[Congressional Record Volume 149, Number 65 (Monday, May 5, 2003)]
[Senate]
[Pages S5730-S5738]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
______
By Mr. REID:
S. 986. A bill to designate Colombia under section 244 of the
Immigration and Nationality Act in order to make nationals of Colombia
eligible for temporary protected status under such section; to the
Committee on the Judiciary.
Mr. REID. Mr. President, amid all the discussions about
reconstruction in Afghanistan and Iraq, it is easy for us
[[Page S5731]]
to lose sight of other humanitarian crises. One particularly pressing
yet overlooked crisis is taking place right here in this hemisphere.
For almost 40 years, an internal conflict has ravaged Colombia. Rebel
and paramilitary groups designated as terrorist organizations by the
State Department have committed thousands of kidnapings, executions and
other brutalities. With an estimated combined force of 25,000
insurgents, they have disrupted life throughout the country and have
displaced nearly 2 million people, creating the third largest internal
refugee crisis in the world. The Colombian people are doing everything
in their power to fight the rebels and rein in the paramilitaries, but
the conflict shows no signs of ending anytime soon.
We should continue to help Colombia battle the terrorists in its
midst. In the meantime, however, it would be unconscionable for us to
forcibly deport law-abiding nationals currently residing in the United
States, thereby placing them in danger of being tortured, kidnaped, or
even murdered upon their return to their war-torn homeland. The bill I
am introducing today will grant many of these people temporary
protected status from deportation until it is safe for them to return
to Colombia. The bill will not grant amnesty to any illegal aliens, nor
will it place any immigrants on the path to citizenship. It is a purely
humanitarian act that enjoys plenty of precedent--refugees from several
Central American and African nations have benefited from temporary
protected status in the wake of natural disasters and political
turmoil. Immigration laws state that this protection covers only
extraordinary circumstances, but we must not hesitate to invoke it when
those circumstances arise. Extending temporary protected status to
Colombians is the right thing to do, and I urge my colleagues to
support this bill.
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. 986
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 ``Colombian Temporary
Protected Status Act of 2003''.
SEC. 2. FINDINGS.
Congress finds that--
(1) Colombia has been embroiled in a 38-year internal
conflict, resulting in the death of tens of thousands of
civilians and combatants;
(2) the 2 main armed anti-government rebel groups, the
Revolutionary Armed Forces of Colombia (Fuerzas Armadas
Revolucionarias de Colombia, or FARC) and the National
Liberation Army (Ejercito de Liberacion Nacional, or ELN),
have engaged in military activities in 700 of 1,098
municipalities in Colombia, and in recent years have
influenced local governments in as much as 40 percent to 50
percent of Colombian territory;
(3) the FARC and ELN not only attack police and military
forces but also regularly attack civilian populations, commit
massacres and extrajudicial killings, collect war taxes,
compel citizens into their ranks, force farmers to grow
illicit crops, and regulate travel, commerce, and other
activities;
(4) paramilitary groups such as the United Self-Defense
Groups of Colombia (Autodefensas Unidas de Colombia or AUC),
originally established to protect rural landowners, have
grown dramatically in recent years to become a major national
military force in Colombia;
(5) paramilitary groups are responsible, according to human
rights groups, for the greatest number of extrajudicial
killings and forced disappearances in Colombia since 1995;
(6) the FARC, ELN, and AUC, all designated by the State
Department as foreign terrorist organizations, have an
estimated combined force of 25,000 combatants;
(7) the Government of Colombia, particularly during the
administration of President Andres Pastrana, has afforded
armed rebel groups numerous opportunities to negotiate a
peace agreement, including the extraordinary step in November
1998 of creating a safe haven for the FARC by withdrawing its
security forces from 5 municipalities covering some 16,000 to
17,000 square miles;
(8) despite having been given the opportunity to seek
peace, the FARC instead used the safe haven to enhance its
military capability to further its violent campaign against
the government and people of Colombia;
(9) while President Pastrana and the Colombian government
negotiated in good faith, the FARC proceeded to kidnap
political officials;
(10) in February 2002, the FARC's actions forced President
Pastrana to withdraw from the peace process and begin the
process of retaking the safe zone he had previously ceded to
the FARC and other rebel groups;
(11) after the election of Alvaro Uribe as Colombia's
President, the FARC began targeting mayors with letters
declaring that they had 24 hours to leave or would be
considered ``military targets'';
(12) although before the recent Presidential election the
violence had been mostly contained in rural areas, it has now
spread to the urban areas, with cities such as Medellin
experiencing an average of 13 killings a day;
(13) an average of 2.8 rebel bombs go off every day in
Colombia while bomb squads disarm another 5;
(14) the middle and upper classes have been targeted for
kidnaping, with an average of 3,250 Colombians being kidnaped
each year since 1998;
(15) between 1,500,000 and 2,000,000 people have been
forced to leave their homes, representing the third largest
internal refugee crisis in the world; and
(16) between 1,500 and 2,500 Colombians were massacred in
contested rural areas in 2001.
SEC. 3. SENSE OF CONGRESS.
It is the sense of Congress that, in view of the recent
escalation of the current civil war in Colombia, Colombia
qualifies for designation under section 244(b)(1)(A) of the
Immigration and Nationality Act (8 U.S.C. 1254a(b)(1)(A)),
pursuant to which Colombian nationals would be eligible for
temporary protected status in the United States.
SEC. 4. DESIGNATION FOR PURPOSES OF GRANTING TEMPORARY
PROTECTED STATUS TO COLOMBIANS.
(a) Designation.--
(1) In general.--For purposes of section 244 of the
Immigration and Nationality Act (8 U.S.C. 1254a), Colombia
shall be treated as if it had been designated under
subsection (b) of that section, subject to the provisions of
this section.
(2) Period of designation.--The initial period of such
designation shall begin on the date of enactment of this Act
and shall remain in effect for 1 year.
(b) Aliens Eligible.--In applying section 244 of the
Immigration and Nationality Act (8 U.S.C. 1254a) pursuant to
the designation made under this section, subject to section
244(c)(3) of the Immigration and Nationality Act (8 U.S.C.
1254a(c)(3)), an alien who is a national of Colombia meets
the requirements of section 244(c)(1) of that Act (8 U.S.C.
1254a(c)(1)) only if--
(1) the alien has been continuously physically present in
the United States since the date of enactment of this Act;
(2) the alien is admissible as an immigrant, except as
otherwise provided under section 244(c)(2)(A) of the
Immigration and Nationality Act (8 U.S.C. 1254a(c)(2)(A)),
and is not ineligible for temporary protected status under
section 244(c)(2)(B) of that Act (8 U.S.C. 1254a(c)(2)(B));
and
(3) the alien registers for temporary protected status in a
manner that the Secretary of Homeland Security shall
establish.
(c) Consent to Travel Abroad.--The Secretary of Homeland
Security shall give the prior consent to travel abroad
described in section 244(f)(3) of the Immigration and
Nationality Act (8 U.S.C. 1254a(f)(3)) to an alien who is
granted temporary protected status pursuant to the
designation made under this section, if the alien establishes
to the satisfaction of the Secretary of Homeland Security
that emergency and extenuating circumstances beyond the
control of the alien require the alien to depart for a brief,
temporary trip abroad. An alien returning to the United
States in accordance with such an authorization shall be
treated the same as any other returning alien provided
temporary protected status under section 244 of the
Immigration and Nationality Act (8 U.S.C. 1254a).
