[Congressional Record Volume 147, Number 82 (Wednesday, June 13, 2001)]
[Senate]
[Pages S6213-S6234]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. WYDEN (for himself, Mr. Smith of Oregon, Mr. Rockefeller, 
        and Mr. Breaux):
  S. 1024. A bill to amend the Public Health Service Act to provide for 
a public response to the public health crisis of pain, and for other 
purposes; to the Committee on Health, Education, Labor, and Pensions.
  Mr. WYDEN. Mr. President, pain is our Nation's silent public health 
crisis. Pain is often left untreated or under-treated, especially among 
older patients, minorities and children. Forty to 50 percent of dying 
patients experience moderate to severe pain at least half of the time 
in the last days of their lives. A Brown University study published in 
last month's Journal of the American Medical Association found that 40 
percent of nursing home patients nationwide with acute or chronic pain 
are not getting treatment that brings them relief. Thousand of 
Americans die in pain every year, and thousands live in chronic pain.
  What is truly tragic for these patients is that the medical 
technology and know-now exist to make them more comfortable. What does 
not exist is a medical system that supports clinicians trying to 
address these issues or a system to support patients and families as 
they try to find help for pain.

[[Page S6214]]

  The primary goal of the Conquering Pain Act, a bipartisan bill that I 
am introducing today with Senators Smith, Rockefeller, and Breaux is to 
create a public health framework with on which effective pain 
management policies can be developed. Providing help to patients in 
pain, to their health care providers, and to others caring for those 
patients will ensure their access to pain management 24 hours a day, 
seven days a week, 365 days a year.
  The widespread crisis of failing to adequately address patients in 
pain is made crystal clear by the fact that only one State in the 
Nation has ever has sanctioned a physician for the under-treatment of 
pain. That State is my home State of Oregon, which is now also 
considering the creation of a commission on pain management with the 
State health department.
  The Conquering Pain Act does not seek to tell clinicians how to 
practice medicine. It does not override State regulation and oversight 
of medicine. it does provide information to physicians and families in 
an effort to support them. It also seeks to find answers to the complex 
problems created by the interplay between State and Federal regulation 
of pain medications.
  Most importantly, the bill would create six regional Family Support 
Networks linking patients, families and providers to information and 
services to assist patients in pain. These networks would also assist 
clinicians who need additional information, mentoring or support to 
deal with the medically complex cases that patients in pain often 
present.
  It would be cruel and callous for this Congress to continue to ignore 
the overwhelming number of scientific studies that show patient after 
patient failing to get relief from pain. This legislation, which enjoys 
broad support with the medical and patient community, would start us 
down the road toward addressing in a bipartisan, positive way one of 
our Nation's most serious and continued health problems.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1024

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the``Conquering 
     Pain Act of 2001''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title.
Sec. 2. Findings.
Sec. 3. Definitions.

    TITLE I--EMERGENCY RESPONSE TO THE PUBLIC HEALTH CRISIS OF PAIN

Sec. 101. Guidelines for the treatment of pain.
Sec. 102. Patient expectations to have pain and symptom management.
Sec. 103. Quality improvement projects.
Sec. 104. Pain coverage quality evaluation and information.
Sec. 105. Surgeon General's report.

                TITLE II--DEVELOPING COMMUNITY RESOURCES

Sec. 201. Family support networks in pain and symptom management.

                   TITLE III--REIMBURSEMENT BARRIERS

Sec. 301. Reimbursement barriers report.
Sec. 302. Insurance coverage of pain and symptom management.

   TITLE IV--IMPROVING FEDERAL COORDINATION OF POLICY, RESEARCH, AND 
                              INFORMATION

Sec. 401. Advisory Committee on Pain and Symptom Management.
Sec. 402. Institutes of Medicine report on controlled substance 
              regulation and the use of pain medications.
Sec. 403. Conference on pain research and care.

                    TITLE V--DEMONSTRATION PROJECTS

Sec. 501. Provider performance standards for improvement in pain and 
              symptom management.
Sec. 502. End of life care demonstration projects.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) pain is often left untreated or under-treated 
     especially among older patients, African Americans, Hispanics 
     and other minorities, and children;
       (2) chronic pain is a public health problem affecting at 
     least 50,000,000 Americans through some form of persisting or 
     recurring symptom;
       (3) 40 to 50 percent of patients experience moderate to 
     severe pain at least half the time in their last days of 
     life;
       (4) 70 to 80 percent of cancer patients experience 
     significant pain during their illness;
       (5) one in 7 nursing home residents experience persistent 
     pain that may diminish their quality of life;
       (6) despite the best intentions of physicians, nurses, 
     pharmacists, and other health care professionals, pain is 
     often under-treated because of the inadequate training of 
     clinicians in pain management;
       (7) despite the best intentions of physicians, nurses, 
     pharmacists, mental health professionals, and other health 
     care professionals, pain and symptom management is often 
     suboptimal because the health care system has focused on cure 
     of disease rather than the management of a patient's pain and 
     other symptoms;
       (8) the technology and scientific basis to adequately 
     manage most pain is known;
       (9) pain should be considered the fifth vital sign; and
       (10) coordination of Federal efforts is needed to improve 
     access to high quality effective pain and symptom management 
     in order to assure the needs of chronic pain patients and 
     those who are terminally ill are met.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Chronic pain.--The term ``chronic pain'' means a pain 
     state that is persistent and in which the cause of the pain 
     cannot be removed or otherwise alleviated. Such term includes 
     pain that may be associated with long-term incurable or 
     intractable medical conditions or disease.
       (2) End of life care.--The term ``end of life care'' means 
     a range of services, including hospice care, provided to a 
     patient, in the final stages of his or her life, who is 
     suffering from 1 or more conditions for which treatment 
     toward a cure or reasonable improvement is not possible, and 
     whose focus of care is palliative rather than curative.
       (3) Family support network.--The term ``family support 
     network'' means an association of 2 or more individuals or 
     entities in a collaborative effort to develop multi-
     disciplinary integrated patient care approaches that involve 
     medical staff and ancillary services to provide support to 
     chronic pain patients and patients at the end of life and 
     their caregivers across a broad range of settings in which 
     pain management might be delivered.
       (4) Hospice.--The term ``hospice care'' has the meaning 
     given such term in section 1861(dd)(1) of the Social Security 
     Act (42 U.S.C. 1395x(dd)(1)).
       (5) Medication therapy management services.--The term 
     ``medication therapy management services'' means 
     consultations with a physician or other health care 
     professional (including a pharmacist) who is practicing 
     within the scope of the professional's license, concerning a 
     patient which results in--
       (A) a change in the drug regimen of the patient to avoid an 
     adverse drug interaction with another drug or disease state;
       (B) a change in inappropriate drug dosage or dosage form 
     with respect to the patient;
       (C) discontinuing an unnecessary or harmful medication with 
     respect to the patient;
       (D) an initiation of medication therapy for a medical 
     condition of the patient;
       (E) consultation with the patient or a caregiver in a 
     manner that results in a significant improvement in drug 
     regimen compliance; or
       (F) patient and caregiver understanding of the appropriate 
     use and adherence to medication therapy.
       (6) Pain and symptom management.--The term ``pain and 
     symptom management'' means services provided to relieve 
     physical or psychological pain or suffering, including any 1 
     or more of the following physical complaints--
       (A) weakness and fatigue;
       (B) shortness of breath;
       (C) nausea and vomiting;
       (D) diminished appetite;
       (E) wasting of muscle mass;
       (F) difficulty in swallowing;
       (G) bowel problems;
       (H) dry mouth;
       (I) failure of lymph drainage resulting in tissue swelling;
       (J) confusion;
       (K) dementia;
       (L) delirium;
       (M) anxiety;
       (N) depression; and
       (O) and other related symptoms
       (7) Palliative care.--The term ``palliative care'' means 
     the total care of patients whose disease is not responsive to 
     curative treatment, the goal of which is to provide the best 
     quality of life for such patients and their families. Such 
     care--
       (A) may include the control of pain and of other symptoms, 
     including psychological, social and spiritual problems;
       (B) affirms life and regards dying as a normal process;
       (C) provides relief from pain and other distressing 
     symptoms;
       (D) integrates the psychological and spiritual aspects of 
     patient care;
       (E) offers a support system to help patients live as 
     actively as possible until death; and
       (F) offers a support system to help the family cope during 
     the patient's illness and in their own bereavement.
       (8) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

    TITLE I--EMERGENCY RESPONSE TO THE PUBLIC HEALTH CRISIS OF PAIN

     SEC. 101. GUIDELINES FOR THE TREATMENT OF PAIN.

       (a) Development of Website.--Not later than 2 months after 
     the date of enactment of

[[Page S6215]]

     this Act, the Secretary, acting through the Agency for 
     Healthcare Research and Quality, shall develop and maintain 
     an Internet website to provide information to individuals, 
     health care practitioners, and health facilities concerning 
     evidence-based practice guidelines developed for the 
     treatment of physical and psychological pain. Websites in 
     existence on such date may be used if such websites meet the 
     requirements of this section.
       (b) Requirements.--The website established under subsection 
     (a) shall--
       (1) be designed to be quickly referenced by health care 
     practitioners; and
       (2) provide for the updating of guidelines as scientific 
     data warrants.
       (c) Provider Access to Guidelines.--
       (1) In general.--In establishing the website under 
     subsection (a), the Secretary shall ensure that health care 
     facilities have made the website known to health care 
     practitioners and that the website is easily available to all 
     health care personnel providing care or services at a health 
     care facility.
       (2) Use of certain equipment.--In making the information 
     described in paragraph (1) available to health care 
     personnel, the facility involved shall--
       (A) ensure that such personnel have access to the website 
     through the computer equipment of the facility;
       (B) carry out efforts to inform personnel at the facility 
     of the location of such equipment; and
       (C) ensure that patients, caregivers, and support groups 
     are provided with access to the website.
       (3) Rural areas.--
       (A) In general.--A health care facility, particularly a 
     facility located in a rural or underserved area, without 
     access to the Internet shall provide an alternative means of 
     providing practice guideline information to all health care 
     personnel.
       (B) Alternative means.--The Secretary shall determine 
     appropriate alternative means by which a health care facility 
     may make available practice guideline information on a 24-
     hour basis, 7 days a week if the facility does not have 
     Internet access. The criteria for adopting such alternative 
     means should be clear in permitting facilities to develop 
     alternative means without placing a significant financial 
     burden on the facility and in permitting flexibility for 
     facilities to develop alternative means of making guidelines 
     available. Such criteria shall be published in the Federal 
     Register.

     SEC. 102. PATIENT EXPECTATIONS TO HAVE PAIN AND SYMPTOM 
                   MANAGEMENT.

       (a) In General.--The administrator of each of the programs 
     described in subsection (b) shall ensure that, as part of any 
     informational materials provided to individuals under such 
     programs, such materials shall include information, where 
     relevant, to inform such individuals that they should expect 
     to have their pain assessed and should expect to be provided 
     with effective pain and symptom relief, when receiving 
     benefits under such program.
       (b) Programs.--The programs described in this subsection 
     shall include--
       (1) the medicare and medicaid programs under titles XIX and 
     XXI of the Social Security Act (42 U.S.C. 1935 et seq., 1936 
     et seq.);
       (2) programs carried out through the Public Health Service;
       (3) programs carried out through the Indian Health Service;
       (4) programs carried out through health centers under 
     section 330 of the Public Health Service Act (42 U.S.C. 
     254b);
       (4) the Federal Employee Health Benefits Program under 
     title 5, United States Code;
       (5) the Civilian Health and Medical Program of the 
     Uniformed Services (CHAMPUS) as defined in section 1073(4) of 
     title 10, United States Code; and
       (6) other programs administered by the Secretary.

     SEC. 103. QUALITY IMPROVEMENT EDUCATION PROJECTS.

       The Secretary shall provide funds for the implementation of 
     special education projects, in as many States as is 
     practicable, to be carried out by peer review organizations 
     of the type described in section 1152 of the Social Security 
     Act (42 U.S.C. 1320c-1) to improve the quality of pain and 
     symptom management. Such projects shall place an emphasis on 
     improving pain and symptom management at the end of life, and 
     may also include efforts to increase the quality of services 
     delivered to chronic pain patients and the chronically ill 
     for whom pain may be a significant symptom.

     SEC. 104. PAIN COVERAGE QUALITY EVALUATION AND INFORMATION.

       (a) In General.--Section 1851(d)(4) of the Social Security 
     Act (42 U.S.C. 42 U.S.C. 1395w-21(d)(4)) is amended--
       (1) in subparagraph (A), by adding at the end the 
     following:
       ``(ix) The organization's coverage of pain and symptom 
     management.''; and
       (2) in subparagraph (D)--
       (A) in clause (iii), by striking ``and'' at the end;
       (B) in clause (iv), by striking the period and inserting 
     ``, and''; and
       (C) by adding at the end the following:
       ``(v) not later than 2 years after the date of enactment of 
     this clause, an evaluation (which may be made part of any 
     other relevant report of quality evaluation that the plan is 
     required to prepare) for the plan (updated annually) that 
     indicates the performance of the plan with respect to access 
     to, and quality of, pain and symptom management, including 
     such management as part of end of life care. Data shall be 
     posted in a comparable manner for consumer use on 
     www.medicare.gov.''.
       (b) Effective Date.--The amendments made by paragraph (1) 
     apply to information provided with respect to annual, 
     coordinated election periods (as defined in section 
     1851(e)(3)(B) of the Social Security Act (42 U.S.C. 1395-
     21(e)(3)(B)) beginning after the date of enactment of this 
     Act.

     SEC. 105. SURGEON GENERAL'S REPORT.

       Not later than October 1, 2002, the Surgeon General shall 
     prepare and submit to the appropriate committees of Congress 
     and the public, a report concerning the state of pain and 
     symptom management in the United States. The report shall 
     include--
       (1) a description of the legal and regulatory barriers that 
     may exist at the Federal and State levels to providing 
     adequate pain and symptom management;
       (2) an evaluation of provider competency in providing pain 
     and symptom management;
       (3) an identification of vulnerable populations, including 
     children, advanced elderly, non-English speakers, and 
     minorities, who may be likely to be underserved or may face 
     barriers to access to pain management and recommendations to 
     improve access to pain management for these populations;
       (4) an identification of barriers that may exist in 
     providing pain and symptom management in health care 
     settings, including assisted living facilities;
       (5) an identification of patient and family attitudes that 
     may exist which pose barriers in accessing pain and symptom 
     management or in the proper use of pain medications;
       (6) an evaluation of medical, nursing, and pharmacy school 
     training and residency training for pain and symptom 
     management;
       (7) a review of continuing medical education programs in 
     pain and symptom management; and
       (8) a description of the use of and access to mental health 
     services for patients in pain and patients at the end of 
     life.

                TITLE II--DEVELOPING COMMUNITY RESOURCES

     SEC. 201. FAMILY SUPPORT NETWORKS IN PAIN AND SYMPTOM 
                   MANAGEMENT.

       (a) Establishment.--The Secretary, acting through the 
     Public Health Service, shall award grants for the 
     establishment of 6 National Family Support Networks in Pain 
     and Symptom Management (in this section referred to as the 
     ``Networks'') to serve as national models for improving the 
     access and quality of pain and symptom management to chronic 
     pain patients (including chronically ill patients for whom 
     pain is a significant symptom) and those individuals in need 
     of pain and symptom management at the end of life and to 
     provide assistance to family members and caregivers.
       (b) Eligibility and Distribution.--
       (1) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       (A) be an academic facility or other entity that has 
     demonstrated an effective approach to training health care 
     providers including mental health professionals concerning 
     pain and symptom management and palliative care services; and
       (B) prepare and submit to the Secretary an application (to 
     be peer reviewed by a committee established by the 
     Secretary), at such time, in such manner, and containing such 
     information as the Secretary may require.
       (2) Distribution.--In providing for the establishment of 
     Networks under subsection (a), the Secretary shall ensure 
     that--
       (A) the geographic distribution of such Networks reflects a 
     balance between rural and urban needs; and
       (B) at least 3 Networks are established at academic 
     facilities.
       (c) Activities of Networks.--A Network that is established 
     under this section--
       (1) shall provide for an integrated interdisciplinary 
     approach, that includes psychological and counseling 
     services, to the delivery of pain and symptom management;
       (2) shall provide community leadership in establishing and 
     expanding public access to appropriate pain care, including 
     pain care at the end of life;
       (3) shall provide assistance, through caregiver supportive 
     services, that include counseling and education services;
       (4) shall develop a research agenda to promote effective 
     pain and symptom management for the broad spectrum of 
     patients in need of access to such care that can be 
     implemented by the Network;
       (5) shall provide for coordination and linkages between 
     clinical services in academic centers and surrounding 
     communities to assist in the widespread dissemination of 
     provider and patient information concerning how to access 
     options for pain management;
       (6) shall establish telemedicine links to provide education 
     and for the delivery of services in pain and symptom 
     management;
       (7) shall develop effective means of providing assistance 
     to providers and families for the management of a patient's 
     pain 24 hours a day, 7 days a week; and
       (8) may include complimentary medicine provided in 
     conjunction with traditional medical services.
       (d) Provider Pain and Symptom Management Communications 
     Projects.--
       (1) In general.--Each Network shall establish a process to 
     provide health care personnel with information 24 hours a 
     day, 7 days a week, concerning pain and symptom management. 
     Such process shall be designed to test the effectiveness of 
     specific forms of communications with health care personnel 
     so that such personnel may obtain information to ensure that 
     all appropriate patients

[[Page S6216]]

     are provided with pain and symptom management.
       (2) Termination.--The requirement of paragraph (1) shall 
     terminate with respect to a Network on the day that is 2 
     years after the date on which the Network has established the 
     communications method.
       (3) Evaluation.--Not later than 60 days after the 
     expiration of the 2-year period referred to in paragraph (2), 
     a Network shall conduct an evaluation and prepare and submit 
     to the Secretary a report concerning the costs of operation 
     and whether the form of communication can be shown to have 
     had a positive impact on the care of patients in chronic pain 
     or on patients with pain at the end of life.
       (4) Rule of construction.--Nothing in this subsection shall 
     be construed as limiting a Network from developing other ways 
     in which to provide support to families and providers, 24 
     hours a day, 7 days a week.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $18,000,000 for 
     fiscal years 2002 through 2004.

                   TITLE III--REIMBURSEMENT BARRIERS

     SEC. 301. REIMBURSEMENT BARRIERS REPORT.

       The Medicare Payment Advisory Commission (MedPac) 
     established under section 1805 of the Social Security Act (42 
     U.S.C. 1396b-6) shall conduct a study, and prepare and submit 
     to the appropriate committees of Congress a report, 
     concerning--
       (1) the manner in which medicare policies may pose barriers 
     in providing pain and symptom management and palliative care 
     services in different settings, including a focus on payment 
     for nursing home and home health services;
       (2) the identification of any financial barriers that may 
     exist within the medicare and medicaid programs under titles 
     XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et 
     seq., 1396 et seq.) that interfere with continuity of care 
     and interdisciplinary care or supportive care for the broad 
     range of chronic pain patients (including patients who are 
     chronically ill for whom pain is a significant symptom), and 
     for those who are terminally ill, and include the 
     recommendations of the Commission on ways to eliminate those 
     barriers that the Commission may identify;
       (3) the reimbursement barriers that exist, if any, in 
     providing pain and symptom management through hospice care, 
     particularly in rural areas, and if barriers exist, 
     recommendations concerning adjustments that would assist in 
     assuring patient access to pain and symptom management 
     through hospice care in rural areas;
       (4) whether the medicare reimbursement system provides 
     incentives to providers to delay informing terminally ill 
     patients of the availability of hospice and palliative care; 
     and
       (5) the impact of providing payments for medication therapy 
     management services in pain and symptom management and 
     palliative care services.

     SEC. 302. INSURANCE COVERAGE OF PAIN AND SYMPTOM MANAGEMENT.

       (a) In General.--The General Accounting Office shall 
     conduct a survey of public and private health insurance 
     providers, including managed care entities, to determine 
     whether the reimbursement policies of such insurers inhibit 
     the access of chronic pain patients to pain and symptom 
     management and pain and symptom management for those in need 
     of end-of-life care (including patients who are chronically 
     ill for whom pain is a significant symptom). The survey shall 
     include a review of formularies for pain medication and the 
     effect of such formularies on pain and symptom management.
       (b) Report.--Not later than 1 year after the date of 
     enactment of this Act, the General Accounting Office shall 
     prepare and submit to the appropriate committees of Congress 
     a report concerning the survey conducted under subsection 
     (a).

   TITLE IV--IMPROVING FEDERAL COORDINATION OF POLICY, RESEARCH, AND 
                              INFORMATION

     SEC. 401. ADVISORY COMMITTEE ON PAIN AND SYMPTOM MANAGEMENT.

