[Congressional Record Volume 149, Number 78 (Friday, May 23, 2003)]
[Senate]
[Pages S7137-S7159]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. BINGAMAN (for himself, Mr. Cochran, Mrs. Lincoln, Ms.
Collins, Mr. Daschle, Mr. Jeffords, Ms. Cantwell, Mrs. Clinton,
and Mr. Johnson):
S. 1142. A bill to provide disadvantaged children with access to
dental services; to the Committee on Finance.
Mr. BINGAMAN. Mr. President, the legislation I am introducing today
with Senators Cochran, Lincoln, Collins, Daschle, Jeffords, Clinton,
Cantwell, and Johnson is entitled the Children's Dental Health
Improvement Act of 2003. This legislation is designed to improve the
access and delivery of dental health services to our Nation's children
through Medicaid, the State Children's Health Insurance Program,
(SCHIP), the Indian Health Services, IHS, and our Nation's safety net
of community health centers.
The oral health problems facing children are highlighted in a
landmark report issued by the Surgeon General and the Department of
Health and Human Services, HHS, in 2000 entitled ``Oral Health in
America: A report of the Surgeon General'' in which he observed that
our Nation is facing what amounts to ``a `silent epidemic' of dental
and oral diseases.''
In fact, dental caries, which refers to both decayed teeth or filled
cavities, is the most common childhood disease. According to the
Surgeon General,``Among 5- to 17-years olds, dental caries is more than
5 times as common as a reported history of asthma and 7 times as common
as hay fever.'' In short, dental care is, as the Surgeon General
adds,``the most prevalent unmet health need among American children.''
I was pleased to chair a hearing in the Health, Education, Labor and
Pensions Committee on June 25, 2002, entitled ``The Crisis in
Children's Dental Health: A Silent Epidemic'' in which the Surgeon
General, Dr. David Satcher, testified. Dr. Satcher's testimony was
strong and compelling.
In his words, ``Over 108 million children and adults lack dental
insurance, which is over 2.5 times the number who lack medical
insurance.'' Dr. Satcher also highlight the following information
specific to the oral health problems in children:
There are striking disparities in dental disease by income. Poor
children suffer twice as much dental cries as their more affluent
peers, and their disease is more likely to be untreated. These poor-
nonpoor differences continue into adolescence. One out of four children
in America is born into poverty, and children living below the poverty
line--annual income of $17,000 for a family of four--have more severe
and untreated decay.
Other birth defects such as hereditary ectodermal dysplasias, where
all or most teeth are missing or misshapen, cause lifetime problems
that can be devastating to children and adults.
Unintentional injuries, many of which include head, mouth, and neck
injuries, are common in children.
Intentional injuries commonly affect the craniofacial tissues.
Tobacco-related oral lesions are prevalent in adolescents who
currently use smokeless--spit tobacco.
Professional care is necessary for maintaining oral health, yet 25
percent of poor children have not seen a dentist before entering
kindergarten.
Medical insurance is a strong predictor of access to dental care.
Uninsured children are 2.5 times less likely than insured children to
receive dental care. Children from families without dental insurance
are three times more likely to have dental needs than children with
either public or private insurance. For each child without medical
insurance, there are at least 2.6 children without dental insurance.
Medicaid has not been able to fill the gap in providing dental care
to poor children. Fewer than one in five Medicaid-covered children
received a single dental visit in a recent year-long study period.
While recent CMS data indicate progress in this area with 1 million
more Medicaid-eligible children now receiving annual dental care than
was the case in 1996, there is still a long way to go to ensuring
greater access. Although new programs such as the State Children's
Health Insurance Program, SCHIP, may increase the number of insured
children, many will still be left without effective dental coverage.
The social impact of oral diseases in children is substantial. More
than 51 million school hours are lost each year to dental-related
illness. Poor children suffer nearly 12 times more restricted-activity
days than children from higher income families. Pain and suffering due
to untreated diseases can lead to problems in eating, speaking, and
attending to learning.
Over 50 percent of 5- to 9-year-old children have at least one cavity
or filling, and that proportion increases to 78 percent among 17-year-
olds. Nevertheless, these figures represent improvements in the oral
health of children compared to a generation ago.
The Senate also heard the testimony of Dr. Burton Edelstein, founding
director of the Children's Dental Health Project; Dr. Gregory Chadwick,
president of the American Dental Association; Dr. Lynn Douglass
Moundon, director of oral health in the Arkansas Department of Health;
Ed Martinez, chief executive officer at San Ysidro Health Center in
California; and, Dr. Timothy Shriver, president and chief executive
officer of Special Olympics, Inc.
Dr. Edelstein underscored the need for more attention to this issue.
As he said, ``The too-widespread belief that childhood dental disease
has been vanquished states in contrast to the thousands upon thousands
of toothaches and acute abscesses experienced daily by America's
children--many as young as 2 years of age.''
In endorsing this legislation, Dr. Chadwick added, ``. . . we cannot
forget the fact that millions of people in this country--particularly
children--aren't getting even basic preventive and restorative dental
care. These children are out there suffering.''
The Children's Dental Health Improvement Act of 2003 seeks to end
that suffering. One important provision in the bill would grant States
flexibility
[[Page S7138]]
to provide dental coverage to low-income children through the State
Children's Health Insurance Program, or SCHIP, just as States currently
are able to do through Medicaid.
Unfortunately, SCHIP law prohibits coverage of children for services
unless they are completely uninsured. As authors Ruth Almeida, Ian
Hill, and Genevieve Kenney of an Urban Institute report entitled ``Does
SCHIP Spell Better Dental Care for Children? An Early Look at New
Initiatives write'', ``. . . many low-income children are covered by
employer-based or other private health insurance for their medical
care, but do not have a comprehensive dental benefit. Because these
children are privately insured, they are not eligible for SCHIP and
cannot avail themselves of dental coverage under SCHIP. Expanding SCHIP
to furnish dental services on a wraparound basis to private covered
low-income children without dental coverage could help achieve broader
improvements in children's oral health.''
For low-income children with medical coverage but no dental insurance
through the private sector, their only option would be to completely
dump their private coverage for their children in order to access SCHIP
coverage.
Instead, the Children's Dental Health Improvement Act of 2003 creates
an option for States to provide low-income families with the ability to
receive wraparound dental coverage through SCHIP without having to
completely drop their private insurance. This reduces the crowd-out of
private insurance, which was a priority of the Congress during passage
of SCHIP, and it provides low-income children with dental services that
other children in the same economic circumstance are already receiving
through SCHIP.