______
By Mr. DORGAN (for himself and Mr. Burns):
S. 987. A bill to amend title XVIII of the Social Security Act to
provide for national standardized payment amounts for inpatient
hospital services furnished under the medicare program and to make
other rural health care improvements; to the Committee on Finance.
Mr. DORGAN. Mr. President, today I am introducing legislation, the
Rural Health Care Fairness and Medicare Equity Act, that will help to
make Medicare reimbursement more fair and equitable for rural and small
urban hospitals and physicians. I am pleased to be joined in
introducing this bill by Senator Burns.
First, let me take a few minutes to describe some of the challenges
facing rural health care systems and why I feel it is critical for the
Senate to act now to reduce the inequities in Medicare funding between
rural and urban providers.
Rural America depends on its small town hospitals, physicians and
nurses, nursing homes, emergency ambulance services, and other members
of our rural health care system. And because of past cuts in Medicare
reimbursement, plus the historical unfairness in Medicare payments,
these vital services are in jeopardy. Fortunately, Congress acted in
1999 and again in 2000 to address some of the cuts that turned out to
have a larger impact than intended.
[[Page S5732]]
However, additional legislation is still needed to improve Medicare
reimbursement for health care providers in order to stabilize the
Medicare program and ensure that beneficiaries, especially in rural
areas, will continue to have access to their local hospitals,
physicians, nursing homes, home health, and other services. Many small
rural hospitals in particular serve as the anchor for the full range of
health care services in their communities, from ambulatory to long-term
care. Medicare is the single most significant payer for services at
these hospitals, and as such, it has an impact on the whole community.
Part of the problem in North Dakota is simply demographics: North
Dakota's population is the fifth oldest in the Nation, and about two-
thirds of North Dakota's 103,000 Medicare beneficiaries live in rural
areas. In addition, North Dakota's population--and the population of
many rural states in our Nation's Heartland--is shrinking daily. In
fact, in 13 of North Dakota's counties, there were 20 or fewer births
for the entire county in 2001.
Admissions to rural hospitals have dropped by a drastic 60 percent in
the last two decades, and those patients who do remain tend to be
older, poorer, and sicker. This means that rural hospitals tend to be
disproportionately dependent upon Medicare reimbursement, to the extent
that Medicare accounts for 75 to 80 percent of the revenue for some
rural hospitals. Obviously, given this reality, Medicare reimbursement
has a major impact on the financial health of rural hospitals.
Another part of the problem is that Medicare has historically
reimbursed urban health care providers at a much higher rate than their
rural counterparts. North Dakota Medicare beneficiaries pay the exact
same Medicare payroll taxes and premiums as beneficiaries elsewhere but
receive less benefit from the Medicare program. Medicare beneficiaries
in North Dakota receive an average of $4,458 in Medicare benefits. This
is $632 less than the national average spending per Medicare
beneficiary of $5,490, and $5,500 less than the spending for Medicare
beneficiaries in Washington, DC. Moreover, most North Dakotans do not
even have the option of Medicare+Choice plans because Medicare
reimbursement for these plans is so low in rural areas that they are
not offered.
As a result of the skewed Medicare formula, North Dakota hospitals
are reimbursed significantly less than hospitals of similar size and
type elsewhere in the country. For instance, North Dakota hospitals are
reimbursed as much as $2,000 less for a Medicare beneficiary with heart
failure compared to hospitals of a similar size and mission in
Minnesota, New York and California. More specifically, for example, St.
Alexius Medical Center in Bismarck, North Dakota is paid about $4,000
for a heart failure patient. A similar sized hospital, with a similar
mission, would be paid $5,900 in California, $6,500 in New York, and
$6,800 in Minneapolis, MN for caring for the same patient.
Likewise, a similar payment inequity exists for physicians. For
example, a physician in Beulah, ND is paid about $46 by Medicare for an
office visit, while a doctor in San Francisco is paid $63 for a
comparable office visit. A physician who inserts a pacemaker in a
patient in New York City is paid about $646, but a doctor who performs
the exact same procedure in Fargo, ND is paid only $481, about a
quarter less.
This inequity in Medicare reimbursement has real consequences for
hospitals and clinics: They have to reduce services, have greater
difficulty recruiting staff, are less able to make capital
improvements, and struggle to give their patients access to the latest
innovations in medical care.
The bill I am introducing today, the Rural Health Care Fairness and
Medicare Equity Act, would address the rural inequity in Medicare
reimbursement in five ways. First, this bill would equalize the
``standardized payment'' which forms the basis for Medicare's
reimbursement to hospitals. You would think something called the
``standardized payment'' would already be standard, but the fact is
that hospitals in rural and small urban areas, including all of North
Dakota, receive a smaller standardized payment than large urban
hospitals. This bill would raise all hospitals up to the same
standardized payment. The fiscal year 2003 Omnibus Appropriations bill
enacted by Congress earlier this year takes a step in the right
direction by equalizing this base payment for the last six months of
this fiscal year, but my bill would make this equalization permanent.
Second, my bill would create a wage index floor for the hospitals in
this country with the very lowest wage indexes. The current wage index,
which is an important factor in a hospital's total Medicare
reimbursement, is based on an antiquated theory that it costs more to
hire hospital staff in urban areas than it does in rural areas. That
may have been true once, but it is no longer true today. Today,
hospitals in North Dakota are competing with hospitals in Minnesota,
Chicago and elsewhere for the same doctors and nurses, and they have to
pay competitive wages in order to recruit staff. However, their low
wage index has the effect of limiting the salaries that many rural and
small urban hospitals can afford to pay their staff. By creating a
floor, we would at least level the playing field a bit for hospitals
with a wage index under 0.85.
Third, this bill would reduce the importance of the wage index in
factoring a hospital's total Medicare reimbursement. The current
``labor market share'' of 71.1 percent overstates the actual amount
that hospitals in North Dakota and nationwide pay for labor. For
instance, in North Dakota, a hospital in Bismarck has a labor market
share of 58 percent, while a small rural hospital in Cando, ND has a
labor market share of 55 percent. For hospitals in North Dakota and
other states that already have a low wage index this overstatement of
labor costs magnifies the reimbursement inequity. My bill would set the
labor market share at 62 percent, which more closely reflects what the
correct proportion should be. However, hospitals that would be
adversely affected by this change would be held harmless.
In addition, this legislation creates alternative criteria for some
hospitals to appeal to the Medicare program for a higher wage index.
Hospitals currently can qualify for reclassification to an area with a
higher wage index if they can demonstrate that they are proximate to
the area to which they seek to be reclassified and pay similar wages or
have a similar patient case-mix. The current reclassification process
has been used predominantly in areas with high population density as a
way for hospitals to increase their Medicare reimbursement. According
to a GAO study last year, two-thirds of all hospitals that are able to
reclassify are in two areas--California and the northeast.
