiveness of other 
alternative therapies. This research is vitally important, but we must 
act now to help the millions Americans who can benefit from the 
knowledge we have already gained.
  The 21st century is just around the corner. Less than 50 years ago, 
treatments that are now considered conventional--organ transplants, 
nitroglycerin for heart patients, immunology, and x-ray and laser 
technology--were decried as quackery by the medical establishment. 
Everyday we face new biological and emotional challenges for which 
modern Western medicine has no remedy. Now science is revealing the 
effectiveness of many complementary and alternative treatments, 
including acupuncture, and increasingly more Americans are choosing 
them to manage their health and treat their illness.
  Let us listen to the science, and heed the urgent need for progress. 
Mr. President, the nation's leading scientists have demonstrated the 
safety and effectiveness of acupuncture as a treatment for a wide range 
of pain and illness. It makes common sense that Medicare and FEHBP 
cover this legitimate course of therapy.
  Mr. President, I ask for unanimous consent that a copy of this bill 
be entered into the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2340

       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 ``Patient Access to 
     Acupuncture Services Act of 1998''.

     SEC. 2. COVERAGE OF ACUPUNCTURIST SERVICES UNDER MEDICARE.

       (a) In General.--Section 1861(s)(2) of the Social Security 
     Act (42 U.S.C. 1395x(s)(2)) (as amended by section 4557 of 
     the Balanced Budget Act of 1997) is amended--
       (1) in subparagraph (S), by striking ``and'' at the end;
       (2) in subparagraph (T), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following:
       ``(U) qualified acupuncturist services (as defined in 
     subsection (uu));''.
       (b) Payment Rules.--
       (1) Determination of amount of payment.--Section 1833(a)(1) 
     of the Social Security Act (42 U.S.C. 1395l(a)(1)) (as 
     amended by section 4556(b) of the Balanced Budget Act of 
     1997) is amended--
       (A) by striking ``and'' before ``(S)'', and
       (B) by striking the semicolon at the end and inserting the 
     following: ``, and (T) with respect to qualified 
     acupuncturist services described in section 1861(s)(2)(U), 
     the amounts paid shall be the amount determined by a fee 
     schedule established by the Secretary for purposes of this 
     subparagraph;''.
       (2) Separate payment for services of institutional 
     providers.--Section 1832(a)(2)(B)(iii) of the Social Security 
     Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended--
       (A) by striking ``and services'' and inserting 
     ``services''; and
       (B) by striking the semicolon at the end and inserting the 
     following: ``, and qualified acupuncturist services described 
     in section 1861(s)(2)(U);''.
       (c) Services Described.--Section 1861 of the Social 
     Security Act (42 U.S.C. 1395x) (as amended by section 4611(b) 
     of the Balanced Budget Act of 1997) is amended by adding at 
     the end the following:

                   ``Qualified Acupuncturist Services

       ``(uu)(1) The term `qualified acupuncturist services' means 
     such services (with such frequency limits as the Secretary 
     determines

[[Page S8780]]

     appropriate) furnished by a qualified acupuncturist (as 
     defined in paragraph (2)) and such services and supplies 
     (with such limits) furnished as an incident to services 
     furnished by the qualified acupuncturist that the qualified 
     acupuncturist is legally authorized to perform under State 
     law (or under a State regulatory mechanism provided by State 
     law).
       ``(2) The term `qualified acupuncturist' means an 
     individual who has been certified, licensed, or registered as 
     an acupuncturist by a State (or under a State regulatory 
     mechanism provided by State law).''.
       (d) Guidance by Secretary of Health and Human Services.--
     The Secretary of Health and Human Services shall provide 
     States with guidance regarding what services a qualified 
     acupuncturist (as defined in section 1861(uu)(2) of the 
     Social Security Act (42 U.S.C. 1395x(uu)(2)) (as added by 
     subsection (c)) should be legally authorized to perform under 
     State law (or under a State regulatory mechanism provided by 
     State law). In providing such guidance, the Secretary of 
     Health and Human Services shall take into consideration the 
     recommendations of the Director of the National Institutes of 
     Health relating to the effectiveness of certain acupuncture 
     services and modalities.
       (e) Effective Date.--The amendments made by this section 
     apply to services furnished on or after January 1, 1999.

     SEC. 3. COVERAGE OF ACUPUNCTURIST SERVICES UNDER FEDERAL 
                   EMPLOYEES HEALTH BENEFIT PLANS.

       (a) In General.--Section 8902(k)(1) of title 5, United 
     States Code, is amended by inserting ``acupuncturist,'' after 
     ``nurse midwife,'' each place it appears.
       (b) Applicability.--The amendment made by subsection (a) 
     applies with respect to services provided on or after January 
     1, 1999.

 Ms. MIKULSKI. Mr. President, today I join my good friend and 
colleague, Senator Harkin, in introducing a bill to allow for coverage 
of acupuncture services under Part B of Medicare and the Federal 
Employee Health Benefits Program (FEHBP). I am proud to be the lead 
cosponsor of this legislation.
  I like this bill for three reasons: it gives patients access to 
affordable, quality health care; it offers patients choice of 
treatment; and it lets patients decide what treatment works for them.
  Some years ago I had some very severe illnesses. Western medicine was 
of limited utility for me and I turned to acupuncture. Acupuncture 
helped me get well and has helped me stay well. Time after time, 
constituents have confirmed what I already know about acupuncture--it 
is an effective treatment for a number of conditions.
  Last November, the Western medical establishment formally endorsed 
what American consumers have been saying for a long time. The National 
Institutes of Health convened a federal panel of experts in medicine, 
anthropology, biostatistics, epidemiology and other scientific 
disciplines to discuss the validity of acupuncture as an effective 
treatment option. The panel concluded that there is clear evidence that 
acupuncture is an effective treatment for certain kinds of pain and 
nausea and may be effective for other conditions. Equally important, 
acupuncture has fewer side effects and is less invasive than many 
``traditional'' medical practices. The panel decided that, given its 
good safety profile and the fact that it is often less expensive than 
conventional medicine, it's time to take acupuncture seriously.
  I think it's time that the federal government take it seriously, too. 
The time has come for Medicare and FEHBP to cover acupuncture for 
American patients who seek this treatment option. I urge the Senate to 
approve this legislation to allow American patients to choose this less 
invasive, less costly, and effective treatment option. I applaud 
Senator Harkin for taking the lead on this important effort.
                                 ______
                                 
      By Mr. DeWINE (for himself, Mr. Coverdell, Mr. Graham, Mr. 
        Faircloth, Mr. Brownback, Mr. Bond, Mr. Helms, Mr. Abraham, Mr. 
        Hutchinson, Mr. Allard, Mr. Frist, Mr. Mack, Mr. Murkowski, Mr. 
        Hatch, Mr. Craig, and Mr. Grassley):
  S. 2341. A bill to support enhanced drug interdiction efforts in the 
major transit countries and support a comprehensive supply eradication 
and crop substitution program in source countries; to the Committee on 
Foreign Relations