In implementing such a change, I want to make it clear that I am in
strong support of providing additional funding to SCHIP to ensure that
these services are provided without reducing current levels of SCHIP
funding. With those additional funds, I strongly believe that SCHIP,
just as Medicaid, should provide services to low-income children who
are both uninsured and underinsured. Children need a comprehensive set
of child health services, including dental services, to ensure their
appropriate health and development.
However, coverage for these services is often not enough. Even when
children do have dental coverage, the access to care is often sorely
lacking. Medicaid is the largest insurer of dental coverage to
children. Yet despite the design of the Medicaid Program to ensure
access to comprehensive services for children, including dental care,
the inspector general of the Department of Health and Human Services
reported in 1996 that only 18 percent of children eligible for Medicaid
received even a single preventive dental service. The same report shows
that no State provides preventive services to more than 50 percent of
eligible children. The factors are complex but the primary one is due
to limited dental participation in Medicaid.
According to GAO, in its September 2000 report entitled ``Oral
Health: Factors Contributing to Low Use of Dental Services by Low-
Income Populations.'' ``Of 39 states that provided information about
dentists' participation in Medicaid, 23 reported that fewer than half
of the states' dentists saw at least one Medicaid patient during
1999.'' Even worse, a 1998 survey by the National Conference of State
Legislatures indicates that fewer than 20 percent of dentists
participate in the Medicaid Program nationwide.
The GAO concludes poor participation rates by dentists is due in
large part to poor reimbursement rates in Medicaid. As the GAO points
out, ``Our analysis showed that Medicaid payment rates are often well
below dentists' normal fees. Only 13 states had Medicaid rates that
exceeded two-thirds of the average regional fees dentists charged. . .
.''
Clearly, Medicaid is chronically underfunded with respect to dental
care. The Surgeon General's report notes, ``On average, state Medicaid
agencies contribute only 2.3 percent of their child health expenditures
to dental care, whereas nationally, the percentage of all child health
expenditures dedicated to dental care is more than 10 times that rate,
almost 30 percent.''
The good news is that many States, including New Mexico, have taken
recent actions to improve the participation of dentists in the Medicaid
Program by raising low payment rates and reducing administrative
requirements. These efforts were highlighted by the GAO in its
September 2000 report. To further encourage such efforts, the
``Children's Dental Health Improvement Act of 2003'' provides $50
million annually as financial incentives and planning grants to States
to undertake additional improvements in their Medicaid Programs
delivery of dental health services to children.
In addition to Medicaid and SCHIP, the Federal Government administers
other health care programs providing dental services or providers for
low-income children and their families, including services administered
by community health centers and the Indian Health Service, or IHS.
Unfortunately, both of these programs are underfunded and, as the GAO
found, ``report difficulty in meeting the dental needs of their target
populations.''
For example, the GAO found that ``HHS and health center officials
report that the demand for dental services significantly exceeds the
[urban and rural health] centers' capacity to deliver it. In 1998 . .
., a little more than half of the nearly 700 health center grantees
funded under this program had active dental programs.'' This is also
true for public health departments across the country.
To assist the health centers and public health departments with this
need, the Children's Dental Health Improvement Act of 2003 provides $40
million to community health centers and public health departments to
expand dental health services through the hiring of additional dental
health professionals to serve low-income populations.
This is particularly a problem that needs to be addressed in areas
with severe dental health professional shortages, such as New Mexico.
For example, New Mexico ranked next to last in the Nation with just
32.1 dentists per 100,000 population in 1998, according to HHS.
This compares to the national average of 48.4 per 100,000. Moreover,
the number of dentists in New Mexico declined by 7 percent between 1991
and 1998 while the State's population grew 12 percent. The result was a
17 percent decline in dentists per capita during the period.
With regard to American Indian and Alaska Native populations, the
need is so great and the funding so little that a comprehensive
solution is requiring throughout the IHS system. With respect to the
unmet need, the GAO notes that ``American Indian and Alaska Native
children aged 2 to 4 years old have five times the rate of decay that
all children have.''
Unfortunately, the GAO adds, ``. . . about one-fourth of IHS' dentist
positions at 269 IHS and tribal facilities were vacant in April 2000.
Vacancies have been chronic at IHS facilities--in the past 5 years, at
least 67 facilities have had one or more dentist positions vacant for
at least a year. According to IHS officials, the primary reason for
these vacancies is that IHS is unable to provide a competitive salary
for new dentists . . .''
The GAO continues, ``The IHS' dental personnel shortages translate
into a large unmet need for dental services among American Indians and
Alaska Natives. IHS reports that only 24 percent of the eligible
population had a dental visit in 1998. The personnel shortages have
also reduced the scope of services that facilities are able to provide.
According to IHS officials, available services have concentrated more
on acute and emergency care, while routine and restorative care have
dropped as a percentage of workload. Emergency services increased from
one-fifth of the workload in 1990 to more than one-third of the
workload in 1999.''
To help alleviate this workforce shortage, the Children's Dental
Health Improvement Act of 2003 provides IHS with the authority to offer
multiyear retention bonuses to dental providers offering services
through the IHS and tribal programs.
The bill also provides for some technical amendments to ensure that
tribal organizations and community health centers are allowed to apply
for school-based dental sealant funding from the Centers for Disease
Control and Prevention, or CDC.
[[Page S7139]]
The legislation also has a new provision that addresses a technical
and unintended problem with the implementation of provisions changing
the way Medicare graduate medical education, or GME, is funded. As
background in the Balanced Budget Act of 1997, or BBA, Congress
recognized the unfairness of subjecting dentistry to GME policies based
on the oversupply of physician specialists by exempting dental
residency positions from caps placed on the number of residents
supported by Medicare GME.
However, the two provisions in that law--both enacted primarily to
alleviate the impact on hospitals that decrease physician slots--have
had the opposite impact on hospitals that increase their dental
residency positions. While successful in achieving the purpose of
reducing the number of physicians being trained, these provisions have
hurt dentistry and access to oral health care in the United States and
are contrary to the congressional goal in 1997 to increase the number
of postgraduate dental residency slots. As a result, the legislation
would exempt dental residency training positions from the 3-year
rolling average provision used to calculate the number of residents for
Medicare GME payments.
The bipartisan legislation I am introducing today would improve the
access and delivery of dental health services to our Nation's children
through Medicaid, SCHIP, IHS, and our Nation's safety net of community
health centers. These problems are well documented and call out for
congressional action as soon as possible.