Unfortunately, however, many rural and small urban hospitals located
in states with a large land base and lots of distance between
communities largely have not been able to take advantage of the
reclassification process because they cannot meet the proximity
criteria. This is the case even though, despite the longer distances
between communities, hospitals are still competing against each other
to recruit nurses and other staff. To address this concern, my bill
would create an alternative reclassification process for hospitals in
sparsely populated states with large distances between metropolitan
areas that do not meet the current proximity criteria but do meet the
other reclassification criteria.
Finally, my legislation would establish a floor of 1.00 for the
physician work component of the Medicare physician payment system. The
Medicare program currently adjusts physician payments based on a
``geographic practice cost index'' that is intended to reflect regional
cost-of-living differences. The result has been that physicians in
rural areas are generally reimbursed less by Medicare for providing the
same exact level of care as doctors in urban areas. Since rural medical
practices tend to serve higher proportions of Medicare beneficiaries,
they are doubly impacted by this payment inequity.
As many of my colleagues know, it is already very difficult to
recruit physicians to rural underserved areas. In fact, many small
towns in my State are increasingly relying on foreign physicians
working in the country under J-1 visas because they are unable to
recruit American physicians. I am very concerned that the disparity in
[[Page S5733]]
Medicare reimbursement for doctors provides yet another reason for
physicians to decline to serve in rural areas.
By establishing a floor of 1.00 for the work geographic practice cost
index, this legislation will ensure that doctors' work in rural areas
would at least be valued at the national average. However, it would
still allow for payments higher than the national average for
physicians serving in areas with a high cost of living.
In closing, I think we as a nation need to acknowledge that a strong
health care system is an important part of our rural infrastructure.
Over the years, we have determined that rural electric service, rural
telephone service, an interstate highway system through rural areas,
and rural mail delivery, to name a few services, make us a better, more
unified nation. We need to make the same determination in support of
our rural health care system, and I will be fighting for policies, such
as those reflected in this legislation, that reflect rural health care
as a strong national priority. I encourage my colleagues to join
Senator Burns and me in cosponsoring this bill.
Mr. BURNS. Mr. President, I rise to introduce The Rural Health Care
Fairness and Medicare Equity Act with my good friend and colleague,
Senator Dorgan, from North Dakota.
Many predominately rural States, such as my home State of Montana,
face difficult challenges in the health care arena. Funding, staffing
shortages, and inadequate reimbursement levels have plagued many
hospitals and health care providers in the most rural areas of our
country since the passage of the Balanced Budget Act of 1997. I have
been a strong supporter of improving access to health care in these
areas through education and telemedicine, but many rural communities in
particular still face dangerous health care-related shortages.
The Rural Health Care Fairness and Medicare Equity Act seeks to make
Medicare reimbursement more fair and equitable for rural and small
urban hospitals and physicians by correcting the unintended inequities
in the Medicare system put in place by the Balanced Budget Act of 1997
with five components. First, this act would provide a single
standardized amount under the Medicare inpatient Provider Payment
System, PPS, by permanently raising the standardized amount for rural
and other hospitals to the same standardized amount level as large
urban area hospitals. My colleagues in the Senate and I recognized the
importance of doing this in the fiscal year 2003 Omnibus Appropriations
package, which made this change for the remaining months of fiscal year
2003. We should now standardize hospital levels by making this change
permanent, and this bill does just that.
Second, this bill would change the hospital labor market share from
its current level of 71.1 percent, to 62 percent, based on a study done
by the University of North Carolina Rural Health Research and Policy
Analysis Center demonstrating that the current hospital labor market
share is too high. Hospitals that would be harmed by this change would
be held harmless. Third, this legislation would create a wage index
floor of 0.85 for hospitals that would otherwise have a wage index less
than the floor. Thirty of my colleagues and I cosponsored legislation
in the 107th Congress that included a 0.925 floor, and I am hopeful
that by setting the floor at 0.85, this provision will be better
targeted toward rural hospitals with negative Medicare inpatient
margins, helping our rural health centers to not only keep their doors
open, but to continue providing quality, affordable health services to
the rural communities they serve.
Fourth, this bill would create new, alternative criteria for hospital
reclassification. This bill would require the Secretary of Health and
Human Services to develop a new category of reclassiciation of
hospitals for area wage index and standardized amount purposes. I am
greatly concerned that the current reclassification process,
particularly the proximity and adjacency criteria, has not been helpful
to hospitals in States like Montana, with large land bases and lots of
distance between communities, even though these hospitals must still
compete with one another for nurses and other health care staff.
Two-thirds of all hospital reclassification take place in California
and in the Northeast, largely because of these proximity and adjacency
criteria. This bill would allow hospitals located in sparsely populated
States that do not meet these prohibitive criteria to re-classify if
they otherwise need reclassification criteria. This bill defines a
sparsely populated state to be one in which there are fewer than 20
people per square mile of land, under which eight States, including
Montana, qualify. Finally, the Rural Health Care Fairness and Medicare
Equity Act would create a physician geographic adjustment floor of 1.0
for the physician work component of the Medicare physician payment
system, beginning in 2004. This provision would lessen the geographic
disparities in Medicare payment so gravely affecting physicians in the
field today.
Patients in both rural and urban areas depend on the availability of
quality health care providers to offer superior, affordable health
services to people across the Nation. Medicare physician payments are
intended to correspond to the costs that efficient providers incur.
Instead, research has shown that the sustainable growth rate, SGR,
under which reimbursement rates are supposed to be adjusted annually
fails to account for all the relevant factors that affect the cost of
physician payments, and maintains further inequities, such as Medicare
paying different amounts for the same service, depending on where the
service is provided.
Cuts in Medicare reimbursement to health care providers have forced
health providers to make difficult choices, including becoming a
nonparticipating Medicare provider, moving to areas with better
reimbursement rates or less Medicare patients, retiring from practice
early, limiting or discontinuing charitble care, reducing staff, or
leaving Medicare entirely. The impact on these cuts has taken a serious
toll on rural communities, such as those in Montana. The most recent
cut in physician payment levels was the largest in Medicare history,
immediately affecting 1 million health care professionals and the
countless millions of elderly and disabled patients they, in turn,
serve. Not only does this create a negative health care environment so
adverse to the principles of the Medicare system, but the inequities in
physician reimbursement rates have created a crisis situation for many
patients in rural areas who do not have the luxury of choosing to see a
different health care provider who can still afford to take Medicare
patients.
This bill is extremely important to ensure that America's seniors and
low-income have access to high quality physician services. It is
imperative that Congress continue it commitment to rural health care
quality, accessibility, and affordability, and the Rural Health Care
Fairness and Medicare Equity Act is an important step toward this goal.
______
By Mr. COLEMAN:
S. 988. A bill to amend the workforce Investment Act of 1998 to
provide for a job training grant pilot program; to the Committee on
Health, Education, Labor, and Pensions.
Mr. COLEMAN. Mr. President, I ask unanimous consent that the bill I
introduce today to amend the Workforce Investment Act of 1998 to
provide for a job training grant pilot program be printed in the
Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 988
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. JOB TRAINING GRANT PILOT PROGRAM.
