[Congressional Record Volume 146, Number 114 (Friday, September 22, 2000)]
[Senate]
[Pages S9094-S9116]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CHILDREN'S HEALTH ACT OF 2000
Mr. LOTT. I ask unanimous consent that the health committee be
discharged from further consideration of H.R. 4365 and the Senate then
proceed to its immediate consideration.
The PRESIDING OFFICER. Without objection, it is so ordered. The clerk
will report the bill by title.
The assistant legislative clerk read as follows:
A bill (H.R. 4365) to amend the Public Health Service Act
with respect to children's health.
There being no objection, the Senate proceeded to consider the bill.
Amendment No. 4181
Mr. LOTT. Senator Frist has an amendment at the desk and I ask for
its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:
The Senator from Mississippi [Mr. Lott], for Mr. Frist,
proposes an amendment numbered 4181.
Mr. LOTT. Mr. President, I ask unanimous consent reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')
Mr. FRIST. Mr. President, I am pleased that the Senate has passed
today, H.R. 4365, the Children's Health Act of 2000, a comprehensive of
several important children's health bills on which I and the rest of
the Senate have spent a great amount of time over the past year and a
half. These bills address a wide variety of critical children's health
issues, including day care safety, maternal and infant health,
pediatric public health promotion, pediatric research, and efforts to
fight youth drug abuse and provide mental health services.
Collectively, this comprehensive bill will form the backbone of efforts
that will improve the health and safety of America's children well into
the coming years.
The bill which passed the Senate today includes two divisions, with
Division A addressing issues regarding children's health, while
Division B addresses youth drug abuse.
Perhaps the most critical section in Division A of this bill are
provisions relating to day care health and safety, which were included
in S. 2263, the ``Children's Day Care Health and Safety Improvement
Act,'' which I introduced with Senator Dodd on March 9, 2000. These
provisions recognize that while more than 13 million children under the
age of six spend some part of their day in day care, including 254,000
children in Tennessee alone, evidence suggests a need to make these
settings safer and improve the health of children in child care
settings.
The danger in child care settings has recently become evident in
Tennessee. Tragically, within the span of 2 years, there have been 4
deaths in child care settings in Memphis, and 1 in 5 child-care
programs in the Nashville area were found to have potentially put the
health and safety of children at risk during 1999. But this isn't just
a Tennessee concern. It affects parents nationwide.
For example, according to a Consumer Product Safety Commission Study,
in 1997, 31,000 children ages four and younger were treated in hospital
emergency rooms for injuries sustained in child care or school
settings. Since 1990, more than 60 children have died in child care
settings. This is unacceptable. The thousands of parents leaving their
children in the hands of child care providers each day deserve
reassurance that their children are safe.
Further evidence of day care health and safety concerns were made
clear in a recent study by the American Academy of Pediatrics which
showed a disturbing trend among infants and Sudden Infant Death
Syndrome (SIDS) in day care. The study examined 1,916 SIDS cases from
1995 to 1997 in 11 states, and found that about 20 percent, 391 deaths,
occurred in day care settings. Most troubling was the fact that in over
half of the cases where caretakers placed children on their stomach,
the children were usually put to sleep on their backs by their parents.
Parents and advocates who are dedicated in helping to eliminate the
incidence of SIDS have urged that child care providers be required to
have SIDS risk reduction education. I agree, which is why I included
provision in the bill to carry out several activities, including the
use of health consultants to give health and safety advice to child
care providers on important issues like SIDS prevention.
Overall the bill provides $200 million to states, including $4.2
million for my state of Tennessee, to help improve the health and
safety of children in child care. The grants could be used for a number
of activities, including child care provider training and education;
inspections and criminal background checks for day care providers;
enhancements to improve a facility's ability to serve children with
disabilities; transportation safety procedures; and information for
parents on choosing a safe and healthy day care setting. The funding
could also be used to help child care facilities meet health and safety
standards or employ health consultants to give health and safety advice
to child care providers.
As a father, my highest concern is the safety of my three sons, and I
understand the fears that so many parents have. Parents shouldn't be
afraid to leave their children in the care of a licensed child care
facility. This bill helps ensure that our child care centers will be
safer.
The major portion of Division A are provisions which were included in
the ``Children's Public Health Act of 2000'' which I introduced on July
13, 2000 with Senators Jeffrods and Kennedy. Provisions in the
``Children's Public Health Act of 2000'' address a wide range of
children's health issues including maternal and infant health,
pediatric health promotion, and pediatric research.
Unintentional injuries are the leading cause of death for every age
group between 1 and 19 years of age, comprising 26 deaths per 100,000
children aged 1-14 and 62 deaths per 100,000 children aged 15-19. More
than 1.5 million American children suffer a brain injury each year.
Therefore, the bill reauthorizes and strengthens the Traumatic Brain
Injury programs at the Centers for Disease Control and Prevention
[[Page S9095]]
(CDC), the National Institutes of Health (NIH) and the Health Resources
and Services Administration (HRSA).
Because birth defects are the leading cause of infant mortality and
are responsible for about 30 percent of all pediatric hospital
admissions, the bill also focuses on maternal and infant health. This
legislation establishes a National Center for Birth Defects and
Developmental Disabilities at the CDC to collect, analyze, and
distribute data on birth defects. In addition, the bill authorizes the
Healthy Start program to reduce the rate of infant mortality and
improve perinatal outcomes by providing grants to areas with a high
incidence of infant mortality and low birth weight.
Furthermore, over 3,000 women experience serious complications due to
pregnancy. Two out of three will die from complications in their
pregnancy. Therefore, the bill develops a national monitoring and
surveillance program to better understand maternal complications and
mortality, and to decrease the disparities among populations at risk of
death and complications from pregnancy.
The bill also combats some of the most common childhood diseases and
conditions. For instance, it provides comprehensive asthma services and
coordinates the wide range of asthma prevention programs in the federal
government to address the most common chronic childhood disease,
asthma, which affects nearly 5 million children.
We also focus on childhood obesity, which has doubled in just the
past 15 years, and produced 4.7 million seriously overweight children
and adolescents ages 6-19 years. To address this epidemic, the bill
supports state and community-based programs to promote good nutrition
and increased physical activity among American youth.
In examining the problems affecting children across the nation and in
Tennessee, I was very concerned to learn that in Memphis, over 12
percent of children under the age of 6 may have lead poisoning. Such
poisoning can cause a variety of debilitating health problems,
including seizure, and coma, and even death. Even at lower levels, lead
can contribute to learning disabilities, loss of intelligence,
hyperactivity, and behavioral problems. This bill includes physician
education and training programs on current lead screening policies,
tracks the percentage of children in the Health Centers program who are
screened for lead poisoning, and conducts outreach and education for
families at risk of lead poisoning,
The May 2000 Surgeon General's report noted that oral health is
inseparable from overall health, and that while a majority of the
population has experienced great improvements in oral health,
disparities affecting poor children and those who live in underserved
areas represent 80 percent of all dental cavities in 20 percent of
children. This bill encourages pediatric oral health by supporting
community-based research and training to improve the understanding of
etiology, pathogenesis, diagnoses, prevention, and treatment of
pediatric oral, dental, and craniofacial diseases.
Finally, the bill strengthens pediatric research efforts by
establishing a Pediatric Research Initiative within the NIH to enhance
collaborative efforts, provide increased support for pediatric
biomedical research, and ensure that opportunities for advancement in
scientific investigations and care for children are realized.
I also want to highlight the critical issue of childhood research
protections. Included in this bill are provisions to address safety
issues in children's research by requiring the Secretary of HHS to
review the current federal regulations for the protection of children
participating in research, which address such issues as determining
acceptable levels of risk and obtaining parental permission, and to
report to Congress on how to ensure the highest standards of safety.
Also, the provision requires that all HHS-funded and regulated research
comply with these additional protections for children. During this
year, the Senate Subcommittee on Public Health, which I chair, held two
important hearings relating to gene therapy trials and human subject
protections. The Subcommittee discovered that there was a lapse of
protection for individuals participating as subjects in clinical trial
research. Next Congress, I intend to make the further review and
updating of human subject protections a major priority of the
Subcommittee.
Division B of the bill contains provisions which address the scourge
upon children of drug abuse. The 1999 National Household Survey on Drug
Abuse, conducted by the Substance Abuse and Mental Health Services
Administration (SAMHSA), reported that 10.9 percent of youths age 12-17
currently use illicit drugs. It further estimated that nearly 11.3
percent of 12-17 year-old boys and 10.5 percent of 12-17 year-old girls
used drugs in the past month. But just as important is the growth in
alcohol abuse among our youth, as SAMHSA reports that 10.4 million
current drinkers are younger than the legal drinking age of 21 and that
more than 6.8 million engaged in binge drinking. Tragically, all of
these numbers among youth substance abuse have risen since 1992.
To address the tragedy of drug use by our children, the bill
incorporates the ``Youth Drug and Mental Health Services Act,'' which I
introduced with Senator Kennedy last spring and was first passed the
Senate on November 3, 1999.
The ``Youth Drug'' bill addresses the problem of youth substance
abuse by reauthorizing and improving SAMHSA through a renewed focus on
youth and adolescent substance abuse and mental health services, in
conjunction with greater flexibility and new accountability for States
for the use of federal funds.
Created in 1992 to assist States in reducing the incidence of
substance abuse and mental illness through prevention and treatment
programs, SAMHSA provides funds to States for alcohol and drug abuse
prevention and treatment programs and activities, as well as mental
health services, with its block grants accounting for 40 percent and 15
percent respectively of all substance abuse and community mental health
services funding in the States. In my own State of Tennessee, SAMHSA
provides more than 70 percent of overall funding for the Tennessee
Department of Health's Bureau of Alcohol and Drug Abuse Services.
This bill accomplishes six critical goals: (1) promotes State
flexibility by easing outdated or unneeded requirements governing the
expenditure of Federal block grants; (2) ensures State accountability
by moving away from the present system's inefficiencies to a
performance based system; (3) provides substance abuse treatment
services and early intervention substance abuse services for children
and adolescents; (4) helps local communities treat violent youth and
minimize outbreaks of youth violence through partnerships among
schools, law enforcement and mental health services; (5) ensures
Federal funding for substance abuse or mental health emergencies; and
(6) supports and expands programs providing mental health and substance
abuse treatment services to homeless individuals.
The bill also includes a number of other important provisions,
including those to address how to treat individuals with co-occurring
mental health and substance abuse disorders the proper and safe use of
restraints and seclusions in mental health facilities, and important
``charitable choice'' provision that permits Federal assistance for
religious organizations providing substance abuse services. We know
that no one approach works for everyone who needs and wants substance
abuse treatment and that faith-based programs have strong records of
successful rehabilitation. This provision will allow faith-based
programs to continue to offer their assistance and expertise.
The ``Youth Drug and Mental Health Services Act'' provides Tennessee
and other states needed funds for community based programs helping
individuals with substance abuse and mental health disorders,
dramatically increasing State flexibility and ensuring that each State
is able to address its unique needs. The bill provides a much needed
focus on the troubling issue of drug use by our youth and helps local
communities deal with the issue of children and violence.
I would also like to highlight the ``Methamphetamine Anti-
Proliferation Act of 1999,'' which is sponsored by Senator Ashcroft and
included in this comprehensive bill. This bill address the plague of
methamphetamine which has severely impacted Tennessee, other
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southern states, the Mid-West, and Rocky Mountain states. Under these
provisions, criminal penalties are increased for individuals who
manufacture methamphetamine. The provisions also increase funding for
law enforcement training and target high intensity methamphetamine
trafficking areas.
Finally the bill also tackles another devastating drug which has
shown signs of increased use in our youth, the drug known as
``Ecstasy.'' In short, the bill directs the Sentencing Commission to
review and amend the Ecstasy guidelines to provide for increased
penalties to reflect the seriousness of the offenses of trafficking in
and importing Ecstasy and related drugs.
Mr. President, this legislation which has passed the Senate today is
a comprehensive, multifaceted attack on the numerous threats to our
children's health. I am thankful for all my colleagues for their
support and willingness to help the children of this nation. I would
especially like to thank Senators Jeffords and Kennedy and
Representatives Tom Bliley, Michael Bilirakis, John Dingell and Sherrod
Brown, and their excellent staffs for all the hard work and dedication
which has gone into this bill. I would also like to thank Mr. Bill
Baird and Ms. Daphne Edwards, of the Office of Senate Legislative
Counsel, for their tireless work and for their great expertise in
drafting this comprehensive bill. I would also like to personally thank
Mr. Joseph Faha, Director of Legislation and External Affairs of the
Substance Abuse and Mental Health Service Administration as well as
other member of the Department of Health of Human Services. Finally, I
would like to thank my Staff Director, of the Public Health
Subcommittees, Anne Phelps and my Health Policy Advisor, Dave Larson.
Finally, I would like to thank the may groups advocating on behalf of
children and parents and families who have worked so hard to bring this
bill to fruition. I look forward to swift action in the House on this
measure and it's enactment into law.
Mr. KENNEDY. Mr. President, this legislation will help millions of
children in the years ahead. It takes needed action to improve
children's health by expanding pediatric research and taking specific
steps to deal with a wide range of childhood illnesses, disorders, and
injuries. It also reauthorizes the Substance Abuse and Mental Health
Services Adminstration, which has an important role in reducing
substance abuse and maintaining and improving the mental health of the
nation's children and adolescents. Coordinated efforts in these areas
can lead to significant benefits for all children.
Senator Frist and I have worked closely with many of our Democratic
and Republican colleagues on this important legislation. We have talked
with experts and advocates in the children's health community and in
the mental health and substance abuse treatment communities. This
legislation will lead to significant progress in addressing many of
today's most pressing pediatric public health problems.
The legislation includes a variety of new and reauthorized children's
health provisions. It represents a compromise with our colleagues in
the House and addresses a wide range of pediatric public health issues
raised by experts in the field and championed by numerous members from
both sides of the aisle in both chambers.
Division A of the bill focuses on general children's health. It
includes programs to improve the health of pregnant women and prenatal
outcomes, including prevention of birth defects and low birth weight.
It establishes a new Center for Birth Defects and Developmental
Disabilities at the Centers for Disease Control and Prevention, in
order to focus the nation's activities more effectively in these
important areas. It also directs the Secretary of the Department of
Health and Human Services to expand public education efforts on folic
acid consumption in order to decrease neural tube birth defects.
The bill also deals with traumatic brain injury which is the leading
cause of death and disability in young Americans. The Centers for
Disease Control and Prevention has estimated that 5.3 million Americans
are living with long-term, severe disability as a result of brain
injuries, and each year 50,000 people die as a result of such injuries.
The Children's Public Health Act revises and extends the authorization
for a series of important programs that were enacted in 1996 to deal
with these injuries. This reauthorization will assure continued
progress toward understanding, treating and preventing them.
In addition, the bill includes the long overdue reauthorization of
the CDC's Injury Prevention and Control Programs. There are steps we
should take to modernize this authority and increase the authorization
levels, but it is welcome progress at last to renew its authorization.
Improving and protecting the safety of child care facilities is also
a high priority for Congress. This legislation creates a new program to
improve the safety of children in child care settings, and to encourage
child care providers to take steps to prevent illness and injuries and
protect the health of the children they serve.
It is said that the 21st century will be the century of life
sciences. Our national health policy will have the benefit of brilliant
new scientific discoveries that have already begun to change how we
diagnose, treat and prevent countless conditions. The legislation
creates a new grant program that focuses on inherited disorders. Based
on legislation introduced last year that has the strong support of a
broad-based coalition of both the genetics and public health
communities, our bill provides funds for state or local public health
departments to expand existing programs or initiate new programs that
provide screening, counseling or health services to infants and
children who have genetic conditions or are at risk for such
conditions. It also establishes an Advisory Committee to assist the
Secretary on these issues.
The bill also takes a number of steps to address other prevalent
childhood conditions. Asthma is the most common chronic childhood
illness, affecting more than seven percent of all American children.
The death rate for children with asthma increased by 78 percent between
1980 and 1993, and asthma-related costs total nearly $2 billion
annually in direct health care for children. The nation is handicapped
by a lack of basic information on where and how asthma strikes, what
triggers it, and how effectively the health care system is responding
to those who suffer from this chronic disease. Our bill will provide
greater asthma services to children, including mobile clinics and
patient and family education, and it will help to reduce allergens in
housing and public facilities.
Poor nutrition and lack of physical activity are also hurting many
American children and contributing to lifelong health problems. The
nation spends $39 billion a year--equal to six percent of overall U.S.
health care expenditures--on direct health care related to obesity.
Twenty percent of American children--one in five--are overweight.
Unhealthy eating habits and physical inactivity in childhood can lead
to heart disease, cancer and other serious illnesses decades later.
Children and adolescents who suffer from eating disorders, such as
anorexia nervosa and bulimia, can have wide-ranging physical and mental
health impairments. Our legislation establishes new grant programs to
reduce childhood obesity and eating disorders, promote better
nutritional habits among children, and encourage an appropriate level
of physical activity for children and adolescents.
The bill also requires the Secretary to study issues related to
effective treatment for metabolic disorders, including PKU, and access
to such treatments, in order to prevent worsening of these conditions.
It is my hope that this study will be useful for employers, insurers,
insurance commissioners and others who provide insurance or set
coverage standards.
Another major area where additional efforts are needed is dental
care. Last May, the Surgeon General published a landmark report on oral
health in America, emphasizing the need to consider oral health as an
essential part of total health. There is no question that oral and
dental health care should be included in primary care. Tooth decay is
the most common childhood infectious disease, and it can lead to
devastating consequences, including problems with eating, learning and
speech. Twenty-five percent of children in the United States suffer 80
percent of the tooth decay, with significant racial and
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age disparities. The number of dentists in the country has been
declining since 1990, and is projected to continue to decline through
the year 2020.
According to a 1995 report by the Inspector General, only one in five
Medicaid-eligible children receive dental services annually, and the
shortage of dentists exacerbates the problem of unmet needs. Yet tooth
decay is largely preventable. More effective efforts to educate parents
and children about the causes of tooth decay--and initiatives to
prevent and treat it--can lead to lasting public health improvements.
Our legislation includes a variety of approaches to deal with this
silent epidemic, including a new grant program to improve the
understanding of prevention, diagnosis, and treatment of pediatric oral
diseases and conditions, and grants to increase community-wide
fluoridation and school-based dental sealant programs. It also directs
the Secretary to undertake a coordinated oral health initiative to fund
innovative activities to improve the oral health of low-income
children.
Research has long shown that childhood lead poisoning can have
devastating effects on children, causing reduced IQ and attention span,
stunted growth, behavior problems, and reading and learning
disabilities. Yet too many children remain unscreened and untreated,
and adequate services often are not available for children with
elevated levels of lead in their blood. There is no excuse for not
taking greater steps to eliminate childhood lead poisoning. Our bill
includes screening for early detection and treatment, professional
education and training programs, and outreach and education activities
for at-risk children.
