Congressional Record, Volume 147 Issue 82 (Wednesday, June 13, 2001)

[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.

____________________