I would like to thank the American Dental Association, the American
Dental Education Association, the American Academy of Pediatric
Dentistry, the National Association of Community Health Centers, Inc.,
the National Association of Children's Hospitals, the American Dental
Hygienists' Association, and the Children's Dental Health Project for
their outstanding support and/or their technical advice on this
legislation. This bill is a result of their outstanding work.
In particular, I want to thank Dr. Burt Edelstein, Libby Mullin, and
Ann De Biasi of the Children's Dental Health Project for their vast
knowledge and technical assistance on this issue. I want to thank Judy
Sherman of the American Dental Association, Myla Moss and Jack Bresch
of the American Dental Education Association, Dr. Herber Simmons and
Scott Litch of the American Academy of Pediatric Dentistry, Karen
Sealander of the American Dental Hygienists' Association, Dr. Jim
Richeson and Judy Kloss Bynum of the Academy of General Dentistry, Dr.
Stephen Corbin of Special Olympics, Inc., and Dan Hawkins, Chris
Koppen, and Roger Schwartz of the National Association of Community
Health Centers, Inc., for their valuable insight, technical advice, and
continued support for this legislation. I look forward to working with
them all to ensure that we achieve increased access to oral health care
for our children.
In addition to those organizations, I would like to thank the
following groups for their support of the bill, whether in the past
session of Congress or this year. They include: the Academy of General
Dentistry, American Academy of Child and Adolescent Psychiatry,
American Academy of Oral and Maxillofacial Pathology, American Academy
of Periodontology, American Association of Dental Examiners, American
Association of Dental Research, American Association of Endodontists,
American Association of Public Health Dentistry, American Association
of Oral and Maxillofacial Surgeons, American Association of
Orthodontists, American Association of Women Dentists, American College
of Dentists, American College of Preventive Medicine, American Dental
Trade Association, American Public Health Association, American Society
of Dentistry for Children, American Student Dental Association,
Association of Clinicians for the Underserved, Association of Maternal
and Child Health Programs, Association of State and Territorial Dental
Directors, Dental Dealers of America, Dental Manufacturers of America,
Inc., Family Voices, Hispanic Dental Association, International College
of Dentists--USA, March of Dimes, National Association of City and
County Health Officers, National Association of Local Boards of Health,
National Dental Association, National Health Law Program, New Mexico
Department of Health, Partnership for Prevention, Society of American
Indian Dentists, Special Care Dentistry, and United Cerebral Palsy
Associations.
Mr. President, I ask unanimous consent for the text of the bill to be
printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1142
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 ``Children's
Dental Health Improvement 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--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER MEDICAID
AND SCHIP
Sec. 101. Grants to improve the provision of dental services under
medicaid and SCHIP.
Sec. 102. State option to provide wrap-around SCHIP coverage to
children who have other health coverage.
TITLE II--CORRECTING GME PAYMENTS FOR DENTAL RESIDENCY TRAINING
PROGRAMS
Sec. 201. Limitation on the application of the 1-year lag in the
indirect medical education ratio (IME) changes and the 3-
year rolling average for counting interns and residents
for IME and direct graduate medical education (D-GME)
payments under the medicare program.
TITLE III--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER
COMMUNITY HEALTH CENTERS, PUBLIC HEALTH DEPARTMENTS, AND THE INDIAN
HEALTH SERVICE
Sec. 301. Grants to improve the provision of dental health services
through community health centers and public health
departments.
Sec. 302. Dental officer multiyear retention bonus for the Indian
Health Service.
Sec. 303. Demonstration projects to increase access to pediatric dental
services in underserved areas.
Sec. 304. Technical correction.
TITLE IV--IMPROVING ORAL HEALTH PROMOTION AND DISEASE PREVENTION
PROGRAMS
Sec. 401. Oral health initiative.
Sec. 402. CDC reports.
Sec. 403. Early childhood caries.
Sec. 404. School-based dental sealant program.
Sec. 405. Basic oral health promotion.
TITLE I--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER MEDICAID
AND SCHIP
SEC. 101. GRANTS TO IMPROVE THE PROVISION OF DENTAL SERVICES
UNDER MEDICAID AND SCHIP.
Title V of the Social Security Act (42 U.S.C. 701 et seq.)
is amended by adding at the end the following:
``SEC. 511. GRANTS TO IMPROVE THE PROVISION OF DENTAL
SERVICES UNDER MEDICAID AND SCHIP.
``(a) Authority to Make Grants.--In addition to any other
payments made under this title to a State, the Secretary
shall award grants to States that satisfy the requirements of
subsection (b) to improve the provision of dental services to
children who are enrolled in a State plan under title XIX or
a State child health plan under title XXI (in this section,
collectively referred to as the `State plans').
``(b) Requirements.--In order to be eligible for a grant
under this section, a State shall provide the Secretary with
the following assurances:
``(1) Improved service delivery.--The State shall have a
plan to improve the delivery of dental services to children,
including children with special health care needs, who are
enrolled in the State plans, including providing outreach and
administrative case management, improving collection and
reporting of claims data, and providing incentives, in
addition to raising reimbursement rates, to increase provider
participation.
``(2) Adequate payment rates.--The State has provided for
payment under the State plans for dental services for
children at levels consistent with the market-based rates and
sufficient enough to enlist providers to treat children in
need of dental services.
``(3) Ensured access.--The State shall ensure it will make
dental services available to children enrolled in the State
plans to the same extent as such services are available to
the general population of the State.
``(c) Use of Funds.--
[[Page S7140]]
``(1) In general.--Funds provided under this section may be
used to provide administrative resources (such as program
development, provider training, data collection and analysis,
and research-related tasks) to assist States in providing and
assessing services that include preventive and therapeutic
dental care regimens.
``(2) Limitation.--Funds provided under this section may
not be used for payment of direct dental, medical, or other
services or to obtain Federal matching funds under any
Federal program.
``(d) Application.--A State shall submit an application to
the Secretary for a grant under this section in such form and
manner and containing such information as the Secretary may
require.
``(e) Authorization of Appropriations.--There are
authorized to be appropriated to make grants under this
section $50,000,000 for fiscal year 2004 and each fiscal year
thereafter.
``(f) Application of Other Provisions of Title.--
``(1) In general.--Except as provided in paragraph (2), the
other provisions of this title shall not apply to a grant
made under this section.