Pediatric research discoveries promote and maintain health throughout
a child's life span, and also contribute significantly to new insights
that aid in the prevention and treatment of illnesses among adults. A
growing body of evidence shows that risk factors for conditions such as
coronary artery disease and stroke begin in childhood and persist
through adulthood. Congress has a strong record of promoting basic and
clinical research, and the steps taken in this legislation continue
that priority with a special focus on children.
The legislation establishes a pediatric research initiative,
authorized at $50 million annually, that will increase support for
pediatric biomedical research at the National Institutes of Health,
including an increase in collaborative efforts among multidisciplinary
fields in areas that are promising for children. The legislation also
requires coordination with the Food and Drug Administration to increase
the number of pediatric clinical trials, and to provide greater
information on safer and more effective use of prescription drugs in
children.
Children have unique health care needs. They are not simply small
adults. Nothing is more important to the future health of America's
children than maintaining a steady supply of pediatricians, pediatric
specialists and pediatric-focused scientists.
Our legislation takes several important steps to improve the growth
and development of a pediatric-focused medical community. It enhances
support through the NIH expressly for training and career development
activities of pediatric researchers, including establishing a loan
repayment program for health care professionals who focus on pediatric
research.
It revises and extends the authorization of a program enacted last
year to support graduate medical education at independent children's
hospitals. These hospitals train half of all pediatric specialists, and
30 percent of all pediatricians. However, because GME activities have
historically been supported by Medicare and because these hospitals
serve very few Medicare patients, they have traditionally received very
little federal financial support for this important and costly
activity. As a result, children's hospitals are struggling to maintain
the important training, pediatric research, and primary and specialty
care services that they provide. Children's hospitals should be treated
like all other teaching hospitals when it comes to support for their
GME activities. I have sponsored other legislation to guarantee full
funding each year, without being subject to the appropriations process.
That proposal has been included in the Balanced Budget Refinement Act
of 2000. It is awaiting consideration in the Finance Committee, and I
hope it will be enacted this year.
The bill also authorizes a new long-term study to monitor and
evaluate health and development of children through adulthood. The kind
of information that will be obtained by this study is long-overdue, and
I look forward to its results.
The bill also takes two steps to protect children who participate in
clinical trials and other research. It requires all HHS-regulated and
funded research to comply with current pediatric-specific human subject
protection regulations. This provision is supported by the FDA and
industry alike, and it is an important step toward assuring full public
confidence in life-saving research activities. In addition, it requires
the Secretary to review those regulations and report on their adequacy
and recommendations, if any, for changes within six months. Our
committee intends to look more broadly at the issue of human subject
protections next year, and this report will help inform those
discussions.
Finally, this legislation also includes a variety of directives to
increase activities at public health agencies on specific disorders and
diseases affecting children. Children living with autism, Fragile X,
diabetes, arthritis, muscular dystrophy, epilepsy, cystic fibrosis, and
a number of other conditions have much to be grateful for today. We all
have the highest hopes that the provisions in this bill will lead to
successful efforts to combat these debilitating and often deadly
conditions.
Division B of the bill will enable the Substance Abuse and Mental
Health Services Administration to meet the mental health and substance
abuse needs of communities through its successful existing programs and
through new and innovative initiatives.
The recent National Household Survey on Drug Abuse indicates that we
have made important progress in combating substance abuse, especially
among the nation's youth. The goal of this legislation is to build on
that progress with expanded prevention and treatment services. Several
of the bill's provisions come from the Mental Health Early
Intervention, Treatment, and Prevention Act, which Senator Domenici and
I introduced in response to the Surgeon General's groundbreaking Report
on Mental Health. These provisions take needed steps to give the
mentally ill the services they need.
This legislation is the product of bi-partisan cooperation, and I
especially commend Senator Frist for his leadership in bringing
everyone together. His efforts have helped ensure that the measure we
pass today is an effective response to the mental illness and substance
abuse problems we face.
Over the past two decades, we have made great progress in determining
the causes of mental illnesses and developing strategies to treat them.
We have also begun to understand the biological basis of substance
abuse. Despite these scientific advances, mental illness and substance
abuse continue to be a national crisis. One in five Americans will
experience some form of mental illness this year--and two-thirds of
them will not seek treatment. Substance abuse costs the country an
estimated $270 billion in annual economic costs, and it leads to
unacceptable violence, injury, and HIV infection in our communities.
Too often, patients with mental illness are denied the state-of-the-
art treatment that would be available if their illnesses were physical
instead of mental. We have failed to provide them with the services
they need to meet the overwhelming obstacles they face. We have not
made an adequate effort to help them overcome their addictions. The
bill we pass today is intended to correct these injustices.
It will provide treatment to those who desperately need it and
prevention services to those at risk. Much of the bill focuses on the
unique needs of youths, adolescents, and young adults. It provides
services for children of substance abusers, training for teachers to
recognize the symptoms of mental illness, and a suicide prevention
program for children and youth. In addition, it provides a range of
community services for children with serious emotional disturbances and
for youth offenders. Agencies will receive funding to study
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and treat post-traumatic stress disorder in children. The bill also
provides funds to coordinate welfare and mental health services for
children who would benefit from this approach.
For homeless individuals, the bill provides expanded mental health
and substance abuse services, along with transition assistance. For
residents of treatment facilities, it offers protections from the
inappropriate and often harmful use of seclusion and restraints. The
bill will help to divert persons with mental illness from the criminal
justice system, which for too long has served as a dumping-ground, and
give them the services they need. It will provide special treatment for
those who suffer simultaneously from mental illness and addiction. It
will also provide funds to designate facilities as emergency mental
health centers, especially in underserved areas. In all the services
included, there will be a special emphasis on meeting the unique needs
of specific cultures and ethnic groups, and on giving states the
flexibility they need to address the concerns of their individual
communities.
For too long, we have blamed the mentally ill and those addicted to
alcohol and other drugs for their behavior, rather than extending a
helping hand. Recent scientific advances have opened new windows onto
the biochemical basis of mental illness and addictive behavior. This
legislation will ensure that these advances are translated into
practical services for those who need them. By creating this more
effective framework to deliver appropriate services, we will help many
more individuals to re-enter society as productive members, and do much
more to dispel the stigma of diseases that affect the mind.
This legislation deserves to be a major public health priority for
the nation. Congress should send the President this legislation before
the end of this session.
I ask unanimous consent that the summary of the legislation be
printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
The Children's Health Act of 2000: Division A--Children's Health
Title I--Autism
Under this provision, the Director of NIH shall expand,
intensify, and coordinate the activities of the NIH with
respect to research on autism. The Director of NIH will
establish not less than 5 Centers of Excellence on autism
research. Each center will conduct basic and clinical
research into the cause, diagnosis, early detection,
prevention, control and treatment of autism, including
research in the fields of developmental neurobiology,
genetics and psychopharmacology. The Director shall provide
for the coordination of information among centers. The
Director shall provide for a program under which samples of
tissues and genetic materials that are of use in research on
autism are made available for this research.
The provision also establishes 3 CDC regional centers of
excellence in autism and pervasive developmental
disabilities, to collect and analyze information on the
number, incidence, and causes of autism and related
developmental disabilities. The Secretary shall also
establish a program to provide information on autism to
health professionals and the general public, and establish a
committee to coordinate all activities within HHS concerning
autism.
Title II--Research and Development Regarding Fragile X
Instructs the National Institute of Child Health and Human
Development to expand, intensify, and coordinate research on
Fragile X and authorizes the development of coordinated
Fragile X research centers.
Title III--Juvenile Arthritis and Related Conditions
Requires the National Institute of Arthritis and
Musculoskeletal and Skin Diseases to expand and intensify
research concerning juvenile arthritis. Directs HHS to
evaluate whether the supply of pediatric rheumatologists is
adequate to meet the health care needs of children with
arthritis.
Title IV--Reducing Burden of Diabetes Among Children and Youth
Directs the Secretary, acting through the CDC, to develop a
sentinel system to collect incidence and prevalence data on
juvenile diabetes. Requires NIH to conduct or support long-
term epidemiology studies to investigate the causes and
characteristics of juvenile diabetes, and to support regional
clinical research centers for the prevention, detection,
treatment and cure of juvenile diabetes. Provides for
research and development of prevention strategies.
Title V--Asthma Services for Children
This provision authorizes the Secretary to award grants to
provide comprehensive asthma services to children, equip
mobile health care clinics, conduct patient and family
education on asthma management, and identify children
eligible for Medicaid, the State Children's Health Insurance
Program, and other children's health programs. This provision
amends the Preventive Health and Health Services Block Grant
program to provide for the establishment, operation, and
coordination of effective and cost-efficient systems to
reduce the prevalence of asthma and asthma-related illnesses,
especially among children, by reducing the level of exposure
to allergens through the use of integrated pest management.
This provision also requires the National Heart Lung and
Blood Institute, through the National Asthma Education
Prevention Program Coordinating Committee, to identify all
federal programs that carry out asthma-related activities,
develop a Federal plan for responding to asthma in
consultation with appropriate federal agencies, professional
and voluntary health organizations, and recommend ways to
strengthen and improve the coordination of asthma-related
Federal activities. CDC will collect and publish data on the
prevalence of children suffering from asthma in each State,
as well as mortality data at the national level.
Title VI--Birth Defects Prevention Activities
This provision expands CDC's folic acid education program
to prevent birth defects. In partnership with the States and
local, public, and private entities, CDC shall expand an
education and public awareness campaign; conduct research to
identify effective strategies for increasing folic acid
consumption by women of reproductive capacity; evaluate the
effectiveness of these strategies; and conduct research to
increase our understanding of the effects of folic acid in
preventing birth defects.
This provision elevates the Division of Birth Defects and
Developmental Disabilities to a National Center for Birth
Defects and Developmental Disabilities within CDC. The
purpose of this Center would be to collect, analyze, and
distribute data on birth defects and developmental
disabilities including information on causes, incidence, and
prevalence; conduct applied epidemiological research on the
prevention of such defects and disabilities; and provide
information to the public on proven prevention activities.
Title VII--Early Detection, Diagnosis and Treatment Regarding Hearing
Loss in Infants
Authorizes grants or cooperative agreements to develop
statewide newborn and infant hearing screening, evaluation
and intervention programs and systems, and provide technical
assistance to State agencies. Directs the NIH to continue a
program of research and development on the efficacy of new
screening techniques and technology. Provides for federal
coordination with State and local agencies, consumer groups,
national medical, health, and education organizations.
Coordinated activities shall include policy recommendations
and development of a data collection system.
Title VIII--Children and Epilepsy
Authorizes the agencies of HHS to expand current epilepsy
surveillance activities; implement public and professional
education activities; enhance research initiatives; and
strengthen partnerships with government agencies and
organizations that have experience addressing the health
needs of people with disabilities. Authorizes demonstration
projects in medically underserved areas, to improve access to
health services regarding seizures, to encourage early
detection and treatment in children.
Title IX--Safe Motherhood and Infant Health Promotion
The provision authorizes the Secretary of HHS to develop a
national surveillance program to better understand the burden
of maternal complications and mortality and to decrease the
disparities among populations at risk of death and
complications from pregnancy. The provision allows the
Secretary to expand the Pregnancy Risk Assessment Monitoring
System to provide surveillance and data collection in each
State. Furthermore, the provision would expand research
concerning risk factors, prevention strategies, and the roles
of the family, health care providers, and the community in
safe motherhood. The provision also authorizes public
education campaigns on healthy pregnancy, education programs
for health care providers, and activities to promote
community support services for pregnant women. Finally, the
provision authorizes grant funding for research initiatives
and programs to prevent drug, alcohol, and tobacco use among
pregnant women.
Title X--Pediatric Research Initiative
This provision establishes a Pediatric Research Initiative
within the National Institutes of Health to enhance
collaborative efforts, provide increased support for
pediatric biomedical research, and ensure that expanding
opportunities for advancement in scientific investigations
and care for children are realized.
The Secretary of HHS will make available enhanced support
for activities relating to the training and career
development of pediatric researchers, including general
authority for loan repayment of a portion of education loans.
This provision also requires that all HHS-funded and
regulated research comply with current pediatric-specific
human subject protection regulations. (Currently FDA-
regulated research is not required to comply).
[[Page S9099]]
National Institute of Child Health and Human Development is
authorized to convene and direct a consortium of federal
agencies, including CDC and EPA, to develop and implement a
prospective cohort study to evaluate the effects of both
chronic and intermittent external influences on human
development, and to investigate basic mechanisms of
developmental disorders and environmental factors, both risk
and protective, that influence growth and developmental
processes. The study will incorporate behavioral, emotional,
educational, and contextual consequences to enable a complete
assessment of the physical, chemical, biological and
psychosocial environmental influences on children's well-
being. The study shall gather data on environmental
influences and outcomes until at least age 21, shall include
diverse populations, and shall consider health disparities.
Title XI--Childhood Malignancies
Directs the Secretary of HHS, through CDC and NIH, to study
risk factors that affect or cause childhood cancers and carry
out projects to improve outcomes for children with cancer and
resultant secondary conditions. Provides for the expansion of
current data collection and support for CDC's National Limb
Loss Information Center.
Title XII--Adoption Awareness
This title authorizes the Secretary of HHS to make grants
to adoption organizations to train the staff of eligible
health centers in providing adoption information and
referrals based on guidelines developed by the adoption
community. The Secretary, through the Health Resources and
Services Administration and the Agency for Healthcare
Research and Qaulity, shall evaluate the effectiveness of the
training program as well as the extent to which such training
complies with federal requirements which may apply to
eligible health centers, to provide adoption information and
referrals on an equal basis with all other courses of action
included in nondirective pregnancy options counseling.
The Secretary shall carry out a national campaign to
provide information to the public about adoption of children
with special needs. Additionally, the Secretary shall make
grants to provide assistance to adoption support groups and
carry out studies to identify components that lead to
favorable long-term outcomes for families that adopt children
with special needs.
Title XIII--Traumatic Brain Injury
This provision reauthorizes the Traumatic Brain Injury Act
of 1996 to extend the authority for CDC to support research
into strategies for the prevention of TBI and to implement
public information and education programs for the prevention
of traumatic brain injuries. CDC will support additional data
collection and development of State TBI registries. NIH
research is expanded to include cognitive disorders and
neurobehavioral consequences arising from TBI. The bill
authorizes HRSA to make grants for new and expanded community
support services. Grants may be used to educate consumers and
families, train professionals, improve case management,
develop best practices in the areas of family support, return
to work, and housing for people with traumatic brain injury.
HRSA shall also make grants to protection and advocacy
systems, to provide services to individuals with traumatic
brain injury. This title also reauthorizes CDC's injury
prevention and control programs to 2005.
Title XIV--Child Care Safety and Health Grants
To address the need for increased safety of child care
facilities, the Secretary of HHS shall provide grants to
States to carry out activities related to the improvement of
the health and safety of children in child care settings.
Grants may be used for two or more of the following
activities: train and educate child care providers to prevent
injuries and illnesses and to promote health-related
practices; strengthen and enforce child care provider
licensing, regulation, and registration; rehabilitate child
care facilities to meet health and safety standards; provide
health consultants to give health and safety advice to child
care providers; enhance child care providers' ability to
serve children with disabilities; conduct criminal background
checks on child care providers; provide information to
parents on choosing a safe and healthy setting for their
children; or improve the safety of transportation of children
in child care.
Title XV--Healthy Start Initiative
Healthy Start, which was created as a demonstration project
in 1991, is authorized in this bill for the first time. The
Healthy Start program is designed to reduce the rate of
infant mortality and improve perinatal outcomes by providing
grants to areas with a high rate of infant mortality and low
birth weight infants. This provision also authorizes a new
grant program to conduct and support research and provide
additional services to enhance access to health care for
pregnant women and infants.
Title XVI--Oral Health
This provision requires HHS to support community-based
research to identify interventions that reduce the burden and
transmission of oral, dental and craniofacial diseases in
high risk populations, and develop clinical approaches for
pediatric assessment. HHS is authorized to fund innovative
oral health activities to decrease the incidence of baby
bottle and early childhood tooth decay, and to increase
utilization of pediatric dental services in children under 6.
The Secretary of HHS is authorized to provide grants to
States to increase community water fluoridation and to
provide school-based dental sealant services to children in
low income areas. This provision also authorizes HHS to
provide for the development of school-based dental sealant
programs to improve the access of children to sealants.
Finally, HHS shall make grants to dental training
institutions and community-based programs, as well as those
operated by the Indian Health Service, to develop oral health
promotion programs and to increase utilization of dental
services by children eligible for such services under a
federal health program.
Title XVII--Vaccine-Related Programs
Modifies the Vaccine Injury Compensation Program, to allow
compensation for those who suffer an adverse reaction to the
rota virus. This provision provides compensation if a vaccine
causes an injury that requires hospitalization and surgical
intervention. Additionally, the preventive health services
childhood immunization program is reauthorized to 2005.
Title XVIII--Hepatitis C
Authorizes HHS to implement a national system to determine
the incidence of hepatitis C virus infection, and to assist
the States in determining the prevalence of HCV infection.
Also authorizes HHS to identify, counsel and offer testing to
individuals who are at risk of HCV infection, and to develop
public and professional education programs for the detection
and control of HCV infection. Provides for improvements in
clinical laboratory procedures regarding Hepatitis C.
Title XIX--NIH Initiative on Autoimmune Diseases
The Director of NIH shall expand, intensify, and coordinate
the activities of NIH with respect to autoimmune diseases.
Title XX--Graduate Medical Education Programs in Children's Hospitals
This provision makes technical corrections to the pediatric
GME program, which supports training activities in
freestanding children's hospitals, and extends its
authorization through fiscal year 2005.
Title XXI--Special Needs of Children Regarding Organ Transplantation
Requires HHS to implement organ donation policies that
recognize the unique needs of children. HHS shall carry out
studies and demonstration projects to improve rates of organ
donation and determine the unique needs of children. HHS
shall conduct a study to determine the costs of
immunosupressive drugs for children who have received
transplants and the extent to which public and private health
insurance plans cover these costs.
Title XXII--Muscular Dystrophy Research
NIH will expand and increase coordination in activities
with respect to research on muscular dystrophies.
Title XXIII--Children and Tourette Syndrome Awareness
HHS will implement public and professional education
programs on Tourette Syndrome, with a particular emphasis on
children.
Title XXIV--Childhood Obesity Prevention
This provision authorizes the CDC to support the
development, implementation, and evaluation of state and
community-based programs to promote good nutrition and
increased physical activity. States would be required to
develop comprehensive, inter-agency school- and community-
based approaches to encourage and promote nutrition and
physical activity in local communities, with technical
support from CDC.
The CDC will coordinate and conduct research to improve our
understanding of the relationship between physical activity,
diet, health, and other factors that contribute to obesity.
Research will also focus on developing and evaluating
effective strategies for the prevention and treatment of
obesity and eating disorders, as well as study the prevalence
and cost of childhood obesity and its effects into adulthood.