Section 171 of the Workforce Investment Act of 1998 (29
U.S.C. 2916) is amended by striking subsection (d) and
inserting the following:
``(d) Job Training Grant Pilot Program.--
``(1) In general.--
``(A) Grants.--The Secretary shall provide grants to
qualified job training programs as follows:
``(i) Placement grants.--Grants in an amount to be
determined by the Secretary shall be provided to qualified
job training programs upon placement of a qualified graduate
in qualifying employment.
``(ii) Retention grants.--An additional grant in an amount
to be determined by the Secretary shall be provided to
qualified job training programs upon retention of a qualified
graduate in qualifying employment for a period of 1 year.
[[Page S5734]]
``(B) Determination.--In determining the amount of the
grants to be provided under subparagraph (A), the Secretary
shall consider the economic benefit received by the
Government from the employment of the qualified graduate,
including increased tax revenue and decreased unemployment
benefits or other support obligations.
``(2) Qualified job training program.--For purposes of this
subsection, a qualified job training program is 1 that--
``(A) is operated by a nonprofit or for-profit entity,
partnership, or joint venture formed under the laws of--
``(i) the United States or a territory of the United
States;
``(ii) any State; or
``(iii) any county or locality;
``(B) offers education and training in--
``(i) basic skills, such as reading, writing, mathematics,
information processing, and communications;
``(ii) technical skills, such as accounting, computers,
printing, and machining;
``(iii) thinking skills, such as reasoning, creative
thinking, decision making, and problem solving; and
``(iv) personal qualities, such as responsibility, self-
esteem, self-management, honesty, and integrity;
``(C) provides income supplements when needed to eligible
participants (defined for purposes of this paragraph as an
individual who meets the criteria described in subparagraphs
(A) through (C) of paragraph (3)) for housing, counseling,
tuition, and other basic needs;
``(D) provides eligible participants with not less than 160
hours of instruction, assessment, or professional coaching;
and
``(E) invests an average of $10,000 in training per
graduate of such program.
``(3) Qualified graduate.--For purposes of this subsection,
a qualified graduate is an individual who is a graduate of a
qualified job training program and who--
``(A) is 18 years of age or older;
``(B) had in either of the 2 preceding taxable years
Federal adjusted gross income not exceeding the maximum
income of a very low-income family (as defined in section
3(b)(2) of the United States Housing Act of 1937 (42 U.S.C.
1437a(b)(2))) for a single individual; and
``(C) has assets of not more than $10,000, exclusive of the
value of an owned homestead, indexed for inflation.
``(4) Qualifying employment.--For purposes of this
subsection, qualifying employment shall include any permanent
job or employment paying annual wages of not less than
$18,000, and not less than $10,000 more than the qualified
graduate earned before receiving training from the qualified
job training program.''.
______
By Mr. INOUYE:
S. 991. A bill to amend title XVIII of the Social Security Act to
provide for patient protection by limiting the number of mandatory
overtime hours a nurse may be required to work at certain medicare
providers, and for other purposes; to the Committee on Finance.
Mr. INOUYE. Mr. President, today I introduce the Registered Nurses'
Safe Staffing Act of 2003. I'm introducing this bill on behalf of the
American Nurses Association's Chief Executive Officer and President
Linda Stierle, MSN, RN, CNAA and Barbara A. Blakeney, MS, APRN, BC, ANP
respectively. For over 4 decades I have been a committed supporter of
nurses and the delivery of safe patient care. While enforceable
regulations will help to ensure patient safety, the complexity and
variability of today's hospitals require that staffing patterns be
determined at the hospital and unit level, with the professional input
of registered nurses. More than a decade of research demonstrates that
nurse staff levels and the skill mix of nursing staff directly affect
the clinical outcomes of hospitalized patients. Studies show that when
there are more registered nurses, there are lower mortality rates,
shorter lengths of stay, reduced costs, and fewer complications.
A study published in the Journal of the American Medical Association
found that the risks of patient mortality rose by 7 percent for every
additional patient added to the average nurse's workload. In the midst
of a nursing shortage and increasing financial pressures, hospitals
often find it difficult to maintain adequate staffing. While nursing
research indicates that adequate registered nurse staffing is vital to
the health and safety of patients, there are no standardized, public
reporting or the enforcement of adequate staffing plans. The only
regulations addressing nursing staff exists vaguely in Medicare
Conditions of Participation which states: ``The nursing service must
have an adequate number of licensed registered nurses, licensed
practice, vocational, nurse, and other personnel to provide nursing
care to all patients as needed''.
This bill will require Medicare Participating Hospitals to develop
and maintain reliable and valid systems to determine sufficient
registered nurse staffing. Given, the demands that the healthcare
industry faces today, it is our responsibility to ensure that patients
have access to adequate nursing care. However, we must ensure that the
decisions in which to provide this care are made by the clinical
experts, the registered nurses caring for these patients. Support of
this bill supports our nation's nurses during a critical shortage, but
more importantly, works to ensure the safety of their patients.
I ask unanimous consent that the text of this bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 991
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 ``Registered Nurse Safe
Staffing Act of 2003''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) There are hospitals throughout the United States that
have inadequate staffing of registered nurses to protect the
well-being and health of the patients.
(2) Studies show that the health of patients in hospitals
is directly proportionate to the number of registered nurses
working in the hospital.
(3) There is a critical shortage of registered nurses in
the United States.
(4) The effect of that shortage is revealed in unsafe
staffing levels in hospitals.
(5) Patient safety is adversely affected by these unsafe
staffing levels, creating a public health crisis.
(6) Registered nurses are being required to perform
professional services under conditions that do not support
quality health care or a healthful work environment for
registered nurses.
(7) As a payer for inpatient and outpatient hospital
services for individuals entitled to benefits under the
medicare program established under title XVIII of the Social
Security Act, the Federal Government has a compelling
interest in promoting the safety of such individuals by
requiring any hospital participating in such program to
establish minimum safe staffing levels for registered nurses.
SEC. 3. ESTABLISHMENT OF MINIMUM STAFFING RATIOS BY MEDICARE
PARTICIPATING HOSPITALS.
(a) Requirement of Medicare Provider Agreement.--Section
1866(a)(1) of the Social Security Act (42 U.S.C.
1395cc(a)(1)) is amended--
(1) in subparagraph (R), by striking ``and'' after the
comma at the end;
(2) in subparagraph (S), by striking the period at the end
and inserting ``, and''; and
(3) by inserting after subparagraph (S) the following new
subparagraph:
``(T) in the case of a hospital, to meet the requirements
of section 1889.''.
(b) Requirements.--Part D of title XVIII of the Social
Security Act is amended by inserting after section 1888 the
following new section:
``staffing requirements for medicare participating hospitals
``Sec. 1889. (a) Establishment of Staffing System.--
``(1) In general.--Each participating hospital shall adopt
and implement a staffing system that ensures a number of
registered nurses on each shift and in each unit of the
hospital to ensure appropriate staffing levels for patient
care.