       (a) Establishment.--The Secretary shall establish an 
     advisory committee, to be known as the Advisory Committee on 
     Pain and Symptom Management, to make recommendations to the 
     Secretary concerning a coordinated Federal agenda on pain and 
     symptom management.
       (b) Membership.--The Advisory Committee established under 
     subsection (a) shall be comprised of 11 individuals to be 
     appointed by the Secretary, of which at least 1 member shall 
     be a representative of--
       (1) physicians (medical doctors or doctors of osteopathy) 
     who treat chronic pain patients or the terminally ill;
       (2) nurses who treat chronic pain patients or the 
     terminally ill;
       (3) pharmacists;
       (4) hospice;
       (5) pain researchers;
       (6) patient advocates;
       (7) caregivers; and
       (8) mental health providers.

     The members of the Committee shall designate 1 member to 
     serve as the chairperson of the Committee.
       (c) Meetings.--The Advisory Committee shall meet at the 
     call of the chairperson of the Committee.
       (d) Agenda.--The agenda of the Advisory Committee 
     established under subsection (a) shall include--
       (1) the development of recommendations to create a 
     coordinated Federal agenda on pain and symptom management;
       (2) the development of proposals to ensure that pain is 
     considered as the fifth vital sign for all patients;
       (3) the identification of research needs in pain and 
     symptom management, including gaps in pain and symptom 
     management guidelines;
       (4) the identification and dissemination of pain and 
     symptom management practice guidelines, research information, 
     and best practices;
       (5) proposals for patient education concerning how to 
     access pain and symptom management across health care 
     settings;
       (6) the manner in which to measure improvement in access to 
     pain and symptom management and improvement in the delivery 
     of care;
       (7) the development of ongoing strategies to assure the 
     aggressive use of pain medications, including opiods, 
     regardless of health care setting; and
       (8) the development of an ongoing mechanism to identify 
     barriers or potential barriers to pain and symptom management 
     created by Federal policies.
       (e) Recommendation.--Not later than 2 years after the date 
     of enactment of this Act, the Advisory Committee established 
     under subsection (a) shall prepare and submit to the 
     Secretary recommendations concerning a prioritization of the 
     need for a Federal agenda on pain and symptom management, and 
     ways in which to better coordinate the activities of entities 
     within the Department of Health and Human Services, and other 
     Federal entities charged with the responsibility for the 
     delivery of health care services or research on pain and 
     symptom management with respect to pain management.
       (f) Consultation.--In carrying out this section, the 
     Advisory Committee shall consult with all Federal agencies 
     that are responsible for providing health care services or 
     access to health services to determine the best means to 
     ensure that all Federal activities are coordinated with 
     respect to research and access to pain and symptom 
     management.
       (g) Administrative Support; Terms of Service; Other 
     Provisions.--The following shall apply with respect to the 
     Advisory Committee:
       (1) The Committee shall receive necessary and appropriate 
     administrative support, including appropriate funding, from 
     the Department of Health and Human Services.
       (2) The Committee shall hold open meetings and meet not 
     less than 4 times per year.
       (3) Members of the Committee shall not receive additional 
     compensation for their service. Such members may receive 
     reimbursement for appropriate and additional expenses that 
     are incurred through service on the Committee which would not 
     have incurred had they not been a member of the Committee.
       (4) The requirements of Appendix 2 of title 5, United 
     States Code.

     SEC. 402. INSTITUTES OF MEDICINE REPORT ON CONTROLLED 
                   SUBSTANCE REGULATION AND THE USE OF PAIN 
                   MEDICATIONS.

       (a) In General.--The Secretary, acting through a contract 
     entered into with the Institute of Medicine, shall review 
     findings that have been developed through research conducted 
     concerning--
       (1) the effects of controlled substance regulation on 
     patient access to effective care;
       (2) factors, if any, that may contribute to the underuse of 
     pain medications, including opiods;
       (3) the identification of State legal and regulatory 
     barriers, if any, that may impact patient access to 
     medications used for pain and symptom management; and
       (4) strategies to assure the aggressive use of pain 
     medications, including opiods, regardless of health care 
     setting.
       (b) Report.--Not later than 18 months after the date of 
     enactment of this Act, the Secretary shall prepare and submit 
     to the appropriate committees of Congress a report concerning 
     the findings described in subsection (a).

     SEC. 403. CONFERENCE ON PAIN RESEARCH AND CARE.

       Not later than December 31, 2005, the Secretary, acting 
     through the National Institutes of Health, shall convene a 
     national conference to discuss the translation of pain 
     research into the delivery of health services including 
     mental health services to chronic pain patients and those 
     needing end-of-life care. The Secretary shall use unobligated 
     amounts appropriated for the Department of Health and Human 
     Services to carry out this section.

                    TITLE V--DEMONSTRATION PROJECTS

     SEC. 501. PROVIDER PERFORMANCE STANDARDS FOR IMPROVEMENT IN 
                   PAIN AND SYMPTOM MANAGEMENT.

       (a) In General.--The Secretary, acting through the Health 
     Resources Services Administration, shall award grants for the 
     establishment of not less than 5 demonstration projects to 
     determine effective methods to measure improvement in the 
     skills, knowledge, and attitudes and beliefs of health care 
     personnel in pain and symptom management as such skill, 
     knowledge, and attitudes and beliefs apply to providing 
     services to chronic pain patients and those patients 
     requiring pain and symptom management at the end of life.
       (b) Evaluation.--Projects established under subsection (a) 
     shall be evaluated to determine patient and caregiver 
     knowledge

[[Page S6217]]

     and attitudes toward pain and symptom management.
       (c) Application.--To be eligible to receive a grant under 
     subsection (a), an entity shall prepare and submit to the 
     Secretary an application at such time, in such manner and 
     containing such information as the Secretary may require.
       (d) Termination.--A project established under subsection 
     (a) shall terminate after the expiration of the 2-year period 
     beginning on the date on which such project was established.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.

     SEC. 502. END OF LIFE CARE DEMONSTRATION PROJECTS.

       The Secretary, acting through the Health Resources and 
     Services Administration, shall--
       (1) not later than January 1, 2004, carry out not less than 
     5 demonstration and evaluation projects that implement care 
     models for individuals at the end of life, at least one of 
     which shall be developed to assist those individuals who are 
     terminally ill and have no family or extended support, and 
     each of which may be carried out in collaboration with 
     domestic and international entities to gain and share 
     knowledge and experience on end of life care;
       (2) conduct 3 demonstration and evaluation activities 
     concerning the education and training of clinicians in end of 
     life care, and assist in the development and distribution of 
     accurate educational materials on both pain and symptom 
     management and end of life care;
       (3) in awarding grants for the training of health 
     professionals, give priority to awarding grant to entities 
     that will provide training for health professionals in pain 
     and symptom management and in end-of-life care at the 
     undergraduate level;
       (4) shall evaluate demonstration projects carried out under 
     this section within the 5-year period beginning on the 
     commencement of each such project; and
       (5) develop a strategy and make recommendations to Congress 
     to ensure that the United States health care system--
       (A) has a meaningful, comprehensive, and effective approach 
     to meet the needs of individuals and their caregivers as the 
     patient approaches death; and
       (B) integrates broader supportive services.

  Mr. SMITH of Oregon. Mr. President, I rise today to join my friend 
and colleague from Oregon in reintroducing the Conquering Pain Act. He 
and I have worked long and hard together to expand access to effective 
pain and symptom management for chronic pain and terminally ill 
patients, and I believe that this legislation is an important step 
toward accomplishing that goal. This is an issue of great importance to 
my home state of Oregon, and a matter of personal significance to me.
  Prior to my service in elected office, I served as a volunteer for my 
church. In this capacity, I found my professional work as a food 
processor in a constant, but blessed, state of interruption. On a 
weekly basis and at the oddest of hours, I found myself making 
continual rounds at St. Anthony's Hospital in Pendleton, Oregon. On 
many occasions I shared with parents the unspeakable joy of welcoming 
newborn babies into this world. On others, I suffered in heartbreaking 
sorrow as I tried to comfort the critically ill, or hold the hands of 
those who lay at the brink of eternity.
  On too many of these occasions, patients suffered intense pain and 
discomfort during their final hours; sometimes as a result of 
inadequate pain management techniques, and sometimes as a result of our 
medical focus on curing illness and prolonging life at any cost. I have 
seen many beloved friends suffer unnecessarily and I believe that all 
Americans have been touched at some point by a friend or family member 
struggling to cope with chronic or acute pain. We all deserve a health 
care system committed to adequately addressing the comfort of ailing 
patients.
  The legislation we reintroduce today, the Conquering Pain Act, is 
consistent with my belief that the practice of medicine must place 
greater emphasis on helping people who are experiencing chronic and 
acute pain.
  The Conquering Pain Act of 2001 will take a number of steps to ensure 
that patients have greater access to effective pain management. This 
legislation will commission studies by the Surgeon General's office, 
the General Accounting Office, the Institute of Medicine, and MedPac to 
examine the state of pain and symptom management in the United States, 
and to review regulatory obstacles that stifle effective pain 
management in our health care system. The Act will establish 
demonstration projects at the Department of Health and Human Services 
and other institutions to provide advanced pain management care and to 
research effective methods to measure improvement in the skills, 
knowledge, and attitudes of health care personnel in pain and symptom 
management. In addition, this bill will make important and timely 
information related to pain management available to patients and health 
care professionals over the Internet.
  The Conquering Pain Act of 2001 will do something that should have 
been done many years ago; it will finally establish a coordinated 
Federal agenda regarding pain and symptom management. For better or for 
worse, our health care system has focused intensely on curing disease 
but has never adequately addressed the need to provide effective pain 
management. Americans should expect their health care providers to 
attend to their comfort as well as their health, and I believe that 
this legislation will go a long way toward addressing this long-
standing deficiency.
                                 ______
                                 
      By Mr. LIEBERMAN:
  S. 1025. A bill to provide for savings for working families; to the 
Committee on Finance.
  Mr. SANTORUM. Mr. President, today, Senator Joseph Lieberman and I 
are introducing the Savings for Working Families Act, which seeks to 
expand opportunities through Individual Development Accounts, IDAs, to 
enable the working poor to save for a home, educational expenses, and 
micro-enterprise and small business efforts. We have already 
reintroduced this provision this year as Title I of bipartisan 
legislation, S. 592, ``the Savings Opportunity and Charitable Giving 
Act of 2001.'' Rep. Pitts and Rep. Stenholm are also introducing a 
bipartisan companion bill on IDAs in the House of Representatives 
today.
  IDAs have been endorsed by President Bush during the presidential 
campaign and were included in his budget. IDAs are also included in 
H.R. 7, ``the Community Solutions Act.'' We strongly support the 
charitable giving incentives in our bill but in the context of this 
legislation, which includes savings incentives provisions, we are 
seeking to add additional tax relief for those working hard to save.
  IDAs are matched savings accounts for working Americans restricted to 
three uses: 1. buying a first home; 2. receiving post-secondary 
education or training; or 3. starting or expanding a small business. 
Individual and matching deposits are not co-mingled; all matching 
dollars are kept in a separate, parallel account. When the account 
holder has accumulated enough savings and matching funds to purchase 
the asset, typically over two to four years, and has completed a 
financial education course, payments from the IDA will be made directly 
to the asset provider.
  Financial institutions, or their contractual affiliates, would be 
reimbursed for all matching funds provided plus a limited amount of the 
program and administrative costs incurred, whether directly or through 
collaborations with other entities. Specifically, the IDA Tax Credit 
would be the aggregate amount of all dollar-for-dollar matches 
provided, up to $500 per person per year, plus a one-time $100 per 
account credit for financial education, recruiting, marketing, 
administration, withdrawals, etc., plus an annual $30 per account 
credit for the administrative cost of maintaining the account. To be 
eligible for the match, adjusted gross income may not exceed $20,000, 
single, $25,000, head of household, or $40,000, married, to prevent the 
creation of any additional marriage penalties.
  Our legislation is aimed at fixing our Nation's growing gap in asset 
ownership, which keeps millions of low-income workers from achieving 
the American dream. Most public attention focuses on our growing income 
gap. Though the booming American economy has delivered significant 
income gains to the Nation's upper-income earners, lower-income workers 
have been left on the sidelines. This suggests to some that closing 
this divide between the have-mosts and the have-leasts is simply a 
matter of raising wages. But the reality is that the income gap is a 
symptom of a larger, more complicated problem.
  Success in today's new economy is defined less and less by how much 
you

[[Page S6218]]

earn and more and more by how much you own--your asset base. This is 
great news for the millions of middle-class homeowners who are tapped 
into America's economic success, but it is bad news for those who are 
simply tapped out--those with no assets and little hope of accumulating 
the means for upward mobility and real financial security. This 
widening asset gap was underscored in a report issued earlier this year 
by the Federal Reserve. The Fed found that while the net worth of the 
typical family has risen substantially in recent years, it has actually 
dropped substantially for low-income families.
  For families with annual incomes of less than $10,000, the median net 
worth dipped from $4,800 in 1995 to $3,600 in 1998. For families with 
incomes between $10,000 and $25,000, the median net worth fell from 
$31,000 to $24,800 over the same period. The rate of home ownership 
among low-income families has dropped as well. For families making less 
than $10,000, it went from 36.1 percent to 34.5 percent from 1995 to 
1998; for those making between $10,000 and $25,000, it fell from 54.9 
percent to 51.7 percent.
  How do we reverse this troubling trend? IDAs are the unfinished 
business of the Community Renewal and New Markets Empowerment 
initiatives which became law in December of 2000 and will increase job 
opportunities and renew hope in what have been hopeless places. But to 
sustain this hope, we must provide opportunities for individuals and 
families to build tangible assets and acquire stable wealth.
  How do we do this? We believe that the marketplace can provide such 
opportunity. Non-profit groups around the country have launched 
innovative private programs that are achieving great success in 
transforming the ``unbanked''--people who have never had a bank 
account--into unabashed capitalists. Through IDAs, banks and credit 
unions offer special savings accounts to low-income Americans and match 
their deposits dollar-for-dollar. In return, participants take an 
economic literacy course and commit to using their savings to buy a 
home, upgrade their education or to start a business.
  Thousands of people are actively saving today through IDA programs in 
about 250 neighborhoods nationwide. In one demonstration project 
undertaken by the Corporation for Enterprise Development, CFED, a 
leading IDA promoter, 2,378 participants have already saved $838,443, 
which has leveraged an additional $1,644,508.
  While data have been encouraging, unfortunately IDA programs are 
still limited and too scattered across the Nation. This amendment will 
expand IDA access nationwide by providing a significant tax credit to 
financial institutions and community groups which they will pass 
through to IDA account holders. This credit would reimburse banks for 
the first $500 of matching funds they contribute, thus significantly 
lowering the cost of offering IDAs. Other State and private funds can 
also be used to provide additional match to savings. It also benefits 
our economy, the long-term stability of which is threatened by our 
pitiful national savings rate. In fact, according to some estimates, 
every $1 invested in an IDA returns $5 to the national economy.
  IDAs are supported by a variety of groups including the Credit Union 
National Association, the Corporation for Enterprise Development, the 
National Association of Homebuilders, the Financial Services 
Roundtable, and the National Conference of State Legislators.
  Individual Development Accounts, combined with other community 
development and wealth creation opportunities, are a first step towards 
restoring the faith in the longstanding American promise of equal 
opportunity. That faith has been shaken by stark divisions of income 
and wealth in our society. With the leadership of the President and the 
Speaker, I am hopeful, along with Senator Lieberman and other 
supporters in the Senate, that Congress will take this significant step 
toward restoring the long-cherished American ideals of rewarding hard 
work, encouraging responsibility, and expanding opportunity this year.
                                 ______
                                 
      By Mr. SCHUMER:
  S. 1027. A bill to expand the purposes of the program of block grants 
to States for temporary assistance for needy families to include 
poverty reduction, and to make grants available under the program for 
that purpose; to the Committee on Finance.
  Mr. WELLSTONE. Mr. President, I rise today to speak on the Schumer-
Wellstone ``Child Poverty Reduction Act.'' This bill would create a 
fifth goal of the Temporary Assistance for Needy Families, TANF, 
Program to reduce poverty among families with children in the United 
States, and it would provide a $150 million annual appropriation for 
high performance bonus grants to States who reduce both the depth and 
extent of child poverty.
  Under current law, TANF has four goals: 1. provide assistance to 
needy families so that children may be cared for in their own homes; 2. 
end dependency on the welfare system; 3. prevent and reduce the 
incidence of out-of-wedlock pregnancies; and 4. encourage the formation 
and maintenance of two parent families. The bill would add language 
stating that the fifth goal of TANF is ``to reduce poverty of families 
with children in the United States.''
  The TANF program currently awards ``high performance'' bonuses to 
States that rank high on outcome measures related to the program's 
goals. A total of $1 billion was provided over 5 years, averaging $200 
million per year, for this bonus. The law charges the Secretary of 
Health and Human Services with developing the criteria for measuring 
high performance in consultation with certain groups representing the 
states. Bonuses have thus far been awarded for fiscal year 1999 and 
fiscal year 2000. For fiscal year 1999 through fiscal year 2001, states 
are judged only on measures related to promoting work for the high 
performance bonus. Beginning in fiscal year 2002, new measures will be 
added that provide bonus awards to States that increase the percent of 
married couple families with children and to States that take steps to 
increase participation in food stamps, Medicaid/SCHIP and child care. 
This bill would create an additional $150 million bonus category to 
provide high performance bonus grants to all States that reduce their 
child poverty rate from the previous year's poverty rate. The grant is 
authorized from fiscal year 2003 onward. To ensure continued 
improvement, States cannot receive a bonus if their child poverty rate 
for any given year is higher than their lowest child poverty rate from 
calendar year 2002 onward. In addition, even if a State reduces the 
overall poverty rate, a State cannot receive the bonus if the average 
amount of income that the State's poor children needed to get above the 
poverty line, the average depth of child poverty, increased from the 
previous year. Each State that qualifies for a grant would receive an 
award equal to the number of the children residing in the State as a 
percentage of the number of children living in the United States. A 
qualifying State can receive no less than $1 million per year, and no 
more than 5 percent of their Basic TANF grant.
  This bill takes the important first step toward reorienting our 
thinking about the purpose of welfare ``reform.'' Many people have 
trumpeted the ``success'' of welfare reform, pointing to the enormous 
reduction in the caseload as proof of this success, but such claims 
miss the point. Reducing the rolls is the easy part--just kick people 
off, close their cases, and wish them well. The more important, and 
infinitely more difficult, part is the reduction of poverty. When 
advocates of welfare ``reform'' talk about ending dependency, there is 
clearly a presumption that they are also advocating moving these same 
families toward economic self-sufficiency. But the reality of the 
situation is that the welfare rolls have declined much more quickly 
than the poverty rate, and it is not at all clear that those families 
who have lost their benefits have moved out of poverty. Of particular 
concern is the fact that too many children in this country continue to 
live in poverty.
  What do we know about the well-being of poor children in this 
country? We know that the number of children who live in poverty has 
declined. In 1998, 18.9 percent of children in the United States lived 
in poverty. In 1999 that figure dropped to 16.9 percent. But before we 
start celebrating, let's think about what this really represents. In 
this period of unheralded economic growth, child poverty has decreased 
by

[[Page S6219]]

two percent. Two percent. Unprecedented, rewrite the economic 
textbooks, prosperity, and childhood poverty has decreased by only two 
percent.
  Worse, though, we also know that poor children are on average now 
more poor than ever before. Their families have incomes further below 
the poverty level than in any other year that this information has been 
collected. And researchers point to the decline in cash assistance and 
food stamps as a primary cause. The percentage of poor children whose 
families received cash assistance fell from 62 percent in 1994 to 43 
percent in 1998; the percent of poor children who received food stamps 
dropped from 94 percent to 75 percent from 1994 to 1998; and a million 
people became uninsured in 1998. Our Nation's programs, designed to 
meet the needs of our most vulnerable citizens, are serving fewer of 
them. This is what we call success? I've said it before and I'll 
continue to say it for as long as we have this debate simply reducing 
the welfare rolls is not success. Reducing the rolls is not the same 
thing as reducing poverty, our real goal, a goal we have not come close 
to reaching.
  It is critical that we reframe the public discourse so that welfare 
``reform'' is about ending poverty, not simply reducing the rolls, and 
we must make it part of a larger discourse about the needs of working 
families in this country. After all, there are about 6 million people 
on the welfare rolls, but there are 32 million people 12 million 
children living in poverty, 43 million people who are uninsured, 30 
million people who are hungry, more than 13 million children who are 
eligible for child care assistance who aren't receiving any, more than 
12 million people teetering on the edge of homelessness, and an 
estimated 6.9 million people in this country earning only the minimum 
wage unable to move their families out of poverty even by working full-
time, year-round. As we begin to consider reauthorization of the 
welfare ``reform'' bill, we need to understand that whatever debate we 
have won't be just about welfare. We need to understand that what we 
will really be talking about is poverty, about hunger and homelessness, 
about whether or not our children are safe, about whether or not they 
come to school ``ready to learn,'' about whether or not they grow and 
prosper. The debate we will have is not simply about what is good for 
the 6 million people in this country receiving public assistance, or 
even the 32 million people living in poverty, but it will be a debate 
about what is good for our country. It will be a debate about our 
priorities.
  Any investment we make in the needs of low-income families will be 
paid back to us a thousand-fold in the well-being of our children, our 
neighborhoods, and our communities. And the cost of not investing in 
these families is similarly multiplied when we see our children fall 
behind in grade school and high school, when we bear witness to 
horrible acts of violence committed by children against children, and 
when we face a cycle of poverty that seems nearly unbreakable. I look 
forward to the day when the needs of all families are met, when we 
ensure that every member of our community leads a life of dignity, able 
to provide for themselves and their families. And I have to believe 
that such a day will come, although I worry that it may not come soon 
enough.
  We must do more to reduce both the extent and the depth of poverty in 
this country, and right now is the time to do so. Right now we have the 
resources to ensure that no family, no child, is left behind. The 
Schumer-Wellstone ``Child Poverty Reduction Act'' is a step in this 
direction. I urge each of my colleagues to support this bill.
                                 ______
                                 
