[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.

                          ____________________