The CDC in collaboration with State and local health,
nutrition, and physical activity experts, will develop a
nationwide public education campaign regarding the health
risks associated with poor nutrition and physical inactivity,
and will promote effective ways to incorporate good eating
habits and regular physical activity into daily living.
The CDC, in collaboration with HRSA, will develop and carry
out a program to train health professionals in effective
strategies to better identify, assess, and counsel (or refer)
patients with obesity, an eating disorder, or who are at risk
of becoming obese or developing an eating disorder. They will
also develop and carry out a program to train educators and
child care professionals in effective strategies to teach
children and their families about ways to improve dietary
habits and levels of physical activity.
Title XXV--Early Detection and Treatment Regarding Childhood Lead
Poisoning
This provision requires HRSA to report annually to the
Congress on the percentage of children in the Health Centers
program who are screened for lead poisoning, and requires
HRSA to work with the CDC and HCFA to conduct physician
education and training programs on current lead screening
policies. CDC will issue recommendations and establish
requirements for its grantees to ensure
[[Page S9100]]
uniform reporting of blood lead levels from laboratories to
State and local health departments and to improve data
linkages between health departments and federally funded
benefit programs.
This provision authorizes new funding through the Maternal
and Child Health Block Grant to states with a demonstrated
need to conduct outreach and education for families at risk
of lead poisoning, provide individual family education
designed to reduce exposures to children with elevated blood
lead levels, implement community environmental interventions,
and ensure continuous quality measurement and improvement
plans for communities committed to comprehensive lead
poisoning prevention.
Title XXVI--Screening for Heritable Disorders
Amends the Public Health Service Act to enhance, improve or
expand the ability of State and local public health agencies
to provide screening, counseling or health care services to
newborns and children having or at risk for heritable
disorders. This provision also creates an advisory committee
to provide advice and recommendations to the Secretary for
the development of grant administration policies and
priorities, and to enhance the ability of the Secretary to
reduce mortality or morbidity from heritable disorders.
Title XXVII--Pediatric Research Protections
This provision addresses critical safety issues in
children's research by requiring the Secretary of HHS to
review the current federal regulations for the protection of
children participating in research, which address such issues
as determining acceptable levels of risk and obtaining
parental permission, and to report to Congress on how to
update them to ensure the highest standards of safety.
Title XXVIII--Miscellaneous Provisions
This provision would require the NIH Director to report to
Congress within 180 days of enactment on activities conducted
and supported by the NIH during FY 2000 with respect to rare
diseases in children and the activities that are planned to
be conducted and supported by the NIH with respect to such
diseases during the FY 2001-2005. This provision also
requires HHS to study issues related to access to effective
treatment for metabolic disorders, including PKU. Results of
the study shall be made available to public health agencies,
Medicaid, insurance commissioners, and other interested
parties.
DIVISION B--YOUTH DRUG AND MENTAL HEALTH SERVICES
This division reauthorizes programs within the Substance
Abuse and Mental Health Services Administration (SAMHSA) to
improve mental health and substance abuse services for
children and adolescents, implement proposals giving States
more flexibility in the use of block grant funds with
accountability based on performance, and consolidate
discretionary grant authorities to give the Secretary more
flexibility to respond to the needs of those who need mental
health and substance abuse services. It also provides a
waiver from the requirements of the Narcotic Addict Treatment
Act that would permit qualified physicians to dispense or
prescribe schedule III, IV, or V narcotic drugs or
combinations of such drugs approved by FDA for the treatment
of heroin addiction. It also provides a comprehensive
strategy to combat Methamphetamine use.
Title XXXI--Provisions Relating to Services for Children and
Adolescents
Section 3101--Children and Violence
Authorizes $100 million for the Secretary to make grants to
public entities in consultation with the Attorney General and
the Secretary of Education to assist local communities in
developing ways to assist children in dealing with violence.
Four different types of grants are permitted under the
authority: grants to provide financial support to enable the
communities to implement the programs; to provide technical
assistance to local communities; to provide technical
assistance in the development of policies; and to assist in
the creation of community partnerships among the schools, law
enforcement and mental health services. Grantees would have
to ensure that they will carry out six activities which
include: security of the school; educational reform to deal
with violence; review and updating of school policies to deal
with violence; alcohol and drug abuse prevention and early
intervention; mental health prevention and treatment
services; and early childhood development and psychosocial
services. However, Federal funding is available for
prevention, early intervention, and treatment services.
Authorizes $50 million for the Secretary to develop
knowledge with regard to evidence-based practices for
treating psychiatric disorders resulting from witnessing or
experiencing domestic, school and community violence and
terrorism. Establishes centers of excellence to provide
technical assistance to communities in dealing with the
emotional burden of domestic, school and community violence
and terrorism if and when they occur.
Section 3102--Emergency Response
Permits the Secretary to use up to 2.5% of the funds
appropriated for discretionary grants for responding to
emergencies. The authority would permit an objective review
instead of peer review. This would permit an expedited
process for making awards. The Secretary is required to
define an emergency in the Federal Register subject to public
comment.
The section also includes language that provides additional
confidentiality protection for the information collected from
individuals who participate in national surveys conducted by
the Substance Abuse and Mental Health Services
Administration.
Section 3103--High Risk Youth Reauthorization
Reauthorizes the High Risk Youth Program, which provides
funds to public and non-profit private entities to establish
programs for the prevention of drug abuse among high risk
youth.
Section 3104--Substance Abuse Treatment Services for Children and
Adolescents
Authorizes $40 million for the Secretary to make grants,
contracts or cooperative agreement to public and non-profit
private entities including American Indian tribes and tribal
organizations for the purpose of providing substance abuse
treatment services for children and adolescents. Priority is
given to applicants who can apply evidenced based and cost
effective methods, coordinate services with other social
service agencies, provide a continuum of care dependent on
the needs of the individual, provide treatment that is gender
specific and culturally appropriate, involve and work with
families of those in treatment, and provide aftercare.
Authorizes $20 million for the Secretary to make grants,
contracts or cooperative agreements to public and non-profit
private entities including local educational agencies for the
purposes of providing early intervention substance abuse
services for children and adolescents. Under the provision,
priority is given to applicants who demonstrate an ability to
screen for and assess the level of involvement of children in
substance abuse, make appropriate referrals, provide
counseling and ancillary services, and who develop a network
with other social agencies. Requires the Secretary to ensure
geographical distribution of awards.
Authorizes $4 million to create centers of excellence to
assist States and local jurisdictions in providing
appropriate care for adolescents who are involved with the
juvenile justice system and have a serious emotional
disturbance.
Authorizes $10 million for the Secretary to make grants,
contracts, or cooperative agreements to carry out school
based as well as community based programs to prevent the use
of methamphetamine and inhalants.
Section 3105--Comprehensive Community Services for Children With
Serious Emotional Disturbance
This program was begun in 1994 to provide seed money to
local communities to develop systems of care for children
with serious emotional disturbances thus improving the
quality of care and increasing the likelihood that these
children would remain in local communities rather than being
sent to residential facilities. This section reauthorizes
this program through fiscal year 2002 and provides an
authority for the Secretary to waive certain requirements for
territories and American Indian tribes.
This section also would extend some grants under this
program to 6 years. The intent of the program is to provide
seed funding for comprehensive systems of care.
Unfortunately, many successful programs have had a difficult
time ensuring their continuation without Federal support.
This provision would give them an additional year to secure
that support.
Section 3106--Services for Children of Substance Abusers
Improves coordination by transferring this program from
Health Resources and Services Administration (HRSA) to SAMHSA
and authorizes the Secretary to make grants to public and
non-profit private entities to provide the following services
to children of substance abusers: periodic evaluations,
primary pediatric care, other health and mental health
services, therapeutic interventions, preventive counseling,
counseling related to witnessing of chronic violence,
referrals for and assistance in establishing eligibility for
services under other programs, and other developmental
services. Grantees would also provide services to families
where one or both of the parents are substance abusers. The
program requires that grantees match Federal funds with funds
from other sources.
The program is authorized at $50 million through fiscal
year 2002 and the authority is updated to include changes
that have occurred since fiscal year 1992 when it was first
authorized: e.g. developing connection to the Temporary
Assistance for Needy Families (TANF) and the Children's
Health Insurance Program (CHIP) programs.
Section 3107--Services for Youth Offenders
Authorizes $40 million for the Secretary to make grants,
contracts or cooperative agreements to State and local
juvenile justice agencies to help such agencies provide
aftercare services for youth offenders who have or are at
risk of a serious emotional disturbance and who have been
discharged from juvenile justice facilities. The funds may be
used for planning, coordinating and implementing these
services.
Section 3108--Grants for strengthening families through community
partnerships
Provides for grants to develop and implement model
substance abuse prevention programs and substance abuse
prevention services for individuals in high risk families.
[[Page S9101]]
Section 3109--Underage Drinking
Authorizes $25 million for the Secretary to make awards of
grants, cooperative agreements or contracts to public and
nonprofit private entities, including Indian tribes and
tribal organizations to enable such entities to develop plans
for and to carry out school based and community based
programs for the prevention of alcoholic beverages
consumption by individuals who have not attained the legal
drinking age.
Section 3110--Services for Individuals with Fetal Alcohol Syndrome
Authorizes $25 million for the Secretary to make grants,
cooperative agreement or contracts with public or nonprofit
private entities including Indian tribes and tribal
organizations to provide services to individuals diagnosed
with fetal alcohol syndrome or alcohol related birth defects.
The funds can be used for screening and testing; mental
health, health or substance abuse services; vocational
services; housing assistance; and parenting skills.
Authorizes $5 million for the Secretary to make grants,
cooperative agreements or contracts to public or nonprofit
private entities for the purposes of establishing not more
than 4 centers of excellence to study techniques for the
prevention of fetal alcohol syndrome and alcohol related
birth defects and adaptations of innovative clinical
interventions and service delivery improvements.
Section 3111--Suicide Prevention
The provision authorizes $75 million for the Secretary to
make grants, contracts or cooperative agreement to public and
nonprofit private entities to establish programs to reduce
suicide deaths in the United States among children and
adolescents. The provision requires collaboration among
various agencies with the Department of Health and Human
Services. Findings from the programs are then to be
disseminated to public and private entities.
Section 3112--General Provisions
This provision amends the sections that establish the
responsibilities of the Centers for Substance Abuse
Treatment, Substance Abuse Prevention and the Mental Health
Services to include an emphasis on children. In the case of
the Center for Mental Health Services it would require the
Director to collaborate with the Attorney General and the
Secretary of Education on programs that assist local
communities in developing programs to address violence among
children in schools.
Title XXXII--Provisions Relating to Mental Health
Section 3201--Priority Mental Health Needs of Regional and National
Significance
In 1996, the appropriation committees started a practice
which they have continued through fiscal year 1999 of
appropriating funds to SAMHSA's general authority (Section
501) instead of specific programs. This section codifies what
the appropriations committees have done by repealing several
specific authorities related to mental health services in
favor of a broad authority that gives the Secretary more
flexibility in responding to individuals in need of mental
health services. It would authorize four types of grants: (1)
knowledge development and application grants which are used
to develop more information on how best to serve those in
need; (2) training grants to disseminate the information that
the agency garners through its knowledge development; (3)
targeted capacity response which enables the agency to
respond to service needs in local communities; and (4)
systems change grants and grants to support family and
consumer networks in States. Repealed in this section are
sections 303, 520A and 520B of the Public Health Service Act
and section 612 of the Stewart B. McKinney Act.
This section includes a provision that would permit
$6,000,000 of the first $100,000,000 appropriated to the
program and 10 percent of all funds above $100,000,000 to be
given competitively to States to assist them in developing
data infrastructures for collecting and reporting on
performance measures.
This section also addresses the importance of the interface
between mental health services and primary care.
Section 3202--Grants for the Benefit of Homeless Individuals
The section reauthorizes the Grants for the Benefit of
Homeless Individuals program which provides grants to develop
and expand mental health and substance abuse treatment
services to homeless individuals. Preference is maintained
for organizations that provide integrated primary health
care, substance abuse and mental health services to homeless
individuals, programs that demonstrate effectiveness in
serving homeless individuals, and programs that have
experience in providing housing for individuals who are
homeless.
Section 3203--Projects for Assistance in Transition from Homelessness
(PATH)
This section reauthorizes the PATH program which provides
funds to States under a formula for the provision of mental
health services to homeless individuals. Preference is
maintained for organizations with demonstrated effectiveness
in serving homeless veterans. The section also provides an
authority for the Secretary to waive certain requirements for
territories.
Section 3204--Community Mental Health Services (CMHS) Performance
Partnership Program
The Community Mental Health Services Block Grant is a
formula program under which funds are distributed to States
for the provision of community based mental health services
for adults with a serious mental illness and children with a
serious emotional disturbance. This program and the Substance
Abuse Prevention and Treatment Block Grant provide funds to
States to provide services. State accountability under these
programs is built on State expenditure of funds.
Provisions in this section and other sections of this bill
provide for the first steps in increasing State flexibility
in the use of funds while establishing an accountability
system based on performance. In this section, the number of
elements that States must include in their plan for use of
CMHS Block Grant funds are reduced from 12 to 5, thus
providing additional flexibility for the States and reduced
administrative costs.
This section also expands the responsibilities of the
already existing State Planning Councils. Under current law,
these councils are required to review and comment on State
plans for use of CMHS Block Grant funds. Under this provision
they would also be required to review and comment on State
reports on the outcomes of their activities.
One provision within current law requires States to
maintain their financial support for providing community
based mental health services at an average of what they spent
over the past two years. This requirement discourages States
from adding one time infusions of funds into community mental
health services since it would increase the States'
maintenance of effort requirement. This provision would
indicate that an infusion of funds of a non-recurring nature
for a singular purpose may be exempt from the calculation of
the maintenance of effort requirement.
Current law allows for the Secretary to set a date for the
submission of grant applications. Applications must include a
plan on how the State intends to use the funds and a report
on how funds were spent the previous year. A provision in
this section would establish that State plans for use of
funds must be submitted by September 1 of the fiscal year
prior to the fiscal year for which the State is seeking
funds and the reports by the following December 1.
The section also makes changes to the current waiver
authority for territories.
Section 3205--Determination of Allotment
There are three elements to determine the allocation of
funding for SAMHSA block grants: (1) the population of
individuals needing services; (2) the cost of providing
services; and (3) the state income level. In August of 1997,
SAMHSA changed the data on determining the cost of providing
services from the use of manufacturing wages to
nonmanufacturing wages, which was determined to be the most
appropriate method to reflect cost differences among states.
This action would have caused a decline of funding in several
states. To address this problem, this section makes permanent
provisions enacted in Public Law 105-277 on the formula for
distribution of funds under the Community Mental Health
Services Block Grant (CMHS). The CMHS Block Grant formula
includes a ``hold harmless'' provision which guarantees that
no State will receive less funding than it did in fiscal year
1998.
Section 3206--Protection and Advocacy for Mentally Ill Individuals Act
of 1986
This section makes technical changes to the formula for
distribution of funds under this program to correct a
provision that would have inappropriately reduced minimum
State allotments. It also provides for the renaming of the
Act to conform with changes made in previous laws, makes a
technical change to the provision on territories and
reauthorizes the program through fiscal year 2002.
The bill would also permit an American Indian Consortia to
receive direct funding after the appropriation exceeds $25
million. It would also extend the responsibilities of the
Protection and Advocacy program to individuals living in the
communities when the appropriation exceeds $30 million.
Section 3207--Requirement Relating to the Rights of Residents of
Certain Facilities
This measure would require facilities that are both within
the purview of the Protection and Advocacy program and which
receive appropriated funding from the Federal government to
protect and promote the rights of individuals with regard to
the appropriate use of seclusions and restraints. Such
covered facilities are required to inform the Secretary of
each death that occurs while a patient is restrained or in
seclusion, or each death that occurs within 24 hours after a
patient is restrained or in seclusion, or where it is
reasonable to assume that a patient's death is a result of
seclusion or restraint. The Secretary is required to issue
regulations within one year of enactment on appropriate staff
levels, appropriate training for staff on the use of
restraints and seclusions.
Requires any such facility that is supported in whole or in
part with funds appropriated under the Public Health Service
Act to protect and promote the rights of each resident of the
facility, including the right to be free from physical or
mental abuse, corporal punishment, and any restraints or
involuntary seclusion imposed for purposes of discipline or
convenience; sets standards for when restraints or seclusion
may be imposed; requires each such facility to notify
[[Page S9102]]
the appropriate State licensing or regulatory agency of each
death that occurs in the facility and of the use of seclusion
or restraint in accordance with regulations promulgated by
the Secretary. Failure to comply with these requirements
including the failure to appropriately train staff makes such
facility ineligible for participation in any program
supported in whole or in part by funds appropriated under
this Act.
Section 3208--Requirements relating to the rights of residents of
certain non-medical community-based facilities for children and youth
Ensures that appropriately-trained supervisory personnel
are present whenever a physical restraint is required of a
resident of a non-medical community-based treatment facility.
The use of mechanical or chemical restraints in such
facilities is prohibited and physical restraint must be used
only in emergency situations. The section also authorizes the
Secretary to develop guidelines for licensing rules regarding
training use of restraints.
Section 3209--Grants for Emergency Mental Health Centers
This provision authorizes $25 million for the Secretary to
make grants to States, political subdivisions of States,
Indian tribes and tribal organizations to support the
designation of hospitals and health centers as Emergency
Mental Health Centers which will serve as a central receiving
point in the community for individuals who may be in need of
emergency mental health services.
Section 3210--Grants for Jail Diversion Programs
Authorizes $10 million for the Secretary to make grants to
States, political subdivisions of States, Indian tribes and
tribal organizations to develop and implement programs to
divert individuals with a mental illness from the criminal
justice system to community-based services.
Section 3211--Grants for Improving Outcomes for Children and
Adolescents Through Services Integration Between Child Welfare and
Mental Health Services
The provision authorizes $10 million for the Secretary to
make grants to States, political subdivisions of States,
Indian tribes and tribal organizations to provide integrated
child welfare and mental health services for children and
adolescents under 19 years of age in the child welfare system
or at risk for becoming part of the system, and parents or
caregivers with a mental illness or a mental illness and a
co-occurring substance abuse disorder.
Section 3212--Grants for the Integrated Treatment of Serious Mental
Illness and Co-occurring Substance Abuse
Authorizes $40 million for the Secretary to make grants,
contracts or cooperative agreements with States, political
subdivisions of States, Indian tribes and tribal
organizations for the development or expansion of programs to
provide integrated treatment services for individuals with a
serious mental illness and a co-occurring substance abuse
disorder.
Section 3213--Training Grants
The prevision authorizes $25 million for the Secretary to
award grants States, political subdivisions of States, Indian
tribes and tribal organizations or non-profit private
entities to train teachers and other relevant school
personnel to recognize symptoms of childhood and adolescent
mental disorders and to refer family members to the
appropriate mental health services if necessary; to train
emergency services personnel to identify and appropriately
respond to persons with a mental illness; and to provide
education to such teachers and emergency personnel regarding
resources that are available in the community for individuals
with a mental illness.