      By Mr. DASCHLE (for himself and Mr. Johnson):
  S. 1028. A bill to direct the Secretary of the Interior to convey 
certain parcels of land acquired for the Blunt Reservoir and Pierre 
Canal Features of the initial stage of Oahe Unit, James Division, South 
Dakota, to the Commission of Schools and Public Lands and the 
Department of Game, Fish and Parks of the State of South Dakota for the 
purpose of mitigating lost wildlife habitat, on the condition that the 
current preferential leaseholders shall have an option to purchase the 
parcels from the Commission, and for other purposes; to the Committee 
on Energy and Natural Resources.
  Mr. DASCHLE. Mr. President, I am today introducing the Blunt 
Reservoir and Pierre Canal Land Conveyance Act of 2001. This proposal 
is the culmination of more than 3 years of discussion with local 
landowners, the South Dakota Water Congress, the U.S. Bureau of 
Reclamation, local legislators, representatives of South Dakota 
sportsmen groups and affected citizens. It lays out a plan to convey 
certain parcels of land acquired for the Blunt Reservoir and Pierre 
Canal features of the Oahe Irrigation Project in South Dakota to the 
Commission of School and Public Lands of the State of South Dakota for 
the purpose of mitigating lost wildlife habitat, and provides the 
option to preferential leaseholders to purchase their original parcels 
from the Commission.
  To more fully understand the issues addressed by the legislation, it 
is necessary to review some of the history related to the Oahe Unit of 
the Missouri River Basin project in South Dakota.
  The Oahe Unit was originally approved as part of the overall plan for 
water development in the Missouri River Basin that was incorporated in 
the Flood Control Act of 1944. Subsequently, Public Law 90-453 
authorized construction and operation of the initial stage of this 
unit. The purposes of the Oahe Unit, as authorized, were to provide for 
the irrigation of 190,000 acres of farmland, conserve and enhance fish 
and wildlife habitat, promote recreation and meet other important 
goals.
  The project came to be known as the Oahe Irrigation Project, and the 
principal features of the initial stage of the project included the 
Oahe pumping plant, located near Oahe Dam, to pump water from the Oahe 
Reservoir, a system of main canals, including the Pierre Canal, running 
east from the Oahe Reservoir, and the establishment of regulating 
reservoirs, including the Blunt Dam and Reservoir, located 
approximately 35 miles east of Pierre, South Dakota.
  Under the authorizing legislation, 42,155 acres were to be acquired 
by the Federal Government in order to construct and operate the Blunt 
Reservoir feature of the Oahe Irrigation Project. Land acquisition for 
the proposed Blunt Reservoir feature began in 1972 and continued 
through 1977. A total of 17,878 acres actually were acquired from 
willing sellers.
  The first land for the Pierre Canal feature was purchased in July 
1975 and included the 1.3 miles of Reach lB. An additional 21-mile 
reach was acquired from 1976 through 1977, also from willing sellers.
  Organized opposition to the Oahe Irrigation Project surfaced in 1973 
and continued to build until a series of public meetings were held in 
1977 to determine if the project should continue. In late 1977, the 
Oahe project was made a part of President Carter's Federal Water 
Project review process.
  The Oahe project construction was then halted on September 30, 1977, 
when Congress did not include funding in the FY 1978 appropriations. 
Thus, all major construction contract activities ceased, and land 
acquisition was halted.
  The Oahe Project remained an authorized water project with a bleak 
future and minimal chances of being completed as authorized. 
Consequently, the Department of Interior, through the Bureau of 
Reclamation, gave to those persons who willingly had sold their lands 
to the project, and their descendants, the right to lease those lands 
and use them as they had in the past until they were needed by the 
Federal Government for project purposes.
  During the period from 1978 until the present, the Bureau of 
Reclamation has administered these lands on a preference lease basis 
for those original landowners or their descendants and on a non-
preferential basis for lands under lease to persons who were not 
preferential leaseholders. Currently, the Bureau of Reclamation 
administers 12,978 acres as preferential leases and 4,304 acres as non-
preferential leases in the Blunt Reservoir.
  As I noted previously, the Oahe Irrigation Project is related 
directly to the overall project purposes of the Pick-Sloan Missouri 
Basin program authorized under the Flood Control Act of 1944. Under 
this program, the U.S. Army Corps of Engineers constructed four major 
dams across the Missouri

[[Page S6220]]

River in South Dakota. The two largest reservoirs formed by these dams, 
Oahe Reservoir and Sharpe Reservoir, caused the loss of approximately 
221,000 acres of fertile, wooded bottomland that constituted some of 
the most productive, unique and irreplaceable wildlife habitat in the 
State of South Dakota. This included habitat for both game and non-game 
species, including several species now listed as threatened or 
endangered. Meriwhether Lewis, while traveling up the Missouri River in 
1804 on his famous expedition, wrote in his diary, ``Song birds, game 
species and furbearing animals abound here in numbers like none of the 
party has ever seen. The bottomlands and cottonwood trees provide a 
shelter and food for a great variety of species, all laying their claim 
to the river bottom.''
  Under the provisions of the Wildlife Coordination Act of 1958, the 
State of South Dakota has developed a plan to mitigate a part of this 
lost wildlife habitat as authorized by Section 602 of Title VI of 
Public Law 105-277, October 21, 1998, known as the Cheyenne River Sioux 
Tribe, Lower Brule Sioux Tribe, and State of South Dakota Terrestrial 
Wildlife Habitat Restoration Act. The State's habitat mitigation plan 
has received the necessary approval and interim funding authorizations 
under Sections 602 and 609 of Title VI.
  The State's habitat mitigation plan requires the development of 
approximately 27,000 acres of wildlife habitat in South Dakota. 
Transferring the 4,304 acres of non-preferential lease lands in the 
Blunt Reservoir feature to the South Dakota Department of Game, Fish 
and Parks would constitute a significant step toward satisfying the 
habitat mitigation obligation owed to the state by the Federal 
Government and as agreed upon by the U.S. Army Corps of Engineers, the 
U.S. Fish and Wildlife Service, and the South Dakota Department of 
Game, Fish and Parks.
  As we developed this legislation, many meetings occurred among the 
local landowners, South Dakota Department of Game, Fish and Parks, 
business owners, local legislators, the Bureau of Reclamation, as well 
as representatives of sportsmen groups. It became apparent that the 
best solution for the local economy, tax base and wildlife mitigation 
issues would be to allow the preferential leaseholders (original 
landowner or descendant or operator of the land at the time of 
purchase) to have an option to purchase the land from the Commission of 
School and Public Lands after the preferential lease parcels are 
conveyed to the Commission. This option will be available for a period 
of 5 years after the date of conveyance to the Commission. During the 
interim period, the preferential leaseholders shall be entitled to 
continue to lease from the Commissioner under the same terms and 
conditions they have enjoyed with the Bureau of Reclamation. If the 
preferential leaseholder fails to purchase a parcel within the 5-year 
period, that parcel will be conveyed to the South Dakota Department of 
Game, Fish and Parks to be use to implement the 27,000-acre habitat 
mitigation plan.
  The proceeds from these sales will be used to finance the 
administration of this bill, support public education in the State of 
South Dakota, and will be added to the South Dakota Wildlife Habitat 
Mitigation Trust Fund to assist in the payment of local property taxes 
on lands transferred from the Federal government to the state of South 
Dakota.
  In summary, the State of South Dakota, the Federal Government, the 
original landowners, the sportsmen and wildlife will benefit from this 
bill. It provides for a fair and just resolution to the private 
property and environmental problems caused by the Oahe Irrigation 
Project some 25 years ago. We have waited long enough to right some of 
the wrongs suffered by our landowners and South Dakota's wildlife 
resources.
  I am hopeful the Senate will act quickly on this legislation. Our 
goal is to enact a bill that will allow meaningful wildlife habitat 
mitigation to begin, give certainty to local landowners who sacrificed 
their lands for a defunct federal project they once supported, ensure 
the viability of the local land base and tax base, and provide well 
maintained and managed recreation areas for sportsmen.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1028

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Blunt Reservoir and Pierre 
     Canal Land Conveyance Act of 2001''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) under the Act of December 22, 1944 (commonly known as 
     the ``Flood Control Act of 1944'') (58 Stat. 887, chapter 
     665; 33 U.S.C. 701-1 et seq.), Congress approved the Pick-
     Sloan Missouri River Basin Program--
       (A) to promote the general economic development of the 
     United States;
       (B) to provide for irrigation above Sioux City, Iowa;
       (C) to provide for municipal and industrial water supply, 
     fish and wildlife, and recreation;
       (D) to protect urban and rural areas from devastating 
     floods of the Missouri River; and
       (E) for other purposes;
       (2) the purpose of the Oahe Unit, James Division, of the 
     Oahe Irrigation Project was to meet the requirements of that 
     Act by providing irrigation above Sioux City, Iowa;
       (3) the principal features of the initial stage of the Oahe 
     Unit, James Division, of the Oahe Irrigation Project 
     included--
       (A) a system of main canals, including the Pierre Canal, 
     running east from the Oahe Reservoir; and
       (B) the establishment of regulating reservoirs, including 
     the Blunt Dam and Reservoir, located approximately 35 miles 
     east of Pierre, South Dakota;
       (4) land to establish the Pierre Canal and Blunt Reservoir 
     was purchased between 1972 and 1977, when construction on the 
     initial stage of the Oahe Unit, James Division, was halted;
       (5) since 1978, the Commissioner of Reclamation has 
     administered the land--
       (A) on a preferential lease basis to original landowners or 
     their descendants; and
       (B) on a nonpreferential lease basis to other persons;
       (6) the 2 largest reservoirs created by the Pick-Sloan 
     Missouri River Basin Program, Lake Oahe and Lake Sharpe, 
     caused the loss of approximately 221,000 acres of fertile, 
     wooded bottomland in South Dakota that constituted some of 
     the most productive, unique, and irreplaceable wildlife 
     habitat in the State;
       (7) the State has developed a plan to meet the Federal 
     obligation under the Fish and Wildlife Coordination Act (16 
     U.S.C. 661 et seq.) to mitigate the loss of wildlife habitat, 
     the implementation of which is authorized by section 602 of 
     title VI of Public Law 105-277 (112 Stat. 2681-660); and
       (8) it is in the interests of the United States and the 
     State to--
       (A) provide original landowners or their descendants with 
     an opportunity to purchase back their land; and
       (B) transfer the remaining land to the State to allow 
     implementation of its habitat mitigation plan.

     SEC. 3. BLUNT RESERVOIR AND PIERRE CANAL.

       (a) Definitions.--In this section:
       (1) Blunt reservoir feature.--The term ``Blunt Reservoir 
     feature'' means the Blunt Reservoir feature of the Oahe Unit, 
     James Division, authorized by the Act of August 3, 1968 (82 
     Stat. 624), as part of the Pick-Sloan Missouri River Basin 
     Program.
       (2) Commission.--The term ``Commission'' means the 
     Commission of Schools and Public Lands of the State.
       (3) Nonpreferential lease parcel.--The term 
     ``nonpreferential lease parcel'' means a parcel of land 
     that--
       (A) was purchased by the Secretary for use in connection 
     with the Blunt Reservoir feature or the Pierre Canal feature; 
     and
       (B) was considered to be a nonpreferential lease parcel by 
     the Secretary as of January 1, 2001, and is reflected as such 
     on the roster of leases of the Bureau of Reclamation for 
     2001.
       (4) Pierre canal feature.--The term ``Pierre Canal 
     feature'' means the Pierre Canal feature of the Oahe Unit, 
     James Division, authorized by the Act of August 3, 1968 (82 
     Stat. 624), as part of the Pick-Sloan Missouri River Basin 
     Program.
       (5) Preferential leaseholder.--The term ``preferential 
     leaseholder'' means a person or descendant of a person that 
     held a lease on a preferential lease parcel as of January 1, 
     2001, and is reflected as such on the roster of leases of the 
     Bureau of Reclamation for 2001.
       (6) Preferential lease parcel.--The term ``preferential 
     lease parcel'' means a parcel of land that--
       (A) was purchased by the Secretary for use in connection 
     with the Blunt Reservoir feature or the Pierre Canal feature; 
     and
       (B) was considered to be a preferential lease parcel by the 
     Secretary as of January 1, 2001, and is reflected as such on 
     the roster of leases of the Bureau of Reclamation for 2001.
       (7) Secretary.--The term ``Secretary'' means the Secretary 
     of the Interior, acting through the Commissioner of 
     Reclamation.
       (8) State.--
       (A) In general.--The term ``State'' means the State of 
     South Dakota.

[[Page S6221]]

       (B) Inclusion.--The term ``State'' includes a successor in 
     interest of the State.
       (9) Unleased parcel.--The term ``unleased parcel'' means a 
     parcel of land that--
       (A) was purchased by the Secretary for use in connection 
     with the Blunt Reservoir feature or the Pierre Canal feature; 
     and
       (B) is not under lease as of the date of enactment of this 
     Act.
       (b) Deauthorization.--The Blunt Reservoir feature is 
     deauthorized.
       (c) Conveyance.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary shall convey all of the 
     preferential lease parcels to the Commission, without 
     consideration, on the condition that the Commission honor the 
     purchase option provided to preferential leaseholders under 
     subsection (e).
       (d) Acceptance of Land and Obligations.--
       (1) In general.--As a condition of each conveyance under 
     subsections (c) and (f), respectively, the State shall agree 
     to accept--
       (A) in ``as is'' condition, the Blunt Reservoir Feature and 
     the Pierre Canal Feature; and
       (B) any liability accruing after the date of conveyance as 
     a result of the ownership, operation, or maintenance of the 
     features referred to in subparagraph (A), including liability 
     associated with certain outstanding obligations associated 
     with expired easements, or any other right granted in, on, 
     over, or across either feature.
       (2) Responsibilities of the state.--An outstanding 
     obligation described in paragraph (1)(B) shall inure to the 
     benefit of, and be binding upon, the State.
       (3) Oil, gas, mineral, and other outstanding rights.--A 
     conveyance under subsection (c) or (f) shall be made subject 
     to--
       (A) oil, gas, and other mineral rights reserved of record, 
     as of the date of enactment of this Act, by or in favor of a 
     third party; and
       (B) any permit, license, lease, right-of-use, or right-of-
     way of record in, on, over, or across a feature referred to 
     in paragraph (1)(A) that is outstanding as to a third party 
     as of the date of enactment of this Act.
       (e) Purchase Option.--
       (1) In general.--A preferential leaseholder shall have an 
     option to purchase from the Commission the preferential lease 
     parcel that is the subject of the lease.
       (2) Terms.--
       (A) In general.--Except as provided in subparagraph (B), a 
     preferential leaseholder may elect to purchase a parcel on 1 
     of the following terms:
       (i) Cash purchase for the amount that is equal to--

       (I) the value of the parcel determined under paragraph (4); 
     minus
       (II) 10 percent of that value.

       (ii) Installment purchase, with 10 percent of the value of 
     the parcel determined under paragraph (4) to be paid on the 
     date of purchase and the remainder to be paid over not more 
     than 30 years at 3 percent annual interest.
       (B) Value under $10,000.--If the value of the parcel is 
     under $10,000, the purchase shall be made on a cash basis in 
     accordance with subparagraph (A)(i).
       (3) Option exercise period.--
       (A) In general.--A preferential leaseholder shall have 
     until the date that is 5 years after the date of the 
     conveyance under subsection (c) to exercise the option under 
     paragraph (1).
       (B) Continuation of leases.--Until the date specified in 
     subparagraph (A), a preferential leaseholder shall be 
     entitled to continue to lease from the Commission the parcel 
     leased by the preferential leaseholder under the same terms 
     and conditions as under the lease, as in effect as of the 
     date of conveyance.
       (4) Valuation.--
       (A) In general.--The value of a preferential lease parcel 
     shall be determined to be, at the election of the 
     preferential leaseholder--
       (i) the amount that is equal to--

       (I) the number of acres of the preferential lease parcel; 
     multiplied by
       (II) the amount of the per-acre assessment of adjacent 
     parcels made by the Director of Equalization of the county in 
     which the preferential lease parcel is situated; or

       (ii) the amount of a valuation of the preferential lease 
     parcel for agricultural use made by an independent appraiser.
       (B) Cost of appraisal.--If a preferential leaseholder 
     elects to use the method of valuation described in 
     subparagraph (A)(ii), the cost of the valuation shall be paid 
     by the preferential leaseholder.
       (5) Conveyance to the state.--
       (A) In general.--If a preferential leaseholder fails to 
     purchase a parcel within the period specified in paragraph 
     (3)(A), the Commission shall convey the parcel to the State 
     of South Dakota Department of Game, Fish, and Parks.
       (B) Wildlife habitat mitigation.--Land conveyed under 
     subparagraph (A) shall be used by the South Dakota Department 
     of Game, Fish, and Parks for the purpose of mitigating the 
     wildlife habitat that was lost as a result of the development 
     of the Pick-Sloan project.
       (6) Use of proceeds.--Of the proceeds of sales of land 
     under this subsection--
       (A) not more than $750,000 shall be used to reimburse the 
     Secretary for expenses incurred in implementing this Act;
       (B) an amount not exceeding 10 percent of the cost of each 
     transaction conducted under this Act shall be used to 
     reimburse the Commission for expenses incurred implementing 
     this Act;
       (C) $3,095,000 shall be deposited in the South Dakota 
     Wildlife Habitat Mitigation Trust Fund established by section 
     603 of the Water Resources Development Act of 1999 (113 Stat. 
     389) for the purpose of paying property taxes on land 
     transferred to the State;
       (D) $185,400 shall be transferred to Sully County, South 
     Dakota;
       (E) $14,600 shall be transferred to Hughes County, South 
     Dakota; and
       (F) the remainder shall be used by the Commission to 
     support public schools in the State.
       (f) Conveyance of Nonpreferential Lease Parcels and 
     Unleased Parcels.--
       (1) Conveyance by secretary to state.--
       (A) In general.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary shall convey to the 
     South Dakota Department of Game, Fish, and Parks the 
     nonpreferential lease parcels and unleased parcels of the 
     Blunt Reservoir and Pierre Canal.
       (B) Wildlife habitat mitigation.--Land conveyed under 
     subparagraph (A) shall be used by the South Dakota Department 
     of Game, Fish, and Parks for the purpose of mitigating the 
     wildlife habitat that was lost as a result of the development 
     of the Pick-Sloan project.
       (2) Land exchanges for nonpreferential lease parcels and 
     unleased parcels.--
       (A) In general.--With the concurrence of the South Dakota 
     Department of Game, Fish, and Parks, the South Dakota 
     Commission of Schools and Public Lands may allow a person to 
     exchange land that the person owns elsewhere in the State for 
     a nonpreferential lease parcel or unleased parcel at Blunt 
     Reservoir or Pierre Canal, as the case may be.
       (B) Priority.--The right to exchange nonpreferential lease 
     parcels or unleased parcels shall be granted in the following 
     order of priority:
       (i) Exchanges with current lessees for nonpreferential 
     lease parcels.
       (ii) Exchanges with adjoining and adjacent landowners for 
     unleased parcels and nonpreferential lease parcels not 
     exchanged by current lessees.
       (C) Easement for water conveyance structure.--As a 
     condition of the exchange of land of the Pierre Canal Feature 
     under this paragraph, the United States reserves a perpetual 
     easement to the land to allow for the right to design, 
     construct, operate, maintain, repair, and replace a pipeline 
     or other water conveyance structure over, under, across, or 
     through the Pierre Canal Feature.
       (g) Release From Liability.--
       (1) In general.--Effective on the date of conveyance of any 
     parcel under this Act, the United States shall not be held 
     liable by any court for damages of any kind arising out of 
     any act, omission, or occurrence relating to the parcel, 
     except for damages for acts of negligence committed by the 
     United States or by an employee, agent, or contractor of the 
     United States, before the date of conveyance.
       (2) No additional liability.--Nothing in this section adds 
     to any liability that the United States may have under 
     chapter 171 of title 28, United States Code (commonly known 
     as the ``Federal Tort Claims Act'').
       (h) Requirements Concerning Conveyance of Lease Parcels.--
       (1) Interim requirements.--During the period beginning on 
     the date of enactment of this Act and ending on the date of 
     conveyance of the parcel, the Secretary shall continue to 
     lease each preferential lease parcel or nonpreferential lease 
     parcel to be conveyed under this section under the terms and 
     conditions applicable to the parcel on the date of enactment 
     of this Act.
       (2) Provision of parcel descriptions.--Not later than 180 
     days after the date of enactment of this Act, the Secretary 
     shall provide the State a full legal description of all 
     preferential lease parcels and nonpreferential lease parcels 
     that may be conveyed under this section.
       (i) Funding of the South Dakota Terrestrial Wildlife 
     Habitat Restoration Trust Fund.--Section 603(b) of the Water 
     Resources Development Act of 1999 (113 Stat. 388) is amended 
     by striking ``$108,000,000'' and inserting ``$111,095,000''.
       (j) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this Act $750,000.
                                 ______
                                 