                Western hemisphere drug elimination act

 Mr. DeWINE. Mr. President, I rise today to introduce 
legislation proposing a new and comprehensive strategy to deal with one 
of the central challenges facing America's young people--the plague of 
illegal drugs.
  Recently, President Clinton and House Speaker Newt Gingrich unveiled 
the latest investment in our war against illegal drug use: a $2 
billion-dollar advertising campaign to send our children a hard-hitting 
message about the life-destroying dangers of drugs.
  Anti-drug ad campaigns like this one are important. But we should 
remember that the creative minds on Madison Avenue are not our best or 
only weapon to get people off drugs. History has proven that a 
successful anti-drug strategy is balanced and comprehensive in three 
key areas: demand reduction (such as education and treatment); domestic 
law enforcement; and international supply reduction.
  Today, though, we are on the wrong side of history. Our overall drug 
strategy is neither balanced nor comprehensive. That's because 
Washington has not done its part. It has not carried out its sole 
responsibility--to reduce the illegal drug imports, either by working 
with foreign governments, or by seizing drugs or disrupting drug 
trafficking routes outside our borders.
  That is why, today, I rise to introduce this legislation. It is a 
bill that will fix our current drug strategy deficit. I, along with 
Senators Coverdell, Graham and 11 other Senators will introduce the 
``Western Hemisphere Drug Elimination Act''--a bill to support enhanced 
drug interdiction efforts in the major transit countries, and support a 
comprehensive supply eradication and crop substitution program in 
source countries.
  Mr. President, this is a $2.6 billion authorization initiative over 
three years for enhanced international eradication, interdiction and 
crop substitution efforts. Let me mention a few highlights of what this 
bill would accomplish, very specifically.
  It would improve our aircraft, maritime and radar coverage of both 
drug-source and drug-transit countries. It would do this by (1) 
authorizing funds for construction, operation and maintenance of 
additional U.S. Customs/Defense aircraft, Coast Guard cutters and 
patrol vessels, and Customs/Coast Guard ``go-fast'' boats for drug 
interdiction efforts; (2) authorizing funds to establish an airbase to 
support counter-narcotics operations in the Southern Caribbean, 
Northern South America, and the Eastern Pacific; and (3) 
authorizing funds to the Department of Defense to restore, operate, and 
maintain critical radar coverage in these regions.

  It would enhance drug-eradication and interdiction efforts in source 
countries--by authorizing funds to the Departments of State and Defense 
to provide necessary resources, equipment, training and other 
assistance needed for the support of eradication and interdiction 
programs in Bolivia, Colombia, Peru and Mexico.
  It would enhance the development of alternative crops in drug-source 
countries, by authorizing funds to the United States Agency for 
International Development to support alternative development programs 
designed to encourage farmers to substitute for narcotic producing 
crops in Bolivia, Colombia, and Peru.
  It would support international law enforcement training--by (1) 
establishing three separate international law enforcement academies 
operated by the Department of Justice, to provide training assistance 
in Latin America, Asia, and Africa; (2) establishing a training center 
for maritime law enforcement instruction, including customs-related 
ports management; and (3) authorizing funds for the promotion of law 
enforcement training and support for Caribbean, Central American and 
South American countries.
  It would enhance law enforcement interdiction operations by 
authorizing funding to the Drug Enforcement Administration, U.S. Coast 
Guard, and Department of Defense for the support of counter-narcotics 
operations and equipment in drug transit and source countries.
  Mr. President, as you can see, this is a very targeted and specific 
investment. And it is necessary. The budget numbers tell an alarming--
undeniable--story: In 1987, the federal government's drug control 
budget of $4.79 billion was divided as follows: 29% for demand 
reduction programs; 38% for domestic law enforcement; and 33% for 
international supply reduction. This

[[Page S8781]]

funding breakdown was the norm during the Reagan and Bush 
Administrations' war on drugs, from 1985-92.
  During that time, drug interdiction was serious business. President 
Bush even tasked the Defense Department to engage in the detection and 
monitoring of drugs in transit to the U.S. As a member of the House of 
Representatives at that time, I can recall very well the major 
commitment we made to reduce the amount of drugs going into the U.S.
  After President Clinton took office in 1993, his administration 
immediately pursued policies that upset the careful balance in drug 
funding. For example, in 1995, the federal drug control budget of $13.3 
billion was divided as follows: 35% was allocated for demand reduction 
programs; 53% for domestic law enforcement, and 12% for international 
supply reduction. Think of it--only 12% of our drug control budget was 
dedicated to stop drugs from coming to our country--down from 33% in 
1987. Though the overall drug budget increased threefold from 1987 to 
1995, the piece of the drug budget pie allocated for international and 
interdiction efforts had decreased.

  Key components of our drug interdiction strategy were slashed. For 
example, Coast Guard funding for counter-narcotics fell 32% from 1992 
to 1995. Not surprisingly, Coast Guard drug seizures dropped from 
90,335 lbs in 1991 to 28,585 lbs in 1996. In addition, interdiction no 
longer remains a priority within the Department of Defense, which 
currently ranks counter narcotics dead last in importance in its Global 
Military Force Policy.
  What were the results of these two clearly different approaches? The 
Reagan-Bush approach achieved real success. From 1988 to 1991, total 
drug use was down 13 percent. Cocaine use dropped by 35 percent. 
Marijuana use was reduced by 16 percent.
  In contrast, under the Clinton approach, since 1992 overall drug use 
among teens aged 12 to 17 rose by 70 percent. Drug-abuse related 
arrests more than doubled for minors between 1992 and 1996. Since 1992, 
there has been an overall 80 percent increase in illicit drug use among 
graduating high school seniors. Further, in 1995 number of heroin 
related emergency room admissions jumped 58% since 1992. And in the 
first half of 1995, methamphetamine related emergency room admissions 
were 321% higher compared to the first half of 1991.
  The price of drugs also decreased during this time period. For 
instance, the price of a pure heroin gram in 1992 was $1,647--and in 
February 1996 it was only $966 per gram.
  These negative effects have sent shockwaves throughout our 
communities and our homes.
  The rise of drug use is not at all surprising. With the Clinton 
administration's decline in emphasis on drug interdiction, it has 
become easier to bring drugs into the U.S. This makes drugs more 
available and more affordable. The Office of National Drug Control 
Policy reported that small ``pieces'' or ``rocks'' of crack, which once 
sold for ten to twenty dollars, are now available for three to five 
dollars.
  No question, continued investments to deal with the ``demand side'' 
of the drug situation are necessary. We have to find ways to persuade 
Americans, particularly young people, that doing drugs is wrong--that 
it destroys lives, families, schools and communities. As long as there 
is a demand for drugs, education and treatment remain essential long-
term components of our anti-drug efforts.