``(2) Exceptions.--The following provisions of this title
shall apply to a grant made under subsection (a) to the same
extent and in the same manner as such provisions apply to
allotments made under section 502(c):
``(A) Section 504(b)(6) (relating to prohibition on
payments to excluded individuals and entities).
``(B) Section 504(c) (relating to the use of funds for the
purchase of technical assistance).
``(C) Section 504(d) (relating to a limitation on
administrative expenditures).
``(D) Section 506 (relating to reports and audits), but
only to the extent determined by the Secretary to be
appropriate for grants made under this section.
``(E) Section 507 (relating to penalties for false
statements).
``(F) Section 508 (relating to nondiscrimination).
``(G) Section 509 (relating to the administration of the
grant program).''.
SEC. 102. STATE OPTION TO PROVIDE WRAP-AROUND SCHIP COVERAGE
TO CHILDREN WHO HAVE OTHER HEALTH COVERAGE.
(a) In General.--
(1) SCHIP.--
(A) State option to provide wrap-around coverage.--Section
2110(b) of the Social Security Act (42 U.S.C. 1397jj(b)) is
amended--
(i) in paragraph (1)(C), by inserting ``, subject to
paragraph (5),'' after ``under title XIX or''; and
(ii) by adding at the end the following:
``(5) State option to provide wrap-around coverage.--A
State may waive the requirement of paragraph (1)(C) that a
targeted low-income child may not be covered under a group
health plan or under health insurance coverage, if the State
satisfies the conditions described in subsection (c)(8). The
State may waive such requirement in order to provide--
``(A) dental services;
``(B) cost-sharing protection; or
``(C) all services.
In waiving such requirement, a State may limit the
application of the waiver to children whose family income
does not exceed a level specified by the State, so long as
the level so specified does not exceed the maximum income
level otherwise established for other children under the
State child health plan.''.
(B) Conditions described.--Section 2105(c) of the Social
Security Act (42 U.S.C. 1397ee(c)) is amended by adding at
the end the following:
``(8) Conditions for provision of wrap-around coverage.--
For purposes of section 2110(b)(5), the conditions described
in this paragraph are the following:
``(A) Income eligibility.--The State child health plan
(whether implemented under title XIX or this XXI)--
``(i) has the highest income eligibility standard permitted
under this title as of January 1, 2002;
``(ii) subject to subparagraph (B), does not limit the
acceptance of applications for children; and
``(iii) provides benefits to all children in the State who
apply for and meet eligibility standards.
``(B) No waiting list imposed.--With respect to children
whose family income is at or below 200 percent of the poverty
line, the State does not impose any numerical limitation,
waiting list, or similar limitation on the eligibility of
such children for child health assistance under such State
plan.
``(C) No more favorable treatment.--The State child health
plan may not provide more favorable coverage of dental
services to the children covered under section 2110(b)(5)
than to children otherwise covered under this title.''.
(C) State option to waive waiting period.--Section
2102(b)(1)(B) of the Social Security Act (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii), by striking the period and inserting
``; and''; and
(iii) by adding at the end the following:
``(iii) at State option, may not apply a waiting period in
the case of a child described in section 2110(b)(5), if the
State satisfies the requirements of section 2105(c)(8).''.
(2) Application of enhanced match under medicaid.--Section
1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
(A) in subsection (b), in the fourth sentence, by striking
``or subsection (u)(3)'' and inserting ``(u)(3), or (u)(4)'';
and
(B) in subsection (u)--
(i) by redesignating paragraph (4) as paragraph (5); and
(ii) by inserting after paragraph (3) the following:
``(4) For purposes of subsection (b), the expenditures
described in this paragraph are expenditures for items and
services for children described in section 2110(b)(5), but
only in the case of a State that satisfies the requirements
of section 2105(c)(8).''.
(3) Application of secondary payor provisions.--Section
2107(e)(1) of the Social Security Act (42 U.S.C.
1397gg(e)(1)) is amended--
(A) by redesignating subparagraphs (B) through (D) as
subparagraphs (C) through (E), respectively; and
(B) by inserting after subparagraph (A) the following:
``(B) Section 1902(a)(25) (relating to coordination of
benefits and secondary payor provisions) with respect to
children covered under a waiver described in section
2110(b)(5).''.
(b) Effective Date.--The amendments made by subsection (a)
shall take effect on January 1, 2003, and shall apply to
child health assistance and medical assistance provided on or
after that date.
TITLE II--CORRECTING GME PAYMENTS FOR DENTAL RESIDENCY TRAINING
PROGRAMS
SEC. 201. LIMITATION ON THE APPLICATION OF THE 1-YEAR LAG IN
THE INDIRECT MEDICAL EDUCATION RATIO (IME)
CHANGES AND THE 3-YEAR ROLLING AVERAGE FOR
COUNTING INTERNS AND RESIDENTS FOR IME AND
DIRECT GRADUATE MEDICAL EDUCATION (D-GME)
PAYMENTS UNDER THE MEDICARE PROGRAM.
(a) IME Ratio and Rolling Average.--Section
1886(d)(5)(B)(vi) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(B)(vi)) is amended by adding at the end the
following new sentence: ``For cost reporting periods
beginning during fiscal years beginning on or after October
1, 2003, subclauses (I) and (II) shall be applied only with
respect to a hospital's approved medical residency training
program in the fields of allopathic medicine and osteopathic
medicine.''.
(b) D-GME Rolling Average.--Section 1886(h)(4)(G) of the
Social Security Act (42 U.S.C. 1395ww(h)(4)(G)) is amended by
adding at the end the following new clause:
``(iv) Application for fy 2004 and subsequent years.--For
cost reporting periods beginning during fiscal years
beginning on or after October 1, 2003, clauses (i) through
(iii) shall be applied only with respect to a hospital's
approved medical residency training program in the fields of
allopathic medicine and osteopathic medicine.''.
TITLE III--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER
COMMUNITY HEALTH CENTERS, PUBLIC HEALTH DEPARTMENTS, AND THE INDIAN
HEALTH SERVICE
SEC. 301. GRANTS TO IMPROVE THE PROVISION OF DENTAL HEALTH
SERVICES THROUGH COMMUNITY HEALTH CENTERS AND
PUBLIC HEALTH DEPARTMENTS.
Part D of title III of the Public Health Service Act (42
U.S.C. 254b et seq.) is amended by insert before section 330,
the following:
``SEC. 329. GRANT PROGRAM TO EXPAND THE AVAILABILITY OF
SERVICES.