Title XXXIII--Provisions Relating to Substance Abuse
Section 3301--Priority Substance Abuse Treatment Needs of Regional and
National Significance
As explained in section 3201, this section codifies what
the appropriations committees have done by repealing several
specific authorities related to substance abuse treatment
services that gives the Secretary more flexibility in
responding to the needs of people in need of substance abuse
treatment. It would authorize three types of grants: (1)
knowledge development and application grants, which are used
to develop more information on how best to serve those in
need; (2) training grants to disseminate the information that
the agency garners through its knowledge development; and (3)
targeted capacity response, which enables the agency to
respond to services needs in local communities. Repealed in
this section are sections 508, 509, 510, 511, 512, 571 and
1971 of the Public Health Service Act.
This section also addresses the importance of the interface
between substance abuse treatment services and primary care.
Section 3302--Priority Substance Abuse Prevention Needs of Regional and
National Significance
This section implements in authorization for substance
abuse prevention what the appropriations committees did in
fiscal year 1996. It authorizes the same type of grants as
described in the previous section except that they pertain to
substance abuse prevention. Repeals sections 516 and 518 of
the Public Health Service Act.
This section also addresses the importance of the interface
between substance abuse prevention services and primary care.
Section 3303--Substance Abuse Prevention and Treatment Performance
Partnership Block Grant
This program provides funds to States for their use in
providing substance abuse prevention and treatment services.
While there is considerable flexibility in State use of
funds, there are a number of requirements which are directly
related to public health issues. This provision would begin
the process of giving States greater flexibility in their use
of funds and accountability based on performance instead of
expenditures.
Greater flexibility is enhanced by the repeal of a
requirement that States spend 35 percent of their allotment
on drug related activities and 35 percent on alcohol related
activities. A provision requiring States to maintain a
$100,000 revolving fund to support homes for persons
recovering from substance abuse would be made optional thus
permitting States to continue such efforts or to use those
funds for other services as they deem necessary.
This section also creates authority for the Secretary to
waive certain requirements for States who meet established
criteria. Those criteria would be established in regulation
after consultation with the States, providers and consumers.
One provision within current law requires the State to
maintain its financial support for substance abuse prevention
and treatment services at the average of what it spent over
the past two years. While States support this requirement, it
discourages States from adding one time infusions of funds
into substance abuse services since it would increase the
calculation of the State's maintenance of effort requirement.
This section includes a provision that would exempt from
maintenance of effort requirements any one time infusion of
funds which are for a singular purpose.
Current law allows the Secretary to set a date for the
submission of grant applications. Applications include a plan
on how funds will be used and a report on how funds were
spent the previous year. A provision in this section would
establish that State applications are due on October 1 of the
fiscal year prior to the fiscal year for which they are
seeking funds.
This section also simplifies the waiver for territories and
reauthorizes the program through fiscal year 2002.
Section 3304--Determination of Allotment
There are three elements to determine the allocation of
funding for SAMHSA block grants: (1) the population of
individuals needing services; (2) the cost of providing
services; and (3) the state income level. In August of 1997,
SAMHSA changed the data on determining the cost of providing
services from the use of manufacturing wages to
nonmanufacturing wages, which was determined to be the most
appropriate method to reflect cost differences among states.
This action would have caused a decline of funding in several
states. To address this problem, this section makes permanent
provisions in Public Law 105-277 on the formula for
distribution of funds under the Substance Abuse Prevention
and Treatment Block Grant (SAPT).
The SAPT Block Grant formula includes Minimum Growth and
Small State Minimum Rules needed to complete the phase-in of
the new formula. Also, the provision includes a Proportional
Scale Down Rule if appropriations decline in future years.
Section 3305--Nondiscrimination and Institutional Safeguards for
Religious Providers
This section would permit religious organizations which
provide substance abuse services to receive Federal
assistance either through the Substance Abuse Prevention and
Treatment Block Grant or discretionary grants through the
Substance Abuse and Mental Health Services Administration
while maintaining their religious character and their ability
to hire individuals of the same faith. Such programs may not
discriminate against anyone interested in treatment at the
facility. If a person who is referred for services needs or
would prefer to be served in a different facility, the
program will refer that person to an appropriate treatment
program.
The provision further stipulates that Federal funds
received under a block or discretionary grant for substance
abuse services by a religious organization will be maintained
in a separate account and only the Federal funds used by such
providers shall be subject to Federal audit requirements.
A religious organization that believes that it has been
discriminated against based on the fact that it is a faith
based program may bring an action for injunctive relief
against the appropriate government agency or entity that has
allegedly committed the violation.
Federal funds may not be used for sectarian worship,
instruction or proselytization.
If a State or local government chooses to co-mingle their
funds with Federal funds, then the State and or local
government funds are subject to the provisions of this
section.
Section 3306--Alcohol and Drug Prevention and Treatment Services for
Indians and Native Alaskans
Authorizes $15 million for the Secretary to make grants,
contracts or cooperative agreements with public and private
non-profit private entities including American Indian
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tribes and tribal organizations and Native Alaskans for the
purpose of providing alcohol and drug prevention or treatment
services for Indians and Native Alaskans. Priority is given
to those entities that will provide such services on
reservations or tribal lands, employ culturally appropriate
approaches, and have provided prevention or treatment
services for at least one year prior to applying for a grant.
The Secretary is required to submit a report to the
Committees of jurisdiction after three years and annually
thereafter describing the services that have been provided
under this program.
Section 3307--Establishment of Commission
Authorizes $5 million to establish a Commission on Indian
and Native Alaskan Health Care that shall carry out a
comprehensive examination of the health concerns of Indians
and Native Alaskans living on reservations or tribal lands.
The Commission will consist of the Secretary as Chair and 15
appointed and voting members, 10 of whom must be American
Indians or Native Alaskans. The Director of the Indian Health
Service and the Commissioner of Indian Affairs are non-voting
members. The commission is to issue a report within three
years detailing the health condition of individuals living on
tribal lands, what services are currently available and if
there are insufficient services detail why this situation
exists, and make recommendations to the Congress on how to
address these issues.
Title XXXIV--Provisions Relating to Flexibility and Accountability
Section 3401--General Authorities and Peer Review
This section removes the requirement that there be an
Associate Administrator for Alcohol Policy, and makes
necessary corrections to the peer review requirements to
reflect changes since 1992. The section also includes
language that provides additional confidentiality protection
for the information collected from individuals who
participate in national surveys conducted by the Substance
Abuse and Mental Health Services Administration.
Section 3402--Advisory Councils
SAMHSA and each of its Centers are required under statute
to have an Advisory Council. Current law requires that they
meet three times a year. This section reduces the number of
times the councils are required to meet to two.
Section 3403--General Provisions for the Performance Partnership Block
Grants
As part of the effort to change the current CMHS and SAPT
Block Grants into performance-based systems, the Secretary is
required to submit to Congress within two years a plan for
what these performance based programs would look like and how
they would operate. This plan would include how the States
would receive greater flexibility, what performance measures
would be used in holding States accountable, definitions for
the data elements that would be collected, the funds needed
to implement this system and where those funds would come
from, and needed legislative changes. This would give the
committees of jurisdiction one year to consider the plan and
implement any necessary changes in the next reauthorization
of SAMHSA in 2003.
Section 3404--Data Infrastructure Projects
This section creates an authority for the Secretary to make
grants to States to assist them in developing the data
infrastructure necessary to implement a performance based
system. States are required to match the Federal
contribution.
Section 3405--Repeal of Obsolete Addict Referral Provisions
This section repeals certain obsolete provisions of the
Narcotic Addict Rehabilitation Act of 1966.
Section 3406--Individuals with Co-Occurring Disorders
The section requires the Secretary to report to the
committees of jurisdiction on how services are currently
being provided to those with a co-occurring mental health and
substance abuse disorder, what improvements are needed to
ensure that they receive the services they need, and a
summary of best practices on how to provide those services
including prevention of substance abuse among individuals who
have a mental illness and treatment for those with a co-
occurring disorder.
Section 3407--Services for Individuals with Co-Occurring Disorders
The section clarifies that both Substance Abuse Prevention
and Treatment and Community Mental Health Service Block Grant
funds may be used to provide services to those with a co-
occurring mental health and substance abuse disorder as long
as the funds are used for the purposes for which they were
authorized.
Title XXXV--Waiver Authority for Physicians Who Dispense or Prescribe
Certain Narcotic Drugs for Maintenance Treatment or Detoxification
Treatment
Section 3501--Short Title
Drug Addition Treatment Act of 2000
Section 3502--Waiver Authority for Physicians Who Dispense or Prescribe
Certain Narcotic Drugs for Maintenance Treatment or Detoxification
Treatment
The waiver from the requirements of the Narcotic Addict
Treatment Act would permit qualified physicians to dispense
(including prescribe) schedule III, IV, or V narcotic drugs
or combinations of such drugs approved by FDA for the
treatment of heroin addiction. The physician would be
required to refer the patient for appropriate counseling and
limit his or her practice to 30 patients.
Physicians are qualified if they are licensed under State
law and hold a subspeciality board certification in addiction
psychiatry from the American Board of Medical Specialties,
certification in a subspeciality from the American
Osteopathic Association, certification from the American
Society of Addiction Medicine, the physician has participated
in a clinical trial on the narcotic drug, is approved by the
State licensing board or has such other training or
experience as the Secretary considers necessary. Permits the
Secretary to issue regulation on criteria for using other
credentialing bodies or on the limit of 30 patients. The
Secretary is also required under the provision to issue
practice guidelines within 120 days. States are given 3 years
in which to pass legislation that would prohibit a
practitioner from dispensing such drugs or combinations of
such drugs if they want.
The Secretary or the Attorney General are authorized to
determine whether the program is working and to stop the
program with 60 days notice.
Title XXXVI--Methamphetamine Anti-Proliferation
Section 3601--Short Title
Methamphetamine Anti-Proliferation Act of 1999
Subtitle A--Methamphetamine Production
Part I--Criminal Penalties
Section 3611--Enhanced Punishment of Amphetamine Laboratory Operators
Section 3602 directs the Sentencing Commission to raise the
penalties for amphetamine related offenses to a level
comparable to those for methamphetamine.
Section 3612--Enhance Punishment of Amphetamine and Methamphetamine
Operators
This section amends the Sentencing Guidelines by increasing
the base offense level for manufacturing amphetamine or
methamphetamine to not less than level 27 if the offense
created a substantial risk of harm to human life or to the
environment and to not less than level 30 if the offense
created a substantial risk of harm to the life of a minor or
incompetent.
Section 3613--Mandatory Restitution for Meth Lab Clean-Up
Section 103 makes reimbursement for the costs incurred by
the U.S. or State and local governments for the cleanup
associated with the manufacture of amphetamine or
methamphetamine mandatory. It also provides that the
restitution money will go to the Asset Forfeiture Fund
instead of the treasury.
Section 3614--Methamphetamine Paraphernalia
This section amends the anti-paraphernalia statute to
include paraphernalia used in connection with methamphetamine
use.
Part II--Enhanced Law Enforcement
Section 3621--Environmental Hazards Associated With Illegal Manufacture
of Amphetamine and Methamphetamine
This section authorizes the DEA to receive money from the
Asset Forfeiture Fund to pay for clean-up costs associated
with the illegal manufacture of amphetamine or
methamphetamine for the purposes of federal forfeiture and
disposition. It also allows for reimbursement to State and
local entities for clean-up costs when they assist in a
federal prosecution on amphetamine or methamphetamine related
charges to the extent such costs exceed equitable sharing
payments made to such State or local government in such
case. The section also expressly states that funds from
the Violent Crime Reduction Trust Fund can be used to pay
for clean-up costs.
Section 3622--Reduction in Threshold for Non-Safe Harbor Productions
This section reduces the threshold for retail sales of non-
safe harbor products containing pseudoephedrine or
phenylpropanolamine from 24 grams to 9 grams. It also limits
the package size to not more than 3 grams of pseudoephedrine
or phenylpropanolamine base.
Section 3623--Training for Drug Enforcement Administration and State
and Local Law Enforcement Personnel Relating to Clandestine
Laboratories
Section 3613 authorizes $5.5 million in funding for DEA
training programs designed to (1) train State and local law
enforcement in techniques used in meth investigations (2)
provide a certification program for State and local law
enforcement enabling them to meet requirements with respect
to the handling of wastes created by meth labs; (3) create a
certification program that enables certain State and local
law enforcement to recertify other law enforcement in their
regions; and (4) staff mobile training teams which provide
State and local law enforcement with advanced training in
conducting clan lab investigations and with training that
enables them to recertify other law enforcement personnel.
The training programs are authorized for 3 years after which
the States, either alone or in consultation/combination with
other States, will be responsible for training their own
personnel. The
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States will be required to submit a report detailing what
measures they are taking to ensure that they have programs in
place to take over the responsibility after the three year
federal program expires.
Sec. 3624--Combating Methamphetamine in High Intensity Drug Trafficking
Areas
This section authorizes $15 million a year for fiscal years
2000-2004 to be appropriated to ONDCP to combat trafficking
of methamphetamine in designated HIDTA's by hiring new
federal, State, and local law enforcement personnel,
including agents, investigators, prosecutors, lab technicians
and chemists. It provides that the funds shall be apportioned
among the HIDTA's based on the following factors: (1) number
of Meth labs discovered in the previous year; (2) number of
Meth prosecutions in the previous year; (3) number of Meth
arrests in the previous year; (4) the amounts of Meth seized
in the previous year; and (5) intelligence and predictive
data from the DEA and HHS showing patterns and trends in
abuse, trafficking and transportation patterns in
methamphetamine, amphetamine and listed chemicals. Before
apportioning any funds, the Director must certify that the
law enforcement entities responsible for clan lab seizures
are providing lab seizure data to the national clandestine
laboratory database at the El Paso Intelligence Center. It
also provides that not more than five percent of the
appropriated amount may be used for administrative costs.
Section 3625--Combating Amphetamine and Methamphetamine Manufacturing
and Trafficking
This section authorizes $6.5 million to be appropriated for
the hiring of new agents to (1) assist State and local law
enforcement in small and mid-sized communities in all phases
of drug investigations, including assistance with foreign-
language interpretation; (2) staff additional regional
enforcement and mobile enforcement teams; (3) establish
additional resident offices and posts of duty to assist State
and local law enforcement in rural areas; and (4) provide the
Special Operations Division with additional agents for
intelligence and investigative operations.
It also authorizes $3 million to enhance the investigative
and related functions of the Chemical Control Program to
implement further the provisions of the Comprehensive
Methamphetamine Control Act of 1996. The funds shall be used
to account accurately for the import and export of List I
chemicals and coordinate investigations surrounding the
diversion of these chemicals; to develop a computer
infrastructure sufficient to process and analyze time
sensitive enforcement information from suspicious orders
reported to DEA field offices and other law enforcement; and
to establish an education, training, and communications
process to alert industry of current trends and emerging
patterns of illicit manufacturing activities.
Part III--Abuse Prevention and Treatment
Section 3631--Expansion of Methamphetamine Research
This section allows the Director of the National Institute
on Drug Abuse (NIDA) to make grants and enter into
cooperative agreements to expand the National Drug Abuse
Treatment Clinical Trials Network and current and on-going
research and clinical trials with treatment centers relating
to methamphetamine abuse and addiction and other biomedical,
behavioral and social issues related to methamphetamine abuse
and addiction. It authorizes to be appropriated such sums as
may be necessary and such sums are to supplement and not
supplant any other amounts appropriated for research on
methamphetamine abuse and addiction.
Section 3632--Methamphetamine and Amphetamine Addiction Treatment
This section authorizes $10 million in grants to States
that have a high rate, or have had a rapid increase, in
methamphetamine or amphetamine abuse or addiction, for
treatment of methamphetamine and amphetamine addiction.
Section 3633--Study of Methamphetamine Treatment
This section requires the Secretary of HHS, in consultation
with the Institute of Medicine of the National Academy of
Sciences, to conduct a study on the development of
medications for the treatment of addiction to amphetamine and
methamphetamine and to report the findings to the Judiciary
Committees of the Senate and House of Representatives.
Part IV--Abuse Prevention and Treatment
Section 3641--Report on Consumption of Methamphetamine and Other
Illicit Drugs in Rural Areas, Metropolitan Areas, and Consolidated
Metropolitan Areas
This section requires HHS to include in its annual National
Household Survey on Drug Abuse prevalence data on the
consumption of methamphetamine and other illicit drugs in
rural, metropolitan, and consolidated metropolitan areas.
Section 3642--Report on Diversion of Ordinary, Over-the-Counter
Pseudoephedrine and Phenylpropanolamine Products
This section requires the Attorney General to conduct a
study on the use of ordinary over-the-counter pseudoephedrine
and phenylpropanolamine products in the clandestine
production of illicit drugs. The report is to be submitted to
Congress and shall include the AG's findings and
recommendations on the need for additional measures,
including thresholds, to prevent diversion of blister pack
products.
Subtitle B--Controlled Substance Generally
Section 3651--Enhanced Punishment of Trafficking in List I Chemicals
This section directs the Sentencing Commission to increase
the penalties for violations involving ephedrine,
pseudoephedrine, and phenylpropanolamine so that the
penalties correspond to the quantity of controlled substance
that could reasonably have been manufactured from these
chemicals. The Sentencing Commission is also directed to
establish a conversion table to determine the quantity of
controlled substances that can be manufactured from these
chemicals. The Sentencing Commission also shall review and
amend its guidelines concerning list I chemicals other than
those above, to provide for increased penalties to reflect
the dangerous nature of such offenses and the dangers
associated with manufacturing methamphetamine.
Section 3652--Mail Order Requirements
This section represents changes to the reporting
requirements of 21 U.S.C. 830(b)(3) worked out between the
DEA and industry. Reporting will no longer be required for
valid prescriptions, limited distributions of sample
packages, distributions by retail distributors if consistent
with authorized activities, distributions to long term care
facilities, and any product which has been exempted by the
AG. It also allows the AG to revoke an exemption if he finds
the drug product being distributed is being used in violation
of the Controlled Substances Act.
Section 3653--Theft and Transportation of Anhydrous Ammonia For
Purposes of Illicit Production of Controlled Substances
This section makes it unlawful for a person to steal
anhydrous ammonia or to transport stolen anhydrous ammonia
across State lines knowing, intending, or having reasonable
cause to believe that such anhydrous ammonia will be used to
manufacture a controlled substance. Also provides funding to
Iowa State University to permit it to continue and expand its
current research into the development of inert agents that
will eliminate the usefulness of anhydrous ammonia as an
ingredient in the production of methamphetamine.
Subtitle C--Ecstasy Anti-Proliferation Act of 2000
Section 3661--3665
Directs the Sentencing Commission to review and amend the
Ecstasy guidelines to provide for increased penalties such
that those penalties reflect the seriousness of the offenses
of trafficking in and importing Ecstasy and related drugs.
Section 3665 authorizes $10 million in grants for prevention
efforts concerning Ecstasy and other ``club drugs.''