``(2) Staffing system requirements.--Subject to paragraph
(3), a staffing system adopted and implemented under this
section shall--
``(A) be based upon input from the direct care-giving
registered nurse staff or their exclusive representatives, as
well as the chief nurse executive;
``(B) be based upon the number of patients and the level
and variability of intensity of care to be provided, with
appropriate consideration given to admissions, discharges,
and transfers during each shift;
``(C) account for contextual issues affecting staffing and
the delivery of care, including architecture and geography of
the environment and available technology;
``(D) reflect the level of preparation and experience of
those providing care;
``(E) account for staffing level effectiveness or
deficiencies in related health care classifications,
including but not limited to, certified nurse assistants,
licensed vocational nurses, licensed psychiatric technicians,
nursing assistants, aides, and orderlies;
``(F) reflect staffing levels recommended by specialty
nursing organizations;
``(G) establish upwardly adjustable registered nurse-to-
patient ratios based upon registered nurses' assessment of
patient acuity and existing conditions;
``(H) provide that a registered nurse shall not be assigned
to work in a particular unit without first having established
the ability to provide professional care in such unit; and
``(I) be based on methods that assure validity and
reliability.
[[Page S5735]]
``(3) Limitation.--A staffing system adopted and
implemented under paragraph (1) may not--
``(A) set registered-nurse levels below those required by
any Federal or State law or regulation; or
``(B) utilize any minimum registered nurse-to-patient ratio
established pursuant to paragraph (2)(G) as an upper limit on
the staffing of the hospital to which such ratio applies.
``(b) Reporting, and Release to Public, of Certain Staffing
Information.--
``(1) Requirements for hospitals.--Each participating
hospital shall--
``(A) post daily for each shift, in a clearly visible
place, a document that specifies in a uniform manner (as
prescribed by the Secretary) the current number of licensed
and unlicensed nursing staff directly responsible for patient
care in each unit of the hospital, identifying specifically
the number of registered nurses;
``(B) upon request, make available to the public--
``(i) the nursing staff information described in
subparagraph (A); and
``(ii) a detailed written description of the staffing
system established by the hospital pursuant to subsection
(a); and
``(C) submit to the Secretary in a uniform manner (as
prescribed by the Secretary) the nursing staff information
described in subparagraph (A) through electronic data
submission not less frequently than quarterly.
``(2) Secretarial responsibilities.--The Secretary shall--
``(A) make the information submitted pursuant to paragraph
(1)(C) publicly available, including by publication of such
information on the Internet site of the Department of Health
and Human Services; and
``(B) provide for the auditing of such information for
accuracy as a part of the process of determining whether an
institution is a hospital for purposes of this title.
``(c) Recordkeeping; Data Collection; Evaluation.--
``(1) Recordkeeping.--Each participating hospital shall
maintain for a period of at least 3 years (or, if longer,
until the conclusion of pending enforcement activities) such
records as the Secretary deems necessary to determine whether
the hospital has adopted and implemented a staffing system
pursuant to subsection (a).
``(2) Data collection on certain outcomes.--The Secretary
shall require the collection, maintenance, and submission of
data by each participating hospital sufficient to establish
the link between the staffing system established pursuant to
subsection (a) and--
``(A) patient acuity from maintenance of acuity data
through entries on patients' charts;
``(B) patient outcomes that are nursing sensitive, such as
patient falls, adverse drug events, injuries to patients,
skin breakdown, pneumonia, infection rates, upper
gastrointestinal bleeding, shock, cardiac arrest, length of
stay, and patient readmissions;
``(C) operational outcomes, such as work-related injury or
illness, vacancy and turnover rates, nursing care hours per
patient day, on-call use, overtime rates, and needle-stick
injuries; and
``(D) patient complaints related to staffing levels.
``(3) Evaluation.--Each participating hospital shall
annually evaluate its staffing system and establish minimum
registered nurse staffing ratios to assure ongoing
reliability and validity of the system and ratios. The
evaluation shall be conducted by a joint management-staff
committee comprised of at least 50 percent of registered
nurses who provide direct patient care.
``(d) Enforcement.--
``(1) Responsibility.--The Secretary shall enforce the
requirements and prohibitions of this section in accordance
with the succeeding provision of this subsection.
``(2) Procedures for receiving and investigating
complaints.--The Secretary shall establish procedures under
which--
``(A) any person may file a complaint that a participating
hospital has violated a requirement or a prohibition of this
section; and
``(B) such complaints are investigated by the Secretary.
``(3) Remedies.--If the Secretary determines that a
participating hospital has violated a requirement of this
section, the Secretary--
``(A) shall require the facility to establish a corrective
action plan to prevent the recurrence of such violation; and
``(B) may impose civil money penalties under paragraph (4).
``(4) Civil money penalties.--
``(A) In general.--In addition to any other penalties
prescribed by law, the Secretary may impose a civil money
penalty of not more than $10,000 for each knowing violation
of a requirement of this section, except that the Secretary
shall impose a civil money penalty of more than $10,000 for
each such violation in the case of a participating hospital
that the Secretary determines has a pattern or practice of
such violations (with the amount of such additional penalties
being determined in accordance with a schedule or methodology
specified in regulations).
``(B) Procedures.--The provisions of section 1128A (other
than subsections (a) and (b)) shall apply to a civil money
penalty under this paragraph in the same manner as such
provisions apply to a penalty or proceeding under section
1128A.
``(C) Public notice of violations.--
``(i) Internet site.--The Secretary shall publish on the
Internet site of the Department of Health and Human Services
the names of participating hospitals on which civil money
penalties have been imposed under this section, the violation
for which the penalty was imposed, and such additional
information as the Secretary determines appropriate.
``(ii) Change of ownership.--With respect to a
participating hospital that had a change in ownership, as
determined by the Secretary, penalties imposed on the
hospital while under previous ownership shall no longer be
published by the Secretary of such Internet site after the 1-
year period beginning on the date of change in ownership.
``(e) Whistleblower Protections.--
``(1) Prohibition of discrimination and retaliation.--A
participating hospital shall not discriminate or retaliate in
any manner against any patient or employee of the hospital
because that patient or employee, or any other person, has
presented a grievance or complaint, or has initiated or
cooperated in any investigation or proceeding of any kind,
relating to the staffing system or other requirements and
prohibitions of this section.
``(2) Relief for prevailing employees.--An employee of a
participating hospital who has been discriminated or
retaliated against in employment in violation of this
subsection may initiate judicial action in a United States
district court and shall be entitled to reinstatement,
reimbursement for lost wages, and work benefits caused by the
unlawful acts of the employing hospital. Prevailing employees
are entitled to reasonable attorney's fees and costs
associated with pursuing the case.
``(3) Relief for prevailing patients.--A patient who has
been discriminated or retaliated against in violation of this
subsection may initiate judicial action in a United States
district court. A prevailing patient shall be entitled to
liquidated damages of $5,000 for a violation of this statute
in addition to any other damages under other applicable
statutes, regulations, or common law. Prevailing patients are
entitled to reasonable attorney's fees and costs associated
with pursuing the case.
``(4) Limitation on actions.--No action may be brought
under paragraph (2) or (3) more than 2 years after the
discrimination or retaliation with respect to which the
action is brought.
``(5) Treatment of adverse employment actions.--For
purposes of this subsection--
``(A) an adverse employment action shall be treated as
retaliation or discrimination; and
``(B) the term `adverse employment' action includes--
``(i) the failure to promote an individual or provide any
other employment-related benefit for which the individual
would otherwise be eligible;
``(ii) an adverse evaluation or decision made in relation
to accreditation, certification, credentialing, or licensing
of the individual; and
``(iii) a personnel action that is adverse to the
individual concerned.