      By Mr. CONRAD (for himself, Mr. Thomas, Mr. Daschle, Mr. Roberts, 
        Mr. Johnson, Mr. Jeffords, Mr. Crapo, Mr. Rockefeller, Mr. 
        Harkin, Mr. Dorgan, Mr. Wellstone, Mr. Bond, Mr. Helms, Mr. 
        Cochran, Mr. Edwards, Mr. Hutchinson, Mr. Domenici, Mr. Burns, 
        Mr. Bingaman, and Mrs. Lincoln):
  S. 1030. A bill to improve health care in rural areas by amending 
title XVIII of the Social Security Act and the Public Health Service 
Act, and for other purposes; to the Committee on Finance.
  Mr. CONRAD. Mr. President, today, I am introducing the Rural Health 
Improvement Act of 2001. This proposal is the result of a bipartisan 
and bicameral effort. I am proud to be joined by Senator Thomas the 
lead cosponsor

[[Page S6222]]

of the bill, along with Senators Daschle, Roberts, Johnson, Lincoln, 
Jeffords, Crapo, Rockefeller, Harkin, Dorgan, Wellstone, Bond, Helms, 
Cochran, Edwards, Hutchinson, Domenici, Burns, and Bingaman. I would 
also like to thank our House companions, led by Representatives Moran 
and McIntyre.
  In addition, I would like to thank the National Rural Health 
Association, the Federation of American Hospitals, the National 
Association of Rural Health Clinics, the American Hospital Association, 
and the College of American Pathologists for their support of this 
effort.
  Working together, I believe we are taking important steps toward 
improving access to health care in our rural communities.
  Rural health care providers are often forced to operate with 
significantly fewer resources than larger, urban facilities. In my 
State of North Dakota, rural hospitals often receive only half the 
Medicare reimbursement of their urban counterparts. For example, a 
rural facility in North Dakota receives approximately $4,200 for 
treating pneumonia, while Our Lady of Mercy in New York city receives 
more than $8,500.
  This funding disparity is simply unfair and has placed many rural 
providers on shaky ground. And in my State, if these facilities close, 
rural communities will be left without access to needed health care 
services. We simply cannot allow this to happen.
  According to the Medicare Payment Advisory Commission, MedPAC, 
continued funding shortfalls have resulted in rural providers having 
much tighter Medicare margins than their urban counterparts. Today, the 
average rural hospital operates with a slim 4.1 percent inpatient 
margin, compared to 13.5 percent for urban providers.
  When you look at overall Medicare margins, the situation is even more 
bleak, rural providers are working with an average negative 2.9 percent 
Medicare margin compared to 6.9 percent for urban hospitals. Our rural 
facilities cannot continue to provide high-quality services it they 
lose nearly 3 percent on every Medicare patient they serve.
  To address these problems, the bill I am introducing today would take 
three important steps to erase inequities in the Medicare inpatient 
hospital payment system and provide new resources to rural health care 
providers.
  As you know, it is nearly impossible for hospitals serving small, 
rural areas to take advantage of economies of scale realized by 
facilities located in larger communities. This problem is compounded by 
the fact that Medicare does not adequately account for the higher 
costs of serving low-volume populations. According to MedPAC, the 
result of these factors is that the majority of small facilities 
operate in the red.

  To ensure our smallest rural hospitals can keep their doors open, the 
Rural Health Care Improvement Act would provide a new, and much needed, 
extra payment to hospitals serving fewer than 800 patients per year. 
This new low-volume adjustment payment would provide up to 25 percent 
in additional funding to help rural providers cover inpatient hospital 
services.
  Second, this proposal would close the gap in payments hospitals 
receive for serving low-income patients. Today, hospitals are provided 
special payments to help cover the costs of serving the uninsured; 
these supplements are called disproportionate share payments, DSH. The 
problem is that under current law urban providers can receive unlimited 
DSH payments, while rural providers' add-ons are capped. There is no 
sound policy reason for this disparity. My bill closes this gap by 
allowing rural providers to also receive unlimited DSH payments.
  Third, this proposal would take steps to equalize another glaring 
Medicare disparity with no policy justification that provides larger 
hospitals a base payment amount 1.6 percent higher than rural 
hospitals. The Rural Health Care Improvement Act would address this 
disparity by increasing the rural hospital base payment amount to the 
level urban providers receive.
  I am happy to say that these improvements to Medicare's inpatient 
hospital reimbursement, combined with our rural health care efforts 
from last year, would significantly reduce the rural/urban payment gap 
by increasing rural providers' Medicare margins to approximately 11.8 
percent. In total, these changes would place our rural hospitals on 
much sounder financial footing.
  In addition to Medicare changes, the Rural Health Care Improvement 
Act would also establish three new rural health care programs.
  Our legislation would allow hospitals to apply for up to $5 million 
to help cover the cots of repairing crumbling buildings. It is my hope 
these resources will help strengthen the infrastructure of our nation's 
rural hospitals.
  In addition, our proposal would make $100,000 per facility available 
to help rural hospitals update or purchase new technology. Often, with 
limited budgets, rural hospitals cannot afford to buy quality, up-to-
date medical tools. This new program ensures rural citizens have access 
to modern and safe health care services.
  Third, our bill would provide funding to help establish Telehealth 
Resource Centers. Today, larger telehealth networks often work with 
fledgling networks to provide technical assistance. This grant program 
would provide new resources to support this collaboration and further 
expand telehealth services into the most remote, rural communities.
  Finally, the Rural Health Care Improvement Act also takes important 
steps to strengthen rural health clinics, RHCs. Today, there are more 
than 3,300 RHCs nationwide that provide health care to thousands of 
rural residents. However, while we recognize the importance of these 
clinics, we also know that more than 50 percent of RHCs are being 
significantly underpaid for their services, according to recent data. 
My bill addresses this funding shortfall by increasing rural health 
clinic payments by 25 percent.
  Thank you again to my Senate and House colleagues, as well as the 
organizations who worked with us, for your cooperation in developing 
this important health care proposal. It is my hope that this 
legislation will help to strengthen and sustain our nation's rural 
health care system.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:
       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Rural 
     Health Care Improvement Act of 2001''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                    TITLE I--RURAL MEDICARE REFORMS

Sec. 101. Medicare inpatient payment adjustment for low-volume 
              hospitals.
Sec. 102. Fairness in the medicare disproportionate share hospital 
              (DSH) adjustment for rural hospitals.
Sec. 103. Establishing a single standardized amount under the medicare 
              inpatient hospital PPS.
Sec. 104. Hospital geographic reclassification for labor costs for all 
              items and services reimbursed under medicare prospective 
              payment systems.
Sec. 105. Treatment of certain physician pathology services under 
              medicare.
Sec. 106. One-time opportunity of critical access hospitals to return 
              to the medicare inpatient hospital PPS.

TITLE II--RURAL GRANT AND LOAN PROGRAMS FOR INFRASTRUCTURE, TECHNOLOGY, 
                             AND TELEHEALTH

Sec. 201. Capital infrastructure revolving loan program.
Sec. 202. High technology acquisition grant and loan program.
Sec. 203. Establishment of telehealth resource centers.

              TITLE III--RURAL HEALTH CLINIC IMPROVEMENTS

Sec. 301. Improvement in rural health clinic reimbursement under 
              medicare.
Sec. 302. Exclusion of certain rural health clinic and Federally 
              qualified health center services from the medicare PPS 
              for skilled nursing facilities.

                    TITLE I--RURAL MEDICARE REFORMS

     SEC. 101. MEDICARE INPATIENT PAYMENT ADJUSTMENT FOR LOW-
                   VOLUME HOSPITALS.

       Section 1886(d) of the Social Security Act (42 U.S.C. 
     1395ww(d)) is amended by adding at the end the following new 
     paragraph:
       ``(12) Payment adjustment for low-volume hospitals.--

[[Page S6223]]

       ``(A) Payment adjustment.--
       ``(i) In general.--Notwithstanding any other provision of 
     this section, for each cost reporting period (beginning with 
     the cost reporting period that begins in fiscal year 2002), 
     the Secretary shall provide for an additional payment amount 
     to each low-volume hospital (as defined in clause (iii)) for 
     discharges occurring during that cost reporting period to 
     increase the amount paid to such hospital under this section 
     for such discharges by the applicable percentage increase 
     determined under clause (ii).
       ``(ii) Applicable percentage increase.--The Secretary shall 
     determine a percentage increase applicable under this 
     paragraph that ensures that--
       ``(I) no percentage increase in payments under this 
     paragraph exceeds 25 percent of the amount of payment that 
     would otherwise be made to a low-volume hospital under this 
     section for each discharge (but for this paragraph);
       ``(II) low-volume hospitals that have the lowest number of 
     discharges during a cost reporting period receive the highest 
     percentage increase in payments due to the application of 
     this paragraph; and
       ``(III) the percentage increase in payments due to the 
     application of this paragraph is reduced as the number of 
     discharges per cost reporting period increases.
       ``(iii) Low-volume hospital defined.--For purposes of this 
     paragraph, the term `low-volume hospital' means, for a cost 
     reporting period, a subsection (d) hospital (as defined in 
     paragraph (1)(B)) other than a critical access hospital (as 
     defined in section 1861(mm)(1)) that--
       ``(I) the Secretary determines--

       ``(aa) had an average of less than 800 discharges during 
     the 3 most recent cost reporting periods for which data are 
     available that precede the cost reporting period to which 
     this paragraph applies; and
       ``(bb) is located at least 15 miles from a similar 
     hospital; or

       ``(II) the Secretary deems meets the requirements of 
     subclause (I) by reason of such factors as the Secretary 
     determines appropriate, including the time required for an 
     individual to travel to the nearest alternative source of 
     appropriate inpatient care (taking into account the location 
     of such alternative source of inpatient care and any weather 
     or travel conditions that may affect such travel time).
       ``(B) Prohibiting certain reductions.--Notwithstanding 
     subsection (e), the Secretary shall not reduce the payment 
     amounts under this section to offset the increase in payments 
     resulting from the application of subparagraph (A).''.

     SEC. 102. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE 
                   HOSPITAL (DSH) ADJUSTMENT FOR RURAL HOSPITALS.

       (a) Equalizing DSH Payment Amounts.--
       (1) In general.--Section 1886(d)(5)(F)(vii) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(5)(F)(vii)) is amended by 
     inserting ``, and, after October 1, 2001, for any other 
     hospital described in clause (iv),'' after ``clause 
     (iv)(I)''.
       (2) Conforming amendments.--Section 1886(d)(5)(F) of such 
     Act (42 U.S.C. 1395ww(d)(5)(F)), as amended by section 211 of 
     the Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (114 Stat. 2763A-483), as enacted into 
     law by section 1(a)(6) of Public Law 106-554, is amended--
       (A) in clause (iv)--
       (i) in subclause (II), by inserting ``or, for discharges 
     occurring on or after October 1, 2001, is equal to the 
     percent determined in accordance with the applicable formula 
     described in clause (vii)'' after ``clause (xiii)'';
       (ii) in subclause (III), by inserting ``or, for discharges 
     occurring on or after October 1, 2001, is equal to the 
     percent determined in accordance with the applicable formula 
     described in clause (vii)'' after ``clause (xii)'';
       (iii) in subclause (IV), by inserting ``or, for discharges 
     occurring on or after October 1, 2001, is equal to the 
     percent determined in accordance with the applicable formula 
     described in clause (vii)'' after ``clause (x) or (xi)'';
       (iv) in subclause (V), by inserting ``or, for discharges 
     occurring on or after October 1, 2001, is equal to the 
     percent determined in accordance with the applicable formula 
     described in clause (vii)'' after ``clause (xi)''; and
       (v) in subclause (VI), by inserting ``or, for discharges 
     occurring on or after October 1, 2001, is equal to the 
     percent determined in accordance with the applicable formula 
     described in clause (vii)'' after ``clause (x)'';
       (B) in clause (viii), by striking ``The formula'' and 
     inserting ``For discharges occurring before October 1, 2001, 
     the formula''; and
       (C) in each of clauses (x), (xi), (xii), and (xiii), by 
     striking ``For purposes'' and inserting ``With respect to 
     discharges occurring before October 1, 2001, for purposes''.
       (b) Effective Date.--The amendments made by this section 
     shall apply with respect to discharges occurring on or after 
     October 1, 2001.

     SEC. 103. ESTABLISHING A SINGLE STANDARDIZED AMOUNT UNDER THE 
                   MEDICARE INPATIENT HOSPITAL PPS.

       (a) In General.--Section 1886(d)(3)(A) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(3)(A)) is amended--
       (1) in clause (iv), by inserting ``and ending on or before 
     September 30, 2001,'' after ``October 1, 1995,''; and
       (2) by redesignating clauses (v) and (vi) as clauses (vii) 
     and (viii), respectively, and inserting after clause (iv) the 
     following new clauses:
       ``(v) For discharges occurring in the fiscal year beginning 
     on October 1, 2001, the average standardized amount for 
     hospitals located in areas other than a large urban area 
     shall be equal to the average standardized amount for 
     hospitals located in a large urban area.
       ``(vi) For discharges occurring in a fiscal year beginning 
     on or after October 1, 2002, the Secretary shall compute an 
     average standardized amount for hospitals located in all 
     areas within the United States equal to the average 
     standardized amount computed under clause (v) or this clause 
     for the previous fiscal year increased by the applicable 
     percentage increase under subsection (b)(3)(B)(i) for the 
     fiscal year involved.''.
       (b) Conforming Amendments.--
       (1) Update factor.--Section 1886(b)(3)(B)(i)(XVII) of the 
     Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(i)(XVII)) is 
     amended by striking ``for hospitals in all areas,'' and 
     inserting ``for hospitals located in a large urban area,''.
       (2) Computing drg-specific rates.--
       (A) In general.--Section 1886(d)(3)(D) of such Act (42 
     U.S.C. 1395ww(d)(3)(D)) is amended--
       (i) in the heading, by striking ``in different areas'';
       (ii) in the matter preceding clause (i)--

       (I) by inserting ``, for fiscal years before fiscal year 
     1997,'' before ``a regional DRG prospective payment rate for 
     each region,''; and
       (II) by striking ``each of which is'';

       (iii) in clause (i)--

       (I) in the matter preceding subclause (I), by inserting 
     ``for fiscal years before fiscal year 2002,'' before ``for 
     hospitals''; and
       (II) in subclause (II), by striking ``and'' after the 
     semicolon at the end;

       (iv) in clause (ii)--

       (I) in the matter preceding subclause (I), by inserting 
     ``for fiscal years before fiscal year 2002,'' before ``for 
     hospitals''; and
       (II) in subclause (II), by striking the period at the end 
     and inserting ``; and''; and

       (v) by adding at the end the following new clause:
       ``(iii) for a fiscal year beginning after fiscal year 2001, 
     for hospitals located in all areas, to the product of--
       ``(I) the applicable average standardized amount (computed 
     under subparagraph (A)), reduced under subparagraph (B), and 
     adjusted or reduced under subparagraph (C) for the fiscal 
     year; and
       ``(II) the weighting factor (determined under paragraph 
     (4)(B)) for that diagnosis-related group.''.
       (B) Technical conforming sunset.--Section 1886(d)(3) of 
     such Act (42 U.S.C. 1395ww(d)(3)) is amended in the matter 
     preceding subparagraph (A), by inserting ``, for fiscal years 
     before fiscal year 1997,'' before ``a regional adjusted DRG 
     prospective payment rate''.

     SEC. 104. HOSPITAL GEOGRAPHIC RECLASSIFICATION FOR LABOR 
                   COSTS FOR ALL ITEMS AND SERVICES REIMBURSED 
                   UNDER MEDICARE PROSPECTIVE PAYMENT SYSTEMS.

       Section 1886(d)(10)(D) of the Social Security Act (42 
     U.S.C. 1395ww(d)(10)(D)), as amended by section 304(a) of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (114 Stat. 2763A-494), as enacted into 
     law by section 1(a)(6) of Public Law 106-554, is amended by 
     adding at the end the following new clause:
       ``(vii)(I) Any decision of the Board to reclassify a 
     subsection (d) hospital for purposes of the adjustment factor 
     described in subparagraph (C)(i)(II) for fiscal year 2001 or 
     any fiscal year thereafter shall apply for purposes of 
     adjusting payments for variations in costs that are 
     attributable to wages and wage-related costs for PPS-
     reimbursed items and services.
       ``(II) For purposes of subclause (I), the term `PPS-
     reimbursed items and services' means, for the fiscal year for 
     which the Board has made a decision described in such 
     subclause, each item and service for which payment is made 
     under this title on a prospective basis and adjusted for 
     variations in costs that are attributable to wages or wage-
     related costs that is furnished by the hospital to which such 
     decision applies, or by a provider-based entity or department 
     of that hospital (as determined by the Secretary).''.

     SEC. 105. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES 
                   UNDER MEDICARE.

       (a) In General.--Section 1848(i) of the Social Security Act 
     (42 U.S.C. 1395w-4(i)) is amended by adding at the end the 
     following new paragraph:
       ``(4) Treatment of certain physician pathology services.--
       ``(A) In general.--With respect to services furnished on or 
     after January 1, 2001, if an independent laboratory furnishes 
     the technical component of a physician pathology service to a 
     fee-for-service medicare beneficiary who is an inpatient or 
     outpatient of a covered hospital, the Secretary shall treat 
     such component as a service for which payment shall be made 
     to the laboratory under this section and not as an inpatient 
     hospital service for which payment is made to the hospital 
     under section 1886(d) or as a hospital outpatient service for 
     which payment is made to the hospital under section 1834(t).
       ``(B) Definitions.--In this paragraph:
       ``(i) Covered hospital.--

       ``(I) In general.--The term `covered hospital' means, with 
     respect to an inpatient or outpatient, a hospital that had an 
     arrangement with an independent laboratory that

[[Page S6224]]

     was in effect as of July 22, 1999, under which a laboratory 
     furnished the technical component of physician pathology 
     services to fee-for-service medicare beneficiaries who were 
     hospital inpatients or outpatients, respectively, and 
     submitted claims for payment for such component to a carrier 
     with a contract under section 1842 and not to the hospital.
       ``(II) Change in ownership does not affect determination.--
     A change in ownership with respect to a hospital on or after 
     the date referred to in subclause (I) shall not affect the 
     determination of whether such hospital is a covered hospital 
     for purposes of such subclause.

       ``(ii) Fee-for-service medicare beneficiary.--The term 
     `fee-for-service medicare beneficiary' means an individual 
     who is entitled to benefits under part A, or enrolled under 
     this part, or both, but who is not enrolled in any of the 
     following:

       ``(I) A Medicare+Choice plan under part C.
       ``(II) A plan offered by an eligible organization under 
     section 1876.
       ``(III) A program of all-inclusive care for the elderly 
     (PACE) under section 1894.
       ``(IV) A social health maintenance organization (SHMO) 
     demonstration project established under section 4018(b) of 
     the Omnibus Budget Reconciliation Act of 1987 (Public Law 
     100-203).''.

       (b) Conforming Amendment.--Section 542 of the Medicare, 
     Medicaid, and SCHIP Benefits Improvement and Protection Act 
     of 2000 (114 Stat. 2763A-550), as enacted into law by section 
     1(a)(6) of Public Law 106-554, is repealed.
       (c) Effective Dates.--The amendments made by this section 
     shall take effect as if included in the enactment of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (114 Stat. 2763A-463 et seq.), as 
     enacted into law by section 1(a)(6) of Public Law 106-554.

     SEC. 106. ONE-TIME OPPORTUNITY OF CRITICAL ACCESS HOSPITALS 
                   TO RETURN TO THE MEDICARE INPATIENT HOSPITAL 
                   PPS.