Subtitle D--Miscellaneous
Section 3671--Anti-drug Messages on Federal Government Internet
Websites
This section requires all federal departments and agencies,
in consultation with ONDCP, to place anti-drug messages on
their Internet websites and an electronic hyperlink to
ONDCP's website. Numerous government agencies have children's
websites, including the Social Security Administration.
Section 3672--Reimbursement By Drug Enforcement Administration of
Expenses Incurred To Remediate Methamphetamine Laboratories
Authorizes $20 million to be appropriated in FY 2001 for
the DEA to reimburse States, units of local government,
Indian tribal governments, and other public entities for
expenses incurred to clean-up and safely dispose of
substances associated with clandestine methamphetamine
laboratories which may present a danger to public health or
the environment.
Section 3673--Severability Section
Any provision held to be invalid or unenforceable by its
terms, or as applied to any person or circumstance, is to be
given the maximum effect permitted by law, or if it is held
to be invalid or unenforceable, such provision shall be
severed from this Act.
Ms. COLLINS. Mr. President, I commend my colleagues, the chair and
ranking member of the Public Health Subcommittee of the Health,
Education, Labor, and Pensions Committee, for all of their efforts in
bringing the Children's Health Act of 2000 to the Senate floor. This
omnibus bill is the result of months of bipartisan collaboration and
discussion between Members of both the House and the Senate in an
effort to address important children's health issues in this Congress.
As the co-chair of the Senate Diabetes Caucus, I am particularly
pleased that the Pediatric Diabetes Research and Prevention Act, which
I introduced earlier this year with Senators Breaux, Abraham, Craig,
and Bunning, has been included in this bill. Our legislation--which was
also cosponsored by Senators Grassley,
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Bingaman, Chafee, Roth, Hollings, and Schumer--will help us to reduce
the tremendous toll that diabetes takes on our nation's children and
young people, and I want to thank my colleagues for including it in the
omnibus bill.
As noted in the recent cover story in Newsweek, diabetes is a
devastating, lifelong condition that affects people of every age, race,
and nationality. Sixteen million Americans suffer from diabetes and
about 800,000 new cases are diagnosed each year. It is one of our
nation's most costly diseases in both human and economic terms.
Diabetes is the leading cause of kidney failure, blindness in adults,
and amputations not related to injury. It is a major risk factor for
heart disease and stroke and shortens life expectancy up to 15 years.
Moreover, diabetes costs our nation more than $105 billion a year in
health-related expenditures. More than one out of every ten health care
dollars and about one out of four Medicare dollars are spent on people
with diabetes.
Unfortunately, there currently is no method to prevent or cure
diabetes and available treatments have only limited success in
controlling its devastating consequences. The burden of diabetes is
particularly heavy for children and young adults with type I, also
known as juvenile diabetes. Juvenile diabetes is the second most common
chronic disease affecting children. Moreover, it is one that they never
outgrow.
As the founder of the Senate Diabetes Caucus, I have met many
children with diabetes who face a daily struggle to keep their blood
glucose levels under control: kids like nine-year-old Nathan Reynolds,
an active young boy from North Yarmouth, who was Maine's delegate to
the Juvenile Diabetes Foundation's Children's Congress last year.
Nathan was diagnosed with diabetes in December of 1997, which forced
him to change both his life and his family's life. He has learned how
to take his blood--something his four-year-old brother reminds him to
do before every meal--check his blood sugar level, and give himself an
insulin shot on his own, sometimes with the help of his parents or his
school nurse. Nathan told me that his greatest wish was that, just
once, he could take a ``day off'' from his diabetes.
The sad fact is that children like Nathan with diabetes can never
take a day off from their disease. There is no holiday from dealing
with their diabetes. They face a lifetime of multiple daily finger
pricks to check their blood sugar levels and daily insulin shots.
Moreover, insulin is not a cure for diabetes, and it does not prevent
the onset of serious complications. As a consequence, children like
Nathan also face the possibility of lifelong disabling complications,
such as kidney failure and blindness.
Reducing the health and human burden of diabetes and its enormous
economic impact depends upon identifying the factors responsible for
the disease and developing new methods for prevention, better
treatment, and ultimately a cure. The provisions of the Pediatric
Diabetes Research and Prevention Act that have been included in the
Children's Health Act of 2000 will do just that.
One of the most important actions we can take is to establish a type
I diabetes monitoring system. Currently there is no way to track the
incidence of type I diabetes across the country. As a consequence, the
estimates for the number of people with type I diabetes from the
American Diabetes Association, the Juvenile Diabetes Foundation, the
Centers for Disease Control and Prevention, and the National Institutes
of Health vary enormously from 123,000 to over 1.5 million, a 13-fold
variation. One of the best ways to define the prevalence and incidence
of a disease, as well as to characterize and study populations, is to
establish a national database specific to that disease, which our
legislation would do.
Obesity and inadequate physical activity--both major problems in the
United States today--are important risk factors for type 2, or non-
insulin dependent diabetes. Unfortunately, obesity is a significant and
growing problem among children in the United States, which has led to a
disturbing increase in the incidence of type 2 diabetes among young
people. This is particularly alarming since type 2 diabetes has long
been considered an ``adult'' disease. Nearly all of the documented
cases of type 2 diabetes in young people have occurred in obese
children, who are also at increased risk for the complications
associated with the disease. Moreover, these complications will likely
develop at an earlier age than if these children had developed type 2
diabetes as adults. Our legislation therefore calls for the
implemention of a national public health effort to address the
increasing incidence of type 2 diabetes in children and young people.
In addition, the legislation calls for long-term studies of persons
with type 1 diabetes at the National Institutes of Health where these
individuals will be followed for 10 years or more. This long-term
analysis of type 1 diabetes will provide an invaluable basis for the
investigation and identification of the causes and characteristics of
diabetes and its complications and it will also help to identify a
potential study population for clinical trials. The legislation also
directs the Secretary of Health and Human Services to support regional
clinical research centers for the prevention, detection, treatment and
cure of type 1 diabetes. And finally, the legislation directs the
Secretary of HHS to provide for a national program to prevent type 1
diabetes, including efforts to develop a vaccine.
Mr. President, these provisions will help us to better understand and
ultimately conquer diabetes, which has had such a devastating impact on
millions of American children and their families. It is therefore most
appropriate that they be included in the Children's Health Act of 2000,
and I urge all of my colleagues to join me in supporting it.
Mr. REED. Mr. President, I rise to add my voice to the chorus of
support for this legislation, which will have a strong positive impact
on the youth of this nation.
The first element of this initiative that I would like to highlight
are the provisions regarding children's public health. This effort will
greatly enhance health promotion and disease prevention directed
towards youth, improve access to certain health care services for needy
children and bolster resources for pediatric-specific medical research.
Children are our most precious resource, and we should do all we can to
enable our children to reach their full potential both physically and
intellectually. The Children's Public Health Act takes an important
step toward achieving this goal by creating an environment where
children are able to grow and develop unhindered by the burden of
disease.
Medical science has made incredible strides in reducing and
preventing devastating childhood diseases that were prevalent only a
generation ago. Yet, despite these advances in our ability to stem the
spread of deadly infectious diseases, there has been an increase in the
incidence of chronic and debilitating disorders that afflict children.
Specifically, over the past decade, we have seen a rise in the number
of children suffering from asthma, autism, and other diseases
attributed to poor diet and lack of physical activity, such as
diabetes, high cholesterol and hypertension in young children. This
legislation sets forth a balanced, creative approach to these troubling
pediatric conditions by augmenting pediatric clinical research, while
also expanding and intensifying screening, education, outreach,
monitoring and training efforts led by State and local public health
agencies and other health care providers.
There are two specific initiatives that I am especially proud of in
this legislation. The first seeks to address an entirely preventable
problem that continues to plague far too many children in this nation--
lead poisoning. While tremendous strides have been made over the last
20 years in reducing lead exposure among our citizens, it is estimated
that nearly one million preschoolers nationwide still have excessive
levels of lead in their blood--making lead poisoning the leading
childhood environmental disease.
Lead is most harmful to children under age six because lead is easily
absorbed into their growing bodies, and interferes with the developing
brain and nervous system. The effect of lead poisoning on a child
ranges from mild to severe. Most often in the U.S., children are
poisoned through chronic, low-level exposure to lead-based paint, which
can cause reduced IQ and attention span, hyperactivity, impaired
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growth, reading and learning disabilities. Children with high blood
lead levels can suffer from brain damage, behavior and learning
problems, slowed growth, and hearing loss, among other maladies.
Timely childhood lead screening and appropriate follow-up care for
children most at-risk of lead exposure is critical to mitigating the
long-term health and developmental effects of lead. Regrettably, our
current system is not adequately protecting children, particularly low-
income children, from this hazard. It is estimated that two-thirds of
at-risk children have never been screened and, consequently, remain
untreated.
This legislation takes some of the critical steps necessary to begin
to address this problem. Specifically, the bill strengthens the lead
program at the Centers for Disease Control and Prevention by providing
new resources to conduct extensive outreach and education in
coordination with other state programs that serve families with
children at-risk of lead poisoning, such as WIC and Head Start. The
bill also authorizes the implementation of community-based
interventions to mitigate lead hazards and establishes guidelines for
the reporting and tracking of blood lead screening tests so that we may
have more accurate data on the number of lead-exposed children
nationwide. The legislation also designates resources for health care
provider education and training on current lead screening practices.
The second element of this bill that I believe will have a major
impact on improving the overall health of children relates to the
problem of childhood obesity. Over the past fifteen years, the number
of overweight children in this country has doubled. It is estimated
that an alarming five million youth 6-19 years of age are overweight,
while another six million children are overweight to the point that
their health is endangered.
Contributing to this alarming trend has been the rise in fast food
consumption, coupled with an increasingly sedentary lifestyle where
time engaged in physical activity has been replaced by hours playing
computer games and watching television. The New York Times recently
noted that the average child between the ages of 6 and 11 watches 25
hours of television a week--and this does not include time spent
playing video games or on a computer.
Another reason for the lack of physical activity in children is the
reduction in daily participation in physical education classes. Fewer
and fewer States require school districts to offer physical education,
despite the fact that children who engage in regular physical activity
often perform better in school. We are raising a generation of inactive
children that will likely become inactive, chronically ill adults. By
not ensuring kids take time to participate in regular physical
activity, we, as a society, are doing them a great disservice in the
long run.
Already, we are seeing younger and younger Americans with the signs
of heart disease and diabetes, among other obesity-linked illnesses.
The Centers for Disease Control and Prevention reports that 60 percent
of overweight 5-10 year old children already have at least one risk
factor for heart disease, such as hypertension, while the number of
children diagnosed with Type II diabetes has skyrocketed. If we
continue on this trajectory, obesity-related illnesses will soon rival
smoking as a leading cause of preventable death, costing hundreds of
thousands of American lives and billions of dollars in health care
costs and lost productivity. Clearly, action needs to be taken.
This legislation acknowledges this trend and attempts to reverse it
through a multi-faceted approach. First, the bill authorizes a new
competitive grant program through the Centers for Disease Control and
Prevention to assist states and localities to develop and implement
comprehensive school- and community-based approaches to promoting good
nutrition and physical activity among children. The bill also calls for
greater applied research to improve our understanding of the multiple
factors that contribute to obesity and eating disorders and emphasizes
the need for a nationwide public education campaign to educate families
about the importance of good eating habits and regular physical
activity. Lastly, the bill provides for health professional education
and training to aid in the identification and treatment of overweight
children, children suffering from an eating disorder or children at
risk of these conditions.
The other major component of this bill is based on S. 976, the Youth
Drug and Mental Health Services Act, which originated in the Senate
Health, Education, Labor, and Pensions Committee, and passed the full
Senate last year. This legislation reauthorizes programs administered
by the Substance Abuse and Mental Health Services Administration
(SAMHSA), and also provides many enhancements that will specifically
benefit children and adolescents suffering from substance abuse or
mental health problems, children who have witnessed violence, and
children from families needing substance abuse or mental health
treatment and other support services.
I am pleased that this legislation includes a provision that I worked
on to address the severe shortage of transitional services for youth
who are leaving the juvenile justice system. Specifically, the bill
addresses this shortage by authorizing grants to local juvenile justice
agencies to provide comprehensive community-based services such as
mental health and substance abuse treatment, job training, vocational
services, and mentoring programs to juvenile offenders.
Studies have found that the juvenile population has a special need
for these types of services, mental health and substance abuse
treatment, in particular. It is estimated that the rate of mental
disorder is two to three times higher among the juvenile offender
population than among youth in the general population. According to a
1994 Department of Justice study, 73 percent of the juveniles surveyed
reported mental health problems, and 57 percent reported past
treatment. Also, it is estimated that 60 percent of youth in the
juvenile justice system have substance abuse disorders, compared to 22
percent in the general population.
Unfortunately, there currently exists little, if any, support for
youth who are leaving the juvenile justice system. Many services, such
as mental health and substance abuse treatment, provided while the
youngster was detained or incarcerated, are discontinued upon their
release. Given this breakdown in the continuity of services, it is
hardly surprising that of the 4 million youngsters arrested each year,
30 percent are likely to recidivate within the year of arrest.
In the handful of places where transitional services have been
provided, the results have been outstanding. For instance, in Rhode
Island we have a successful program called ``Project Reach.'' Yale
University, in its evaluation of Project Reach, found that children
receiving transitional services improved dramatically: 80 percent had
significant increases in their grades in school; school attendance
increased from 50 to 75 percent; and there was a 60 percent reduction
in youth encounters with police after enrolling in the program. In
addition, there was a 50 percent decrease in out-of-home placement for
these children. In other words, children who once had problems so
severe that they had to be removed from their homes are now able to
remain with their families in their communities.
Adequate transitional and aftercare services to prevent recidivism
are essential to reducing the societal costs associated with juvenile
delinquency, promoting teen health, and fostering safe communities.
These provisions recognize the serious gap in services for youth
offenders and takes important steps to address this serious deficiency.
I am grateful for the inclusion of this critical language in the bill.
As I have noted, there are many positive aspects to this legislation.
However, I have deep reservations about a particular provision that was
retained in the SAMHSA bill that allows all religious institutions,
including pervasively religious organizations, such as churches and
other houses of worship, to use taxpayer dollars to advance their
religious mission. I oppose this ``charitable choice'' language and
offered an amendment to modify it when the original legislation was
considered in Committee last year.
Although charitable choice has already become law as a part of
welfare reform and the Community Services Block Grant, CSBG, section of
the Human Services Reauthorization Act,
[[Page S9107]]
the inclusion of charitable choice in this legislation is particularly
disturbing since, unlike its application to the intermittent services
provided under Welfare Reform and CSBG, SAMHSA funds are used to
provide substance abuse treatment which is ongoing, involves direct
counseling of beneficiaries and is often clinical in nature. In the
context of these programs it would be difficult if not impossible to
segregate religious indoctrination from the social service.
Faith-based organizations do have an important and necessary role to
play in combating many of our nation's social ills, including youth
violence, homelessness, and substance abuse. In fact, I have seen
first-hand the impact that faith-based organizations such as Catholic
Charities have on delivering certain services to people in need in my
own state. By enabling faith-based organizations to join in the battle
against substance abuse, we add another powerful tool in our ongoing
efforts to help people move from dependence to independence.
While there are many benefits that come with allowing religious
organizations to provide social services with federal funds, I am
concerned that without proper safeguards, well-intentioned proposals to
help religious organizations aid needy populations, might actually harm
the First Amendment's principle of separation of church and state. The
charitable choice provision creates a disturbing new avenue for
employment discrimination and proselytization in programs funded by
SAMHSA. Under current law, many religiously-affiliated nonprofit
organizations already provide government-funded social services without
employment discrimination and proselytization. However, the legislation
extends Title VII's religious exemption to cover the hiring practices
of organizations participating in SAMHSA programs.
As I already mentioned, during markup, I offered an amendment that
would have addressed this issue by including important safeguards and
protections for beneficiaries and employees of SAMHSA funded programs.
Specifically, the amendment would have removed the provision that
allows religious organizations to require employees hired for SAMHSA
funded programs to subscribe to the organization's religious tenets and
teachings. Since the bill prohibits religious organizations from
proselytizing in conjunction with the dissemination of social services
under SAMHSA programs, it seems contradictory to permit religious
organizations to require their employees to subscribe to the
organization's tenets and teachings when it has no bearing on the
provision of services. Second, the amendment would have eliminated the
extension of Title VII's religious exemption to cover the hiring
practices of organizations participating in SAMHSA funded programs.
Ultimately, my proposal would not have reduced the ability of
religious groups to hire co-religionists or more actively participate
in SAMHSA funded programs. It merely would have eliminated the explicit
ability to discriminate in taxpayer-funded employment and left to the
courts the decision of whether employees who work on, or are paid
through, government grants or contracts are exempt from the prohibition
on religious employment discrimination.
For the last 30 years, federal civil rights laws have expanded
employment opportunities and sought to counter discrimination in the
workplace. I recognize that we need the assistance of religious
organizations in the battle against substance abuse. However,
partnerships with faith-based organizations should augment--not
replace--government programs. These partnerships should respect First
Amendment protections and not allow taxpayer dollars to be used to
proselytize or to support discrimination. I believe we need a far more
robust and informed debate before we allow any expansion of current
exemptions to Title VII.
Nevertheless, this combined legislation has many meaningful
provisions that will go a long way towards improving the health and
well-being of our children. This legislation not only strengthens
pediatric medical research, it also includes important enhancements in
maternal and prenatal health as well as several other health promotion
and disease prevention initiatives that will greatly enhance the
quality of life for children. Similarly, the bill contains elements
that will greatly improve mental health and substance abuse services
for children and adolescents.
I am pleased to have worked on this legislation and look forward to
its expeditious passage this year.
Mr. DOMENICI. Mr. President, I rise today to briefly speak about the
passage of the children's health bill and the Substance Abuse and
Mental Health Services Administration reauthorization bill.
I would like to begin by congratulating Senators Frist and Kennedy
for their work on this important piece of legislation and to tell them
how pleased I am the package contains a number of provisions from the
Mental Health Early Intervention, Treatment, and Prevention Act of
2000, S. 2639.
Today we do not even question whether mental illness is treatable.
But, today we recoil in shock and disbelief at the consequences of
individuals not being diagnosed or following their treatment plans. The
results are tragedies we would have prevented.
Just look at the tragic incidents at the Baptist Church in Dallas/
Fort Worth, the Jewish Day Care Center in Los Angeles, and the United
States Capitol to see the common link: a severe mental illness. Or the
fact that there are 30,000 suicides every year, including 2,000
children and adolescents.
It was not too long ago that our Nation decided we did not want to
keep people with a mental illness institutionalized. Simply put, it was
inhumane to simply lock these individuals up without even using science
to consider other alternatives.
Make no mistake, our Nation still has these same individuals with
mental illness, we just do not have a very good way to deal with these
individuals. Many of these individuals formerly locked up are now our
neighbors taking the proper medication to manage their illness.