  Casual drug users also are influenced by price, which is why a 
balanced anti-drug strategy includes fighting drugs beyond our borders. 
The drug lords in South America are well aware that the U.S. is no 
longer pursuing a tough interdiction strategy. I have seen Coast Guard 
operations first hand, and while the Coast Guard and other agencies can 
detect and monitor drug trafficking operations, they usually stand by 
helpless because they lack necessary equipment to turn detection into 
seizures and arrests. Of the total drug air events in the Bahamas from 
April 1997 to April 1998, there was only an 8% success rate in stopping 
drug air flights that have been detected. That means over 92% got away. 
Without doubt, the drug lords can get a larger flow of drugs into the 
U.S.
  With additional resources, we can make it more difficult to import 
illegal narcotics, and drive up the cost for the drug cartels to engage 
in this illicit and immoral practice. Interdiction drives up the 
price--and drives down the purity--of cocaine on the street. Also, 
seizing or destroying a ton of cocaine outside our borders is more cost 
effective than trying to seize the same quantity of drugs at the point 
of sale.
  Mr. President, that is why I think that this bill is absolutely 
essential. The bill can get us back on the right track. I want to take 
this opportunity to acknowledge Representative Bill McCollum's tireless 
efforts and dedication to this initiative. He has shown tremendous 
leadership on anti-drug efforts.
  Mr. President, it is time to reverse the current administration's 
policy and get right with history. It is time we returned to a 
comprehensive, balanced drug control strategy that will put us back on 
a course toward ridding our schools and communities of illegal and 
destructive drugs. The evidence clearly shows that with a balanced 
strategy, we were making great progress. We significantly reduced drug 
use. For the sake of our children, it is time for us to embrace the 
lessons of history, and stop trying to escape them.
 Mr. GRAHAM. Mr. President, I am proud to join Senator DeWine 
and my other colleagues in introducing the Western Hemisphere Drug 
Elimination Act of 1998. This bill will provide an additional $2.6 
billion over a 3-year period to implement a more comprehensive 
eradication, interdiction, and crop substitution strategy for our 
nation's counter-drug efforts.
  The bill will help the United States meet its goal of reducing the 
flow of cocaine and heroin into the U.S. by 80 percent in three years 
by combining a reduction in availability with demand reduction efforts. 
This is accomplished by providing more funding to those doing the heavy 
lifting in this fight--the Coast Guard, the Customs Service, the Drug 
Enforcement Administration, and the Department of Defense.
  The U.S. needs to focus its resources in a comprehensive way to 
protect the entire southern frontier of the United States from San 
Diego to San Juan. Previously, resources were shifted from one part of 
the country to another, alternating between those states along the 
Southwest border and the Caribbean. This created ``gates'' where drug 
smugglers could move their product without fear of U.S. interdiction. 
This bill will provide the necessary resources to eliminate the chinks 
from the anti-drug fence, so that we do not have to choose between 
stopping drug smuggling in one area of the country or another.
  On June 22 of this year, I chaired a field hearing in Miami on behalf 
of the Senate Caucus on International Narcotics Control. The purpose 
was to examine the flow of drugs into the United States through the 
Caribbean into Florida. I wanted to gain a clearer picture of the 
current patterns of narcotics trafficking from the Southwest border 
back to the Caribbean and South Florida, obtain a better understanding 
for what the United States needs to do to increase our anti-drug 
effectiveness, and improve our efforts to stem this flow which 
threatens our youth. We held the hearing on the deck of a U.S. Coast 
Guard Medium Endurance Cutter named the Valiant, which had just 
returned from a seven week counter-narcotics patrol in the Caribbean.
  We selected the Coast Guard venue to underscore a number of very 
important realities in the United States' current strategy to fight the 
drug war. One of our principal interdiction forces--the United States 
Coast Guard--is conducting its mission on vessels such as the Valiant, 
a ship that is more than 30 years old, with an equally antiquated 
surface search radar. The Coast Guard needs new ships and newer radars. 
As I approached the Valiant, I noticed that there were a number of 
weapons systems on board, including two .50 caliber machine guns and a 
25mm chain gun. These weapons reminded me that this effort is indeed a 
war. Despite the words of some officials who prefer not to characterize 
the effort as such, it is indeed. We are fighting a well-organized, 
well-financed, and doggedly determined enemy whose objective is to 
inundate our nation with a chemical weapon that demeans, degrades, and 
defeats the most precious asset we have--our people. What more do we

[[Page S8782]]

need to know to energize ourselves to fight back?
  The individuals who testified at the field hearing painted a very 
disturbing picture. Consider the following facts:
  The United States Southern Command cannot maintain adequate radar and 
airborne early warning coverage of the region or sustain the right 
number of tracker aircraft to perform its mission to provide counter-
drug support to states in South America and the Caribbean.
  The Joint Interagency Task Force East, located in Key West, Florida, 
does not know the extent of drug smuggling in the Eastern Pacific 
because the Department of Defense has not provided the necessary assets 
to conduct its Detection & Monitoring mission.
  The Coast Guard had to end a very successful counter-narcotics 
operation in the Caribbean, OPERATION FRONTIER LANCE, because of a lack 
of funding.
  The United States Customs Service is limited in its ability to 
capture drug runners in go-fast boats because of a lack of funds to 
procure newer and faster boats, as well as a lack of personnel to 
adequately maintain those go-fast boats currently in service due to 
lack of funding.
  The Drug Enforcement Administration lacks sufficient special agents 
in the Caribbean, as well as accompanying administrative and 
intelligence personnel, because the DEA does not have sufficient funds 
to hire and retain these individuals.
  The South Florida High Intensity Drug Trafficking Area--responsible 
for coordinating and integrating federal, state, and local law 
enforcement agencies' counter-drug efforts--is constrained in its 
ability to conduct investigations by paying overtime salaries because 
of the lack of funding.
  If there is a trend underlying all these problems, it is the lack of 
funds being made available to those agencies responsible for performing 
the supply reduction component of the drug war. By adding resources to 
the supply side of the drug war--more planes, helicopters, radars, 
personnel, and boats--we will eliminate the need to constantly shift 
resources from one area of the country to another. Drug smugglers will 
no longer be able to exploit our weaknesses, such as the lack of Coast 
Guard, Customs, and DEA resources in the Caribbean. South Florida will 
no longer be a gate through which drug smugglers have entry into the 
United States.
  Those responsible for coordinating the national drug control strategy 
say that reducing our own demand for drugs is tremendously important. I 
could not agree more. That is why I was an original co-sponsor of the 
Drug Free Communities Act, and why I took steps to create and fund the 
Central Florida High Intensity Drug Trafficking Area. But addressing 
our demand for drugs is only one part of the solution, and that 
reduction will take time. We must take strong steps to interrupt the 
supply side of the equation as well. And quite frankly, we are not 
doing as much on the supply side as we should, or as much as we can.
  I am committed to seeing that more is done, and this legislation goes 
a long way towards achieving our goals. By restoring the support we 
provide to eradication and interdiction, I believe we can make a 
difference in this war, and the time to make that difference is 
now.
                                 ______
                                 
      By Mr. BURNS:
  S. 2342. A bill to amend title XVIII of the Social Security Act to 
exempt certain facilities from the 3-year transition period under the 
prospective payment system for skilled nursing facilities; to the 
Committee on Finance.