       (a) In General.--Notwithstanding section 1814(l) of the 
     Social Security Act (42 U.S.C. 1395f(l)), the Secretary of 
     Health and Human Services (in this section referred to as the 
     ``Secretary'') shall pay each critical access hospital having 
     an application approved under subsection (b)(2) under the 
     prospective payment system for inpatient hospital services 
     under section 1886(d) of such Act (42 U.S.C. 1395ww(d)) 
     rather than under such section 1814(l).
       (b) One-Time Application and Approval.--
       (1) Application.--Not later than the date that is 6 months 
     after the date of enactment of this Act, each eligible 
     critical access hospital (as defined in subsection (c)) that 
     desires to receive payment under the prospective payment 
     system for inpatient hospital services under section 1886(d) 
     of the Social Security Act (42 U.S.C. 1395ww(d)) instead of 
     receiving payment of the reasonable costs for such services 
     under section 1814(l) of such Act (42 U.S.C. 1395f(l)) shall 
     submit an application to the Secretary in such manner and 
     containing such information as the Secretary may require.
       (2) Approval.--Not later than the date that is 3 months 
     after the date on which the Secretary receives the 
     application submitted under paragraph (1), the Secretary 
     shall approve or deny the application.
       (c) Eligible Critical Access Hospital Defined.--In this 
     section, the term ``eligible critical access hospital'' means 
     a critical access hospital (as defined in section 1861(mm)(1) 
     of the Social Security Act (42 U.S.C. 1395x(mm)(1))) that 
     received payments under the prospective payment system for 
     inpatient hospital services under section 1886(d) of such Act 
     (42 U.S.C. 1395ww(d)) prior to its designation as a critical 
     access hospital under section 1820(c)(2) of such Act (42 
     U.S.C. 1395i-4(c)(2)).

TITLE II--RURAL GRANT AND LOAN PROGRAMS FOR INFRASTRUCTURE, TECHNOLOGY, 
                             AND TELEHEALTH

     SEC. 201. CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM.

       (a) In General.--Part A of title XVI of the Public Health 
     Service Act (42 U.S.C. 300q et seq.) is amended by adding at 
     the end the following new section:

            ``capital infrastructure revolving loan program

       ``Sec. 1603. (a) Authority To Make and Guarantee Loans.--
       ``(1) Authority to make loans.--The Secretary may make 
     loans from the fund established under section 1602(d) to any 
     rural entity for projects for capital improvements, 
     including--
       ``(A) the acquisition of land necessary for the capital 
     improvements;
       ``(B) the renovation or modernization of any building;
       ``(C) the acquisition or repair of fixed or major movable 
     equipment; and
       ``(D) such other project expenses as the Secretary 
     determines appropriate.
       ``(2) Authority to guarantee loans.--
       ``(A) In general.--The Secretary may guarantee the payment 
     of principal and interest for loans made to rural entities 
     for projects for any capital improvement described in 
     paragraph (1) to any non-Federal lender.
       ``(B) Interest subsidies.--In the case of a guarantee of 
     any loan made to a rural entity under subparagraph (A), the 
     Secretary may pay to the holder of such loan and for and on 
     behalf of the project for which the loan was made, amounts 
     sufficient to reduce by not more than 3 percent of the net 
     effective interest rate otherwise payable on such loan.
       ``(b) Amount of Loan.--The principal amount of a loan 
     directly made or guaranteed under subsection (a) for a 
     project for capital improvement may not exceed $5,000,000.
       ``(c) Funding Limitations.--
       ``(1) Government credit subsidy exposure.--The total of the 
     Government credit subsidy exposure under the Credit Reform 
     Act of 1990 scoring protocol with respect to the loans 
     outstanding at any time with respect to which guarantees have 
     been issued, or which have been directly made, under 
     subsection (a) may not exceed $50,000,000 per year.
       ``(2) Total amounts.--Subject to paragraph (1), the total 
     of the principal amount of all loans directly made or 
     guaranteed under subsection (a) may not exceed $250,000,000 
     per year.
       ``(d) Capital Assessment and Planning Grants.--
       ``(1) Nonrepayable grants.--Subject to paragraph (2), the 
     Secretary may make a grant to a rural entity, in an amount 
     not to exceed $50,000, for purposes of capital assessment and 
     business planning.
       ``(2) Limitation.--The cumulative total of grants awarded 
     under this subsection may not exceed $2,500,000 per year.
       ``(e) Termination of Authority.--The Secretary may not 
     directly make or guarantee any loan under subsection (a) or 
     make a grant under subsection (d) after September 30, 
     2006.''.
       (b) Rural Entity Defined.--Section 1624 of the Public 
     Health Service Act (42 U.S.C. 300s-3) is amended by adding at 
     the end the following new paragraph:
       ``(15)(A) The term `rural entity' includes--
       ``(i) a rural health clinic, as defined in section 
     1861(aa)(2) of the Social Security Act;
       ``(ii) any medical facility with at least 1, but less than 
     50 beds that is located in--
       ``(I) a county that is not part of a metropolitan 
     statistical area; or
       ``(II) a rural census tract of a metropolitan statistical 
     area (as determined under the most recent modification of the 
     Goldsmith Modification, originally published in the Federal 
     Register on February 27, 1992 (57 Fed. Reg. 6725));
       ``(iii) a hospital that is classified as a rural, regional, 
     or national referral center under section 1886(d)(5)(C) of 
     the Social Security Act; and
       ``(iv) a hospital that is a sole community hospital (as 
     defined in section 1886(d)(5)(D)(iii) of the Social Security 
     Act).
       ``(B) For purposes of subparagraph (A), the fact that a 
     clinic, facility, or hospital has been geographically 
     reclassified under the medicare program under title XVIII of 
     the Social Security Act shall not preclude a hospital from 
     being considered a rural entity under clause (i) or (ii) of 
     subparagraph (A).''.
       (c) Conforming Amendments.--Section 1602 of the Public 
     Health Service Act (42 U.S.C. 300q-2) is amended--
       (1) in subsection (b)(2)(D), by inserting ``or 
     1603(a)(2)(B)'' after ``1601(a)(2)(B)''; and
       (2) in subsection (d)--
       (A) in paragraph (1)(C), by striking ``section 
     1601(a)(2)(B)'' and inserting ``sections 1601(a)(2)(B) and 
     1603(a)(2)(B)''; and
       (B) in paragraph (2)(A), by inserting ``or 1603(a)(2)(B)'' 
     after ``1601(a)(2)(B)''.

     SEC. 202. HIGH TECHNOLOGY ACQUISITION GRANT AND LOAN PROGRAM.

       Subpart I of part D of title III of the Public Health 
     Service Act (42 U.S.C. 241 et seq.), as amended by section 
     1501 of the Children's Health Act of 2000 (Public Law 106-
     310; 114 Stat. 1146), is amended by adding at the end the 
     following section:

     ``SEC. 330I. HIGH TECHNOLOGY ACQUISITION GRANT AND LOAN 
                   PROGRAM.

       ``(a) Establishment of Program.--The Secretary, acting 
     through the Director of the Office of Rural Health Policy of 
     the Health Resources and Services Administration, shall 
     establish a high technology acquisition grant and loan 
     program for the purpose of--
       ``(1) improving the quality of health care in rural areas 
     through the acquisition of advanced medical technology;
       ``(2) fostering the development of the networks described 
     in section 330A;
       ``(3) promoting resource sharing between urban and rural 
     facilities; and
       ``(4) improving patient safety and outcomes through the 
     acquisition of high technology, including software, 
     information services, and staff training.
       ``(b) Grants and Loans.--Under the program established 
     under subsection (a), the Secretary, acting through the 
     Director of the Office of Rural Health Policy, may award 
     grants and make loans to any eligible entity (as defined in 
     subsection (d)(1)) for any costs incurred by the eligible 
     entity in acquiring eligible equipment and services (as 
     defined in subsection (d)(2)).
       ``(c) Limitations.--
       ``(1) In general.--Subject to paragraph (2), the total 
     amount of grants and loans made under this section to an 
     eligible entity may not exceed $100,000.
       ``(2) Federal sharing.--
       ``(A) Grants.--The amount of any grant awarded under this 
     section may not exceed 70 percent of the costs to the 
     eligible entity in acquiring eligible equipment and services.
       ``(B) Loans.--The amount of any loan made under this 
     section may not exceed 90 percent of the costs to the 
     eligible entity in acquiring eligible equipment and services.
       ``(d) Definitions.--In this section:

[[Page S6225]]

       ``(1) Eligible entity.--The term `eligible entity' means a 
     hospital, health center, or any other entity that the 
     Secretary determines is appropriate that is located in a 
     rural area or region.
       ``(2) Eligible equipment and services.--The term `eligible 
     equipment and services' includes--
       ``(A) unit dose distribution systems;
       ``(B) software, information services, and staff training;
       ``(C) wireless devices to transmit medical orders;
       ``(D) clinical health care informatics systems, including 
     bar code systems designed to avoid medication errors and 
     patient tracking systems;
       ``(E) telemedicine technology; and
       ``(F) any other technology that improves the quality of 
     health care provided in rural areas including systems to 
     improve privacy and address administrative simplification 
     needs.
       ``(e) Authorization of Appropriations.--For the purpose of 
     carrying out this section there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2002 through 2007.''.

     SEC. 203. ESTABLISHMENT OF TELEHEALTH RESOURCE CENTERS.

       Subpart I of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254b et seq.), as amended by section 
     202, is amended by adding at the end the following:

     ``SEC. 330J. TELEHEALTH RESOURCE CENTERS.

       ``(a) Program Authorized.--The Secretary, acting through 
     the Director of the Office for the Advancement of Telehealth 
     of the Health Resources and Services Administration, shall 
     award grants to eligible entities to establish telehealth 
     resource centers in accordance with this section.
       ``(b) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means a 
     public or nonprofit private entity.
       ``(2) Telehealth.--The term `telehealth' means the use of 
     electronic information and telecommunications technologies to 
     support long-distance clinical health care, patient and 
     professional health-related education, public health, and 
     health administration.
       ``(c) Amount.--Each entity that receives a grant under 
     subsection (a) shall receive an amount not to exceed 
     $1,500,000.
       ``(d) Equitable Distribution.--In awarding grants under 
     subsection (a), the Secretary shall ensure, to the greatest 
     extent possible, that such grants are equitably distributed 
     among the geographical regions of the United States.
       ``(e) Preference.--In awarding grants under subsection (a), 
     the Secretary shall give preference to eligible entities that 
     have a demonstrated record of providing or supporting the 
     provision of health care services for populations in rural 
     areas.
       ``(f) Use of Funds.--An entity that receives a grant under 
     subsection (a) shall use funds from such grant to establish a 
     telehealth resource center that shall--
       ``(1) provide technical assistance, training, and support 
     to health care providers and a range of health care entities 
     that provide or will provide telehealth services for a 
     medically underserved community, including hospitals, 
     ambulatory care entities, long-term care facilities, public 
     health clinics, and schools;
       ``(2) provide for the dissemination of information and 
     research findings related to the use of telehealth 
     technologies;
       ``(3) provide for the dissemination of information 
     regarding the latest developments in health care;
       ``(4) conduct evaluations to determine the best application 
     of telehealth technologies to meet the health care needs of 
     the medically underserved community;
       ``(5) promote the integration of clinical information 
     systems with other telehealth technologies;
       ``(6) foster the use of telehealth technologies to provide 
     health care information and education for health care 
     professionals and consumers in a more effective manner; and
       ``(7) provide timely and appropriate evaluations to the 
     Office for the Advancement of Telehealth on lessons learned 
     and best telehealth practices in any areas served.
       ``(g) Collaboration.--In providing the services described 
     in subsection (f)(5), such entity shall collaborate, if 
     feasible, with private and public organizations and centers 
     or programs that receive Federal assistance and provide 
     telehealth services.
       ``(h) Application.--An entity that desires a grant under 
     subsection (a) shall submit an application to the Secretary 
     at such time, in such manner, and containing such information 
     as the Secretary may require, including--
       ``(1) a description of the manner in which the entity shall 
     establish and administer a telehealth resource center to meet 
     the requirements of this subsection; and
       ``(2) a description of the manner in which the activities 
     carried out by such center will meet the health care needs of 
     individuals in rural communities.
       ``(i) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall submit to the 
     appropriate committees of Congress a report on each activity 
     funded with a grant under this section.
       ``(j) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section--
       ``(1) for fiscal year 2002, $30,000,000; and
       ``(2) for fiscal years 2003 through 2008, such sums as may 
     be necessary.''.

              TITLE III--RURAL HEALTH CLINIC IMPROVEMENTS

     SEC. 301. IMPROVEMENT IN RURAL HEALTH CLINIC REIMBURSEMENT 
                   UNDER MEDICARE.

       Section 1833(f) of the Social Security Act (42 U.S.C. 
     1395l(f)) is amended--
       (1) in paragraph (1), by striking ``, and'' at the end and 
     inserting a semicolon;
       (2) in paragraph (2)--
       (A) by striking ``in a subsequent year'' and inserting ``in 
     1989 through 2001''; and
       (B) by striking the period at the end and inserting a 
     semicolon; and
       (3) by adding at the end the following new paragraphs:
       ``(3) in 2002, at $79 per visit; and
       ``(4) in a subsequent year, at the limit established under 
     this subsection for the previous year increased by the 
     percentage increase in the MEI (as so defined) applicable to 
     primary care services (as so defined) furnished as of the 
     first day of that year.''.

     SEC. 302. EXCLUSION OF CERTAIN RURAL HEALTH CLINIC AND 
                   FEDERALLY QUALIFIED HEALTH CENTER SERVICES FROM 
                   THE MEDICARE PPS FOR SKILLED NURSING 
                   FACILITIES.

       (a) In General.--Section 1888(e) of the Social Security Act 
     (42 U.S.C. 1395yy(e)) is amended--
       (1) in paragraph (2)(A)(i)(II), by striking ``clauses (ii) 
     and (iii)'' and inserting ``clauses (ii), (iii), and (iv)''; 
     and
       (2) by adding at the end of paragraph (2)(A) the following 
     new clause:
       ``(iv) Exclusion of certain rural health clinic and 
     federally qualified health center services.--Services 
     described in this clause are--

       ``(I) rural health clinic services (as defined in paragraph 
     (1) of section 1861(aa)); and
       ``(II) Federally qualified health center services (as 
     defined in paragraph (3) of such section);

     that would be described in clause (ii) if such services were 
     not furnished by an individual affiliated with a rural health 
     clinic or a Federally qualified health center.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to services furnished on or after January 1, 
     2002.

  Mr. THOMAS. Mr. President, I am pleased to rise today to introduce 
the Rural Health Care Improvement Act of 2001 with Senator Conrad and 
fellow Senate Rural Health Caucus members Senators Roberts, Johnson, 
Helms, Dorgan, Domenici, Daschle, Crapo, Bingaman, Bond, Lincoln, 
Cochran, Wellstone, Burns, Rockefeller, Hutchinson, Edwards, Harkin, 
and Jeffords. As always, it is important to note that rural health care 
legislation has a long history of bipartisan collaboration and 
cooperation.
  I want to thank the National Rural Health Association, the Federation 
of American Hospitals, the National Association of Rural Health 
Clinics, the American Hospital Association and the College of American 
Pathologists for their work and support in this effort.
  The Rural Health Care Improvement Act of 2001 will go a long way in 
addressing current inequities in the Medicare payment system that 
continually place rural providers at a disadvantage. This legislation 
recognizes the unique needs of rural hospitals and levels the playing 
field between rural and urban providers.
  First, the bill equalizes Medicare Disproportionate Share Hospital, 
DSH, payments. These add-on payments help hospitals cover the costs of 
serving a high proportion of low-income and uninsured patients. While 
urban facilities can receive unlimited add-ons corresponding with the 
amount of these types of patients served, rural add-on payments are 
capped at 5.25 percent. The ``Rural Health Care Improvement Act of 
2001'' eliminates the rural hospital cap, bringing their payments in 
line with the benefits urban facilities receive.
  Second, this legislation closes the gap between urban and rural 
``standardized payment'' levels. Inpatient hospital payments are 
calculated by multiplying several different factors, including a 
standardized payment amount. Under current law, hospitals located in 
cities with a population over 1 million receive a base payment amount 
1.3 percent higher than those serving smaller populations, $4,130 vs. 
$4,197. This disparity is corrected in our bill by bringing the rural 
base payment up to the urban payment level.
  Third, the bill recognizes that low-volume hospitals have a higher 
cost per case, which results in negative operating margins. To address 
this problem, the Rural Health Care Improvement Act of 2001 establishes 
a low-volume inpatient payment adjustment for hospitals that have less 
than 800 annual discharges per year and are located more than 15 miles 
from another

[[Page S6226]]

hospital. This provision will improve payments for approximately 900 
rural facilities nationwide, which is just over one-third of all rural 
hospitals.
  In addition to these Medicare payment reforms, this legislation 
strengthens the over 3,000 rural health clinics that serve many rural 
Americans. Under current law, rural health clinics receive an all-
inclusive payment rate that is capped at approximately $63. This 
payment has not been adjusted, except for inflation, since 1988. To 
recognize the rising costs of health care this bill raises the rural 
health clinic cap to $79.
  Certain provider services, such as those offered by physicians, nurse 
practitioners, physician assistants, and qualified psychologists are 
excluded from the consolidated payments made to skilled nursing 
facilities, SNFs, under the prospective payment system. However, the 
same services provided to SNFs by physicians and other providers 
employed by rural health clinics and federally qualified health centers 
are not excluded from the consolidated SNF payment. This bill includes 
a provision that ensures skilled nursing services, offered by rural 
health clinic and qualified health center providers, will receive the 
same payment treatment as services offered by providers employed in 
other settings.
  It is time for the Federal Government to recognize that the ``one 
payment system does not fit all.'' Rural providers care for patients 
under different circumstances than their urban counterparts and the 
Rural Health Care Improvement Act of 2001 ensures that rural hospitals, 
rural health clinics and qualified health centers are paid accurately 
and fairly. I strongly encourage all my colleagues with an interest in 
rural health to cosponsor this legislation.
  Mr. BURNS. Mr. President, I rise today to detail my support of the 
Rural Health Care Improvement Act of 2001, which was introduced today 
by Senator Conrad and is cosponsored by myself and a number of my 
colleagues from rural States across this Nation.
  The Rural Health Care Improvement Act of 2001 will increase payments 
for low-volume hospitals, equalize Medicare Disproportionate Share, 
DSH, payments, close the gap between urban and rural ``standardized 
payment'' levels, streamline wage index re-classification, ensure rural 
communities access to independent lab services, provide grant and loan 
programs for infrastructure and technology improvement projects, and 
strengthen rural health clinics.
  Those of us from rural and frontier areas recognize that rural health 
care is in a state of crisis. Through mismanagement of Medicare 
reimbursement policies and an unwillingness to truly evaluate the 
obstacles inherent in providing quality health care in rural areas, we 
have allowed rural health care to reach the brink of complete 
breakdown. The Rural Health Care Improvement Act of 2001 will go a long 
way towards rectifying this dire situation.
  The investments through the Rural Health Care Improvement Act of 2001 
will address the kernel problem of health care in America. Next week 
the Senate will engage in a healthy debate about patients' rights 
legislation and it is likely that Congress will tackle Medicare reform 
within the near future as well. These arguments will be academic for 
many of my constituents if rural hospitals, clinics, and other 
providers across my State can no longer afford to serve their 
communities.
  By passing the Rural Health Care Improvement Act of 2001, we can 
defuse the time bomb which is rural America's health care crisis. I 
urge each of my colleagues to consider this legislation carefully and 
hope for its prompt passage.
                                 ______
                                 
      By Mr. FRIST (for himself, Mr. Kerry, Mr. Helms, Mr. Leahy, Mr. 
        Durbin, and Mr. Chafee):
  S. 1032. A bill to expand assistance to countries seriously affected 
by HIV/AIDS, malaria, and tuberculosis; to the Committee on Foreign 
Relations.
  Mr. FRIST. Mr. President, I have spoken several times over the last 
few months on what many consider to be the most pressing moral, 
humanitarian and public health crisis of modern times, the worldwide 
epidemic of HIV/AIDS. I have previously gone into great detail about 
the impact of the disease on families, communities, economies, and 
regional stability.
  Sometimes we feel overwhelmed by the enormity of insolvable problems. 
We become inured to the tragedy, and look for problems we can more 
easily solve. But we must not turn away from the world-wide devastation 
of HIV/AIDS. Just consider this: right now, 36 million people are 
infected with HIV/AIDS a fatal infectious disease, mostly in developing 
countries. That number is more than the total combined populations of 
Virginia, Massachusetts, Tennessee, Maryland, Kentucky, Connecticut, 
New Mexico, Vermont and Nebraska. As of today, AIDS have orphaned 13 
million children, more than the entire population of Illinois.
  Compounding this burden, over 8 million people acquire tuberculosis 
each year, and 500 million more get malaria, both diseases that 
disproportionately affect the poorest countries. Frequently forgotten, 
malaria still kills a child every 40 seconds. Remember the horrific 
links between HIV/AIDS, TB and malaria. If you have AIDS you are much 
more likely to contract TB, and TB has become the greatest killer of 
those with AIDS. Similarly, if a person with HIV/AIDS contracts 
malaria, that person is more likely to die. And infectious diseases 
such as these cause 25 percent of all the deaths in the world today. 
But as Americans, we have many reasons to be proud of our response to 
the challenges.
  The U.S. has been a leader in the global battles against AIDS, 
malaria and TB. This year, we are spending over $460 million on 
international AIDS assistance alone, not including research. This is 
approximately half of all the funds being spent on HIV/AIDS from all 
sources worldwide. In addition, we spend over $250 million on 
international TB and malaria programs. But we, and the rest of the 
world, must do more. The U.N. estimates that for basic HIV/AIDS 
prevention, treatment and care programs in Africa alone, over $3 
billion will be required, and at least $5 billion needed if specific 
anti-AIDS drugs are more widely used.
  In Abuja, Nigeria, on April 26, U.N. Secretary General Kofi Annan 
called for a global ``war chest'' to combat HIV/AIDS, malaria and TB. 
Few thought that his call would so quickly be answered.
  On May 11, just 2 weeks later, Senator Leahy and I joined Secretary 
General Kofi Annan and Nigerian President Obasanjo as President Bush 
announced his intent to contribute $200 million as seed money for a new 
global fund designed to provide grants for prevention, infrastructure 
development, care and treatment for AIDS, malaria and TB. And this is 
to be over and above our already substantial bilateral commitments.
  Uniquely, it will be financed jointly by governments and the private 
sector, and will focus on integrated approaches to turning back, and 
eventually conquering these scourges. While emphasizing prevention, 
this new initiative will also seek to develop health infrastructures so 
necessary to deliver services. Importantly, it will also support 
science-based care and treatment programs, including provision of 
drugs, and support for those, such as orphans, who are affected by 
disease, not just infected by it.
  And because of recent action by the pharmaceutical companies to slash 
prices of AIDS drugs in Africa, for the first time in history, the 
drugs that revolutionized AIDS care and treatment in the U.S. can 
become part of a comprehensive prevention and care strategy in many 
more countries. This global fund is a new idea, it isn't a U.S. fund, 
or a U.N. fund, or a World Bank fund. However, it builds on last year's 
landmark work and legislation spearheaded by Congressman Jim Leach, 
Congresswoman Barbara Lee, and Senator John Kerry to establish a 
multilateral funding mechanism for HIV/AIDS.
  A key component of the Global Fund will be the full participation of 
the private sector, including business, NGOs, foundations and 
individual citizens. The problem is so large that governments cannot do 
the work alone. Non-governmental organizations, both faith-based and 
secular will be critical in the delivery of prevention and care 
services and to quickly converting good intentions into practical 
programs on the ground. And use of the funds will be closely monitored 
to ensure that good public health and