``(a) In General.--The Secretary, acting through the Health
Resources and Services Administration, shall establish a
program under which the Secretary may award grants to
eligible entities and eligible individuals to expand the
availability of primary dental care services in dental health
professional shortage areas or medically underserved areas.
``(b) Eligibility.--
``(1) Entities.--To be eligible to receive a grant under
this section an entity--
``(A) shall be--
``(i) a health center receiving funds under section 330 or
designated as a Federally qualified health center;
``(ii) a county or local public health department, if
located in a federally-designated dental health professional
shortage area;
``(iii) an Indian tribe or tribal organization (as defined
in section 4 of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b));
``(iv) a dental education program accredited by the
Commission on Dental Accreditation;
``(v) a community-based program whose child service
population is made up of at least 33 percent of children who
are eligible children, including at least 25 percent of such
children being children with mental retardation or related
developmental disabilities, unless specific documentation of
a lack of need for access by this sub-population is
established; and
``(B) shall prepare and submit to the Secretary an
application at such time, in such manner, and containing such
information as
[[Page S7141]]
the Secretary may require, including information concerning
dental provider capacity to serve individuals with
developmental disabilities.
``(2) Individuals.--To be eligible to receive a grant under
this section an individual shall--
``(A) be a dental health professional licensed or certified
in accordance with the laws of State in which such individual
provides dental services;
``(B) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require; and
``(C) provide assurances that--
``(i) the individual will practice in a federally-
designated dental health professional shortage area; or
``(ii) not less than 25 percent of the patients of such
individual are--
``(I) receiving assistance under a State plan under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.);
``(II) receiving assistance under a State plan under title
XXI of the Social Security Act (42 U.S.C. 1397aa et seq.); or
``(III) uninsured.
``(c) Use of Funds.--
``(1) Entities.--An entity shall use amounts received under
a grant under this section to provide for the increased
availability of primary dental services in the areas
described in subsection (a). Such amounts may be used to
supplement the salaries offered for individuals accepting
employment as dentists in such areas.
``(2) Individuals.--A grant to an individual under
subsection (a) shall be in the form of a $1,000 bonus payment
for each month in which such individual is in compliance with
the eligibility requirements of subsection (b)(2)(C).
``(d) Authorization of Appropriations.--
``(1) In general.--Notwithstanding any other amounts
appropriated under section 330 for health centers, there is
authorized to be appropriated $40,000,000 for each of fiscal
years 2004 through 2008 to hire and retain dental health care
providers under this section.
``(2) Use of funds.--Of the amount appropriated for a
fiscal year under paragraph (1), the Secretary shall use--
``(A) not less than 65 percent of such amount to make
grants to eligible entities; and
``(B) not more than 35 percent of such amount to make
grants to eligible individuals.''.
SEC. 302. DENTAL OFFICER MULTIYEAR RETENTION BONUS FOR THE
INDIAN HEALTH SERVICE.
(a) Terms and Definitions.--In this section:
(1) Creditable service.--The term ``creditable service''
includes all periods that a dental officer spent in graduate
dental educational (GDE) training programs while not on
active duty in the Indian Health Service and all periods of
active duty in the Indian Health Service as a dental officer.
(2) Dental officer.--The term ``dental officer'' means an
officer of the Indian Health Service designated as a dental
officer.
(3) Director.--The term ``Director'' means the Director of
the Indian Health Service.
(4) Residency.--The term ``residency'' means a graduate
dental educational (GDE) training program of at least 12
months leading to a specialty, including general practice
residency (GPR) or an advanced education general dentistry
(AEGD).
(5) Specialty.--The term ``specialty'' means a dental
specialty for which there is an Indian Health Service
specialty code number.
(b) Requirements for Bonus.--
(1) In general.--An eligible dental officer of the Indian
Health Service who executes a written agreement to remain on
active duty for 2, 3, or 4 years after the completion of any
other active duty service commitment to the Indian Health
Service may, upon acceptance of the written agreement by
the Director, be authorized to receive a dental officer
multiyear retention bonus under this section. The Director
may, based on requirements of the Indian Health Service,
decline to offer such a retention bonus to any specialty
that is otherwise eligible, or to restrict the length of
such a retention bonus contract for a specialty to less
than 4 years.
(2) Limitations.--Each annual dental officer multiyear
retention bonus authorized under this section shall not
exceed the following:
(A) $14,000 for a 4-year written agreement.
(B) $8,000 for a 3-year written agreement.
(C) $4,000 for a 2-year written agreement.
(c) Eligibility.--
(1) In general.--In order to be eligible to receive a
dental officer multiyear retention bonus under this section,
a dental officer shall--
(A) be at or below such grade as the Director shall
determine;
(B) have completed any active duty service commitment of
the Indian Health Service incurred for dental education and
training or have 8 years of creditable service;
(C) have completed initial residency training, or be
scheduled to complete initial residency training before
September 30 of the fiscal year in which the officer enters
into a dental officer multiyear retention bonus written
service agreement under this section; and
(D) have a dental specialty in pediatric dentistry or oral
and maxillofacial surgery.
(2) Extension to other officers.--The Director may extend
the retention bonus to dental officers other than officers
with a dental specialty in pediatric dentistry, as well as to
other dental hygienists with a minimum of a baccalaureate
degree, based on demonstrated need.
(d) Termination of Entitlement to Special Pay.--The
Director may terminate, with cause, at any time a dental
officer's multiyear retention bonus contract under this
section. If such a contract is terminated, the unserved
portion of the retention bonus contract shall be recouped on
a pro rata basis. The Director shall establish regulations
that specify the conditions and procedures under which
termination may take place. The regulations and conditions
for termination shall be included in the written service
contract for a dental officer multiyear retention bonus under
this section.
(e) Refunds.--
(1) In general.--Prorated refunds shall be required for
sums paid under a retention bonus contract under this section
if a dental officer who has received the retention bonus
fails to complete the total period of service specified in
the contract, as conditions and circumstances warrant.
(2) Debt to united states.--An obligation to reimburse the
United States imposed under paragraph (1) is a debt owed to
the United States.
(3) No discharge in bankruptcy.--Notwithstanding any other
provision of law, a discharge in bankruptcy under title 11,
United States Code, that is entered less than 5 years after
the termination of a retention bonus contract under this
section does not discharge the dental officer who signed such
a contract from a debt arising under the contract or under
paragraph (1).
SEC. 303. DEMONSTRATION PROJECTS TO INCREASE ACCESS TO
PEDIATRIC DENTAL SERVICES IN UNDERSERVED AREAS.