       the skilled nursing facility payment fairness act of 1998

 Mr. BURNS. Mr. President, today I am pleased to introduce 
legislation to put more equality into the Medicare payment system for 
skilled nursing facilities (SNFs). The Skilled Nursing Facility Payment 
Fairness Act of 1998 will allow certain SNFs--those which will suffer a 
real cut in Medicare payments--to use a more equitable payment formula 
that more closely reflects their actual costs.
  The Balanced Budget Act of 1997 required HCFA to develop a 
prospective payment system (PPS) for Medicare-covered services provided 
by skilled nursing facilities. Under the PPS, SNFs will be paid a 
single federal per diem rate for all routine, ancillary, and capital-
related Part A costs. For SNFs that participated in Medicare before 
October 1, 1995, there is a three-year transition period to the PPS. 
During this transition period, facilities will be paid a blended rate 
based on a facility-specific rate and a federal rate. In the first year 
of the transition, the blended rate will be 75% of the facility-
specific rate and 25% of the federal rate; in the second year the split 
will be 50%-50%; and in the third year 25%-75%.
  For facilities that have had a substantial change in the level of 
services they provide since 1995, the transitional blended payment rate 
will have a severe impact. And of those facilities adversely affected, 
a significant number are low-utilization SNFs is rural areas. For 
example, facilities in Montana provide fewer services as measured by 
Medicare patient days than the national average. They are hit in two 
ways: first, their utilization levels (length of stay, level of 
acuity), though still low, are higher today than they were in 1995, so 
the facility-specific rate which is based on 1995 cost reports does not 
reflect today's costs; second, the low-utilization facilities are less 
able to absorb Medicare payment reductions and are more likely to drop 
out of Medicare altogether. As a result, rural communities with few 
providers may have no post-hospital services. Patients will then have 
to leave their communities to seek services elsewhere or go without 
these services.
  The bill I'm introducing today will allow facilities to skip the 
transition period and go directly to the more equitable federal rate if 
(1) the Secretary of Health and Human Services determines that the 
facility's level of services has changed substantially since 1995, or 
(2) the facility had fewer than 1500 Medicare patient days in its last 
cost reporting period. By receiving payments based on the federal rate, 
which is adjusted for case-mix, geographic variations in wages, and 
inflation, facilities will be compensated in an amount closer to their 
actual costs. On the other hand, the facility-specific portion of the 
current blended rate bases costs in part on 1995 expenses, which does 
not reflect current costs.
  Rural areas will suffer under the current prospective payment system. 
In Montana alone, cuts in Medicare payments to skilled nursing 
facilities are estimated at $5.6 million in the first year of the 
prospective payment system, which began on July 1, 1998. It will result 
in decreased access to care for Medicare patients as fewer services are 
offered and fewer facilities participate in Medicare. This bill 
provides a straightforward, workable solution and is supported by the 
Montana Health Care Association and the American Health Care 
Association. It will correct the unintended negative consequences of 
the transition to a prospective payment system and restore fairness to 
the process.
                                 ______
                                 
      By Mr. BINGAMAN:
  S. 2343. A bill to amend the Radiation Exposure Compensation Act to 
provide for partial restitution to individuals who worked in uranium 
mines, or transport which provided uranium for the use and benefit of 
the United States Government, and for other purposes; to the Committee 
on the Judiciary.


            radiation exposure compensation improvement act

  Mr. BINGAMAN. Mr. President, I rise to make a few remarks regarding a 
bill I am introducing today, the Radiation Exposure Compensation 
Improvement Act.
  Mr. President, the Radiation Exposure Compensation Act or RECA was 
originally enacted as a means of compensating thousands of individuals 
who suffered from exposure to radiation as a result of the federal 
government's nuclear testing program and federal uranium mining 
activities. While the government can never fully compensate for the 
loss of a life or the reduction in the quality of life, RECA serves as 
a cornerstone for the national apology Congress extended in 1990 to the 
victims of the radiation tragedies. In keeping with the spirit of that 
apology, the legislation I introduce today will further correct 
existing injustices and provide compensation for those whose lives and 
health were sacrificed as part of our nation's effort to win the Cold 
War.
  In 1990, I was pleased to have been a sponsor of the RECA legislation 
here in

[[Page S8783]]

the Senate. I was very optimistic that after years of waiting, some 
degree of redress would be given to the thousands of miners in my state 
of New Mexico. I chaired the Senate oversight hearing on this issue in 
Shiprock, N.M. for the Senate Labor and Human Resources Committee in 
1993 and began to hear of changes that were necessary. To that end, I 
worked to facilitate changes in the regulatory and administrative 
areas.
  Unfortunately, I have heard from many of my constituents that the 
program still does not work as intended. I have received compelling 
letters of need from constituents telling me how RECA needs to be 
amended. The letters come from widows unable to access the current 
compensation. Miners and millers tied to oxygen tanks, in respiratory 
distress or dying from cancer write to tell me how they have been 
denied compensation under the current act. Family members write of the 
pain of fathers who worked in the mills. They recount how their fathers 
came home covered in the ``yellow cake'' of uranium oxide that was 
floating in the air of the mills. The story of their father's cancers 
and painful breathing are vivid in these letters and yet the current 
act does not address their needs.
  Mr. President, the bill I introduce today will address the issues 
they raise in their sometimes angry and often tear stained letters. 
Their points are backed by others as well. In fact, the bill 
incorporates findings by the prestigious Committee on the Biological 
Effects of Ionizing Radiation (BEIR) which has, since 1990, enlarged 
scientific evidence about radiogenic cancers and the health effects of 
radiation exposures. In other words, because of their good work, 
we know more now than we did in 1990 and we need to make sure the 
compensation we provide keeps pace with our medical knowledge.

  Other amendments will, in essence, adopt and incorporate into RECA 
the recommendations made in October 1995 by the President's Advisory 
Committee on Human Radiation Experiments. This blue-ribbon committee 
determined that U.S. uranium miners were used as subjects of an 
experiment which had tragic results. It used this language to condemn 
the ethical outcome of this study:

       The grave injustice that the government did to the uranium 
     miners, by failing to take action to control the hazard and 
     by failing to warn the miners of the hazard, should not be 
     compounded by unreasonable barriers to receiving the 
     compensation the miners deserve for the wrongs and harms 
     inflicted upon them as they served their country.

  Mr. President, I would like to cite several of the key provisions in 
the Radiation Exposure Compensation Improvement Act. Currently RECA 
covers those exposed to radiation released in underground uranium mines 
that were providing uranium for the primary use and benefit of the 
nuclear weapons program of the U.S. government. The bill would make all 
uranium workers eligible for compensation including above ground 
miners, millers, and transport workers.
  RECA currently covers individual termed ``downwinders'' who were in 
the areas of Nevada, Utah, and Arizona affected by atmospheric nuclear 
testing in the 1950's. This bill expands the geographical area eligible 
for compensation to include the Navajo Reservation. In addition, the 
bill expands the compensable diseases for the downwind population by 
adding salivary gland, urinary bladder, brain, colon, and ovarian 
cancers.
  Currently, the law has disproportionately high levels of radiation 
exposure requirements for miners to qualify for compensation as 
compared to the ``downwinders.'' My legislation would set a standard of 
proof for uranium workers that is more realistic given the availability 
of mining and mill data. The bill also removes the provision that only 
permits a claim for respiratory disease if the uranium mining occurred 
on a reservation. Thus, the bill will allow for further filing of a 
claim by those miners, millers, and transport workers who did not have 
a work history on a reservation. In addition, the bill would change the 
current law so that requirements for written medical documentation is 
updated to allow for use of high resolution CAT scans and allow for 
written diagnoses by physician in either the Department of Veterans 
Affairs or the Indian Health Service to be considered conclusive.
  In 1990, we joined together in a bipartisan, bicameral effort and 
assured passage of the Radiation Exposure Compensation Act (RECA). Now, 
either years later, I put forward this comprehensive amendment to RECA 
to correct some omissions, make RECA consistent with current medical 
knowledge, and to address what have become administrative horror 
stories for the claimants. I look forward to the debate in the Senate 
on this issue and hope that we can move to amend the current statue to 
ensure our original intent . . . fair and rapid compensation to those 
who served so well.
  Mr. President, I ask unanimous consent to have the text of the 
Radiation Improvement Compensation Act printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2343