``(f) Relationship to State Laws.--Nothing in this section
shall be construed as exempting or relieving any person from
any liability, duty, penalty, or punishment provided by any
present or future law of any State or political subdivision
of a State, other than any such law which purports to require
or permit the doing of any act which would be an unlawful
practice under this title.
``(g) Regulations.--The Secretary shall promulgate such
regulations as are appropriate and necessary to implement
this section.
``(h) Definitions.--In this section:
``(1) Participating hospital.--The term `participating
hospital' means a hospital that has entered into a provider
agreement under section 1866.
``(2) Registered nurse.--The term `registered nurse' means
an individual who has been granted a license to practice as a
registered nurse in at least 1 State.
``(3) Unit.--The term `unit' of a hospital is an
organizational department or separate geographic area of a
hospital, such as a burn unit, a labor and delivery room, a
post-anesthesia service area, an emergency department, an
operating room, a pediatric unit, a stepdown or intermediate
care unit, a specialty care unit, a telemetry unit, a general
medical care unit, a subacute care unit, and a transitional
inpatient care unit.
``(4) Shift.--The term `shift' means a scheduled set of
hours or duty period to be worked at a participating
hospital.
``(5) Person.--The term `person' means 1 or more
individuals, associations, corporations, unincorporated
organizations, or labor unions.''.
(c) Effective Date.--The amendments made by this section
shall take effect on January 1, 2004.
______
By Mr. NICKLES (for himself, Mr. Conrad, and Mr. Bunning):
S. 992. A bill to amend the Internal Revenue Code of 1986 to repeal
the provision taxing policyholder dividends of mutual life insurance
companies and to repeal the policyholders surplus account provisions;
to the Committee on Finance.
[[Page S5736]]
Mr. NICKLES. Mr. President, I rise today to introduce legislation to
simplify the taxation of life insurance companies. I am joined by my
colleague from North Dakota, Mr. Conrad, and my colleague from
Kentucky, Mr. Bunning.
Our legislation repeals Sections 809 and Section 815 of the Internal
Revenue Code. These provisions are no longer relevant given the
significant changes in the life insurance industry over the past 25
years, and repeal will simplify the tax code.
Section 809 was enacted in 1984 as a part of major revisions to the
laws governing life insurance companies. It was intended to ensure that
mutual life insurance companies do not have a competitive tax advantage
over stock life insurance companies. At that time, mutual life
insurance companies dominated the market. Now, however, mutuals account
for only 10 percent of the industry, and there are very few large
mutuals in existence. Section 809 reduces the amount of policyholder
dividends a mutual insurance company can deduct according to a complex
formula based on the previous 3 years' earnings of stock companies.
Section 809 is burdensome and raises very little revenue. Because its
original purpose is no longer valid, our bill would repeal the
provision permanently. In last year's economic stimulus bill, Congress
temporarily suspended Section 809. In addition, President Bush included
in his fiscal year 2003 budget submission a proposal to repeal Section
809 permanently.
Section 815 has an even longer history, dating back to 1959. Tax
changes in 1959 created an accounting mechanism called a ``policyholder
surplus account'' for stock life insurance companies. Stock companies
were permitted to defer tax on one-half of their underwriting income as
long as that income was not distributed to shareholders. This income
was accounted for through the policyholder surplus account, PSA. In
1984, Congress eliminated deferral of tax on underwriting income, but
did not address the issue of PSAs. The amounts in these accounts, which
are just an accounting entry, and do not contain real money, remain
subject to tax if certain triggering events occur. Because virtually no
company is willing to ``trigger'' the tax on the account, Section 815
also raises little or no revenue. It does, however, directly inhibit
the business decisions of stock companies with PSAs.
Congress has worked hard over the last few years to modernize laws
governing the financial services industry to encourage growth and
enhance competitiveness. Elimination of outdated tax provisions such as
Sections 809 and 815 will complement this effort and provide more
rational taxation of life insurance companies.
I urge my colleagues to join us in this initiative.
______
By Mr. LEAHY:
S. 995. A bill to amend the Richard B. Russell National School Lunch
Act and the Child Nutrition Act of 1966 to improve certain child
nutritional programs, and for other purposes; to the Committee on
Agriculture, Nutrition, and Forestry.
Mr. LEAHY. Mr. President, I rise today to introduce my Child
Nutrition Initiatives Act of 2003. This legislation consists of a
number of proposals that I believe will significantly improve the
nutrition benefits available to our Nation's children through Federal
child nutrition programs.
I am hoping that this legislation will serve as a starting point in
the Senate's debate over how to improve child nutrition programs this
year. It is not meant to be a comprehensive proposal for
reauthorization, nor does it represent all of the potential
improvements that could be made to the programs that I will be
supporting in the Agriculture Committee. I look forward to working with
Chairman Cochran and with Senator Harkin, the ranking Democrat on the
Committee, as well as the rest of the Committee to craft a
comprehensive bill.
The Committee has already held two hearings on child nutrition
legislation, where we heard from a wide variety of nutritionists,
school food service operators and others interested in these programs.
They presented us with a wide variety of ideas, some of them appearing
in my bill, which underlined the immense impact of these programs to
the nutritional health and well-being of all of our children and
grandchildren. Undersecretary Bost also testified, and he too offered
an array of proposals for improving these programs. I look forward to
more detailed proposals from the Department of Agriculture on how we
can better serve the children in these programs.
I was encouraged to hear that the Administration is interested in
providing much-needed financial help for schools choosing to improve
their nutritional environment. We know that many school food service
directors and employees want to offer healthier, more appetizing
options to the children they serve, yet the cost of providing
attractive fresh fruits and vegetables, or milk in child-friendly
plastic containers kept chilled in a cooler, is often prohibitive.
Increased per-meal reimbursements will encourage school cafeterias to
spend more on the foods that are healthiest for kids. With these funds,
schools will be able to make the salad bar and the milk cooler just as
attractive to school children as less nutritious foods.
Healthier food in the school cafeteria does little good if children
do not understand the benefits of eating apples over high-fat junk
food. For years, the Nutrition Education and Training, NET, program
provided critical support for state and local efforts to increase and
improve nutrition education in classrooms. It is in the classrooms
where the most effective and innovative nutrition education is
happening, and NET offered teachers the resources they needed to
develop a nutritional curriculum for their students. Unfortunately,
this program has not been funded in the last few years. My bill would
reinstate funding for the NET program, and encourage strong nutrition
education at the local level.
It is amazing how many kids do not know where the food that they eat
comes from. It's also amazing how far some farm products travel to get
to the cafeteria table. My bill includes a farm-to-cafeteria program
that will provide one-time grants to connect farms with their local
school system. These grants would be used to buy equipment and pay for
other costs to provide the freshest farm products available to our
children. Projects funded by the farm-to-cafeteria program would also
give children first-hand experience about how food is produced. This
new program would also provide economic benefits for small, local firms
by keeping food dollars within the community.