[[Page S6227]]

science drive the programs and intellectual property rights are 
protected.
  The legislation Senators Kerry, Helms, Leahy, Durbin, and I are 
introducing today authorizes $200 million for fiscal year 2002, and 
$500 million for fiscal year 2003 to be appropriated for payment to the 
global trust fund. It will not substitute for, or reduce, resource 
levels otherwise appropriated for our excellent bilateral and 
multilateral HIV/AIDS, malaria and TB programs. This will be money well 
spent, it will save lives, and just as important, it will provide hope 
to the millions of people around the world who can do so much if given 
the prospect of a healthy future for themselves and their children.
  Since the President was the first to announce our participation in 
the Global Fund for HIV/AIDS and Other Infectious Diseases, others have 
stepped up. France announced an initial contribution of $128 million, 
the United Kingdom has promised $106 million, and Japan is considering 
a significant commitment in the near future. Of particular interest, 
Winterthur- Credit Swisse has just announced a $1 million contribution, 
and others in the global business community are expected to follow. 
Other companies and foundations are considering financial or in-kind 
contributions.
  Kofi Annan himself has offered $100,000 of his own money for the 
fund. I have also been told by U.N. Staff in New York that they have 
received many calls from private citizens asking how they can 
contribute. One gentleman from Virginia wants to send a check for $600. 
I have been assured that he and others like him will not have long to 
wait. A tax-exempt account for donations and toll-free number for 
information are being created as I speak. I understand that 
negotiations are underway with United Way to see if it can use its vast 
outreach to encourage donations. This is terrific news.
  Every American, and others throughout the world, should join this 
fight against the diseases that have too long threatened our children, 
destroyed families, and undermined economic development of dozens of 
nations. This is not just government's fight. It is all of our 
responsibility to conquer HIV/AIDS, malaria and TB and consign them to 
the waste-bin of history.
  Last week I had the opportunity of meeting with a remarkable woman 
from Atlanta who contracted HIV/AIDS at age 16. Denise Stokes has 
struggled with the virus for 15 years. She described what it was like 
spending time in hospital intensive care units and what it was like to 
not have access to available drugs. She prayed that some day there 
would be a cure and watched, from the depth of her illness, as 
policymakers seemed unable to grapple with the public health and 
personal tragedy that was AIDS. She is now sharing her experiences with 
churches, college students, community and professional organizations--
challenging us to follow her example--to embrace our moral obligation 
to reach out beyond our selves, our communities and beyond our own 
country borders to fully battle the infectious diseases that are 
destroying so many lives on our planet. Denise Stokes' message is one 
of rising to a challenge, and bringing hope to the sick and their loved 
ones. All America must rise to this historic challenge and join in 
sending a message of hope.
                                 ______
                                 
      By Ms. STABENOW (for herself, Mr. Fitzgerald, Mr. Levin, Mr. 
        Kohl, Mr. Feingold, Mr. Dayton, Mrs. Boxer, Mrs. Clinton, Mr. 
        Durbin, Mr. Corzine, Mr. Wellstone, Mr. Bayh, and Mr. Chafee):
  S. 1033. A bill to amend the Federal Water Pollution Control Act to 
protect \1/5\ of the world's fresh water supply by directing the 
Administrator of the Environmental Protection Agency to conduct a study 
on the known and potential environmental effects of oil and gas 
drilling on land beneath the water in the Great Lakes, and for other 
purposes, to the Committee on Environment and Public Works.
                                 ______
                                 
      By Ms. STABENOW (for herself, Mr. Fitzgerald, Mr. Levin, Mr. 
        Kohl, Mr. Feingold, Mr. Durbin, Mr. Dayton, Mr. Wellstone, Mr. 
        DeWine, Mr. Voinovich, Mr. Schumer, Mr. Bayh, and Mrs. 
        Clinton):
  S. 1034. A bill to amend the Nonindigenous Aquatic Nuisance 
Prevention and Control Act of 1990 to require the Secretary of 
Transportation to promulgate and review regulations to ensure, to the 
maximum extent practicable, that vessels entering the Great Lakes do 
not spread nonindigenous aquatic species, to require treatment of 
ballast water and its sediments through the most effective and 
efficient techniques available, and for other purposes; to the 
Committee on Commerce, Science, and Transportation.
                                 ______
                                 
      By Ms. STABENOW (for herself, Mr. Fitzgerald, Mr. Levin, Mr. 
        Kohl, Mr. Feingold, Mr. Dayton, Mr. Schumer, Mr. Bayh, and Mrs. 
        Clinton):
  S. 1035. A bill to establish programs to protect the resources of and 
areas surrounding the Great Lakes; to the Committee on Banking, 
Housing, and Urban Affairs.
  Ms. STABENOW. Mr. President, I rise today to introduce three bills 
called the Great Lakes Initiative which are designed to protect the 
five Great Lakes.
  The Great Lakes are one of our Nation's most precious natural 
resources. They contain one-fifth of the world's fresh water supply and 
provide safe drinking water to millions of people every day.
  The Great Lakes also play a vital role in the economies of the Great 
Lakes States, including recreation, tourism, commercial shipping, 
industrial and agriculture. That is why I am introducing legislation 
today to protect this vital resource for the use, benefit, and 
enjoyment of present and future generations of Americans.
  Three bills make up this new Great Lakes Initiative: (1) the Great 
Lakes Water Protection Act; (2) the Great Lakes Ecology Protection Act; 
and (3) the Great Lakes Preservation Act.
  The first bill, the Great Lakes Water Protection Act, would protect 
the Great Lakes from environmentally dangerous oil and gas drilling. I 
am pleased that this bill has strong bipartisan support in both the 
House and the Senate, with Senators Fitzgerald, Levin, Chafee, Kohl, 
Feingold, Dayton, Clinton, Durbin, Wellstone, Bayh, Corzine, and Boxer 
as original cosponsors.
  The Great Lakes support many fragile coastlines and wetlands. Lake 
Michigan alone contains over 417 coastal wetlands, the most of any 
Great Lake. These shorelines are also home to many rare and endangered 
plant and wildlife species, including the rare piping plover, Michigan 
monkey flower, Pitcher's thistle, and the dwarf lake iris.
  The Great Lakes also play a vital role in the economies of the Great 
Lakes States. In particular, coastal communities rely heavily on the 
Great Lake's resources and natural beauty to support tourism and 
recreation activities. The most recent estimate shows that recreational 
fishing totaled $1.5 billion in expenditures in Michigan alone.
  Drilling in the Great Lakes could expose our valuable fresh water 
supply to serious contamination, cause serious environmental damage to 
the water and shoreline of the Great Lakes, and have crippling effects 
on Great Lakes communities that depend on tourism and recreation for 
their local economies. The Great Lakes Water Protection Act would 
prohibit new oil and gas drilling in the Great Lakes.
  During the ban, the Environmental Protection Agency and National 
Academy of Sciences would conduct a two-year study examining the 
impacts on drilling on the environment, public health, the water 
supply, and local economies. Once the study is completed, Congress can 
analyze the results of the study and lift the ban on oil and gas 
drilling if it deems appropriate.
  This bill would also provide $50 million per year for park and 
shoreline conservation to the Great Lakes States to offset any lost oil 
royalty revenues during the ban on drilling.
  The second bill, Great Lakes Ecology Protection Act, seeks to curb 
the influx of invasive species into the Great Lakes. I am pleased that 
this bill also has strong bipartisan support with Senators Fitzgerald, 
Levin, Voinovich, Kohl, Feingold, Durbin, DeWine, Dayton, Wellstone, 
Schumer, and Bayh as original cosponsors. The bill would

[[Page S6228]]

try to stop the importation of invasive species by prohibiting ballast 
water discharges in the Great Lakes and requiring sophisticated 
sterilization of ballast water tanks as well. This is based on a 
bipartisan bill in the House introduced by Congressman Hoekstra and 
Congressman Barcia.
  Invasive species have already damaged the Great Lakes in a number of 
ways. They have destroyed thousands of fish and threatened clean 
drinking water.
  For example, Lake Michigan once housed the largest self-reproducing 
lake trout fishery in the entire world. The invasive sea lamprey, which 
was introduced from ballast water almost 80 years ago, has contributed 
greatly to the decline of trout and whitefish in the Great Lakes by 
feeding on and killing native trout species.
  Today, lake trout must be stocked because they cannot naturally 
reproduce in the lake. Many Great Lakes States have had to place severe 
restrictions on catching yellow perch because invasive species such as 
the zebra mussel disrupt the Great Lakes' ecosystem and compete with 
yellow perch for food. The zebra mussel's filtration also increases 
water clarity, which may be making it easier for predators to prey upon 
the yellow perch. Moreover, tiny organisms like zooplankton that help 
form the base of the Great Lakes food chain, have declined due to 
consumption by exploding populations of zebra mussels.
  The Great Lakes Ecology Protection Act would ban ballast water 
discharges in the Great Lakes. The bill would require ships to 
discharge ballast water and sterilize the ballast water tanks before 
entering the Great Lakes to prevent the introduction of any non-
indigenous species. The act also would significantly increase funding 
for invasive species research and ballast water technology, by 
providing $100 million in research grants over the next five years.
  The research grants would encourage collaboration between the 
colleges and universities, and the shipping industry to help develop 
new and better ballast water purification technologies.
  The third bill, the Great Lakes Preservation Act, would ban dangerous 
bulk water diversions while the Great Lakes Compact makes 
recommendations on how specifically to implement appropriate governing 
standards. This bill also has strong bipartisan support with Senators 
Fitzgerald, Levin, Kohl, Feingold, Dayton, Schumer, and Bayh as 
original co-sponsors.
  Bulk water diversion could become a serious threat to the fresh water 
supplies of the Great Lakes in the future. We must stop this in our 
countries and negotiate with Canada to do the same.
  Global water demand is doubling every 21 years, while only 1 percent 
of the water in the Great Lakes is renewed each year by precipitation 
or runoff. At the same time, scientists predict that by the end of the 
century, Great Lakes water levels could decline by 1.5 to 8 feet due to 
increased evaporation; and within the next three decades we may see a 
decline by as much as 3 feet. This of course is in addition to the 
historic fluctuations in lake levels that can vary by as much as 6.5 
feet.
  The bill also would help provide new funding sources to preserve and 
restore historic Great Lakes lighthouses. Great Lakes lighthouses have 
helped mariners navigate the Great Lakes and find safe harbors for 
decades, and are an important part of the maritime history of the Great 
Lakes. Many of these lighthouses have historical or architectural 
significance, but are unfortunately in poor condition because of 
neglect and deterioration.
  The Act would help find new funding sources to preserve the 
lighthouses by directing the National Park Service to Study the Great 
Lakes lighthouses and recommend the best course of action for 
preserving and restoring the lighthouses.
  The Great Lakes are a precious natural resource not just to their 
neighboring States, but to the entire country. I urge my Senate 
colleagues to join me and protect this vital resource for the use, 
benefit, and enjoyment of present and future generations of Americans.
  I ask unanimous consent that the text of the bills be printed in the 
Record.
  There being no objection, the bills were ordered to be printed in the 
Record, as follows:

                                S. 1033

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Great Lakes Water Protection 
     Act''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) the Great Lakes contain \1/5\ of the world's fresh 
     water supply;
       (2) the Great Lakes basin is home to over 33,000,000 people 
     and is a vital source of safe drinking water for millions of 
     people;
       (3) the Great Lakes support many wetlands, sand dunes, and 
     other fragile coastal habitats;
       (4) those coastal habitats are home to many endangered and 
     threatened wildlife and plant species, including the piping 
     plover, Pitcher's thistle, and the dwarf lake iris;
       (5) the Great Lakes are crucial to the economies of the 
     Great Lakes States for recreation, commercial shipping, and 
     industrial and agriculture uses; and
       (6) oil and gas development beneath the water in any of the 
     Great Lakes could--
       (A) expose a valuable fresh water supply of the United 
     States to serious contamination; and
       (B) cause serious environmental damage to the water and 
     shoreline of the Great Lakes.

     SEC. 3. EFFECTS OF OIL AND GAS DEVELOPMENT ON THE GREAT 
                   LAKES.

       The Federal Water Pollution Control Act is amended by 
     inserting after section 108 (33 U.S.C. 1258) the following:

     ``SEC. 108A. EFFECTS OF OIL AND GAS DEVELOPMENT ON THE GREAT 
                   LAKES.

       ``(a) Definitions.--In this section:
       ``(1) Academy.--The term `Academy' means the National 
     Academy of Sciences.
       ``(2) Drilling activity.--
       ``(A) In general.--The term `drilling activity' means any 
     drilling to extract oil or gas from land beneath the water in 
     any of the Great Lakes.
       ``(B) Inclusions.--The term `drilling activity' includes--
       ``(i) directional drilling (also known as `slant 
     drilling'); and
       ``(ii) offshore drilling.
       ``(3) Great lake.--The term `Great Lake' means--
       ``(A) Lake Erie;
       ``(B) Lake Huron (including Lake Saint Clair);
       ``(C) Lake Michigan;
       ``(D) Lake Ontario (including the Saint Lawrence River from 
     Lake Ontario to the 45th parallel of latitude); and
       ``(E) Lake Superior.
       ``(4) Great lakes state.--The term `Great Lakes State' 
     means each of the States of Illinois, Indiana, Michigan, 
     Minnesota, New York, Ohio, Pennsylvania, and Wisconsin.
       ``(b) Incentives To Prevent Drilling Activity.--
       ``(1) In general.--To be eligible to receive an incentive 
     grant under paragraph (2), a grant under section 601(a), or a 
     grant under section 1452 of the Safe Drinking Water Act (42 
     U.S.C. 300j-12), a Great Lakes State shall not issue any oil 
     or gas permit or lease for drilling activity.
       ``(2) Incentive grants.--
       ``(A) In general.--For each fiscal year or portion of a 
     fiscal year in which paragraph (1) is in effect, the 
     Secretary of the Interior shall make grants to Great Lakes 
     States.
       ``(B) Use of grants.--A Great Lakes State shall use a grant 
     under this paragraph to carry out conservation activities in 
     the State, including activities to conserve parkland and 
     protect shores.
       ``(C) Amount of grants.--For each fiscal year or portion of 
     a fiscal year, the amount of a grant to a Great Lakes State 
     under subparagraph (A) shall be equal to the product obtained 
     by multiplying--
       ``(i) the amount available for grants under this paragraph 
     for the fiscal year or portion of a fiscal year; and
       ``(ii) the ratio that--

       ``(I) the amount of funds that the Great Lakes State would 
     have received, but for paragraph (1), from the sale of oil 
     and gas from the Great Lakes during the fiscal year; bears to
       ``(II) the amount of funds that all Great Lakes States 
     would have received, but for paragraph (1), from the sale of 
     oil and gas from the Great Lakes during the fiscal year.

       ``(D) Maximum amount of grants.--For each fiscal year, the 
     Secretary of the Interior may make grants under this 
     paragraph in an aggregate amount not to exceed $50,000,000.
       ``(c) Study.--
       ``(1) In general.--Not later than 1 year after the date of 
     enactment of this section, the Administrator shall conduct a 
     study to examine the known and potential environmental 
     effects of drilling activity, including any effects on--
       ``(A) water quality (including the quality of drinking 
     water);
       ``(B) the sediments and shorelines of the Great Lakes;
       ``(C) fish and other aquatic species, plants, and wildlife 
     that are dependent on Great Lakes resources;
       ``(D) competing uses of water and shoreline areas of the 
     Great Lakes; and
       ``(E) public health of local communities.
       ``(2) Consultation.--In designing and conducting the study, 
     the Administrator shall consult with--

[[Page S6229]]

       ``(A) the Secretary of Energy;
       ``(B) the Administrator of the National Oceanic and 
     Atmospheric Administration;
       ``(C) the Chief of Engineers;
       ``(D) the Great Lakes States; and
       ``(E) as appropriate, representatives of environmental, 
     industry, academic, scientific, public health, and other 
     relevant organizations.
       ``(3) Independent review.--Not later than 180 days after 
     the date of enactment of this section, the Administrator 
     shall enter into an agreement with the Academy under which 
     the Administrator shall submit to the Academy, and the 
     Academy shall review, the results of the study.
       ``(4) Report.--Not later than 1 year after the date of 
     submission to the Academy of the study under paragraph (3), 
     the Academy shall submit to the Administrator and Congress--
       ``(A) the study; and
       ``(B) a report that describes the results of the review by 
     the Academy (including any recommendations concerning the 
     results of the study).
       ``(5) Action by congress.--It is the sense of Congress 
     that, after receiving the study and report under paragraph 
     (4), Congress should--
       ``(A) review the study and report;
       ``(B) conduct hearings concerning the impact of drilling 
     activity; and
       ``(C) determine whether to eliminate the condition under 
     subsection (b)(1).
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as are necessary to 
     carry out this section.''.
                                  ____


                                S. 1034

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Great Lakes Ecology 
     Protection Act''.

     SEC. 2. BALLAST WATER TREATMENT REGULATIONS.