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

     SECTION 1. SHORT TITLE; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``Radiation 
     Exposure Compensation Improvement Act''.
       (b) Findings.--Congress finds the following:
       (1) The intent of the Radiation Exposure Compensation Act 
     (42 U.S.C. 2210 note), enacted in 1990, was to apologize to 
     victims of the weapons program of the Federal Government, but 
     uranium workers who have applied for compensation under the 
     Act have faced a disturbing number of challenges.
       (2) The congressional oversight hearing conducted by the 
     Committee on Labor and Human Resources of the Senate has 
     shown that since passage of the Radiation Exposure 
     Compensation Act, former uranium workers and their families 
     have not received prompt and efficient compensation.
       (3) There is no plausible justification for the Federal 
     Government's failure to warn and protect the lives and health 
     of uranium workers.
       (4) Progress on implementing the Radiation Exposure 
     Compensation Act has been impeded by criteria for 
     compensation that is far more stringent than for other groups 
     for which compensation is provided.
       (5) The President's Advisory Committee on Human Radiation 
     Experiments recommended that amendments to the Radiation 
     Exposure Compensation should be made.
       (6) Uranium millers, aboveground miners, and individuals 
     who transported uranium ore should be provided compensation 
     that is similar to that provided for underground uranium 
     miners in cases in which those individuals suffered disease 
     or resultant death as a result of the failure of the Federal 
     Government to warn of health hazards.

     SEC. 2. TRUST FUND.

       Section 3(d) of the Radiation Exposure Compensation Act (42 
     U.S.C. 2210 note) is amended by striking ``of this Act'' and 
     inserting ``of the Radiation Exposure Compensation 
     Improvement Act''.

     SEC. 3. AFFECTED AREA; CLAIMS RELATING TO SPECIFIED DISEASES.

       (a) Affected Area.--Section 4(b)(1) of the Radiation 
     Exposure Compensation Act (42 U.S.C. 2210 note) is amended--
       (1) by striking ``and'' at the end of subparagraph (B); and
       (2) by adding at the end the following:
       ``(D) those parts of Arizona, Utah, and New Mexico 
     comprising the Navajo Nation Reservation that were subjected 
     to fallout from nuclear weapons testing conducted in Nevada; 
     and''.
       (b) Claims Relating to Specified Diseases.--Section 4(b)(2) 
     of the Radiation Exposure Compensation Act (42 U.S.C. 2210 
     note) is amended--
       (1) by striking ``the onset of the disease was between 2 
     and 30 years of first exposure,'' and inserting ``the onset 
     of the disease was at least 2 years after first exposure, 
     lung cancer (other than in situ lung cancer that is 
     discovered during or after a post-mortem exam),'';
       (2) by striking ``(provided initial exposure occurred by 
     the age of 20)'' after ``thyroid'';
       (3) by inserting ``male or'' before ``female breast'';
       (4) by striking ``(provided initial exposure occurred prior 
     to age 40)'' after ``female breast'';
       (5) by striking ``(provided low alcohol consumption and not 
     a heavy smoker)'' after ``esophagus'';
       (6) by striking ``(provided initial exposure occurred 
     before age 30)'' after ``stomach'';
       (7) by striking ``(provided not a heavy smoker)'' after 
     ``pharynx'';
       (8) by striking ``(provided not a heavy smoker and low 
     coffee consumption)'' after ``pancreas'';
       (9) by inserting ``salivary gland, urinary bladder, brain, 
     colon, ovary,'' after ``gall bladder,''; and
       (10) by inserting before the period at the end the 
     following: ``, and chronic lymphocytic leukemia''.

[[Page S8784]]

     SEC. 4. URANIUM MINING AND MILLING AND TRANSPORT.

       (a) Amendment to Heading.--Section 5 of the Radiation 
     Exposure Compensation Act (42 U.S.C. 2210 note) is amended by 
     striking the section heading and inserting the following:

     ``SEC. 5. CLAIMS RELATING TO URANIUM MINING OR MILLING OR 
                   TRANSPORT.''.

       (b) Milling.--Section 5(a) of the Radiation Exposure 
     Compensation Act (42 U.S.C. 2210 note) is amended--
       (1) by striking ``Any'' and inserting ``Any individual who 
     was employed to transport or handle uranium ore or any''; and
       (2) by inserting ``or in any other State in which uranium 
     was mined, milled, or transported'' after ``Utah''.
       (c) Mines.--Section 5(a) of the Radiation Exposure 
     Compensation Act (42 U.S.C. 2210 note), as amended by 
     subsection (a) of this section, is amended by striking ``a 
     uranium mine'' and inserting ``a uranium mine (including a 
     mine located aboveground or an open pit mine in which uranium 
     miners worked, or a uranium mill)''.
       (d) Dates.--Section 5(a) of the Radiation Exposure 
     Compensation Act (42 U.S.C. 2210 note), as amended by 
     subsections (b) and (c) of this section, is amended by 
     striking ``January 1, 1947, and ending on December 31, 1971'' 
     and inserting ``January 1, 1942, and ending on December 31, 
     1990''.
       (e) Amendment of Period of Exposure; Expansion of Coverage; 
     Increase in Compensation Awards; and Removal of Smoking 
     Distinction.--Section 5(a) of the Radiation Exposure 
     Compensation Act (42 U.S.C. 2210 note), as amended by 
     subsections (b) through (d) of this section, is amended--
       (1) by striking paragraph (1) and all that follows through 
     the end of the subsection and inserting the following:
       ``(2) Compensation.--Any individual shall receive $200,000 
     for a claim made under this Act if--
       ``(A) that individual--
       ``(i) was exposed to 40 or more working level months of 
     radiation and submits written medical documentation that the 
     individual, after exposure developed--

       ``(I) lung cancer,
       ``(II) a nonmalignant respiratory disease, or
       ``(III) any other medical condition associated with uranium 
     mining or milling, or

       ``(ii) worked in uranium mining, milling, or transport for 
     a period of at least 1 year and submits written medical 
     documentation that the individual, after exposure, 
     developed--

       ``(I) lung cancer,
       ``(II) a nonmalignant respiratory disease, or
       ``(III) any other medical condition associated with uranium 
     mining, milling, or transport,