However, our Nation simply does not have an understanding of what
happens when individuals stop taking their medications because sadly
many of these highly publicized incidents of mass violence all too
often involve an individual with a mental illness.
When these incidents occur, my wife and I watch with horror on
television and we often turn to each other and say that person was a
schizophrenic or that individual was a manic depressive.
Some of you may have seen the recent 4 part series of articles in the
New York Times reviewing the cases of 100 rampage killers. Most notably
the review found that 48 killers had some kind of formal diagnosis for
a mental illness, often schizophrenia.
Twenty-five of the killers had received a diagnosis of mental illness
before committing their crimes. Fourteen of 24 individuals prescribed
psychiatric drugs had stopped taking their medication prior to
committing their crimes.
With this in mind I am especially pleased that with the passage of
this package we are taking a very positive step forward to address the
problem I have mentioned. The provisions adopted from the Mental Health
Early Intervention, Treatment, and Prevention Act of 2000 will serve to
give more people the ability to identify when someone might be
suffering from mental illness and pose a threat to themselves or
others.
I think it's important that we begin to find ways to get these people
help before we find them involved in a violent tragedy and I would like
to briefly touch upon several of those provisions I believe will take
us a long way towards that goal:
A grant program will provide training to teachers and emergency
services personnel to identify and respond to individuals with mental
illness, and to raise awareness about available mental health
resources. Another grant program creates Emergency Mental Health
Centers that will serve as a specific site in communities for
individuals in need of emergency mental health services, and will also
provide mobile crisis intervention teams.
The Jail Diversion Demonstration will create 125 programs to divert
individuals with mental illness from the criminal justice system to
community-based services. And finally, the Mental Illness Treatment
Grant will provide integrated treatment for individuals with a serious
mental illness and a co-
[[Page S9108]]
occurring substance abuse disorder with an emphasis placed on
individuals with a history of involvement with law enforcement or a
history of unsuccessful treatment.
In closing, I really believe we have a historic opportunity to become
preventers of serious, serious acts of violence before they happen and
I look forward to working with my colleagues in the future to continue
addressing this important issue.
Mr. WELLSTONE. Mr. President, I rise today in support of the passage
of the Children's Health Act of 2000, an extraordinary bipartisan bill
that includes so many outstanding provisions to improve the health and
mental health of the children of our country. The bill includes the
reauthorization of the Substance Abuse and Mental Health Services
Administration, a long-overdue reauthorization and revitalization of an
agency that provides most of the public funding of mental health and
addiction services to our communities. SAMHSA has many dedicated staff
who have worked so hard to develop and manage remarkable programs over
the last several years. I am proud to have played a role in the
development of this comprehensive bill, and to join my colleagues in
encouraging its quick passage into law.
The Children's Health Act of 2000 takes a major step forward in
supporting research, services, treatment, and professional training to
begin to address some of the most significant health problems affecting
children of all ages. This legislation clearly states that children's
health, including their mental health and addiction treatment needs,
must be a priority for our country. It is not enough to deal with our
children's health needs only after they have become crises. Many of the
programs outlined in this bill recognize this problem by focusing on
prevention and education programs, and by supporting programs to train
researchers and health care providers who specialize in children's
health.
Many of the health areas included in this comprehensive bill were
identified by the Department of Health and Human Services as among the
top 10 leading health indicators for children in its major public
health initiative ``Healthy People 2010,'' launched in January 2000.
Several were of particular importance to me as I worked on this bill,
especially programs supporting treatment of mental illness and
addiction; increased access to health care, especially for our mentally
ill youth in correctional facilities; and overall improvements in
fitness and oral health for all our children, including low-income
children and children living in rural areas.
Dr. David Satcher, the United States Surgeon General, has released
several groundbreaking reports in recent years which highlight the
scope and the specific health needs of our children. These reports
included ``Mental Health: A Report of the Surgeon General''; ``The
Surgeon General's Call to Action to Prevent Suicide''; and the first
ever ``Oral Health In America: A Report of the Surgeon General,'' which
each begins to address these severe health crises in these areas for so
many of our children. The problems identified by Dr. Satcher touch on
both the national problems across our country, and also highlight the
significant health care disparities for different groups. I am pleased
to have contributed to many new legislative and funding efforts to
support improvements in these areas of health care.
In the Surgeon General's 2000 report on oral health, the strong link
between oral health and overall health was highlighted, and this bill
helps to address the problems identified in the report. Dr. Satcher
emphasized the devastating consequences of untreated oral disease and
how it can affect children's health and well-being, leading to serious
pain and suffering, time lost from school, loss of permanent teeth,
damage to self-esteem, and co-existing medical conditions. So much of
what we need to do is already known. We need to identify the unmet need
and improve access to care for those who need it most. This bill
includes funding for school-based and other innovative oral health care
programs to improve the overall health of our children. The oral health
programs included in this bill are an important step forward.
Healthy People 2010 goals also identified obesity as a major problem
for children, particularly because of the decline in physical activity
among our children. One-fourth of our children aged 6-17 are
overweight, and the percentage of children who are seriously overweight
has doubled in the last thirty years. This is not a minor issue for the
health of our children: obesity as a chronic illness is related to
other serious chronic conditions in children, including type II
diabetes, hypertension, and asthma. Research has also shown that 60% of
overweight children 5-10 years old already have at least one risk
factor for heart disease. Adult obesity is associated with many of the
leading causes of death and disability, including heart disease,
diabetes, arthritis, and cancer. The public health efforts in this bill
that focus on this serious national problem, including improvements in
physical education funding, public health education, and nutrition
education, are ones I enthusiastically support. In the future we must
do even more to again make physical education a high priority for our
country and establish a national foundation to promote physical
activity for all ages.
I am particularly proud of the section of this bill that supports
local suicide prevention programs focusing on our young people. Youth
suicide must be recognized for the national crisis that it is. In my
own state of Minnesota, suicide is the second leading cause of death
among our youth, as it is in half of the states in our country.
Overall, in the United States, it is the third leading cause of death
among our children, taking more lives than homicide. We know from the
outstanding research supported by the National Institute of Mental
Health that 90% of all completed suicides are linked to untreated or
inadequately treated mental illness or addiction. More than 500,000
Americans attempt to take their own lives every year. In this bill, $75
million will be authorized to support local prevention programs
focusing on our children who are at risk of taking their own lives.
More than 50 groups supported our efforts to improve funding for
suicide prevention programs this year, including local programs, like
the Minnesota group, Suicide Awareness/Voices of Education (SA/VE), as
well as national groups, such as Suicide Prevention and Advocation
Network (SPAN), the National Hope Line Network, and the National Mental
Health Association.
We can no longer afford to turn our eyes away from the horrible
reality that many of our citizens, even our children, may want to die.
We continue to treat mental illness and severe drug addiction as
somehow less important than other illnesses. We blame the sick for
their disease, and the result can be death and tragedy. Today, we begin
to acknowledge that this kind of discrimination is against many of our
own children.
I am also pleased to have worked to include an additional $4 million
to support resource centers for those who work with our mentally ill
youth in correctional facilities. Our children need help in many areas:
education, child care, juvenile justice, and health care. Many are
experiencing severe drug addiction, mental illness, and lack of access
to health care coverage. The Director of the Office of National Drug
Control Policy (ONDCP) has recognized that the number one priority for
the nation's National Drug Control Strategy is to educate and enable
America's youth to reject illegal drugs as well as alcohol and tobacco.
And yet 80 percent of adolescents needing treatment are unable to
access services because of the severe lack of coverage for addiction
treatment or the unavailability of treatment programs or trained health
care providers in their community. Many of these children end up in the
juvenile justice system as a result.
The reauthorization of SAMHSA within this bill, with its state block
grant funding for mental health and addiction treatment, is a good
beginning. But so much more must be done to stop treating our children
as second class citizens, and to stop treating mental illness and
addiction as second class illnesses. We must continue to fight for
fairness and parity in health care coverage for our children, indeed
for all of our citizens, who suffer from mental illness and addiction.
It is their future, and ours, as a country, that is at stake.
Mr. ASHCROFT. Mr. President, I am pleased to support the Children's
[[Page S9109]]
Health Act of 2000 that will pass the Senate today. This legislation is
the result of months of dedicated work by a number of Senators and
House members. I believe the final language represents a comprehensive
approach to promote physical and mental health for children, and
protect them from dangerous, illegal drugs. I am a co-sponsor of the
Senate version of this bill, a previous Senate version of the
Children's Health Act (S. 2868), as well as the author of two key
provisions contained in the package we are considering today.
I rise today to speak in favor of this legislation and to thank the
bill's sponsor, Senator Frist, for working with me to include two
provisions that I believe are essential tools for advancing health and
safety of America's children. The bill that will pass today, H.R. 4365,
contains three main sections: (1) the text of S. 486, the
Methamphetamine Anti-Proliferation Act, a bill I introduced last year
that previously passed the Senate and has been approved by the House
Judiciary Committee for consideration by the House of Representatives;
(2) the Youth Drug and Mental Health Services Act, which reauthorizes
programs within the jurisdiction of the Substance Abuse and Mental
Health Services Administration (SAMHSA) to improve mental health and
substance abuse services for children and adolescents and allows the
Charitable Choice concept, which I first authored in the 104th
Congress, to be applied to the programs covered by this Act and (3) the
Children's Health Act, which amends the Public Health Services Act to
revise, extend, and establish programs with respect to children's
health research, health promotion and disease prevention activities
conducted through Federal public health agencies.
Mr. President, let me touch briefly on each of these three main
sections.
First, this bill includes the text of S. 486, the Methamphetamine
Anti-Proliferation Act, a bill I introduced in February 25, 1999 in
response to the growing problem of methamphetamine production and use
in my home state of Missouri, throughout the Midwest and in many other
states as well. Unfortunately, the problem of methamphetamine has only
gotten worse in the past year and a half. This anti-meth measure I
authored will help fight meth in Missouri and the U.S. with $55 million
in new resources for enforcement, cleanup, school- and community-based
prevention efforts, and rehabilitation services.
The Methamphetamine Anti-Proliferation Act will bolster the fight
against meth through stiffer penalties for drug criminals; more money
for law enforcement, education, and prevention; and a wider ban on meth
paraphernalia. The bill directs the U.S. Sentencing Commission to raise
its guidelines for sentencing meth offenders. It requires mandatory
reimbursement for the costs incurred by federal, state and local
governments for the cleanup associated with meth labs. It authorizes
$5.5 million in funding for DEA programs to train State and local law
enforcement in techniques used in meth investigations and staff mobile
training teams which provide State and local law enforcement with
advanced training in conducting lab investigations. It also provides
$15 million in funding to combat the trafficking of meth in counties
designated High Intensity Drug Trafficking Areas.
This legislation also provides for further research into the use of
meth; authorizes $15 million in funds for community- and school-based
anti-meth education programs; and includes an additional $10 million in
resources for treatment of meth addiction. It directs HHS to include
its annual National Household Survey on Drug Abuse prevalence data on
the consumption of methamphetamine and other illicit drugs in rural,
metropolitan, and consolidated metropolitan areas and requires the
Secretary of HHS, in consultation with the Institute of Medicine, to
conduct a study on the development of medications for the treatment of
addiction to methamphetamine.
The nation's lead anti-drug agency, the Drug Enforcement
Administration (DEA), has thrown its support behind the Methamphetamine
Anti-Proliferation Act. In endorsing this bill, DEA Administrator
Donnie Marshall said this bill is ``landmark methamphetamine
legislation.'' Marshall stated: ``I believe this bill (the
Methamphetamine Anti-Proliferation Act) will prove instrumental in the
Drug Enforcement Administration's efforts to bring to a halt the
continued spread of methamphetamine across our country.''
Mr. President, I am sad that Missouri is notorious as a national
center of meth production and distribution. Methamphetamine, for those
who are lucky enough not to have a meth problem in their areas, is a
highly addictive synthetic drug that is typically made in illegal
clandestine ``labs.'' Missouri and California lead the nation in
seizures of such labs. In Missouri, the federal Drug Enforcement
Administration and state and local law enforcement officers seized only
two such labs in 1992, 14 in 1994, and a record 679 in 1998. This
number jumped to 920 in 1999, setting a new record.
The second section of this bill is the Youth Drug and Mental Health
Services Act, which reauthorizes the Substance Abuse and Mental Health
Services Administration (SAMHSA). This section addresses the issue of
drug abuse in our nation's youth which has dramatically increased this
decade. It creates new programs to provide additional funding for
youth-targeted treatment and early intervention services. Under this
bill, states will receive more flexibility in the use of block grant
funds and the Secretary of Health and Human Services will have more
flexibility to respond to the needs of young people who need mental
health and substance abuse services.
I am especially pleased that included in the Youth Drug and Mental
Health Services Act is an expansion of the Charitable Choice provision,
which will allow federally-funded substance abuse services to be open
to faith-based providers. Under Charitable Choice, which was first
enacted into law in 1996 as part of the welfare reform law, churches
and other faith-based providers are able to compete on an equal footing
with other non-governmental organizations in providing services to
disadvantaged Americans.
Since its enactment, Charitable Choice has been expanded from job
training and related services for welfare clients to include the
Community Services Block Grant program, which is used for a variety of
anti-poverty activities, such as improving job and educational
opportunities and providing financial management and emergency
assistance. This latest expansion will apply Charitable Choice to
federal drug treatment programs that will total $1.6 billion for Fiscal
Year 2000. My home state of Missouri is slated to receive $24.46
million in substance abuse block grant funding for the coming fiscal
year.
Charitable Choice calls our nation to its highest and best in our
effort to help those in need. It meets the tests of compassion and
common sense that count for so much in Missouri. When people of faith
extend compassionate help to those in need, the results can be
stunningly successful. Where too many traditional substance abuse
treatment programs have failed to help those in need, faith-based
programs have succeeded. For example, Teen Challenge has show that 86%
of its graduates remain drug-free. San Antonio's Victory Fellowship
boasts of a success rate of over 80%. This is the test of common sense:
America needs to create a vibrant partnership that succeeds where other
approaches have failed.
Mr. President, the bipartisan support for Charitable Choice is
overwhelming in Congress. In additional, both Presidential candidates--
Governor Bush and Vice President Gore--strongly support the program. It
is my hope that this broad national consensus will continue to grow and
that soon will be able to enact a comprehensive expansion of Charitable
Choice to all federally-funded social services programs.
Third, the Children's Public Health Act has four overriding themes
represented in its four titles: Injury Prevention, Maternal and Infant
Health, Pediatric Health Promotion, and Pediatric Research. This
legislation focuses federal research efforts in these areas and
provides a comprehensive approach to children's health. For example,
the bill includes authorization for research to prevent traumatic brain
injuries, provides federal grants for comprehensive asthma services to
children, and establishes a National Center for Birth
[[Page S9110]]
Defects and Development Disabilities within the CDC. The bill also
includes childhood obesity prevention programs, childhood lead
prevention programs, and a groundbreaking pediatric research initiative
within NIH to ensure the realization of expanding opportunities for
advancement in scientific investigations and care for children. This
legislation also includes support for pediatric graduate medical
education in children's hospitals, an issue that has been a high
priority of mine for years.
I am hopeful, that with passage of this landmark legislation, we can
improve the lives of America's children. By funding research for many
childhood diseases and disabilities, expanding programs to assist youth
with addiction and mental health problems through faith-based
providers, and drastically increasing the war against meth, this bill
is an important step in the right direction. I thank all those who
worked on this legislation, and urge the President to sign this bill to
help secure a safer and healthier future for the next generation.
Mr. LOTT. Mr. President, I ask consent that the amendment that is
offered in the nature of a substitute be agreed to, the bill be read
the third time and passed, as amended, the motion to reconsider be laid
on the table, and that any statements related to the bill be printed in
the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment (No. 4181) was agreed to.
The bill (H.R. 4365), as amended, was read the third time and passed.
Mr. BOND. Mr. President, I rise to speak on an issue of great
importance to America's families--the health of our nation's children--
and to talk about crucial legislation which the Senate has passed today
called the Children's Health Act of 2000.
Whenever we talk about children's health, we should not ignore the
fact that there is a lot of good news. The fact is that most children
are persistently healthy. A majority of children can actually go
through a year with no more serious health problems than scrapes and
bruises, a stuffy nose, or an easily-treatable earache. I'm not sure
how many of us can say that--I know I can't. And on a variety of
indicators that measure children's health, the good news is only
getting better. In the last decade, we have seen improvements in
immunization rates, infant mortality, child mortality, and reduced teen
birth rates.
There are of course exceptions to these healthy kids. Thousands of
children are born every year with a birth defect. Too many children
suffer moderate to serious accidents of all types. And an unfortunate
minority face other serious or long-term health problems. Worse,
children who are sick are often very sick. These exceptions to the rule
are all the more tragic because our expectation is that our children
will be healthy.
That is why the Children's Health Act, which the Senate has passed
today, is so important. As sound as our children's overall health is,
it can be better. As well as our nation is doing to protect our
children's health, we can do more.
Mr. President, the Children's Health Act covers many specific health
problems that afflict children--autism, arthritis, asthma, brain
injuries, lead poisoning, and so on. Each of the legislative provisions
that addresses these problems deserves attention, and I hope that the
merits of each of these sections can be presented. Right now, I would
like to focus on the sections of the Children's Health Act that I have
strongly supported. Most of these provisions were included in
legislation--called Healthy Kids 2000--which I introduced last year.
As both a Governor and a Senator, one of my main priorities in health
care has been to try to find new ways to prevent birth defects. Because
we expect our children and our babies to be healthy, birth defects can
be truly devastating to a family. Yet they happen far too frequently--
150,000 children are born every year with some type of birth defect.
Today alone, about 6 or 7 families in this country will have a child
with one very serious type of birth defect, called a neural tube
defect. Spina bifida is the most well known of these defects of the
brain and spine. The complications that result from this type of birth
defect range from serious, long-term health problems to death, but the
real tragedy is that many of these birth defects could have been
prevented.
One simple step--women of childbearing age taking 400 micrograms of
folic acid every day--can help women and families significantly reduce
the chance of this type of birth defect by up to 70 percent. Yet most
women just don't know about folic acid. Simply making them aware of the
importance of folic acid is such an easy and inexpensive way to prevent
birth defects, it is simply silly not to do everything we can to make
sure every woman in this country knows about the benefits of folic
acid.
One provision of the Children's Health Act was taken from the Folic
Acid Promotion Act, which I have introduced with Senator Abraham. This
section authorizes expanded effort by the Centers for Disease Control
to get more women of childbearing age to use folic acid. The CDC has
begun activity in this area, but the continued depth of the problem
demonstrates that much more can be done.
Another easy thing we can do to bring greater focus and attention to
the problem of birth defects is to simply reorganize how and where the
work on birth defects is done within the Centers for Disease Control.
Right now, the CDC's work on birth defects is done within one of its
main branches, the National Center for Environmental Health, whose
responsibilities expand significantly beyond birth defects.