(a) Authority To Conduct Projects.--The Secretary of Health
and Human Services, through the Administrator of the Health
Resources and Services Administration and the Director of the
Indian Health Service, shall establish demonstration projects
that are designed to increase access to dental services for
children in underserved areas, as determined by the
Secretary.
(b) Authorization of Appropriations.--There is authorized
to be appropriated such sums as may be necessary to carry out
this section.
SEC. 304. TECHNICAL CORRECTION.
Section 340G(b)(1)(B) of the Public Health Service Act (42
U.S.C. 256g(b)(1)(B)) is amended by striking ``and'' at the
end and inserting ``or''.
TITLE IV--IMPROVING ORAL HEALTH PROMOTION AND DISEASE PREVENTION
PROGRAMS
SEC. 401. ORAL HEALTH INITIATIVE.
(a) Establishment.--The Secretary of Health and Human
Services shall establish an oral health initiative to reduce
the profound disparities in oral health by improving the
health status of vulnerable populations, particularly low-
income children and children with developmental disabilities,
to the level of health status that is enjoyed by the majority
of Americans.
(b) Activities.--The Secretary of Health and Human Services
shall, through the oral health initiative--
(1) carry out activities to improve intra- and inter-agency
collaborations, including activities to identify, engage, and
encourage existing Federal and State programs to maximize
their potential to address oral health;
(2) carry out activities to encourage public-private
partnerships to engage private sector communities of interest
(including health professionals, educators, State
policymakers, foundations, business, and the public) in
partnerships that promote oral health and dental care;
(3) carry out activities to reduce the disease burden in
high risk populations through the application of best-science
in oral health, including programs such as community water
fluoridation and dental sealants; and
(4) carry out activities to improve the oral health
literacy of the public through school-based education
programs.
(c) Coordination.--The Secretary of Health and Human
Services shall--
(1) through the Administrator of the Centers for Medicare &
Medicaid Services, establish the Chief Dental Officer for the
medicaid and State children's health insurance programs
established under titles XIX and XXI, respectively, of the
Social Security Act (42 U.S.C. 1396 et seq. 1397aa et seq.);
(2) through the Administrator of the Health Resources and
Services Administration, establish the Chief Dental Office
for all oral health programs within the Health Resources and
Services Administration;
(3) through the Director of the Centers for Disease Control
and Prevention, establish the Chief Dental Officer for all
oral health programs within such Centers; and
(4) carry out this section in collaboration with the
Administrators and Chief Dental Officers described in
paragraphs (1), (2), and (3).
(d) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $25,000,000 for
fiscal year 2004, and such sums as may be necessary for each
subsequent fiscal year.
[[Page S7142]]
SEC. 402. CDC REPORTS.
(a) Collection of Data.--The Director of the Centers for
Disease Control and Prevention, in collaboration with other
organizations and agencies, shall collect data through State-
based oral health surveillance systems describing the dental,
craniofacial, and oral health of residents of all 50 States
and certain Indian tribes.
(b) Reports.--The Director of the Centers for Disease
Control and Prevention shall compile and analyze data
collection under subsection (a) and annually prepare and
submit to the appropriate committees of Congress a report
concerning the oral health of States and Indian tribes.
SEC. 403. EARLY CHILDHOOD CARIES.
(a) In General.--The Secretary of Health and Human
Services, acting through the Director of the Centers for
Disease Control and Prevention, shall--
(1) expand existing surveillance activities to include the
identification of children at high risk of early childhood
caries, including sub-populations such as children with
developmental disabilities;
(2) assist State, local, and tribal health agencies and
departments in collecting, analyzing and disseminating data
on early childhood caries; and
(3) provide for the development of public health nursing
programs and public health education programs on early
childhood caries prevention.
(b) Appropriateness of Activities.--The Secretary of Health
and Human Services shall carry out programs and activities
under subsection (a) in a culturally appropriate manner with
respect to populations at risk of early childhood caries.
(c) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, such sums as
may be necessary for each fiscal year.
SEC. 404. SCHOOL-BASED DENTAL SEALANT PROGRAM.
Section 317M(c) of the Public Health Service Act (as added
by section 1602 of Public Law 106-310)) is amended--
(1) in paragraph (1), by inserting ``and school-linked''
after ``school-based'';
(2) in the first sentence of paragraph (2)--
(A) by inserting ``and school-linked'' after ``school-
based''; and
(B) by inserting ``or Indian tribe'' after ``State''; and
(3) by striking paragraph (3) and inserting the following:
``(3) Eligibility.--To be eligible to receive funds under
paragraph (1), an entity shall--
``(A) prepare and submit to the State or Indian tribe an
application at such time, in such manner and containing such
information as the State or Indian tribe may require; and
``(B) be a--
``(i) public elementary or secondary school--
``(I) that is located in an urban area in which more than
50 percent of the student population is participating in
Federal or State free or reduced meal programs; or
``(II) that is located in a rural area and, with respect to
the school district in which the school is located, the
district involved has a median income that is at or below 235
percent of the poverty line, as defined in section 673(2) of
the Community Services Block Grant Act (42 U.S.C. 9902(2));
or
``(ii) public or non-profit organization, including a
grantee under section 330 and urban Indian clinics under
title V of the Indian Health Care Improvement Act, that is
under contract with an elementary or secondary school
described in subparagraph (B) to provide dental services to
school-age children.''.
SEC. 405. BASIC ORAL HEALTH PROMOTION.
(a) In General.--The Secretary of Health and Human
Services, acting through the Director of the Centers for
Disease Control and Prevention and in consultation with
dental organizations (including organizations having
expertise in the prevention and treatment of oral disease in
underserved pediatric populations), shall award grants to
States and Indian tribes to improve the basic capacity of
such States and tribes to improve the oral health of children
and their families.
(b) Requirements.--A State or Indian tribes shall use
amounts received under a grant under this section to conduct
one or more of the following activities:
(1) Establish an oral health plan, policies, effective
prevention programs, and accountability measures and systems.
(2) Establish and guide coalitions, partnerships, and
alliances to accomplish the establishment of the plan,
policies, programs and systems under paragraph (1).
(3) Monitor changes in oral disease burden, disparities,
and the utilization of preventive services by high-risk
populations.
(4) Identify, test, establish, support, and evaluate
prevention interventions to reduce oral health disparities.
(5) Promote public awareness and education in support of
improvements of oral health.