       ``(B) the claim for that payment is filed with the Attorney 
     General by or on behalf of that individual, and
       ``(C) the Attorney General determines, in accordance with 
     section 6, that the claim meets the requirements of this 
     Act.''.
       (2) by striking ``(a) Eligibility of Individuals.--Any'' 
     and inserting the following: ``(a) Eligibility.--
       ``(1) In general.--Any''; and
       (3) in paragraph (1), as so designated, by striking the 
     dash at the end and inserting a period.
       (f) Claims Related to Human Radiation Experimentation and 
     Death Resulting From Cause Other Than Radiation.--Section 5 
     of the Radiation Exposure Compensation Act (42 U.S.C. 2210 
     note) is amended--
       (1) by redesignating subsection (b) as subsection (d); and
       (2) by inserting after subsection (a) the following:
       ``(b) Claims Relating to Human Use Research and Death 
     Resulting From Nonradiological Causes.--
       ``(1) In general.--
       ``(A) Payment.--Any individual described in subparagraph 
     (B) shall receive $50,000 if--
       ``(i) a claim for that payment is filed with the Attorney 
     General by or on behalf of that individual; and
       ``(ii) the Attorney General determines, in accordance with 
     section 6, that the claim meets the requirements of this Act.
       ``(B) Description of individuals.--An individual described 
     in this subparagraph is an individual who--
       ``(i) was employed in a uranium mining, milling, or 
     transport within any State referred to in subsection (a) at 
     any time during the period referred to in that subsection, 
     and
       ``(ii)(I) in the course of that employment, without the 
     individual's knowledge or informed consent, was intentionally 
     exposed to radiation for purposes of testing, research, 
     study, or experimentation by the Federal Government 
     (including any agency of the Federal Government) to determine 
     the effects of that exposure on the human body; or
       ``(II) in the course of or arising out of the individual's 
     employment, suffered death, that, because the individual or 
     the estate of the individual was barred from pursuing 
     recovery under a worker's compensation system or civil action 
     available to similarly situated employees of mines or mills 
     that are not uranium mines or mills, is not otherwise--
       ``(aa) compensable under subsection (a); or
       ``(bb) redressable.
       ``(2) Payments.--Payments under this subsection may be made 
     only in accordance with section 6.''.
       (g) Other Injury or Disability.--Section 5 of the Radiation 
     Exposure Compensation Act (42 U.S.C. 2210 note), as amended 
     by subsection (f) of this section, is amended by adding after 
     subsection (b) the following:
       ``(c) Other Injury or Disability.--
       ``(1) In general.--
       ``(A) Payment.--Any individual described in subparagraph 
     (B) shall receive $20,000 if--
       ``(i) a claim for that payment is filed with the Attorney 
     General by or on behalf of that individual; and
       ``(ii) the Attorney General determines, in accordance with 
     section 6, that the claim meets the requirements of this Act.
       ``(B) Description of individuals.--An individual described 
     in this subparagraph is an individual who--
       ``(i) was employed in a uranium mine or mill or transported 
     uranium ore within any State referred to in subsection (a) at 
     any time during the period referred to in that subsection; 
     and
       ``(ii) submits written medical documentation that 
     individual suffered injury or disability, arising out of or 
     in the course of the individual's employment that, because 
     the individual or the estate of the individual was barred 
     from pursuing recovery under a worker's compensation system 
     or civil action available to similarly situated employees of 
     mines or mills that are not uranium mines or mills, is not 
     otherwise--

       ``(I) compensable under subsection (a); or
       ``(II) redressable.

       ``(2) Payments.--Payments under this subsection may be made 
     only in accordance with section 6.''.
       (h) Definitions.--Subsection (d) of section 5 of the 
     Radiation Exposure Compensation Act (42 U.S.C. 2210 note), as 
     redesignated by subsection (f) of this section, is amended--
       (1) in paragraph (1)--
       (A) by striking ``radiation exposure'' and inserting 
     ``exposure to radon and radon progeny''; and
       (B) by inserting ``based on a 6-day workweek,'' after 
     ``every work day for a month,'';
       (2) by striking paragraph (2) and inserting the following:
       ``(2) the term `affected Indian tribe' means any Indian 
     tribe, band, nation, pueblo, or other organized group or 
     community, that is recognized as eligible for special 
     programs and services provided by the United States to Indian 
     tribes because of their status as Native Americans, whose 
     people engaged in uranium mining or milling or were employed 
     where uranium mining or milling was conducted;'';
       (3) by striking paragraphs (3) and (4); and
       (4) by adding at the end the following:
       ``(3) the term `course of employment' means--
       ``(A) any period of employment in a uranium mine or uranium 
     mill before or after December 31, 1971, or
       ``(B) the cumulative period of employment in both a uranium 
     mine and uranium mill in any case in which an individual was 
     employed in both a uranium mine and a uranium mill;
       ``(4) the term `lung cancer' means any physiological 
     condition of the lung, trachea, and bronchus that is 
     recognized under that name or nomenclature by the National 
     Cancer Institute, including any in situ cancer;
       ``(5) the term `nonmalignant respiratory disease' means 
     fibrosis of the lung, pulmonary fibrosis, corpulmonale 
     related to pulmonary fibrosis, or moderate or severe 
     silicosis or pneumoconiosis;
       ``(6) the term `other medical condition associated with 
     uranium mining, milling, or uranium transport' means any 
     medical condition associated with exposure to radiation, 
     heavy metals, chemicals, or other toxic substances to which 
     miners and millers are exposed in the mining and milling of 
     uranium;
       ``(7) the term `uranium mill' includes milling operations 
     involving the processing of uranium ore or vanadium-uranium 
     ore, including carbonate and acid leach plants;
       ``(8) the term `uranium transport' means human physical 
     contact involved in moving uranium ore from 1 site to 
     another, including mechanical conveyance, physical shoveling, 
     or driving a vehicle;
       ``(9) the term `uranium mine' means any underground 
     excavation, including dog holes, open pit, strip, rim, 
     surface, or other aboveground mines, where uranium ore or 
     vanadium-uranium ore was mined or otherwise extracted;
       ``(10) the term `working level' means the concentration of 
     the short half-life daughters (known as `progeny') of radon 
     that will release (1.3 x 105) million electron 
     volts of alpha energy per liter of air; and
       ``(11) the term `written medical documentation' for 
     purposes of proving a nonmalignant respiratory disease means, 
     in any case in which the claimant is living--
       ``(A) a chest x-ray administered in accordance with 
     standard techniques and the interpretive reports thereof by 2 
     certified `B' readers classifying the existence of the 
     nonmalignant respiratory disease of category 1/0 or higher 
     according to a 1989 report of the International Labour Office 
     (known as the `ILO'), or subsequent revisions;
       ``(B) a high resolution computed tomography scan (commonly 
     known as an `HCRT scan') and any interpretive report for that 
     scan;
       ``(C) a pathology report of a tissue biopsy;
       ``(D) a pulmonary function test indicating restrictive lung 
     function (as defined by the American Thoracic Society); or
       ``(E) an arterial blood gas study.''.

[[Page S8785]]

     SEC. 5. DETERMINATION AND PAYMENT OF CLAIMS.