My support for these new farm-to-cafeteria projects comes in part
from the amazing successes demonstrated by the WIC Farmers Market
Nutrition Program. Years ago, I helped create this program, which
provides vouchers to WIC families good for fruits and vegetables at
their local farmers market. The effects of this program have been
stunning. In Vermont, recipients and farmers are raving about this
program, which provides fresh, local, and healthy food to those who
need it most. There has also been an unexpected educational component
to this program, with many recipients reporting that the farmers who
sell them the food have also helped them learn how to best prepare it.
This is a win-win situation. My bill will secure steady and predictable
funding for the Farmers Market Nutrition Program.
Every State receives a small amount of funds to administer and ensure
the integrity of all Federal child nutrition programs. Though these
funds are distributed based on usage of the programs, there has been an
all-State minimum to ensure that all States still have enough funds to
meet the basic administrative requirements mandated by law. This
minimum, however, has not been raised since 1981, despite inflation and
expansion of the responsibilities of the states. My bill updates the
minimum funding level to reflect inflation since 1981 and also indexes
it for inflation into the future.
I am pleased that my bill has the support of the American School Food
Service Association, the National Association for Farmers Market
Nutrition Programs, the National Milk Producers Federation, the
International Dairy Foods Association, and the Community Food Service
Coalition.
Opponents of my bill will undoubtedly point to the cost of these
programs, stating ``there is no money for such programs.'' Well, I
answer them
[[Page S5737]]
with one word: priorities. Our Nation is faced with a growing health
crisis. Children are growing up and growing out. They eat more, eat
less nutritious foods and exercise less. It is a health epidemic that
plagues them throughout life. By acting now, we can increase the
quality of life for these children and save in healthcare costs down
the line. For example, a study for the American School Food Service
Association and the National Dairy Council found that by improving the
quality, and therefore consumption, of milk in our school lunch
programs, we could save between $800 million to $1.1 billion in health
care costs every year.
I joined with a number of fellow senators in requesting that Congress
provide a modest increase of $1 billion per year in the Budget
Resolution so that we on the authorizing committees might make some
long-awaited and essential improvements to the child nutrition
programs. I am disappointed that increased funds were not provided. The
Senate sent a clear message to America's children: we would rather give
a several hundred billion dollar tax cut to a small minority of health
adults than protect our children, through $1 billion in programming,
from a health crisis.
The Federal Government reaches well over 25 million children each
year with these programs. We have a tremendous opportunity to be
proactive--to teach kids about food and give them nutritious options.
We have a growing health crisis on our hands as our children grow wider
because of unhealthy diets and less exercise. We must get serious about
finding solutions to the problem. Or we can wait, and allow a system
already doing its very best, working at maximum capacity, to
deteriorate. I am for acting now and I hope the Senate is too.
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. 995
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 ``Child
Nutrition Initiatives Act of 2003''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--SCHOOL LUNCH AND RELATED PROGRAMS
Sec. 101. Incentives for healthier schools.
Sec. 102. Grants to support farm-to-cafeteria projects.
TITLE II--SCHOOL BREAKFAST AND RELATED PROGRAMS
Sec. 201. State administrative expenses.
Sec. 202. Special supplemental program for women, infants and children.
Sec. 203. Nutrition education and training.
TITLE III--EFFECTIVE DATE
Sec. 301. Effective date.
TITLE I--SCHOOL LUNCH AND RELATED PROGRAMS
SEC. 101. INCENTIVES FOR HEALTHIER SCHOOLS.
Section 12 of the Richard B. Russell National School Lunch
Act (42 U.S.C. 1760) is amended by adding at the end the
following:
``(q) Incentives for Healthier Schools.--
``(1) In general.--To encourage healthier nutritional
environments in schools and institutions receiving funds
under this Act and the Child Nutrition Act of 1966 (42 U.S.C.
1771 et seq.) (other than section 17 of that Act (42 U.S.C.
1786)), the Secretary shall establish a program under which
any such school or institution may (in accordance with
paragraph (3)) receive an increase in the reimbursement rate
for meals otherwise payable under this Act and the Child
Nutrition Act of 1966, if the school or institution
implements a plan for improving the nutritional value of
meals consumed in the school or institution by increasing the
consumption of fluid milk, fruits, and vegetables, as
approved by the Secretary in accordance with criteria
established by the Secretary.
``(2) Plans.--
``(A) In general.--For purposes of the program established
under paragraph (1), the Secretary shall establish criteria
for the approval of plans of schools and institutions for
increasing consumption of fluid milk, fruits, and vegetables.
``(B) Criteria.--An approved plan may--
``(i) establish targeted goals for increasing fluid milk,
fruit, and vegetable consumption throughout the school or
institution or at school or institution activities;
``(ii) improve the accessibility, presentation,
positioning, or promotion of fluid milk, fruits, and
vegetables throughout the school or institution or at school
or institution activities;
``(iii) improve the ability of a school or institution to
tailor its food services to the customs and demographic
characteristics of--
``(I) the population of the school or institution; and
``(II) the area where the school or institution is located;
and
``(iv) provide--
``(I) increased standard serving sizes for fluid milk
consumed in middle and high schools; and
``(II) packaging, flavor variety, merchandising,
refrigeration, and handling requirements that promote the
consumption of fluid milk, fruits, and vegetables.
``(C) Administration.--In establishing criteria for
approval of plans under this subsection, the Secretary
shall--
``(i) take into account relevant research; and
``(ii) consult with school food service professionals,
nutrition professionals, food processors, agricultural
producers, and other groups, as appropriate.
``(3) Reimbursement rates.--
``(A) In general.--For purposes of administering the
program established under paragraph (1), the Secretary shall
increase reimbursement rates for meals under this Act and the
Child Nutrition Act of 1966 in an amount equal to not less
than 2 cents and not more than 10 cents per meal, to reflect
the additional costs incurred by schools and institutions in
increasing the consumption of fluid milk, fruits, and
vegetables under the program.
``(B) Criteria.--The Secretary may vary the increase in
reimbursement rates for meals based on the degree to which
the school or institution adopts the criteria established by
the Secretary under paragraph (2).''.
SEC. 102. GRANTS TO SUPPORT FARM-TO-CAFETERIA PROJECTS.
Section 12 of the Richard B. Russell National School Lunch
Act (42 U.S.C. 1760) (as amended by section 101) is amended
by adding at the end the following:
``(r) Grants to Support Farm-to-Cafeteria Projects.--
``(1) In general.--To improve access to local foods in
schools and institutions receiving funds under this Act and
the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)
(other than section 17 of that Act (42 U.S.C. 1768)), the
Secretary shall provide competitive grants to nonprofit
entities and educational institutions to establish and carry
out farm-to-cafeteria projects that may include the purchase
of equipment, the procurement of foods, and the provision of
training and education activities.
``(2) Preference for certain projects.--In selecting farm-
to-cafeteria projects to receive assistance under this
subsection, the Secretary shall give preference to projects
designed to--
``(A) procure local foods from small- and medium-sized
farms for the provision of foods for school meals;
``(B) support nutrition education activities or curriculum
planning that incorporates the participation of school
children in farm and agriculture education projects; and
``(C) develop a sustained commitment to farm-to-cafeteria
projects in the community by linking schools, agricultural
producers, parents, and other community stakeholders.