       (a) In General.--Section 1101(b) of the Nonindigenous 
     Aquatic Nuisance Prevention and Control Act of 1990 (16 
     U.S.C. 4711(b)) is amended--
       (1) by redesignating paragraph (4) as paragraph (5); and
       (2) by striking ``(3) Additional regulations.--In 
     addition'' and inserting the following:
       ``(3) Regulations concerning aquatic nuisance species.--
       ``(A) In general.--The Secretary of Transportation shall, 
     in consultation with the Secretary of the Interior, the 
     Secretary of Commerce, the Secretary of Defense, the 
     Administrator of the Environmental Protection Agency, the 
     Governors of States that border the Great Lakes, and in 
     accordance with this paragraph, promulgate and review 
     regulations to prevent, to the maximum extent practicable, 
     the introduction and spread of aquatic nuisance species in 
     the Great Lakes.
       ``(B) Contents of regulations.--The regulations promulgated 
     under subparagraph (A)--
       ``(i) shall apply to all vessels capable of discharging 
     ballast water (including vessels equipped with ballast water 
     tank systems or other water tank systems) that enter the 
     Great Lakes after operating on water outside of the Exclusive 
     Economic Zone;
       ``(ii) shall ensure, to the maximum extent practicable, 
     that ballast water containing aquatic nuisance species is not 
     discharged into the Great Lakes (including by establishing 
     the standard described in clause (iii));
       ``(iii) shall include a ballast water treatment standard 
     for vessels that elect to carry out ballast water management 
     or treatment that, at a minimum, requires--

       ``(I) a demonstrated 95 percent volumetric exchange of 
     ballast water; or
       ``(II) a ballast treatment that destroys not less than 95 
     percent of all animal fauna in a standard ballast water 
     intake, as approved by the Secretary;

       ``(iv) shall protect the safety of each vessel (including 
     crew and passengers);
       ``(v) shall include requirements on new vessel construction 
     to ensure that vessels entering service after January 1, 
     2005, minimize the transfer of organisms;
       ``(vi) shall require vessels to carry out any discharge or 
     exchange of ballast water within the Great Lakes only in 
     compliance with the regulations;
       ``(vii) shall be promulgated after taking into 
     consideration a range of vessel operating conditions, from 
     normal to extreme;
       ``(viii) shall--

       ``(I) ensure that technologies and practices implemented 
     under this section are environmentally sound treatment 
     methods for ballast water and ballast sediments that prevent 
     and control infestations of aquatic nuisance species; and
       ``(II) include a detailed timetable for--

       ``(aa) the implementation of treatment methods determined 
     to be technologically available and cost-effective at the 
     time of the publication of the notice of proposed rulemaking; 
     and
       ``(bb) the development, testing, evaluation, approval, and 
     implementation of additional technologically innovative 
     treatment methods;
       ``(ix) shall provide for certification by the master of 
     each vessel entering the Great Lakes that the vessel is in 
     compliance with the regulations;
       ``(x) shall ensure compliance with the regulations, to the 
     maximum extent practicable, through--

       ``(I) sampling or monitoring procedures;
       ``(II) the inspection of records;
       ``(III) the imposition of sanctions in accordance with 
     subsection (g)(1); and
       ``(IV) the certification of ballast water treatment vendors 
     and vessel vendors;

       ``(xi) shall be based on the best scientific information 
     available;
       ``(xii) shall not supersede or adversely affect any 
     requirement or prohibition pertaining to the discharge of 
     ballast water into water of the United States under the 
     Federal Water Pollution Control Act (33 U.S.C. 1251 et seq.); 
     and
       ``(xiii) shall include such other requirements as the 
     Secretary of Transportation considers appropriate.
       ``(C) Regulatory schedule.--
       ``(i) Notice of proposed rulemaking.--

       ``(I) In general.--Not later than 120 days after the date 
     of enactment of the Great Lakes Ecology Protection Act, the 
     Secretary of Transportation shall publish, in the Federal 
     Register and through other means designed to reach persons 
     likely to be subject to or affected by the regulations 
     (including publication in local newspapers and by electronic 
     means), a notice of proposed rulemaking concerning the 
     regulations proposed to be promulgated under this paragraph.
       ``(II) Final regulations.--The Secretary of Transportation 
     shall promulgate final regulations under this paragraph--

       ``(aa) with respect to the implementation of treatment 
     methods described in subparagraph (B)(vii)(II)(aa), not later 
     than 270 days after the date of enactment of the Great Lakes 
     Ecology Protection Act; and
       ``(bb) with respect to the additional technologically 
     innovative treatment methods described in subparagraph 
     (B)(vii)(II)(bb), not later than the earlier of--
       ``(AA) the date established by the timetable under 
     subparagraph (B)(vii)(II) for implementation of those 
     methods; or
       ``(BB) 720 days after the date of enactment of the Great 
     Lakes Ecology Protection Act.

       ``(III) Review and revision of regulations.--Not later than 
     3 years after the date on which final regulations are 
     promulgated under this subparagraph, and every 3 years 
     thereafter, the Secretary shall review and revise as 
     necessary, the regulations--

       ``(aa) to improve the effectiveness of the regulations; and
       ``(bb) to incorporate better management practices and 
     ballast water treatment standards and methods.

       ``(IV) Public participation.--The Secretary of 
     Transportation shall--

       ``(aa) provide not less than 120 days for public comment on 
     the proposed regulations; and
       ``(bb) provide for an effective date that is not less than 
     30 days after the date of publication of the final 
     regulations.
       ``(4) Additional regulations.--In addition''.
       (b) Definition of Treatment Method.--Section 1003 of the 
     Nonindigenous Aquatic Nuisance Prevention and Control Act of 
     1990 (16 U.S.C. 4702) is amended--
       (1) by redesignating paragraphs (13), (14), (15), (16), and 
     (17) as paragraphs (14), (15), (16), (17), and (18), 
     respectively; and
       (2) by inserting after paragraph (12) the following:
       ``(13) `treatment method' means a method for treatment of 
     the contents of a ballast water tank (including the sediments 
     within the tank) to remove or destroy nonindigenous organisms 
     through--
       ``(A) filtration;
       ``(B) the application of biocides or ultraviolet light;
       ``(C) thermal methods; or
       ``(D) other treatment techniques that meet applicable 
     ballast water treatment standards, as approved by the 
     Secretary;''.

     SEC. 3. INVASIVE SPECIES AND BALLAST WATER TECHNOLOGIES 
                   RESEARCH GRANTS.

       (a) Grants Authorized.--The Secretary of Commerce, through 
     the National Oceanic and Atmospheric Administration, and in 
     consultation with the Secretary of the Interior, the 
     Secretary of Agriculture, the Secretary of Transportation, 
     and the Administrator of the Environmental Protection Agency, 
     is authorized to award Invasive Species and Ballast Water 
     Technologies Research Grants.
       (b) Use of Funds.--Grants awarded under subsection (a) may 
     be used to--
       (1) study the impact of invasive species on the environment 
     of the Great Lakes region; and
       (2) develop technologies and treatment methods, including 
     ballast water tank technology, designed to destroy or remove 
     invasive species.
       (c) Eligible Recipients.--
       (1) In general.--The Secretary may award grants under 
     subsection (a) to any post-secondary educational institution 
     in the United States.
       (2) Special consideration for institutions collaborating 
     with industry.--In awarding grants under subsection (a), the 
     Secretary shall give special consideration to post-secondary 
     educational institutions that work collaboratively with 
     members of the United States shipping industry to carry out 
     an activity for which grant funds may be used under 
     subsection (b).
       (d) Availability and Marketing of Technology.--In awarding 
     grants under subsection (a), the Secretary shall ensure that

[[Page S6230]]

     to the greatest extent practicable, technologies and 
     treatments developed as the result of a grant awarded under 
     subsection (a) are made commercially available.
       (e) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out the provisions of this 
     section $100,000,000 for the period of fiscal year 2002 
     through fiscal year 2006.
                                  ____


                                S. 1035

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Great Lakes Preservation 
     Act''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) the Great Lakes are precious public natural resources, 
     and are renewable but finite bodies of water that should be 
     protected, conserved, and managed for the use, benefit, and 
     enjoyment of all present and future generations of people of 
     the United States;
       (2) the Great Lakes are crucial to the economies of the 
     Great Lakes States for recreation, commercial shipping, 
     industrial, and agricultural uses;
       (3) the Great Lakes contain \1/5\ of the world's fresh 
     water supply and are a vital source of safe drinking water 
     for millions of people;
       (4) the Great Lakes Charter of 1985 is a voluntary 
     international agreement that provides the procedural 
     framework for notice and consultation by the Great Lakes 
     States and the Great Lakes Provinces concerning the diversion 
     of the water of the Great Lakes basin;
       (5) the Governors of the Great Lakes States and the 
     Premiers of the Great Lakes Provinces have based decisions on 
     proposals to withdraw, divert, or use Great Lakes water on 
     the extent to which the proposals conserve and protect water 
     and water-dependent natural resources of the Great Lakes 
     basin; and
       (6) decisionmaking concerning Great Lakes water should 
     remain vested in the Governors of the Great Lakes States, who 
     manage the water and resources on a day-to-day basis.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Administrator.--The term ``Administrator'' means the 
     Administrator of the Environmental Protection Agency.
       (2) Bulk fresh water.--The term ``bulk fresh water'' means 
     fresh water extracted in quantities intended for 
     transportation by tanker or similar form of mass 
     transportation, without further processing.
       (3) From the great lakes basin.--The term ``from the Great 
     Lakes basin'', with respect to water, means--
       (A) water from Lake Erie, Lake Huron, Lake Michigan, Lake 
     Ontario, Lake St. Clair, or Lake Superior;
       (B) water from any interconnecting waterway within any 
     watercourse that drains into or between any of those lakes; 
     and
       (C) water from a tributary surface or underground channel 
     or area that drains into or comprises part of any watershed 
     that drains into any of those lakes.
       (4) Great lake.--The term ``Great Lake'' means--
       (A) Lake Erie;
       (B) Lake Huron (including Lake Saint Clair);
       (C) Lake Michigan;
       (D) Lake Ontario (including the Saint Lawrence River from 
     Lake Ontario to the 45th parallel of latitude); and
       (E) Lake Superior.
       (5) Great lakes province.--The term ``Great Lakes 
     Province'' means the Province of Ontario or Quebec, Canada.
       (6) Great lakes state.--The term ``Great Lakes State'' 
     means the State of Illinois, Indiana, Michigan, Minnesota, 
     New York, Ohio, Pennsylvania, or Wisconsin.
       (7) Secretary.--The term ``Secretary'' means the Secretary 
     of the Interior, acting through the Director of the National 
     Park Service.

     SEC. 4. MORATORIUM ON EXPORT OF BULK FRESH WATER.

       (a) In General.--Bulk fresh water from the Great Lakes 
     basin shall not be exported from the United States.
       (b) Sunset Provision.--Subsection (a) shall cease to be 
     effective on the date of enactment of an Act of Congress 
     approving the operation of a mechanism and conservation 
     standard for making decisions concerning the withdrawal, 
     diversion, and use of water of the Great Lakes that has been 
     agreed to by each of the Governors of the Great Lakes States, 
     acting in cooperation with the Premiers of the Great Lakes 
     Provinces.
       (c) Sense of Congress.--It is the sense of Congress that 
     the Federal Government should enter into an agreement with 
     the Government of Canada stating that the United States and 
     Canada shall abide by the terms of the moratorium under 
     subsection (a) until the date specified in subsection (b).

     SEC. 5. PRESERVATION OF HISTORIC GREAT LAKES LIGHTHOUSES.

       (a) Findings.--Congress finds that--
       (1) the Great Lakes have greatly influenced settlement, 
     commerce, transportation, industry, and recreation throughout 
     the rich maritime history of the Great Lakes States;
       (2) lighthouses in Great Lakes States have helped mariners 
     navigate dangerous shoals and find safe harbors for decades 
     and are an important part of the maritime history of the 
     Great Lakes;
       (3) many of the lighthouses have historical or 
     architectural significance; and
       (4) the future of the lighthouses is uncertain because many 
     are in poor condition because of neglect and deterioration.
       (b) Study.--Not later than 3 years after the date on which 
     funds are made available to carry out this section, the 
     Secretary shall conduct and submit to Congress a study to 
     identify options to preserve the lighthouses in the Great 
     Lakes States.
       (c) Procedure.--In conducting the study under subsection 
     (b), the Secretary shall--
       (1) review programs, policies, and standards of the 
     National Park Service to determine the most appropriate means 
     of ensuring that the lighthouses (including any associated 
     natural, cultural, and historical resources) are preserved; 
     and
       (2) consult with--
       (A) State and local historical associations and societies 
     in the Great Lakes States;
       (B) historic preservation agencies in the Great Lakes 
     States;
       (C) the Commandant of the Coast Guard; and
       (D) other appropriate entities.
       (d) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as are necessary to carry out 
     this section.

  Mr. LEVIN. Mr. President, I am pleased to join Senator Stabenow, in 
introducing 3 pieces of legislation to help protect the nation's 
largest source of fresh water--the Great Lakes.
  The first bill, The Great Lakes Water Protection Act, will prevent 
new oil and gas drilling beneath the lakes until the EPA, in 
cooperation with the National Academy of Science, the Great Lakes 
States, and other interested parties, is able to study the impacts that 
drilling may have to water quality, fish and wildlife habitat, drinking 
water, and other coastal land-use activities.
  It is just not worth taking a chance on harming this critical 
resource for a small amount of oil and natural gas.
  Slant drilling, while a more environmentally friendly method than the 
traditional drilling methods, is imperfect. Wells can blow out and 
equipment can be damaged. Because just one quart of oil can contaminate 
up to two million gallons of drinking water, the risk of drilling is 
especially acute when these wells are located directly next to the 
Great Lakes which serve as the source of drinking water for so many 
communities. According to a recent study by the Lake Michigan 
Federation, the normal slant drilling process could result in ground 
water contamination, surface water pollution, and the release of 
hazardous gases. If an accident were to occur, an oil or natural gas 
spill could impact Michigan's sensitive wetlands, sand dunes, and 
wildlife habitat. Oil leaked or washed into the Lakes would affect fish 
species, especially in the sensitive near-shore spawning and nursery 
areas, detrimentally impacting the Great Lakes commercial and 
recreational fisheries. We surely need to thoroughly review all 
possible risks before making decisions that could chance these 
irreplaceable natural resources.
  Additionally, there are existing human activities along the Great 
Lakes' coasts, and we need to find out how drilling activities could 
impact those communities. Even advocates of drilling admit that some 
damage at shore-line drilling sites is inevitable. Drilling requires 
the construction of new infrastructure such as drilling rigs and sites, 
storage tanks, and new pipelines. These facilities can deter tourism 
and hinder local community development.
  Our pristine Great Lakes coastline is valuable to the tourism 
industry in Michigan while the Great Lakes' energy potential is very 
small. Since the first U.S. well was drilled under Lake Michigan in 
1979, only 438,000 barrels of oil and about 17.5 billion cubic feet of 
natural gas have been produced. This is not even a drop in the bucket 
compared to the Nation's annual energy consumption of 20 million 
barrels of oil per day and 65 billion cubic feet of natural gas per 
day. In contrast, Great Lakes recreational fishers spend $1.4 billion 
annually on gear and lake trips. The thousands of hikers, birdwatchers, 
beach-goers and other recreational users enjoying the Great Lakes 
shoreline and coastal waters contribute millions of dollars to local 
economies.
  I believe that if this country should focus more on advancing 
alternative fuels. In Michigan, we can advance environmental quality 
and economic growth by supporting research into advanced technology 
vehicles.
  I encourage my colleagues to support this important legislation. 
There is

[[Page S6231]]

simply too much at stake to risk the Great Lakes and their shoreline.
  The second piece of legislation, The Great Lakes Water Protection 
Act, prohibits bulk fresh water from the Great Lakes basin to be 
exported from the United States until a conservation standard governing 
withdrawals, diversion, and use of Great Lakes water is in place. The 
Great Lakes hold nearly 20% of the world's supply of freshwater.
  As this legislation clearly states, the Great Lakes Governors 
currently have the authority to veto proposals to divert water from the 
Great Lakes outside the basin. However, the existing process over out-
of-basin water diversions may be subject to an international trade 
dispute. So as the global water demand doubles every 21 years, we need 
a back up conservation strategy.
  Additionally, this legislation authorizes the National Park Service 
to complete a resource study outlining options for the preservation of 
lighthouses in the Great Lakes. There are 120 Michigan lighthouses, and 
approximately 70 of these structures will be surplus property over the 
next 10 years. Under legislation that I sponsored last year, these 
historic treasures will be smoothly transferred from government 
ownership, and the Secretary of the Department of the Interior, through 
the National Park Service, is authorized to establish a historic 
lighthouse preservation program. The bill we are introducing today 
reinforces the government's commitment to preserving these historic 
structures.
  Lastly, I am cosponsoring the Great Lakes Ecology Protection Act to 
attempt to control one of the most expensive and environmentally 
dangerous problems facing the Great Lakes-aquatic nuisance species.
  Nearly 150 nonindigenous aquatic species have been accidently 
introduced into the Great Lakes in the past century. Most of the recent 
invasive species have been transported to the Lakes in commercial 
ships' ballast water. In 1990 and 1996 Congress enacted legislation 
which slowed down the introduction of aquatic nuisance species in the 
Great Lakes, however, approximately 1 new non-native organism enters 
the Lakes each year.
  This legislation that I am cosponsoring is designed to prevent these 
invaders from coming into the Great Lakes and to control the movement 
of organisms once they have been introduced into the Lakes. The Coast 
Guard needs to design a standard for vessels capable of discharging 
ballast water in the Great Lakes that ensures that ballast water 
containing aquatic species are not discharged in the Great Lakes. The 
Coast Guard needs to establish a Ballast Treatment Performance Standard 
which will provide flexibility for industry to utilize and improve 
technology in order to meet that standard in whatever manner they want. 
Additionally, this legislation authorizes up to $100 million for 
invasive species and ballast water technologies research grants.
  I encourage the rest of my colleagues to support legislative efforts 
to control aquatic nuisance species. In 2002, the National Invasive 
Species Act of 1996 expires, and Congress will be tasked with improving 
and reauthorizing this legislation. I believe that a national 
reauthorization is important to create a unified approach rather than 
forcing the States to enact individual standards for ships in an 
attempt to control aquatic nuisance species. However, if efforts to 
reauthorize a national program should stall, I believe that this 
legislation will help protect the Great Lakes from aquatic invaders.
                                 ______
                                 
      By Mr. HARKIN (for himself, Mr. Leahy Mr. Durbin, Mr. DeWine, Mr. 
        Dorgan, Mr. Daschle, Mr. Kohl, Mr. Lugar, Mr. Kennedy, Mr. 
        Johnson, Mr. Conrad, Ms. Landrieu, and Mr. Dayton):
  S. 1036. A bill to amend the Agricultural Trade Development and 
Assistance Act of 1954 to establish an international food for education 
and child nutrition program; to the Committee on Agriculture, 
Nutrition, and Forestry.
  Mr. HARKIN. Mr. President, together with a bipartisan group of 
colleagues, I am pleased to be introducing this legislation to address 
two of the most glaring problems facing children across the globe: 
malnutrition and the lack of educational opportunity. I very much 
appreciate the opportunity to work with Senator Leahy and Senator 
Lugar, who have so strongly supported nutrition assistance for many 
years, in developing this legislation.
  An estimated 300 million poor children around the world either do not 
receive food at school or do not go to school at all. About 130 million 
of the world's children, 60 percent of them girls, are presently not 
attending school. With the abundance of food here in America and in 
other nations, this reality is absolutely unconscionable.
  Our bill, the George McGovern-Robert Dole International Food for 
Education and Child Nutrition Act of 2001, will provide U.S. 
agricultural commodities and other assistance to boost child nutrition 
in connection with educational programs in developing countries.
  I salute former Senators George McGovern and Bob Dole for their work 
in promoting the Global Food for Education Initiative, and President 
Clinton for recognizing its merits early on and beginning a pilot 
project for this year.
  The bill permanently adds this new program to existing U.S. foreign 
food assistance programs, such as P.L. 480 and Food for Progress.
  Our bill will apply the producing power of American farmers and 
agriculture-related industries to help families, villages and even 
nations escape the treadmill of poverty by supporting both improved 
nutrition and education for children. It also offers nutritious food 
and learning as an alternative to sending children down the dead-end 
path of exploitive work in sweatshops, mines or factories.
  The International Food for Education and Child Nutrition Program 
established in this legislation will be carried out through private 
nonprofit groups, cooperatives, and intergovernmental organizations. 
Under the bill, USDA will purchase U.S. commodities and cover the costs 
of making them available in developing countries to provide nutrition 
for children in connection with educational programs. Funding would 
begin at $300 million in fiscal 2002 and increase to $750 million in 
fiscal 2006.
  The problems of global malnutrition and limited education are so 
large that participation by other countries is crucially important. 
Accordingly, this bill specifically encourages other donor countries 
and the private sector to support the program. If concerned nations 
will come together and make a firm commitment, we can end child hunger, 
child poverty and exploitive child labor and lift families and nations 
from poverty.
  This bill continues our Nation's proud tradition of helping to build 
a better future for children in developing countries and I am proud we 
are introducing it today. I strongly urge my colleagues to support this 
important legislation and ask, unanimous consent that the text of the 
bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1036

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``George McGovern-Robert Dole 
     International Food for Education and Child Nutrition Act of 
     2001''.

     SEC. 2. INTERNATIONAL FOOD FOR EDUCATION AND CHILD NUTRITION.

       Title IV of the Agricultural Trade Development and 
     Assistance Act of 1954 (7 U.S.C. 1731 et seq.) is amended by 
     adding at the end the following:

     ``SEC. 417. INTERNATIONAL FOOD FOR EDUCATION AND CHILD 
                   NUTRITION.