I believe the seriousness of this problem--over 400 infants are born
every day with some type of birth defect--and the significant amount of
CDC funding spent on birth defects justify a Center within the Centers
for Disease Control focused exclusively on this issue. The Children's
Health Act calls for a fourth Center within the CDC--the National
Center for Birth Defects and Developmental Disabilities--which will
allow for consolidation, greater visibility and expansion of CDC's
efforts to prevent birth defects. This builds on the comprehensive
prevention program outlined in the Birth Defects Prevention Act, which
I sponsored and Congress passed in 1998.
One area of children's health that has been getting worse over the
last decade is the percentage of babies born with a low birth weight.
Low birth-weight babies have a much higher chance of developmental and
other problems as they grow up. One reason for this declining trend is
the persistent levels of cigarette, alcohol, and drug use during
pregnancy. Somewhere between 19 and 27 percent of pregnant women in the
U.S. smoke during pregnancy, despite the fact that these smokers are at
a significantly higher risk for stillbirth, premature births, low
birth-weight, and birth defects.
The Children's Health Act contains another provision from my Healthy
Kids 2000 legislation which establishes a grant program run by CDC to
establish community-based programs designed to reduce and prevent
prenatal smoking, alcohol, and drug use. We can work with women to help
them understand the consequences of using these types of substances
on their babies and to help them change their behavior so they can have
healthier infants.
The health of a mother during her pregnancy obviously has a
tremendous health impact on her child. Yet we as a nation still have a
surprisingly large amount of serious complications that occur during
pregnancy even before labor. 1,000 women actually die every year during
pregnancy, and this figure has been increasing in the 1990s. A full 20
percent of women have serious health problems even before they go into
labor.
But despite these problems, our public health system does not have a
comprehensive system in place to monitor, research, and try to prevent
these maternal deaths and complications. Only 15 states have a program
of their own that does this. Well, if we can't look at a problem and
study it, we certainly can't hope to understand the problem, much less
to solve it. I believe the CDC needs to do further work with states to
understand exactly why so many women are having pregnancy-related
problems and to figure out what we can do about it. The Children's
Health Act authorizes CDC to expand their efforts so we can prevent
these problems and help women have healthy pregnancies so they can have
healthy kids.
Finally, I have been a strong supporter of Senator DeWine's Pediatric
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Research Initiative within the National Institutes of Health. I am
pleased to be a cosponsor of his bill, and I included the Pediatric
Research Initiative in my Healthy Kids 2000 legislation. I am happy to
report that the Pediatric Research Initiative has been included in the
Children's Health Act.
I believe we need to encourage the NIH to focus more on children's
health care research. In recent years, NIH has seen significant
increases in the funding needed to support the critical research they
do. This crucial work helps us better understand how various diseases
work, what we can do to prevent them, and how to cure those who are
afflicted. I am concerned, however, that pediatric research at NIH has
not shared fully in this research expansion.
The Pediatric Research Initiative provides the NIH with additional
funds that are specifically dedicated to pediatric research. This
funding can be used by the NIH Director for research that shows the
most promise to address successfully childhood health concerns. The
Pediatric Research Initiative would not earmark funds to any specific
institute or to any specific disease. This commonsense legislation
simply provides extra funding to the Office of the Director with
maximum flexibility to invest that money in any area of pediatric
research in any of the NIH Institutes. I believe this is a reasonable,
and not a very restrictive, response to concerns that the NIH
shortchanges pediatric research.
Mr. President, I would like to commend and thank Senators Frist,
Kennedy, and all of the other distinguished Senators who have worked to
put this crucial bill together. I have been pleased to work with them
to ensure that this bill addresses some of the most pressing health
care concerns our nation's children face. I hope and expect that the
House of Representatives will follow-up quickly on Senate action so we
can send this bill to the President.
Last year, I introduced the Healthy Kids 2000 Act based on a simple
idea--we want children to be healthy, and we want pregnant women to be
healthy. Passage today of the Children's Health Act promises to bring
us closer to this simple but critically important goal.
Mr. LEVIN. Mr. President, according to the experts, the number of
heroin users is on the rise while the average age of first heroin use
is dropping. Heroin addiction is a public health crisis of significant
proportion. This legislation, the Hatch-Levin Drug Addiction Act, S.
324, will allow us to effectively utilize a new medical discovery of a
substance called Buprenorphine, which has proven to be an
extraordinarily effective means for combating heroin addiction by
blocking the craving for heroin.
But this anti-addiction medication can help us win the war against
heroin and heroin addiction only if we change our laws so that the
medication can be dispensed in physician's offices instead of a
centralized clinic. That is what this legislation accomplishes.
It is estimated that there are approximately one million heroin
addicts in the U.S. According to the U.S. Department of Health and
Human Services, many of these heroin addicts want to kick their habit,
but do not wish to receive treatment in methadone clinics ``. . .
because of the stigma of being in methadone treatment or their concerns
about the medical effects of methadone.''
The Drug Addiction Treatment Act has now passed the House of
Representatives in slightly different form than we passed in the Senate
on November 19. Its adoption again by the Senate as Title XXXV, Section
3501 and Section 3502 of the substitute amendment to H.R. 4365, the
Children Health Act of 2000, paves the way for physician office-based
dispensing of a medication which has been the subject of extensive
successful research and clinical trials in the U.S. and France. This
medication, Buprenorphine, was developed under a Cooperative Research
and Development Agreement between the National Institute on Drug Abuse
and a private pharmaceutical manufacturer, and is expected to receive
FDA approval in the weeks ahead. Buprenorphine has already been in use,
in physician offices, for a number of years in France, where
significant success has been achieved in getting individuals off of
heroin, reducing crime and heroin-related deaths. For example, since
the introduction of Buprenorphine in France, there has been an 80
percent decline in deaths by heroin overdose--from 505 in 1994 to 92 in
1998; user crime and arrests are down by 57 percent--from 17,356 in
1995 to 7,649 in 1998; and trafficking arrests have declined by 40
percent--from 3,329 in 1995 to 1,979 in 1997.
Over a year ago, I introduced the Drug Addiction Treatment Act, S.
324, along with Senator Hatch, Senator Moynihan and Senator Biden, in
order to put in place the necessary mechanisms to accommodate this
revolutionary new treatment that can block the craving for heroin and
dramatically restore the quality of the lives of individuals and
families who have struggled to get out from under heroin addiction.
There are a number of reasons why our legislation is necessary. Under
current law, the Narcotic Addict Treatment Act of 1974, the process by
which individual physicians must be approved in order to prescribe
narcotics in drug treatment is a cumbersome and complex regulatory
process. Federal regulations and State regulations, which could, under
existing law, be written to allow Buprenorphine to be utilized in
physician offices will take an extensive period of time to be written
and take many years to be implemented. Indeed, there is no assurance
that such regulations will ever be written by both federal and state
governments. In the meantime, a very effective medication is
unavailable to those who are addicted to Heroin.
The Hatch-Levin legislation would allow for the utilization of
Buprenorphine by qualified physicians in a physician's office. It will
also assure that Buprenorphine will be made available in every state
unless a state expressly opts out of the program through legislation.
The current federal regulatory process needed to be utilized before
treatment of addiction in an office-based setting is allowed include:
(1) Writing the regulations, which could take up to a year or more; (2)
Issuance of the proposed rule which would be published in the Federal
Register, including the announcement of a period of time for public
comment on the proposed rule; (3) A review of the public comments,
which could take a year or more; (4) The issuance of the final rule,
(5) Then each State is required to affirmatively approve and implement
the physician office approach which typically takes 2-4 years, in those
states that do act.
Based on the experience with the introduction of LAAM for the
treatment of heroin addiction--a medication similar to methadone which
is effective for up to three days, as opposed to the daily dosage
required by methadone--most states may never approve the physician
office approach and for those that do the process could go on for as
many as 4-5 years. That was the case with California and New York.
According to findings reported by the U.S. Department of Health and
Human Services on July 14, 1999: ``Current federal and state
regulations prevent ease of entry into methadone or LAMM maintenance
treatment. . . .''
So, while it is possible under current law for regulations to be
written by HHS allowing for the use of Buprenorphine in the treatment
of heroin addiction and to allow for it to be prescribed in physician
offices,
(1) there is no certainty that they will be written;
(2) if such regulations are written, it would take years for them to
take effect; and
(3) each state must explicitly opt into the program by writing
regulations or adopting a law.
In each state not opting in, the treatment in a physician office
would not be available as described
The result of the above cumbersome and complex process has been a
treatment system consisting primarily of large methadone clinics,
preventing physicians from treating patients in convenient office-based
settings, thereby making treatment unavailable as a practical matter to
many in need of it. Also, experts say that many heroin addicts who want
treatment are often deterred because, in addition to the stigma that is
associated with large centralized methadone clinics, they must travel
long distances daily to receive such treatment and cannot maintain a
job while doing so. Even though Buprenorphine does not possess the
addictive qualities of methadone, because of the constraints in current
law, it
[[Page S9112]]
would nonetheless have to be dispensed in this same manner--in
centralized clinics--rather than in the private office of a qualified
physician.
The Drug Addiction Treatment Act, S. 324 (H.R. 2634), will make it
possible for medications like Buprenorphine, which have little or no
likelihood of diversion or abuse, to be made available in the offices
of physicians who have the training and certification and license to
treat persons addicted to opiates. It is anticipated that the initial
group of eligible physicians to dispense Buprenorphine will come from
the 10,000 practitioners with addiction treatment certification from
the American Society of Addiction Medicine, or board certification in
addiction psychiatry or medical toxicology from the American Board of
Medical Specialties or certification in addiction medicine from the
American Osteopathic Association. The protections in the legislation
against abuse are as follows: Physicians may not treat more than 30
patients in an office setting; appropriate counseling and other
ancillary services are a requirement under this legislation; the
Attorney General may terminate a physician's DEA registration if these
conditions are violated; and the program may be discontinued altogether
if the Secretary of HHS and Attorney General determine that this new
type of decentralized treatment has not proven to be an effective form
of treatment. Finally, states may opt out of the provision.
Recent findings of the Monitoring the Future Program, headed by Dr.
Lloyd Johnson of the University of Michigan, indicates that heroin use
among American teens doubled between 1991 and 1998, and represents a
clear danger for a significant number of American young people. Dr.
Johnson attributes this sharp increase to non-injectable use--smoking
and snorting, and notes that the very high purity and low cost of
heroin on the street has made these new developments possible; and
that, unfortunately, a number of those users will switch over to
injection.
The Drug Enforcement Administration reports that the price of heroin
has steadily declined since 1980, though it is more potent. In 1980,
heroin cost $3.90 per milligram and was 3.6 percent pure heroin. Today,
heroin costs about $1 per milligram, yet it is 10 times more pure. This
purer, cheaper heroin is available everywhere--in our inner cities, in
our suburbs and in our small towns. For instance, according to the
National Center on Addiction and Substance Abuse, over 32 percent of
persons living in small towns, age of 12 and over, have easy access to
heroin.
The need for this change in our law to make available more broadly an
effective heroin blocker was expressed by experts at a May 9, 1997 Drug
Forum on Anti-addiction Research, which I convened along with Senator
Moynihan and Senator Bob Kerrey. Forum participants, including
distinguished experts such as Dr. Herbert Kleber and Dr. Donald Landry
of Columbia University, Dr. Charles Schuster of Wayne State University
and Dr. James H.Wood of the University of Michigan told us that this
dramatic new anti-addiction medication is coming in the nick of time.
The untreated population of opiate addicts, and other injection drug
users, is the primary means for the spread of HIV, hepatitis B and C,
and tuberculosis into the general population, not to mention the
families of such addicted persons. Failure to block the craving for
illicit drugs along with failure to provide traditional treatment will
most certainly contribute to the crime related to addiction and
continue the spiral of huge health care costs--costs that will largely
be borne not by the addicts, not by insurance companies--but by the
American taxpayer.
The President of the Michigan Public Health Association, Dr.
Stephanie Meyers Schim, has spoken out eloquently about the ``great
problems'' of substance abuse. In her letter to me in support of our
bill she says: ``Substance abuse affects health care costs, mortality,
workers' compensation claims, reduced productivity, crime, suicide,
domestic violence, child abuse, and increased costs associated with
extra law enforcement, motor vehicle crashes, crime, and lost
productivity.'' Dr. Schim goes on to say, ``Buprenorphine will allow
drug addicted individuals to maximize everyday life activities, and
participate more fully in work day and family activities while seeking
the needed treatment and counseling to become drug free''.
Dr. James H. Wood, Professor of Pharmacology at the University of
Michigan Medical School recently wrote: ``One of the most important
aspects of your bill is the use of Buprenorphine by well-trained
physicians to treat narcotic addiction from their offices, which has
the potential to attract and treat effectively sizable populations of
currently untreated addicts. A major byproduct of this increased
treatment, of course, will be reduction in the demand for illicit
narcotics in the U.S.''
Dr. Thomas Kosten, President of the American Academy of Addiction
Psychiatry echoed these sentiments in recent testimony on The Drug
Addiction Treatment Act before the House Commerce Committee on Health
and Environment, and I quote: ``. . . I would like to support the
availability of Buprenorphine for office based practice. Addiction is a
brain disease and office-based practice is primarily needed for
effective treatment of Buprenorphine.''
The American Society of Addiction Medicine (ASAM), and the College on
Problems of Drug Dependence which is the nation's longest standing
organization of scientists addressing drug dependence and drug abuse,
have stated that the availability of Buprenorphine in physicians'
offices adds a needed expansion of current treatment for heroin
addiction. ASAM also cautioned that Buprenorphine will lose much of its
utility if it is tied to the very heavily regulated structure for
current treatments of heroin addiction.
There are other compelling reasons why we must expedite the delivery
of anti-addiction medications. Of the juveniles who land behind bars in
state institutions, more than 60 percent of them reported using drugs
once a week or more, and over 40 percent reported being under the
influence of drugs while committing crimes, according to a report from
the Bureau of Justice Statistics. Drug-related incarcerations are up
and we are building more jails and prisons to accommodate them--more
than 1000 have been built over the past 20 years. According to the July
14, 1999 Office of National Drug Control Policy Update, ``Drug-related
arrests are up from 1.1 million arrests in 1988 to 1.6 million arrests
in 1997--steady increases every year since 1991''.
In crafting the provisions of this legislation, we consulted with the
U.S. Department of Health and Human Services, including the Federal
Drug Administration, and the Drug Enforcement Administration. Of
critical importance is the fact that Buprenorphine is not addictive
like methadone so the likelihood of diversion is small. Nothing in our
bill is intended to change the rules pertaining to methadone clinics or
other facilities or practitioners that conduct drug treatment services
with addictive substances. I received a very supportive letter from HHS
Secretary Donna Shalala in which she reports on the safety and utility
of Buprenorphine, as follows:
I am especially encouraged by the results of published
clinical studies of Buprenorphine. Buprenorphine is a partial
mu opiate receptor agonist, in Schedule V of the Controlled
Substances Act, with unique properties which differentiate it
from full agonists such as methadone or LAAM. The
pharmacology of the combination tablet consisting of
Buprenorphine and naloxone results in. . . .low value and low
desirability for diversion on the street.
Published clinical studies suggest that it has very limited
euphorigenic affects, and has the ability to percipitate
withdrawal in individuals who are highly dependent upon other
opioids. Thus, Buprenorphine and Buprenorphine/naloxone
products are expected to have low diversion potential.
Buprenorphine and Buprenorphine/naloxone products are
expected to reach new groups of opiate addicts--for example,
those who do not have access to methadone programs, those who
are reluctant to enter methadone treatment programs, and
those who are unsuited to them {this would include for
example, those in their first year of opiates addiction or
those addicted to lower doses of opiates .
Buprenorphine and Buprenorphine/naloxone products should
increase the amount of treatment capacity available and
expand the range of treatment options that can be used by
physicians. Buprenorphine and Buprenorphine/Naloxone would
not replace methadone. Methadone and LAAM clinics would
remain an important part of the treatment continuum.
[[Page S9113]]
In closing, I would like to include excerpts from the statement which
was presented by Dr. Charles O'Brien before the Senate Caucus on
International Narcotics Control, May 9, 2000. Dr. O'Brien is Professor
and Vice Chair of Psychiatry at the University of Pennsylvania,
Director of the Behavioral Health, Philadelphia VA Medical Center,
Center for Studies of Addiction, Upenn/VAMC, and Research Director,
Philadelphia VA. Mental Illness Research, Education and Clinical
Center. Dr. O'Brien's remarks are as follows:
While our first goal in the treatment of heroin addiction
is complete abstinence, we know that this is not realistic
for a great majority of patients. Even those who do well
initially in a drug free residential program have a high
frequency of relapse when they return to the neighborhood
where drugs are available.
Another new medication that is being successfully used in
France and is currently being reviewed by the FDA for use in
the U.S. is buprenorphine. Its chemical category is somewhat
different from methadone in that it is a partial agonist at
opiate receptors. This medication has been found to be as
effective as methadone and in some cases even better. It
seems to be particularly effective for adolescents with a
heroin problem. Buprenorphine is very unlikely to produce
overdose and in France, the death rate due to opiate overdose
has dropped by about 75 percent. Not only does it not produce
overdose itself, but it may even provide a measure of
protection against overdose by heroin.
The safety and efficacy of buprenorphine is such that it
should be made available to all physicians to treat patients
with opiate problems in their offices. This would be a major
benefit to patients who are unable and unwilling to come to
specialized methadone programs. It would be available not
just to heroin addicts, but to anyone with an opiate problem,
including many citizens who would not ordinarily be
associated with the term addiction. The availability of
buprenorphine would enable physicians to control the opiate
abuse problems of many Americans who are now being
inadequately treated or not treated at all.
One important development is the combination of
buprenorphine with naloxone, a full antagonist. If the
combination is taken by mouth, this new medication is
effective in reducing drug craving and stabilizing the person
to lead a normal life. If someone tries to abuse it by
injecting it, the naloxone component would then be effective
in blocking the effects and preventing a ``high'' or
euphoria. Thus, the diversion potential of this new
medication should be minimized.
Several treatment programs have already studied
buprenorphine in the treatment of adolescent heroin abusers.
It has been found to detoxify, that is treat withdrawal
symptoms, while the body cleanses itself of heroin, more
effectively than other medications. Thus a greater proportion
of young people are able to get off of heroin and receive
counseling and other forms of rehabilitation. Buprenorphine
is also very effective as a longer term medication that a
young person can take daily, return to school or job training
and after six months or more maintain a stable drug free
state. Once this medication is approved by the FDA and is
allowed to be used in physicians' offices, it could
dramatically improve the treatment of heroin addiction in the
U.S.
In summary Mr. Chairman, we are in the midst of the highest
availability of relatively pure heroin in our recorded
history. Fortunately we have effective treatments including
new medications that are coming on line. One of them,
buprenorphine, is well advanced in the FDA approval process
and is being considered for use in a new approach to opiate
addiction. This new approach [embodied in S. 324] in keeping
with the scientific data, would allow physicians to treat
heroin addiction in their offices just as we treat any other
medical problem.