``(3) Technical assistance and related information.--
``(A) Technical assistance.--In carrying out this
subsection, the Secretary may provide technical assistance
regarding farm-to-cafeteria projects, processes, and
development to an entity seeking the assistance.
``(B) Sharing of information.--The Secretary may provide
for the sharing of information concerning farm-to-cafeteria
projects and issues among and between government, private
for-profit and nonprofit groups, and the public through
publications, conferences, and other appropriate means.
``(4) Grants.--
``(A) In general.--From amounts made available to carry out
this subsection, the Secretary shall make grants to assist
private nonprofit entities and educational institutions to
establish and carry out farm-to-cafeteria projects.
``(B) Maximum amount.--The maximum amount of a grant
provided to an entity under this subsection shall be
$100,000.
``(C) Matching funds requirements.--
``(i) In general.--The Federal share of the cost of
establishing or carrying out a farm-to-cafeteria project that
receives assistance under this subsection may not exceed 75
percent of the cost of the project during the term of the
grant, as determined by the Secretary.
``(ii) Form.--In providing the non-Federal share of the
cost of carrying out a farm-to-cafeteria project, the grantee
shall provide the share through a payment in cash or in kind,
fairly evaluated, including facilities, equipment, or
services.
``(iii) Source.--An entity may provide the non-Federal
share through State government, local government, or private
sources.
``(D) Administration.--
``(i) Single grant.--A farm-to-cafeteria project may be
supported by only a single grant under this subsection.
``(ii) Term.--The term of a grant made under this
subsection may not exceed 3 years.
``(5) Evaluation.--Not later than January 30, 2008, the
Secretary shall--
``(A) provide for the evaluation of the projects funded
under this subsection; and
[[Page S5738]]
``(B) submit to the Committee on Education and the
Workforce of the House of Representatives and the Committee
on Agriculture, Nutrition, and Forestry of the Senate a
report on the results of the evaluation.
``(6) Funding.--
``(A) In general.--On October 1, 2002, and on each October
1 thereafter through October 1, 2007, out of any funds in the
Treasury not otherwise appropriated, the Secretary of the
Treasury shall transfer to the Secretary of Agriculture to
carry out this subsection $10,000,000, to remain available
until expended.
``(B) Receipt and acceptance.--The Secretary shall be
entitled to receive, shall accept, and shall use to carry out
this subsection the funds transferred under subparagraph (A),
without further appropriation.''.
TITLE II--SCHOOL BREAKFAST AND RELATED PROGRAMS
SEC. 201. STATE ADMINISTRATIVE EXPENSES.
(a) Minimum Amount.--Section 7(a)(2) of the Child Nutrition
Act of 1966 (42 U.S.C.1776(a)(2)) is amended by striking the
last sentence and inserting the following: ``In no case shall
the grant available to any State under this subsection be
less than $200,000, as adjusted in accordance with section
11(a)(3)(B) of the Richard B. Russell National School Lunch
Act (42 U.S.C. 1759a(a)(3)(B)).''.
(b) Extension.--Section 7(g) of the Child Nutrition Act of
1966 (42 U.S.C. 1776(g) is amended by striking ``2003'' and
inserting ``2008''.
SEC. 202. SPECIAL SUPPLEMENTAL PROGRAM FOR WOMEN, INFANTS AND
CHILDREN.
(a) Sense of Congress on Full Funding for WIC.--It is the
sense of Congress that the special supplemental nutrition
program for women, infants, and children established under
section 17 of the Child Nutrition Act of 1966 (42 U.S.C.
1786) should be fully funded for fiscal year 2004 and each
subsequent fiscal year so that all eligible participants for
the program will be permitted to participate at the full
level of participation for individuals in their category, in
accordance with regulations promulgated by the Secretary of
Agriculture.
(b) Reauthorization of Program.--Section 17(g)(1) of the
Child Nutrition Act of 1966 (42 U.S.C. 1786(g)(1)) is amended
in the first sentence by striking ``2003'' and inserting
``2008''.
(c) Nutrition Services and Administration Funds.--Section
17(h) of the Child Nutrition Act of 1966 (42 U.S.C. 1786(h))
is amended--
(1) in paragraph (2)(A), by striking ``2003'' and inserting
``2008''; and
(2) in paragraph (10)(A), by striking ``2003'' and
inserting ``2008''.
(d) Farmers' Market Nutrition Program.--Section 17(m) of
the Child Nutrition Act of 1966 (42 U.S.C. 1786(m)) is
amended--
(1) in paragraph (1), by striking ``(m)(1) Subject'' and
all that follows through ``the Secretary'' and inserting the
following:
``(m) Farmers' Market Nutrition Program.--
``(1) In general.--The Secretary'';
(2) in paragraph (6)(B)--
(A) by striking ``(B)(i) Subject to the availability of
appropriations, if'' and inserting the following:
``(B) Minimum amount.--If''; and
(B) by striking clause (ii); and
(3) in paragraph (9), by striking ``(9)(A)'' and all that
follows through the end of subparagraph (A) and inserting the
following:
``(9) Funding.--
``(A) In general.--Out of any funds in the Treasury not
otherwise appropriated, the Secretary of the Treasury shall
transfer to the Secretary of Agriculture to carry out this
subsection--
``(i) on October 1, 2003, $25,000,000;
``(ii) on October 1, 2004, $29,000,000;
``(iii) on October 1, 2005, $33,000,000;
``(iv) on October 1, 2006, $37,000,000; and
``(v) on October 1, 2007, $41,000,000.
``(B) Receipt and acceptance.--The Secretary shall be
entitled to receive, shall accept, and shall use to carry out
this subsection the funds transferred under subparagraph (A),
without further appropriation.
``(C) Availability of funds.--Funds transferred under
subparagraph (A) shall remain available until expended.''.
SEC. 203. NUTRITION EDUCATION AND TRAINING.
Section 19(i) of the Child Nutrition Act of 1966 (42 U.S.C.
1788 (i)) is amended by striking ``(i) Authorization of
appropriations.--'' and all that follows through the end of
paragraph (1) and inserting the following:
``(i) Funding.--
``(1) Payments.--
``(A) In general.--On October 1, 2003, and on each October
1 thereafter through October 1, 2007, out of any funds in the
Treasury not otherwise appropriated, the Secretary of the
Treasury shall transfer to the Secretary of Agriculture to
carry out this section $27,000,000, to remain available until
expended.
``(B) Receipt and acceptance.--The Secretary shall be
entitled to receive, shall accept, and shall use to carry out
this section the funds transferred under subparagraph (A),
without further appropriation.
``(2) Grants.--
``(A) In general.--Grants to each State from the amounts
made available under subparagraph (A) shall be based on a
rate of 50 cents for each child enrolled in schools or
institutions within the State.
``(B) Minimum amount.--The minimum amount of a grant
provided to a State for a fiscal year under this section
shall be $200,000, as adjusted in accordance with section
11(a)(3)(B) of the Richard B. Russell National School Lunch
Act (42 U.S.C. 1759a(a)(3)(B)).''.
TITLE III--EFFECTIVE DATE
SEC. 301. EFFECTIVE DATE.
This Act and the amendments made by this Act take effect on
October 1, 2003.
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