       ``(a) Definitions.--In this section:
       ``(1) Eligible commodity.--The term `eligible commodity' 
     means--
       ``(A) an agricultural commodity; and
       ``(B) a vitamin or mineral produced--
       ``(i) in the United States; or
       ``(ii) in limited situations determined by the Secretary, 
     outside the United States.
       ``(2) Eligible organization.--The term `eligible 
     organization' means a private voluntary organization, 
     cooperative, or intergovernmental organization, as determined 
     by the Secretary.
       ``(3) Program.--The term `Program' means the International 
     Food for Education and Child Nutrition Program established 
     under subsection (b)(1).
       ``(4) Recipient Country.--The term `recipient country' 
     means 1 or more developing

[[Page S6232]]

     countries covered by a plan approved under subsection 
     (d)(1)(A)(ii).
       ``(b) Program Establishment.--
       ``(1) In general.--In cooperation with other countries, the 
     Secretary shall establish, and the Department of Agriculture 
     shall act as the lead Federal agency for, the International 
     Food for Education and Child Nutrition Program, through which 
     the Secretary shall provide to eligible organizations 
     eligible commodities and technical and nutritional assistance 
     for pre-school and school-age children in connection with 
     education programs to improve food security and enhance 
     educational opportunities for pre-school age and primary-
     school age children in recipient countries.
       ``(2) Administration.--In carrying out the Program, the 
     Secretary may use the personnel and other resources of the 
     Food and Nutrition Service and other agencies of the 
     Department of Agriculture.
       ``(c) Purchase and Donation of Eligible Commodities and 
     Provision of Assistance.--
       ``(1) In general.--Under the Program, the Secretary shall 
     enter into agreements with eligible organizations--
       ``(A) to purchase, acquire, and donate eligible commodities 
     to eligible organizations; and
       ``(B) to provide technical and nutritional assistance.
       ``(2) Other donor countries.--Consistent with the Program, 
     the Secretary shall encourage other donor countries, directly 
     or through eligible organizations--
       ``(A) to donate goods and funds to recipient countries; and
       ``(B) to provide technical and nutritional assistance to 
     recipient countries.
       ``(3) Private sector.--The President and the Secretary are 
     urged to encourage the support and active involvement of the 
     private sector, foundations, and other individuals and 
     organizations in programs and activities assisted under this 
     section.
       ``(d) Plans and Agreements.--
       ``(1) In general.--To be eligible to receive eligible 
     commodities and assistance under this section, an eligible 
     organization shall--
       ``(A)(i) submit to the Secretary a plan that describes the 
     manner in which--
       ``(I) the eligible commodities and assistance will be used 
     in 1 or more recipient countries to meet the requirements of 
     this section; and
       ``(II) the role of the government in the recipient 
     countries in carrying out the plan; and
       ``(ii) obtain the approval of the Secretary for the plan; 
     and
       ``(B) enter into an agreement with the Secretary 
     establishing the terms and conditions for use of the eligible 
     commodities and assistance.
       ``(2) Multiyear agreements.--
       ``(A) In general.--An agreement under paragraph (1)(B) may 
     provide for eligible commodities and assistance on a 
     multiyear basis.
       ``(B) Local capacity.--The Secretary shall facilitate, to 
     the extent the Secretary determines is appropriate, the 
     development of agreements under paragraph (1)(B) that, on a 
     multiyear basis, strengthen local capacity for implementing 
     and managing assistance programs.
       ``(3) Streamlined procedures.--The Secretary shall develop 
     streamlined procedures for the development, review, and 
     approval of plans submitted under paragraph (1)(A) by 
     eligible organizations that demonstrate organizational 
     capacity and the ability to develop, implement, monitor, and 
     report on, and provide accountability for, activities 
     conducted under this section.
       ``(4) Graduation.--An agreement under paragraph (1)(B) 
     shall include provisions--
       ``(A)(i) to sustain the benefits to the education, 
     enrollment, and attendance of children in schools in the 
     targeted communities when the provision of commodities and 
     assistance to a recipient country under the Program 
     terminates; and
       ``(ii) to estimate the period of time required for the 
     recipient country or eligible organization to provide 
     assistance described in subsection (b)(1) without additional 
     assistance provided under this section; or
       ``(B) to otherwise provide other long-term benefits to the 
     targeted populations.
       ``(e) Effective Use of Eligible Commodities.--The Secretary 
     shall ensure that each eligible organization--
       ``(1) uses eligible commodities made available under this 
     section effectively, in the areas of greatest need, and in a 
     manner that promotes the purposes of this section;
       ``(2) in using assistance provided under this section, 
     assesses and takes into account the nutritional and 
     educational needs of participating pre-school age and 
     primary-school age children;
       ``(3) to the maximum extent practicable, uses the lowest 
     cost means of delivering eligible commodities and providing 
     other assistance authorized under the Program;
       ``(4) works with recipient countries and indigenous 
     institutions or groups in recipient countries to design and 
     carry out mutually acceptable food and education assistance 
     programs for participating pre-school age and primary-school 
     age children;
       ``(5) monitors and reports on the distribution or sale of 
     eligible commodities provided under this section using 
     methods that will facilitate accurate and timely reporting;
       ``(6) periodically evaluates the effectiveness of the 
     Program, including evaluation of whether the food security 
     and education purposes can be sustained in a recipient 
     country if the recipient country is gradually terminated from 
     the assistance in accordance with subsection (d)(4); and
       ``(7) considers means of improving the operation of the 
     Program by the eligible organization and ensuring and 
     improving the quality of the eligible commodities provided 
     under this section, including improvement of the nutrient or 
     micronutrient content of the eligible commodities.
       ``(f) Interagency Coordination on Policy Goals.--The 
     Secretary shall consult and collaborate with other Federal 
     agencies having appropriate expertise in order to provide 
     assistance under this section to promote equal access to 
     education to improve the quality of education, combat 
     exploitative child labor, and advance broad-based sustainable 
     economic development in recipient countries.
       ``(g) Sales and Barter.--
       ``(1) In general.--Notwithstanding subsection (d)(1)(A), 
     with the approval of the Secretary, an eligible organization 
     may--
       ``(A) acquire funds or goods by selling or bartering 
     eligible commodities provided under this section within the 
     recipient country or countries near the recipient country; 
     and
       ``(B) use the funds or goods to improve food security and 
     enhance educational opportunities for pre-school age and 
     primary-school age children within the recipient country, 
     including implementation and administrative costs incurred in 
     carrying out this subsection.
       ``(2) Payment of administrative costs.--An eligible 
     organization that receives payment for administrative costs 
     under paragraph (1) shall not be eligible to receive payment 
     for the same administrative costs under subsection (h)(3).
       ``(h) Eligible Costs.--Subject to subsections (d)(1) and 
     (m), the Secretary shall pay all or part of--
       ``(1) the costs and charges described in paragraphs (1) 
     through (5) and (7) of section 406(b) with respect to an 
     eligible commodity;
       ``(2) the internal transportation, storage, and handling 
     costs incurred in moving the eligible commodity, if the 
     Secretary determines that--
       ``(A) payment of the costs is appropriate; and
       ``(B) the recipient country is a low income, net food-
     importing country that--
       ``(i) meets the poverty criteria established by the 
     International Bank for Reconstruction and Development for 
     Civil Works Preference; or
       ``(ii) has a national government that is committed to or is 
     working toward, through a national action plan, the World 
     Declaration on Education for All convened in 1990 in Jomtien, 
     Thailand, and the follow-up Dakar Framework for Action of the 
     World Education Forum in 2000; and
       ``(3) the projected costs of an eligible organization for 
     administration, sales, monitoring, and technical assistance 
     under a plan approved by the Secretary under subsection 
     (d)(1)(A) (including an itemized budget), taking into 
     consideration, as determined by the Secretary--
       ``(A) the projected amount of such costs itemized by 
     category; and
       ``(B) the projected amount of assistance received from 
     other donors.
       ``(i) Displacement.--Subsections (a)(2), (b), and (h) of 
     section 403 shall apply to this section.
       ``(j) Audits and Training.--The Secretary shall take such 
     actions as are necessary to support, monitor, audit, and 
     provide necessary training in proper management under the 
     Program.
       ``(k) Annual Report.--The Secretary shall submit to the 
     Committee on Agriculture of the House of Representatives and 
     the Committee on Agriculture, Nutrition, and Forestry of the 
     Senate an annual report that describes--
       ``(1) the results of the implementation of the Program 
     during the applicable year, including the impact on the 
     enrollment, attendance, and performance of children in 
     primary schools targeted under the Program; and
       ``(2) the level of commitments by, and the potential for 
     obtaining additional goods and assistance from, other 
     countries for the purposes of this section during subsequent 
     years.
       ``(l) Independence of Authorities.--Each authority granted 
     under this section shall be in addition to, and not in lieu 
     of, any authority granted to the Secretary or the Commodity 
     Credit Corporation under any other provision of law.
       ``(m) Funding.--
       ``(1) In general.--Subject to paragraphs (2) and (3), for 
     each of fiscal years 2002 through 2006, the Secretary shall 
     use the funds, facilities, and authorities of the Commodity 
     Credit Corporation to carry out this section.
       ``(2) Fiscal year limitations.--
       ``(A) In general.--Subject to subparagraph (B), the amount 
     of funds of the Commodity Credit Corporation uses to carry 
     out this section shall not exceed--
       ``(i) $300,000,000 for fiscal year 2002; or
       ``(ii) $400,000,000 for each of fiscal years 2003 through 
     2006.
       ``(B) Participation by donor countries.--If the Secretary 
     determines for any of fiscal years 2004 through 2006 that 
     there is adequate participation in the Program by donor 
     countries, in lieu of the maximum amount authorized for that 
     fiscal year under subparagraph (A)(ii), the amount of funds 
     of the

[[Page S6233]]

     Commodity Credit Corporation uses to carry out this section 
     shall not exceed--
       ``(i) $525,000,000 for fiscal year 2004;
       ``(ii) $625,000,000 for fiscal year 2005; or
       ``(iii) $750,000,000 for fiscal year 2006.
       ``(3) Use limitations.--Of the funds provided under 
     paragraph (2), the Secretary may use to carry out subsection 
     (h)(3), not more than--
       ``(A) $40,000,000 for fiscal year 2002;
       ``(B) $50,000,000 for fiscal year 2003;
       ``(C) $60,000,000 for fiscal year 2004;
       ``(D) $70,000,000 for fiscal year 2005; or
       ``(E) $80,000,000 for fiscal year 2006.''.

     SEC. 3. CONFORMING AMENDMENTS.

       (a) Section 401(a) of the Agricultural Trade Development 
     and Assistance Act of 1954 (7 U.S.C. 1731(a)) is amended by 
     inserting ``(other than section 417)'' after ``this Act'' 
     each place it appears.
       (b) Section 404(b)(4) of the Agricultural Trade Development 
     and Assistance Act of 1954 (7 U.S.C. 1734(b)(4)) is amended 
     by inserting ``with respect to agreements entered into under 
     this Act (other than section 417),'' after ``(4)''.
       (c) Section 406(d) of the Agricultural Trade Development 
     and Assistance Act of 1954 (7 U.S.C. 1736(d)) is amended by 
     inserting ``(other than section 417)'' after ``this Act''.
       (d) Section 408 of the Agricultural Trade Development and 
     Assistance Act of 1954 (7 U.S.C. 1736b) is amended by 
     inserting ``(other than section 417)'' after ``this Act''.
       (e) Section 412(b)(1) of the Agricultural Trade Development 
     and Assistance Act of 1954 (7 U.S.C. 1736f(b)(1)) is amended 
     by inserting ``(other than section 417)'' after ``this Act'' 
     each place it appears.

  Mr. LEAHY. Mr. President, today we introduce the George McGovern-
Robert Dole International Food for Education and Child Nutrition Act of 
2001.
  This is a momentous day for needy children around the world. And it 
is America's opportunity to embark on a bold venture that can have 
unexpected benefits, and advance world peace and understanding.
  The name of our legislation honors two great leaders, and two great 
friends, Ambassador George McGovern and Senator Bob Dole. It was a 
privilege for me to serve on the Senate Agriculture, Nutrition and 
Forestry Committee with both of them for many years. I have known both 
of them for years and they know that each hungry child is an empty 
promise.
  Nutrition is the key not only to health but to education and economic 
progress in many developing societies. This initiative taps America's 
agricultural bounty to become a catalyst for real and lasting change in 
many struggling nations. This bill can literally change the world.
  I am thrilled that Chairman Tom Harkin will join with ranking member 
Dick Lugar and me on this Senate bill. It would be hard to find, in the 
last 13 years, a nutrition or agriculture bill sponsored by Senator 
Lugar, Senator Harkin and me--that is not now the law of the land.
  We are pleased to have Senator DeWine with us in this effort. I work 
with him on the Judiciary Committee and I know he is a strong fighter 
for children. Senators Kohl, Dorgan, Dashle, Kennedy, Durbin, Conrad, 
Johnson, Landrieu, and Dayton are also on the bill. Each, in their own 
right, are leaders in protecting children.
  This bill will make private voluntary organizations and the World 
Food Program full partners with USDA in implementing this bold 
education and child nutrition vision. I want to make clear that the 
bill unambiguously provides that PVOs are full partners with USDA, just 
as the WFP will be.
  Ambassador George McGovern has said about this effort that, ``Dollar 
for dollar it is the best investment we can make in creating a 
healthier, better educated and more effective global citizenry.'' He 
spoke of how the program would be of ``enormous benefit'' to the 
education of girls, since in Third World countries parents will also 
send girls to school if meals are offered.
  I want to point out that one Catholic Relief Services project 
offering meals and education in Ghana has seen the ``number of girls 
enrolled in school jump by 88 percent, and their attendance rose by 50 
percent.'' In Pakistan, the World Food Program offered cooking oil to 
families if they sent their children, especially girls, to school. The 
parents' response was overwhelming and the ``enrollment of girls has 
doubled.'' In similar projects in Niger ``girls' attendance rose by 75 
percent, and by 100 percent in Morocco.''
  This is clearly a great idea for children who otherwise may have no 
hope, and no future.
  Most beginnings rarely seem momentous at the time, and then, looking 
back, every detail is studied by students and scholars and meaning is 
attached to every step. I want to chronicle some aspects of this 
beginning when memories are fresh.
  I will again mention my good friend Ambassador George McGovern. 
First, I appreciate that President George W. Bush decided to keep 
George McGovern on as Ambassador to the U.N. food agencies in Rome, 
Italy. This demonstrated a keen bipartisan spirit, and the best choice 
for the job.
  Last year, George McGovern authored a paper setting forth a bold 
vision for a multinational effort to provide meals to children in 
school settings. He is an expert having worked on school lunch issues 
during his eighteen years on the Agriculture, Nutrition and Forestry 
Committee, as a Director of the Food for Peace program, and now as U.S. 
Ambassador to the U.N. food agencies.
  He further explained this bold vision at Senate Agriculture Committee 
hearing on July 27, 2000. What a pleasure it was for me to listen to 
both Ambassador McGovern and Former Majority Leader Bob Dole at this 
hearing presided over by my friend and colleague, then Chairman Dick 
Lugar. The hearing featured two giants in the history of nutrition 
programs adding another chapter to their legacies, under the watchful 
eye of a very decent, intelligent, and understanding Senator, Senator 
Lugar, who cares about the state of the world.
  At the hearing, George McGovern said that ``if we could achieve the 
goal of reaching 300 million hungry children with one good meal every 
day, that would transform life on this planet.'' He pointed out another 
significant benefit in that `'it would raise the income of American 
farmers and those in other countries that have farm surpluses.''
  Senator Dole, another giant in the history of nutrition programs, 
supported this vision and commended the Clinton administration for 
launching a $300 million school feeding pilot program to feed hungry 
children throughout the world. He said, ``I can think of no better 
solution to the problem [of agricultural surpluses] than to support a 
program that will help our farmers while putting food in the stomachs 
of desperately hungry and malnourished children.''
  This brings me to another leading player in this bipartisan effort, 
former President William Clinton. He elevated these issues by raising 
the idea at the G8 meeting in Okinawa, Japan, in July, 2000. He urged 
the eight industrialized democracies at the start of the new millennium 
to contribute some of their wealth, natural resources and goodness to 
help the next generation of the world. The President announced this 
$300 million Global Food for Education Initiative to feed hungry 
children and pledged to work with other nations to seek support and 
contributions from them. This gave the McGovern-Dole proposal new force 
and captured the interest and attention of other nations. The 
President's staff, including Tom Friendman and chief of staff John 
Podesta, worked diligently to get this program off the ground and 
dedicated career staff at USDA, including Richard Fritz and Mary 
Chambliss, worked long hours to launch the President's initiative.
  At that same hearing, then Secretary Dan Glickman noted that 
worldwide 120 million children are not enrolled in school and that tens 
of millions drop out before achieving basic literacy. He explained how 
a global school meals program would reduce the incidence of child labor 
and have the potential to raise academic performance and increase 
literacy rates. He noted what a draw school meals can be, when a school 
feeding program in the Dominican Republic was temporarily suspended, 25 
percent of the children dropped out of school.
  Another tremendous force in the history of this initiative is 
Catherine Bertini, the Executive Director of the World Food Program. I 
have known Cathy since I first met her when she was being confirmed as 
Assistant Secretary of Agriculture for Food and Consumer Service over a 
decade ago, under President George Bush.
  She was an outstanding and creative leader in that job and I was 
happy to support her for the World Food Program position. I treasure 
memories of a detailed briefing she gave my wife, Marcelle, and me at 
her apartment in

[[Page S6234]]

Rome, Italy. Her concern for hungry children, her command of the facts 
and her extreme competence and management abilities have made her a 
truly outstanding director.
  In an interesting coincidence, my chief advisor and legal counsel on 
nutrition policies since 1987, Ed Barron, has been a friend of Cathy's 
since high school. He went to school in Homer, NY, and Cathy attended 
neighboring Cortland High School.
  Cathy explained that in one original idea the WFP offered ``take 
home'' food to a family for every month that a girl attended school 
regularly. Cathy noted that `'the results have been dramatic'' as 
school attendance greatly increased. Cathy proposed some great 
principles that, I agree, should be followed. Such an international 
feeding program should be sustainable, it should be mostly school-
based, and it should be targeted to the most needy. Of course, we need 
to employ a loose definition of school, since a teacher can teach and 
school children can learn in practically any setting.
  In addition, she noted that the United States should use its special 
knowledge and experience to help other countries develop these 
programs. USDA and US AID experts should make periodic visits to work 
with national personnel and PVOs and others to build capacity and 
sustainable projects.
  Joseph Scalise who represents the World Food Program here in 
Washington, D.C. has done a wonderful job keeping me and my staff 
informed of developments regarding WFP efforts and views.
  Another major force in international feeding efforts is Ellen 
Levinson. As Executive Director of the Coalition for Food Aid, she has 
done a very effective job representing many private voluntary 
organizations who provide food and other assistance throughout the 
world. She is a strong advocate for an integrated approach for physical 
and cognitive child development, with a focus on much more than just a 
meal or food ration. In addition to food assistance, Ellen wants the 
initiative to provide quality education and development.
  Another leader in the area has been my good friend Marshall Matz. He 
has been a vigorous advocate and friendly adviser in this effort.
  I also want to mention Elizabeth Darrow of my staff who has played a 
major role in helping organize this effort and making sure we kept it 
on track.
  This bill has been greatly advanced by staff of Senators Harkin and 
Luger. Chief of Staff Mark Halverson and chief economist Stephanie 
Mercier attended many meetings and helped craft a fine bill. The 
Republican Chief of Staff for the Committee, Keith Luse, and his staff 
including Chris Salisbury, Dave Johnson and Michael Knipe, provided 
extremely useful guidance and advice about how best to structure this 
program and help ensure that the benefits get delivered to needy 
children. This was truly a team effort.
  As always, the outstanding drafting skills of Gary Endicott of Senate 
Legislative Counsel are much appreciated. I have many times recognized 
his tremendous service to the Senate.
  Congressman Jim McGovern and Congresswoman Jo Ann Emerson, along with 
Congressman Tony Hall and others, recognized the bold potential of this 
effort right from the start. Many staff working for the other body 
provided a great deal of assistance, but Cindy Buhl needs to be 
especially recognized for her long hours of work, and dedication to the 
project. Cindy, and her boss Jim McGovern, took command of this effort 
and deserve a lot of credit.
  This bipartisan, bicameral effort, now looks to the new 
Administration for assistance. I, and all my colleagues, are eager to 
work with the Bush White House and Secretary Veneman to make this 
international education and child nutrition initiative a success. It 
may be imperative to have the President extend the current pilot 
program for one more year to insure continuity of service, and to 
provide an opportunity to work out all the kinks in a new project. The 
President could provide additional funding out of the Commodity Credit 
Corporation to help us bridge the gap.
  I also want to thank the GAO team that is working on analyzing the 
current effort. The GAO is helping to provide valuable advice on how to 
improve this effort.
  I want to briefly mention some thoughts from Ambassador McGovern's 
book, ``The Third Freedom.'' He begins with: ``Hunger is a political 
condition. The earth has enough knowledge and resources to eradicate 
this ancient scourge.''
  I completely agree--and because addressing hunger is a moral 
imperative, the U.S. should lead the way. I am very hopeful that many 
nations who we have helped in the past--including economic gains in 
Europe who benefited from our Marshall Plan after WWII--will follow our 
lead and offer food, technical assistance and financial aid.
  I look forward to working with my colleagues on this legislative and 
moral effort.
  Mr. KENNEDY. Mr. President, I am proud to join so many of my 
colleagues in sponsoring the global school lunch legislation proposed 
today by Senators Leahy and DeWine. This bill is the product of much 
hard work by our former colleagues Dole and McGovern, and also by 
officials at all levels of government, the World Food Program, and the 
many non-governmental agencies that have pioneered international school 
feeding programs.
  Much has already been accomplished. Under a trial program, the 
Department of Agriculture is preparing to ship 630,000 tons of wheat, 
soybeans, rice, dry milk, corn, and other food to nine million children 
in 38 nations throughout Latin America, Africa, Asia, and Eastern 
Europe. This legislation will be an important incentive to strengthen 
the worldwide effort.
  Bob Dole and George McGovern worked well together in the Senate to 
promote child nutrition in America. The results of their landmark 
National School Lunch program have been impressive--improved nutrition 
and health, and increased academic performance as well. Their 
successful school lunch idea can benefit children in need throughout 
the world.
  Hunger remains a painful reality every day for over 300 million 
children across the globe, and we can do more--much more to combat it. 
We know the cure for hunger, and I hope that Congress will move quickly 
to enact this needed legislation.

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