(6) Support training programs for dental and other health
professions needed to strengthen oral health prevention
programs.
(7) Establish, enhance, or expand oral disease prevention
and disparity reduction programs.
(8) Evaluate the progress and effectiveness of the State's
oral disease prevention and disparity reduction program.
(c) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, such sums as
may be necessary for fiscal year 2004 and each subsequent
fiscal year.
______
By Mrs. HUTCHISON (for herself, Mr. Kennedy, Mr. Campbell, Mr.
Biden, Mr. Smith, Mr. Dodd, Mr. Cornyn, Mr. Bingaman, Mr.
Daschle, Mr. Breaux, Mr. Johnson, Mr. Schumer, Mrs. Clinton,
and Mr. Jeffords):
S. 1143. A bill to amend the Public Health Service Act to direct the
Secretary of Health and Human Services to establish, promote, and
support a comprehensive prevention, research, and medical management
referral program for hepatitis C virus infection; to the Committee on
Health, Education, Labor, and Pensions.
Mrs. HUTCHISON. Mr. President, 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. 1143
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 ``Hepatitis C Epidemic Control
and Prevention Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Over 3,000,000 individuals in the United States are
chronically infected with the hepatitis C virus (referred to
in this section as ``HCV''), making it the Nation's most
common blood borne virus infection.
(2) Nearly 2 percent of the population of the United States
have been infected with HCV.
(3) Conservative estimates indicate that approximately
35,000 Americans are newly infected with HCV each year.
(4) HCV infection can cause life-threatening liver disease.
(5) Individuals infected with HCV serve as a source of
transmission to others and, since few individuals are aware
they are infected, are unlikely to take precautions to
prevent the spread or exacerbation of their infection.
(6) There is no vaccine available to prevent HCV infection.
(7) Treatments are available to slow the progression of
chronic hepatitis C.
(8) An estimated 2,400,000 to 2,700,000 people who are
chronically infected with hepatitis C are receiving no
treatment.
(9) Conservative estimates place the costs of lost
productivity and medical care arising from chronic hepatitis
C in the United States at more than $600,000,000 annually and
such costs will undoubtedly increase in the absence of
expanded prevention and treatment efforts.
(10) To combat the HCV epidemic in the United States, the
Centers for Disease Control and Prevention developed
Recommendations for Prevention and Control of Hepatitis C
Virus (HCV) Infection and HCV-Related Chronic Disease in 1998
and the National Hepatitis C Prevention Strategy in 2001, and
the National Institutes of Health convened Consensus
Development Conferences on the Management of Hepatitis C in
1997 and 2002. These recommendations and guidelines provide a
framework for hepatitis C prevention, control, research, and
medical management referral programs.
(11) Federal support is necessary to increase knowledge and
awareness of hepatitis C and to assist State and local
prevention and control efforts.
SEC. 3. PREVENTION, CONTROL, AND MEDICAL MANAGEMENT OF
HEPATITIS C.
Title III of the Public Health Service Act (42 U.S.C. 241
et seq.) is amended by adding at the end the following:
``PART R--PREVENTION, CONTROL, AND MEDICAL MANAGEMENT OF HEPATITIS C
``SEC. 399AA. FEDERAL PLAN FOR THE PREVENTION, CONTROL, AND
MEDICAL MANAGEMENT OF HEPATITIS C.
``(a) In General.--The Secretary shall develop and
implement a plan for the prevention, control, and medical
management of hepatitis C which includes strategies for
education and training, surveillance and early detection, and
research.
``(b) Input in Development of Plan.--In developing the plan
under subsection (a), the Secretary shall--
``(1) be guided by existing recommendations of the Centers
for Disease Control and Prevention and the National
Institutes of Health; and
``(2) consult with--
``(A) the Director of the Centers for Disease Control and
Prevention;
``(B) the Director of the National Institutes of Health;
``(C) the Director of the Health Resources and Services
Administration;
``(D) the heads of other Federal agencies or offices
providing services to individuals with hepatitis C virus
(referred to in this part as `HCV') infections or the
functions of which otherwise involve hepatitis C;
``(E) medical advisory bodies that address issues related
to HCV; and
``(F) the public, including--
``(i) individuals infected with the HCV; and
``(ii) advocates concerned with issues related to HCV.
``(c) Biennial Update of Plan.--
[[Page S7143]]
``(1) In general.--The Secretary shall conduct a biennial
assessment of the plan developed under subsection (a) for the
purpose of incorporating into such plan new knowledge or
observations relating to HCV and chronic HCV (such as
knowledge and observations that may be derived from clinical,
laboratory, and epidemiological research and disease
detection, prevention, and surveillance outcomes) and
addressing gaps in the coverage or effectiveness of the plan.
``(2) Publication of notice of assessments.--Not later than
October 1 of the first even numbered year beginning after the
date of enactment of this part, and October 1 of each even
numbered year thereafter, the Secretary shall publish in the
Federal Register a notice of the results of the assessments
conducted under paragraph (1). Such notice shall include--
``(A) a description of any revisions to the plan developed
under subsection (a) as a result of the assessment;
``(B) an explanation of the basis for any such revisions,
including the ways in which such revisions can reasonably be
expected to further promote the original goals and objectives
of the plan; and
``(C) in the case of a determination by the Secretary that
the plan does not need revision, an explanation of the basis
for such determination.
``SEC. 399BB. ELEMENTS OF THE FEDERAL PLAN FOR THE
PREVENTION, CONTROL, AND MEDICAL MANAGEMENT OF
HEPATITIS C.
``(a) Education and Training.--The Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, shall implement programs to increase awareness
and enhance knowledge and understanding of hepatitis C. Such
programs shall include--
``(1) the conduct of health education, public awareness
campaigns, and community outreach activities to promote
public awareness and knowledge about risk factors, the
transmission and prevention of infection with HCV, the value
of screening for the early detection of HCV infection, and
options available for the treatment of chronic hepatitis C;
``(2) the training of health care professionals regarding
the prevention, detection, and medical management of
hepatitis B and hepatitis C, and the importance of
vaccinating HCV-infected individuals and those at risk for
HCV infection against the hepatitis A virus and hepatitis B
virus (referred to in this part as `HBV'); and
``(3) the development and distribution of curricula
(including information relating to the special needs of
individuals infected with HBV or HCV, such as the importance
of early intervention and treatment and the recognition of
psychosocial needs) for individuals providing hepatitis
counseling, as well as support for the implementation of such
curricula by State and local public health agencies.