       (a) Determination and Payment of Claims, Generally.--
     Section 6 of the Radiation Exposure Compensation Act (42 
     U.S.C. 2210 note) is amended--
       (1) in subsection (b)--
       (A) in paragraph (1), by adding at the end the following: 
     ``All reasonable doubt with regard to whether a claim meets 
     the requirements of this Act shall be resolved in favor of 
     the claimant.'';
       (B) by redesignating paragraph (2) as paragraph (5); and
       (C) by inserting after paragraph (1) the following:
       ``(2) Evidence.--In support of a claim for compensation 
     under section 5, the Attorney General shall permit the 
     introduction of, and a claimant may use and rely upon, 
     affidavits and other documentary evidence, including medical 
     evidence, to the same extent as permitted by the Federal 
     Rules of Evidence.
       ``(3) Interpretation of chest x-rays.--For purposes of this 
     Act, a chest x-ray and the accompanying interpretive report 
     required in support of a claim under section 5(a), shall--
       ``(A) be considered to be conclusive, and
       ``(B) be subject to a fair and random audit procedure 
     established by the Attorney General.
       ``(4) Certain written diagnoses.--
       ``(A) In general.--For purposes of this Act, in any case in 
     which a written diagnosis is made by a physician described in 
     subparagraph (B) of a nonmalignant pulmonary disease or lung 
     cancer of a claimant that is accompanied by written medical 
     documentation that meets the definition of that term under 
     subsection (b)(11), that written diagnosis shall be 
     considered to be conclusive evidence of that disease.
       ``(B) Description of physicians.--A physician described in 
     this subparagraph is a physician who--
       ``(i) is employed by--

       ``(I) the Indian Health Service of the Department of Health 
     and Human Services, or
       ``(II) the Department of Veterans Affairs, and

       ``(ii) is responsible for examining or treating the 
     claimant involved.'';
       (2) in subsection (c)(2)--
       (A) in subparagraph (A)(ii), by striking ``in a uranium 
     mine'' and inserting ``in uranium mining, milling, or 
     transport''; and
       (B) in subparagraph (B)(ii), by striking ``by the Federal 
     Government'' and inserting ``through the Department of 
     Veterans Affairs'';
       (3) in subsection (d)--
       (A) by striking ``(d) Action on Claims.--The Attorney 
     General'' and inserting the following:
       ``(d) Action on Claims.--
       ``(1) In general.--The Attorney General''; and
       (B) by adding at the end the following:
       ``(2) Determination of period.--For purposes of determining 
     the tolling of the 12-month period under paragraph (1), a 
     claim under this Act shall be considered to have been filed 
     as of the date of the receipt of that claim by the Attorney 
     General.
       ``(3) Administrative review.--If the Attorney General 
     denies a claim referred to in paragraph (1), the claimant 
     shall be permitted a reasonable period of time in which to 
     seek administrative review of the denial by the Attorney 
     General.
       ``(4) Final determination.--The Attorney General shall make 
     a final determination with respect to any administrative 
     review conducted under paragraph (3) not later than 90 days 
     after the receipt of the claimant's request for that review.
       ``(5) Effect of failure to render a determination.--If the 
     Attorney General fails to render a determination during the 
     12-month period under paragraph (1), the claim shall be 
     deemed awarded as a matter of law and paid.'';
       (4) in subsection (e), by striking ``in a uranium mine'' 
     and inserting ``uranium mining, milling, or transport'';
       (5) in subsection (k), by adding at the end the following: 
     ``With respect to any amendment made to this Act after the 
     date of enactment of this Act, the Attorney General shall 
     issue revised regulations, guidelines, and procedures to 
     carry out that amendment not later than 180 days after the 
     date of enactment of that amendment.''; and
       (6) in subsection (l)--
       (A) by striking ``(l) Judicial Review.--An individual'' and 
     inserting the following:
       ``(l) Judicial Review.--
       ``(1) In general.--An individual''; and
       (B) by adding at the end the following:
       ``(2) Attorney's fees.--If the court that conducts a review 
     under paragraph (1) sets aside a denial of a claim under this 
     Act as unlawful, the court shall award claimant reasonable 
     attorney's fees and costs incurred with respect to the 
     court's review.
       ``(3) Interest.--If, after a claimant is denied a claim 
     under this Act, the claimant subsequently prevails upon 
     remand of that claim, the claimant shall be awarded interest 
     on the claim at a rate equal to 8 percent, calculated from 
     the date of the initial denial of the claim.
       ``(4) Treatment of attorney's fees, costs, and interest.--
     Any attorney's fees, costs, and interest awarded under this 
     section shall--
       ``(A) be considered to be costs incurred by the Attorney 
     General, and
       ``(B) not be paid from the Fund, or set off against, or 
     otherwise deducted from, any payment to a claimant under this 
     section.''.
       (b) Furtherance of Special Trust Responsibility to Affected 
     Indian Tribes; Self-Determination Program Election.--In 
     furtherance of, and consistent with, the trust responsibility 
     of the United States to Native American uranium workers 
     recognized by Congress in enacting the Radiation Exposure 
     Compensation Act (42 U.S.C. 2210 note), section 6 of that 
     Act, as amended by subsection (a) of this section, is 
     amended--
       (1) in subsection (a), by adding at the end the following: 
     ``In establishing any such procedure, the Attorney General 
     shall take into consideration and incorporate, to the fullest 
     extent feasible, Native American law, tradition, and custom 
     with respect to the submission and processing of claims by 
     Native Americans.'';
       (2) in subsection (b), by inserting after paragraph (3) the 
     following:
       ``(4) Pulmonary function standards.--In determining the 
     pulmonary impairment of a claimant, the Attorney General 
     shall evaluate the degree of impairment based on ethnic-
     specific pulmonary function standards.'';
       (3) in subsection (b)(5)--
       (A) by striking ``and'' at the end of subparagraph (B);
       (B) by striking the period at the end of subparagraph (C) 
     and inserting ``; and''; and
       (C) by inserting after subparagraph (C) the following:
       ``(D) in consultation with any affected Indian tribe, 
     establish guidelines for the determination of claims filed by 
     Native American uranium miners, millers, and transport 
     workers pursuant to section 5.'';
       (4) in subsection (b), by adding after paragraph (5) the 
     following:
       ``(6) Self-determination program election.--
       ``(A) In general.--The Attorney General on the request of 
     any affected Indian tribe by tribal resolution, may enter 
     into 1 or more self-determination contracts with a tribal 
     organization of that Indian tribe pursuant to the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450 et seq.) to plan, conduct, and administer the disposition 
     and award of claims under this Act to the extent that members 
     of the affected Indian tribe are concerned.
       ``(B) Approval.--(i) On the request of an affected Indian 
     tribe to enter into a self-determination contract referred to 
     in subparagraph (A), the Attorney General shall approve or 
     reject the request in a manner consistent with section 102 of 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450f).
       ``(ii) The Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.) shall apply to the 
     approval and subsequent implementation of a self-
     determination contract entered into under clause (i) or any 
     rejection of such a contract, if that contract is rejected.
       ``(C) Use of funds.--Notwithstanding any other provision of 
     law, funds authorized for use by the Attorney General to 
     carry out the functions of the Attorney General under 
     subsection (i) may be used for the planning, training, 
     implementation, and administration of any self-determination 
     contract that the Attorney General enters into with an 
     affected Indian tribe under this section.''; and
       (5) in subsection (c)(4), by adding at the end the 
     following:
       ``(D) Application of native american law.--In determining 
     the eligibility of individuals to receive compensation under 
     this Act by reason of marriage, relationship, or 
     survivorship, the Attorney General shall take into 
     consideration and give effect to established law, tradition, 
     and custom of affected Indian tribes.''.