The success of this vital legislation would not have been possible
without the leadership and support of Senator Hatch, Chairman of the
Judiciary Committee. Nor would it have been possible without the strong
support of Senator Moynihan, Ranking Member of the Finance Committee,
and Senator Biden, Ranking Member of the Judiciary Subcommittee on
Youth Violence, both of whom possess a clear grasp of the issues
surrounding illicit drug addiction and have long sought to address
them.
Mr. MOYNIHAN. Mr. President, I rise to commend the Senate for again
unanimously passing the Drug Addiction Treatment Act of 2000. Today it
passed as an amended version of S. 324, of which I am an original
cosponsor, in Title XXXV, sections 3501 and 3502, of the Senate
substitute to the Children's Health Act of 2000, H.R. 4365. The
Senate's action today marks a milestone in the treatment of opiate
dependence. The Drug Addiction Treatment Act increases access to new
medications, such as buprenorphine, to treat opiate addiction. I thank
my colleagues Senator Levin (whose long-term vision inspired this
legislation), Senator Hatch, and Senator Biden for their leadership and
dedication in developing this Act, and I look forward to seeing the
Drug Addiction Treatment Act of 2000 become law.
Determining how to deal with the problem of addiction is not a new
topic. Just over a decade ago when we passed the Anti-Drug Abuse Act of
1988, I was assigned by our then-Leader, Senator Robert Byrd, with
Senator Sam Nunn, to co-chair a working group to develop a proposal for
drug control legislation. We worked together with a similar Republican
task force. We agreed, at least for a while, to divide funding under
our bill between demand reduction activities (60 percent) and supply
reduction activities (40 percent). And we created the Director of
National Drug Control Policy (section 1002); next, ``There shall be in
the Office of National Drug Control Policy a Deputy Director for Demand
Reduction and a Deputy Director for Supply Reduction.''
We put demand first. To think that you can ever end the problem by
interdicting the supply of drugs, well, it's an illusion. There's no
possibility.
I have been intimately involved with trying to eradicate the supply
of drugs into this country. It fell upon me, as a member of the Nixon
Cabinet, to negotiate shutting down the heroin traffic that went from
central Turkey to Marseilles to New York --``the French Connection''--
but we knew the minute that happened, another route would spring up.
That was a given. The success was short-lived. What we needed was
demand reduction, a focus on the user. And we still do.
Demand reduction requires science and it requires doctors. I see the
science continues to develop, and The Drug Addiction Treatment Act of
2000 will allow doctors and patients to make use of it.
Congress and the public continue to fixate on supply interdiction and
harsher sentences (without treatment) as the ``solution'' to our drug
problems, and adamantly refuse to acknowledge what various experts now
know and are telling us: that addiction is a chronic, relapsing
disease; that is, the brain undergoes molecular, cellular, and
physiological changes which may not be reversible.
What we are talking about is not simply a law enforcement problem, to
cut the supply; it is a public health problem, and we need to treat it
as such. We need to stop filling our jails under the misguided notion
that such actions will stop the problem of drug addiction. The Drug
Addiction Treatment Act of 2000 is a step in the right direction.
Mr. BIDEN. Mr. President, today the United States Senate has passed
the Children's Health Act of 2000, an Act which will have a far-ranging
impact on the health of America's youth. This legislation not only
addresses juvenile arthritis, diabetes, asthma and other childhood
diseases, but it also takes important steps to address what I would
argue is a public health epidemic for both children and adults--
substance abuse and addiction.
The Children's Health Act reauthorizes the Substance Abuse and Mental
Health Services Administration (SAMHSA), the federal agency devoted to
substance abuse prevention and treatment services as well as a wide
range of mental health programs. The bill also includes three important
drug bills which I have cosponsored: the Methamphetamine Anti-
Proliferation Act, the Ecstasy Anti-Proliferation Act and the Drug
Addiction Treatment Act. The result is a comprehensive piece of
legislation which includes the law enforcement, treatment and
prevention services necessary to address substance abuse in the United
States today.
Mr. President, in 1996 I joined with my distinguished friend and
colleague, Senator Hatch, to introduce the ``Hatch-Biden
Methamphetamine Control Act'' to address the growing threat of
methamphetamine use in our country before it was too late.
Our failure to foresee and prevent the crack cocaine epidemic is one
of the most significant public policy mistakes in recent history. We
were determined not to repeat that mistake with methamphetamine.
That 1996 Act provided crucial tools that we needed to stay ahead of
the methamphetamine epidemic--increased penalties for possessing and
trafficking in methamphetamine and the precursor
[[Page S9114]]
chemicals and equipment used to manufacture the drug; tighter reporting
requirements and restrictions on the legitimate sales of products
containing precursor chemicals to prevent their diversion; increased
reporting requirements for firms that sell those products by mail; and
enhanced prison sentences for meth manufacturers who endanger the life
of any individual or endanger the environment while making this drug.
We also created a national working group of law enforcement and public
health officials to monitor any growth in the methamphetamine epidemic.
I have no doubt that our 1996 legislation slowed this epidemic
significantly. But we are up against a powerful and highly addictive
drug.
The Methamphetamine Anti-Proliferation Act--which I have
cosponsored--builds on the 1996 Act. First and foremost, it closes the
``amphetamine loophole'' in current law by making the penalties for
manufacturing, distributing, importing and exporting amphetamine the
same as those for meth. After all, the two drugs differ by only one
chemical and are sold interchangeably on the street. If users can't
tell the difference between the two substances, there is no reason why
the penalties should be different.
The bill also addresses the growing problem of meth labs by
establishing penalties for manufacturing the drug with an enhanced
penalty for those who would put a child's life at risk in the process.
We provide $20 million for the Drug Enforcement Administration (DEA) to
reimburse states for cleaning up toxic meth labs and $5.5 million for
the DEA to certify state and local officials to handle the hazardous
byproducts at the lab sites. We also provide $15 million for additional
law enforcement personnel--including agents, investigators,
prosecutors, lab technicians, chemists, investigative assistants and
drug prevention specialists--in High Intensity Drug Trafficking Areas
where meth is a problem.
Also included in the bill is $6.5 million for new agents to assist
State and local law enforcement in small and mid-sized communities in
all phases of drug investigations and assist state and local law
enforcement in rural areas. The bill also provides $3 million to
monitor List I chemicals, including those used in manufacturing
methamphetamine, and prevent their diversion to illicit use.
Further, the legislation provides $10 million in prevention funds and
$10 million for treating methamphetamine addiction, as well as much
needed money for researching new treatment modalities, including
clinical trials. It asks the Institute of Medicine to issue a report on
the status of the development of pharmacotherapies for treatment of
amphetamine and methamphetamine addiction, such as the good work that
the scientists at the National Institute on Drug Abuse have done to
isolate amino acids and develop medications to deal with meth overdose
and addiction.
The Children's Health Act also includes the ``Ecstasy Anti-
Proliferation Act,'' a bill which Senators Graham, Grassley and Thomas
and I introduced in May to address the new drug on the scene--Ecstasy,
a synthetic stimulant and hallucinogen. The legislation takes the
steps--both in terms of law enforcement and prevention--to address this
problem in a serious way before it gets any worse.
Ecstasy belongs to a group of drugs referred to as ``club drugs''
because they are associated with all-night dance parties known as
``raves.'' There is a widespread misconception that it is not a
dangerous drug--that it is ``no big deal.'' I believe that Ecstasy is a
very big deal. The drug depletes the brain of serotonin, the chemical
responsible for mood, thought, and memory.
If that isn't a big deal, I don't know what is.
A few months ago we got a significant warning sign that Ecstasy use
is becoming a real problem. The University of Michigan's Monitoring the
Future survey, a national survey measuring drug use among students,
reported that while overall levels of drug use had not increased, past
month use of Ecstasy among high school seniors increased more than 66
percent.
The survey showed that nearly six percent of high school seniors have
used Ecstasy in the past year. This may sound like a small number, but
put in perspective it is deeply alarming--it is five times the number
of seniors who used heroin and it is just slightly less than the
percentage of seniors who used cocaine.
And with the supply of Ecstasy increasing as rapidly as it is, the
number of kids using this drug is only likely to increase. So far this
year, the Customs Service has already seized 9 million Ecstasy pills--
three times the total amount seized in all of 1999 and twelve times the
amount seized in all of 1998.
Though New York is the East Coast hub for this drug, it is spreading
quickly throughout the country. In my home state of Delaware, law
enforcement officials have seized Ecstasy pills in Rehoboth Beach and
are noticing the emergence of an Ecstasy problem in Newark among
students at the University of Delaware.
The legislation directs the United States Sentencing Commission to
increase the recommended penalties for manufacturing, importing,
exporting or trafficking Ecstasy.
The legislation also authorizes a $10 million prevention campaign in
schools and communities to make sure that everyone--kids, adults,
parents, teachers, cops, coaches, clergy, etc.--know just how dangerous
this drug really is. We need to dispel the myth that Ecstasy is not a
dangerous drug because, as I stated earlier, this is a substance that
can cause brain damage and can even result in death. We need to spread
the message so that kids know the risk involved with taking Ecstasy,
what it can do to their bodies, their brains, their futures. Adults
also need to be taught about this drug--what it looks like, what
someone high on Ecstasy looks like, and what to do if they discover
that someone they know is using it.
Mr. President, I have come to the floor of the United States Senate
on numerous occasions to state what I view as the most effective way to
prevent a drug epidemic. My philosophy is simple: the best time to
crack down on a drug with uncompromising enforcement pressure is before
the abuse of the drug has become rampant. The advantages of doing so
are clear--there are fewer pushers trafficking in the drug and, most
important, fewer lives and fewer families will have suffered from the
abuse of the drug.
It is clear that Ecstasy use is on the rise and I am pleased that the
Senate has acted today to address the escalating problem of this drug
before it gets any worse.
In addition to stopping the proliferation of new drugs, we also need
to invest in treating those who are already addicted. More than ten
years ago, in December 1989, I released a Senate Judiciary Committee
Report entitled ``Pharmacotherapy: A Strategy for the 1990s.'' In this
report I argued that there was scientific promise for medicines that
might lessen an addict's craving for cocaine and heroin, as well as to
reduce their enjoyment of those drugs.
This report asked the question: ``If drug abuse is an epidemic, are
we doing enough to find a medical `cure'?''
At the time, despite the efforts of myself and other members of
Congress, the answer to that question was as clear as it was
distressing: the nation was doing far too little to find medicines that
treat the disease of drug addiction.
To address this shortfall, I authored, along with Senator Kennedy,
the Pharmacotherapy Development Act--which passed into law in 1992. The
cornerstone of this Act was its call for a ten year, $1 billion effort
to research and develop anti-addiction medications.
I cannot think of a more worthwhile investment. There is no other
disease that effects so many, directly and indirectly. We have 14
million drug users in this country, four million of whom are hard-core
addicts. We all have a family member, neighbor, colleague or friend who
has become addicted. We are all impacted by the undeniable correlation
between drugs and crime--an overwhelming 80 percent of the men and
women behind bars today have a history of drug and alcohol abuse or
addiction or were arrested for a drug-related crime. It only makes
sense to unleash the full powers of medical science to find a ``cure''
for this social and human ill.
Ten years ago, the question was: ``Are we doing enough to find a
`cure'?''
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Unfortunately that question is still with us. But today we also have
another question: ``Are we doing enough to get the `cures' we have to
those who need them?'' We have an enormous ``treatment gap'' in this
country. Only two million of the estimated 4.4 to 5.3 million people
who need drug treatment are receiving it.
That is why I have worked with Senators Hatch, Levin and Moynihan and
Representative Biley to craft the ``Drug Addiction Treatment Act,'' a
bill which creates a new system for delivering anti-addiction
medications to patients who need them. Under the bill qualified doctors
can be granted a waiver to prescribe certain Schedule III, IV and V
medications from their offices. This is a significant step toward
bridging the treatment gap.
Right now we have some highly effective pharmacotherapies to treat
heroin addiction and we are still working on developing similar
medications for cocaine addiction. Access to currently available
medications such as methadone and LAAM (Levo-Alpha Acetylmethadol) has
been strangled by layers of bureaucracy and regulation. As a result,
only 22 percent of opiate addicts are now receiving pharmacotherapy
treatment. General McCaffrey and Secretary Shalala are leading the
charge to fix that problem and I applaud their efforts.
Under the legislation passed today, patients will be able to get new
medications such a buprenorphine and a buprenorphine-naloxone
combination product--which are now under review by the Food and Drug
Administration--much like they can get other medications: a doctor
prescribes them and the patient can get the medication from the local
pharmacy. This new system helps to move drug treatment into the
mainstream of medicine.
The difficulties of distributing treatment medications to addicts not
only hurts those who are not getting the treatment they need, but it
also stifles private research. I have often bemoaned the fact that
private industry has not aggressively developed pharmacotherapies. As
we increase access to these drugs, we increase incentives for private
investment in this valuable research.
I am proud that the Senate has acted today to pass ``The Drug
Addiction Treatment Act'' because it helps get new, promising anti-
addiction medications get to those who need them. By allowing certain
doctors to dispense Schedule III, IV and V drugs from their offices,
the bill expands treatment flexibility and access and encourages others
to develop similar medications.
Mr. President, in passing the Children's Health Act today, the Senate
has taken an important step to addressing the problem of substance
abuse and all of the social ills that go along with it. I congratulate
all of my colleagues who have worked on this legislation which will
make an important contribution to public health and public safety in
this country.
Mr. DeWINE. Mr. President, I rise today as a co-author of the
``Children's Health Act of 2000.'' This bill is essential in enabling
us to build a health care system that is responsive to the unique needs
of children. The ``Children's Health Act of 2000'' is a big step in the
right direction, and I commend my colleagues, Senators Frist, Jeffords,
and Kennedy for their efforts to construct a bill that can really make
a positive difference in the health and the lives of children.
Mr. President, I am especially pleased that the ``Children's Health
Act'' contains several important initiatives that my colleagues and I
had introduced already as separate bills. One such initiative--the
Pediatric Research Initiative--would help ensure that more of the
increased research funding at the National Institutes of Health (NIH)
is invested specifically in children's health research.
While children represent close to 30 percent of the population of
this country, NIH devotes only about 12 percent of its budget to
children, and, in recent years, that proportion has been declining even
further. We must reverse this disturbing trend. It simply makes no
sense to conduct health research for adults and hope that those
findings also will apply to children. A ``one size fits all'' research
approach just doesn't work. The fact is that children have medical
conditions and health care needs that differ significantly from adults.
Children's health deserves more attention from the research community.
That's why the Pediatric Research Initiative is such an important part
of the ``Children's Health Act.'' It would provide the federal support
for pediatric research that is so vital to ensuring that children
receive the appropriate and best health care possible.
The Pediatric Research Initiative would authorize at least $50
million for each of the next five years for the Office of the Director
of the National Institute of Health (NIH) to conduct, coordinate,
support, develop, and recognize pediatric research. In doing so, we
will be able to ensure researchers target and study child-specific
diseases. With more than 20 Institutes and Centers and Offices within
NIH that conduct, support, or develop pediatric research in some way,
this investment would promote greater coordination and focus in
children's health research, and hopefully encourage new initiatives and
areas of research.
The ``Children's Health Act'' also would authorize the Secretary of
HHS to establish a pediatric research loan repayment program for
qualified health professionals who conduct pediatric research. Trained
researchers are essential if we are to make significant advances in the
study of pediatric health care, especially in light of the new and
improved Food and Drug Administration (FDA) policies that encourage the
testing of medications for use by children.
Additionally, the ``Children's Health Act'' includes the ``Children's
Asthma Relief Act,'' which Senator Durbin and I introduced last year.
The sad reality for children is that asthma is becoming a far too
common and chronic childhood illness. From 1979 to 1992, the
hospitalization rates among children due to asthma increased 74
percent. Today, estimates show that more than seven percent of children
now suffer from asthma. Nationwide, the most substantial prevalence
rate increase for asthma occurred among children aged four and younger.
Those four and younger also were hospitalized at the highest rate among
all individuals with asthma.
According to 1998 data from the Centers for Disease Control (CDC), my
home state of Ohio ranks about 17th in the estimated prevalence rates
for asthma. Based on a 1994 CDC National Health Interview Survey, an
estimated 197,226 children under 18 years of age in Ohio suffer from
asthma. We need to address this problem adequately. The ``Children's
Health Act'' would help do that by ensuring that children with asthma
receive the care they need to lead healthy lives. The bill would
authorize funding for fiscal years 2001 through 2005 for the Secretary
of Health and Human Services (HHS) to establish state and local
community grants to be used for asthma detection, treatment, and
education services; require coordination with current children's health
programs to identify children who are asthmatic and may otherwise
remain undetected and untreated; require NIH to direct more resources
to its National Asthma Education Prevention Program to develop a
federal plan for responding to asthma; and require the Center for
Disease Control to conduct local asthma surveillance activities to
collect data on the prevalence and severity of asthma. This
surveillance data will help us better detect asthmatic conditions, so
that we can treat more children and ensure that we are targeting our
resources in an effective and efficient way to reverse the disturbing
trend in the hospitalization and death rates of asthmatic children.
Since research shows that children living in urban areas suffer from
asthma at such alarming rates and that allergens, such as cockroach
waste, contribute to the onset of asthma, this bill also adds urban
cockroach management to the current preventive health services block
grant, which currently can be used for rodent control.
The ``Children's Health Act'' also includes a bill I introduced
separately with Senator Dodd. This section would require that the
Secretary of HHS ensure that all research that is conducted, supported,
or regulated by HHS complies with regulations governing the protection
of children involved in research. Children who participate in clinical
trials are medical pioneers. It is just common sense that we update and
apply the strongest federal guidelines to ensure the safety of these
young people as they participate in clinical trials that will ensure
that
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medicines will be safe and appropriate for use in all children.
Finally, Mr. President, the ``Children's Health Act'' includes
language that I strongly support to re-authorize funding for children's
hospitals' Graduate Medical Education (GME) programs for four
additional years. Last year, as part of the ``Health Care Research and
Quality Act,'' which was signed into law, we authorized funding for two
years for children's hospitals' GME programs. The teaching mission of
these hospitals is essential. Children's hospitals comprise less than
one percent of all hospitals, yet they train five percent of all
physicians, nearly 30 percent of all pediatricians, and almost 50
percent of all pediatric specialists. By providing our nation with
highly qualified pediatricians, children's hospitals can offer children
the best possible care and offer parents peace of mind. They serve as
the health care safety net for low-income children in their respective
communities and are often the sole regional providers of many critical
pediatric services. These institutions also serve as centers of
excellence for very sick children across the nation. Federal funding
for GME in children's hospitals is a sound investment in children's
health and provides stability for the future of the pediatric
workforce.
Mr. President, as the father of eight children and the grandfather of
five, I firmly believe that we must move forward to protect the
interests--and especially the health--of all children. The ``Children's
Health Act of 2000'' makes crucial investments in our country's
future--investments that will yield great returns. If we focus on
improving health care for all children today, we will have a generation
of healthy adults tomorrow.
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