     SEC. 6. CHOICE OF REMEDIES.

       Section 7(b) of the Radiation Exposure Compensation Act (42 
     U.S.C. 2210 note) is amended to read as follows:
       ``(b) Choice of Remedies.--
       ``(1) In general.--Except as provided in paragraph (1), the 
     payment of an award under any provision of this Act does not 
     preclude the payment of an award under any other provision of 
     this Act.
       ``(2) Limitation.--No individual may receive more than 1 
     award payment for any compensable cancer or other compensable 
     disease.''.

     SEC. 7. LIMITATION ON CLAIMS; RETROACTIVE APPLICATION OF 
                   AMENDMENTS.

       Section 8 of the Radiation Exposure Compensation Act (42 
     U.S.C. 2210 note) is amended to read as follows:

     ``SEC. 8. LIMITATION ON CLAIMS.

       ``(a) Bar.--After the date that is 20 years after the date 
     of enactment of the Radiation Exposure Compensation 
     Improvement Act no claim may be filed under this Act.
       ``(b) Applicability of Amendments.--The amendments made to 
     this Act by the Radiation Exposure Compensation Improvement 
     Act shall apply to any claim under this Act that is pending 
     or commenced on or after October 5, 1990, without regard to 
     whether payment for that claim could have been awarded before 
     the date of enactment of the Radiation Exposure Compensation 
     Improvement Act as the result of previous filing and prior 
     payment under this Act.''.

     SEC. 9. REPORT.

       Section 12 of the Radiation Exposure Compensation Act (42 
     U.S.C. 2210 note) is amended--
       (1) by striking the section heading and inserting the 
     following:

     ``SEC. 12. REPORTS.'';

     and
       (2) by adding at the end the following:

[[Page S8786]]

       ``(c) Uranium Mill and Mine Report.--Not later than January 
     1, 2000, the Secretary of Health and Human Services in 
     consultation with the Secretary of Energy shall prepare and 
     submit to Congress a report that--
       ``(1) summarizes medical knowledge concerning adverse 
     health effects sustained by residents of communities who 
     reside adjacent to--
       ``(A) uranium mills or mill tailings,
       ``(B) aboveground uranium mines, or
       ``(C) open pit uranium mines; and
       ``(2) summarizes available information concerning the 
     availability and accessibility of medical care that 
     incorporates the best available standards of practice for 
     individuals with malignancies and other compensable diseases 
     relating to exposure to uranium as a result of uranium mining 
     and milling activities;
       ``(3) summarizes the reclamation efforts with respect to 
     uranium mines, mills, and mill tailings in Colorado, New 
     Mexico, Arizona, Wyoming, and Utah; and
       ``(4) makes recommendations for further actions to ensure 
     health and safety relating to the efforts referred to in 
     paragraph (3).''.
                                 ______
                                 
      By Mr. COVERDELL (for himself, Mr. Faircloth, Mr. Lott, Mrs. 
        Hutchison, Mr. Gramm, Mr. Shelby, Mr. Lugar, and Mr. Cochran):
  S. 2344. A bill to amend the Agricultural Market Transition Act to 
provide for the advance payment, in full, of the fiscal year 1999 
payments otherwise required under production flexibility contracts; to 
the Committee on Agriculture, Nutrition, and Forestry.


                the emergency farm financial relief act

 Mr. COVERDELL. Mr. President, the past several years have been 
devastating for a large number of Georgia farmers. Due to the large 
amounts of weather damage and associated agriculture production losses, 
numerous farmers and agribusinesses are faced with dire financial 
situations.
  Farmers from across the state of Georgia are facing their worst crop 
disaster in many years. Currently, damages are estimated at about $450 
million and rising. The drought in Georgia has already lasted 3 months 
and has caused farmers water supplies to dry up, leaving many without a 
source of irrigation water. I understand fully that it is not only in 
my home state where farmers are suffering. It is occuring in many parts 
of the country.
  To help alleviate farmers' financial difficulties, today I am proud 
to introduce legislation with my esteemed colleagues Majority Leader 
Lott, Senator Cochran, Senator Faircloth, Senator Shelby, Senator 
Gramm, Senator Lugar and Senator Hutchison, which will help provide 
American farmers with much needed financial relief. The bill--The 
Emergency Farm Financial Relief Act--would allow farmers the option of 
receiving all of the Agriculture Market Transition Act (AMTA) contract 
payments for FY 1999 immediately after the beginning of the fiscal 
year. Annual payments can now be made two times a year, in December or 
January and again in September. The legislation we introduce today is a 
Senate companion to House legislation introduced by Representative Bob 
Smith, Chairman of the House Agriculture Committee.
  The bill would make $5.5 billion available much earlier in order to 
help farmers cope with the cash shortages they are now experiencing due 
to low prices and poor production. This important initiative leaves the 
decision to accept early payments or not solely with the farmer. Since 
all of the 1999 AMTA payments occur within the same fiscal year, the 
Congressional Budget Office (CBO) has determined that this proposal 
would not cost any additional taxpayer funds.
  While this legislation is not the only answer to helping farmers 
during their time of economic hardship, it is a much needed overture 
which provides farmers with immediate financial relief. Certainly we 
have other measures to consider, but this is a good first step. I look 
forward to working with my colleagues in the Senate on this proposal 
and urge its speedy consideration.
 Mr. FAIRCLOTH. Mr. President, I rise as a co-sponsor of the 
Emergency Farm Financial Relief Act of 1998, which will permit farmers 
to receive their fiscal year 1999 Agriculture Market Transition Act 
(AMTA) payments at the start of the fiscal year in October of 1998 
rather than the semi-annual payments in December of 1998 and September 
of 1999.
  This bill thus readies some $5.5 billion to help farmers cope with 
their current cash shortage that stems from high debts and low 
commodity prices.
  This is a first to address the farm crisis, and it will help some 
farmers with their cash flow, but there are a lot of other growers in 
rough straits. Therefore, this is just a first step, and we need to 
take more aggressive steps to open export markets to American 
commodities.
  This bill will not solve the farm crisis in North Carolina. In fact, 
because we managed to preserve the tobacco and peanut programs in the 
1996 farm bill, the acceleration of AMTA contract payments will be 
limited, for the most part, to cotton, corn, and wheat growers.
  The fields of North Carolina, Mr. President, are dry. All the farmers 
are in the same dire situation, and the scope of this bill is limited, 
but we need to address the tobacco growers.
  I am concerned that efforts to bring the tobacco program to the 
Senate floor will get torn to shreds, but, certainly, the anti-tobacco 
crowd needs to rise above politics and realize that this is about farm 
families and family farms.
  In addition to cash flow assistance, farmers need aggressive 
leadership to boost exports, and President Clinton needs to pay 
attention to farmers and to use the tools we gave him--like the Export 
Enhancement Program--to secure foreign markets for American 
agricultural commodities. Farmers just can't afford this continued 
silence from President Clinton. Agriculture is our number one export, 
so, clearly, we need the White House to engage on this issue.
  Thank you, Mr. President, and I urge my colleagues to join us in 
support of the Emergency Farm Financial Relief Act of 1998.

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