``(b) Early Detection and Surveillance.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall support activities described in paragraph (2) to
promote the early detection of HCV infection, identify risk
factors for infection, and conduct surveillance of HCV
infection trends.
``(2) Activities.--
``(A) Voluntary testing programs.--
``(i) In general.--The Secretary shall support and promote
the development of State, local, and tribal voluntary
hepatitis C testing programs to aid in the early
identification of infected individuals.
``(ii) Confidentiality of test results.--The results of a
hepatitis C test conducted by a testing program developed or
supported under this subparagraph shall be considered
protected health information (in a manner consistent with
regulations promulgated under section 264(c) of the Health
Insurance Portability and Accountability Act of 1996 (42
U.S.C. 1320d-2 note)) and may not be used for any of the
following:
``(I) Issues relating to health insurance.
``(II) To screen or determine suitability for employment.
``(III) To discharge a person from employment.
``(B) Counseling regarding viral hepatitis.--The Secretary
shall support State, local, and tribal programs in a wide
variety of settings, including those providing primary and
specialty health care services in the private and the public
sectors, to--
``(i) provide individuals with information about ongoing
risk factors for hepatitis C virus infection with client-
centered education and counseling which concentrates on
changing behaviors that place them at risk for infection; and
``(ii) provide individuals infected with hepatitis C virus
with education and counseling to reduce the risk of harm to
themselves and transmission of the virus to others.
``(C) Vaccination against viral hepatitis.--With respect to
individuals infected, or at risk for infection, with HCV, the
Secretary shall provide for--
``(i) the vaccination of such individuals against hepatitis
A virus, HBV, and other infectious diseases, as appropriate,
for which such individuals may be at increased risk; and
``(ii) the counseling of such individuals regarding
hepatitis A, hepatitis B, and other viral hepatides.
``(D) Medical referral.--The Secretary shall support--
``(i) referral of persons infected with or at risk for HCV,
for drug or alcohol abuse treatment where appropriate; and
``(ii) referral of persons infected with HCV--
``(I) for medical evaluation to determine their stage of
chronic hepatitis C and suitability for antiviral treatment;
and
``(II) for ongoing medical management of hepatitis C.
``(3) Hepatitis c coordinators.--The Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, shall, upon request, provide a Hepatitis C
Coordinator to a State health department in order to enhance
the additional management, networking, and technical
expertise needed to ensure successful integration of
hepatitis C prevention and control activities into existing
public health programs.
``(c) Surveillance and Epidemiology.--
``(1) In general.--The Secretary shall promote and support
the establishment and maintenance of State HCV surveillance
databases, in order to--
``(A) identify risk factors for HCV infection;
``(B) identify trends in the incidence of acute and chronic
HCV;
``(C) identify trends in the prevalence of HCV infection
among groups that may be disproportionately affected by
hepatitis C, including individuals living with HIV, military
veterans, emergency first responders, racial or ethnic
minorities, and individuals who engage in high risk
behaviors, such as intravenous drug use; and
``(D) assess and improve HCV infection prevention programs.
``(2) Seroprevalence studies.--The Secretary shall conduct
a population-based seroprevalence study to estimate the
current and future impact of hepatitis C. Such studies shall
consider the economic and clinical impacts of hepatitis C, as
well as the impact of hepatitis C on quality of life.
``(3) Confidentiality.--Information contained in the
databases under paragraph (1) or derived through studies
under paragraph (2) shall be de-identified in a manner
consistent with regulations under section 264(c) of the
Health Insurance Portability and Accountability Act of 1996.
``(d) Research Network.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention
and the Director of the National Institutes of Health,
shall--
``(1) conduct epidemiologic research to identify best
practices for HCV prevention;
``(2) establish and support a Hepatitis C Clinical Research
Network for the purpose of conducting research related to the
treatment and medical management of hepatitis C; and
``(3) conduct basic research to identify new approaches to
prevention (such as vaccines) and treatment for HCV.
``(e) Referral for Medical Management of Chronic Hepatitis
C.--The Secretary shall support and promote State, local, and
tribal programs to provide HCV-positive individuals with
referral for medical evaluation and management, including
currently recommended antiviral therapy when appropriate.
``(f) Underserved and Disproportionately Affected
Populations.--In carrying out this section, the Secretary
shall provide expanded support for individuals with limited
access to health education, testing, and health care services
and groups that may be disproportionately affected by
hepatitis C.
``(g) Evaluation of Program.--The Secretary shall develop
benchmarks for evaluating the effectiveness of the programs
and activities conducted under this section and make
determinations as to whether such benchmarks have been
achieved.
``SEC. 399CC. GRANTS.
``(a) In General.--The Secretary may award grants to, or
enter into contracts or cooperative agreements with, States,
political subdivisions of States, Indian tribes, or non-
profit entities that have special expertise relating to HCV,
to carry out activities under this part.
``(b) Application.--To be eligible for a grant, contract,
or cooperative agreement under subsection (a), an entity
shall prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
``SEC. 399DD. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated to carry out this
part $90,000,000 for fiscal year 2004, and such sums as may
be necessary for each of fiscal years 2005 through 2008.''.
SEC. 4. LIVER DISEASE RESEARCH ADVISORY BOARD.
Part A of title IV of the Public Health Service Act (42
U.S.C. 281 et seq.) is amended by adding at the end the
following:
``SEC. 409J. LIVER DISEASE RESEARCH ADVISORY BOARD.
``(a) Establishment.--Not later than 90 days after the date
of enactment of this section, the Director of the National
Institutes of Health shall establish a board to be known as
the Liver Disease Research Advisory Board (referred to in
this section as the `Advisory Board').
``(b) Duties.--The Advisory Board shall advise and assist
the Director of the Centers for Disease Control and
Prevention concerning matters relating to liver disease
research, including by developing and revising the Liver
Disease Research Action Plan.
``(c) Voting Members.--The Advisory Board shall be composed
of 18 voting members to be appointed by the Director of the
[[Page S7144]]
National Institutes of Health, in consultation with the
Director of the Institute of Allergy and Infectious Diseases,
of whom 12 such individuals shall be eminent scientists and 6
such individuals shall be lay persons. The Director of the
National Institutes of Health, in consultation with the
Director of the Institute, shall select 1 of the members to
serve as the Chair of the Advisory Board.
``(d) Ex Officio Members.--The Director of the National
Institutes of Health shall appoint each director of a
national research institute that funds liver disease research
to serve as a nonvoting, ex officio member of the Advisory
Board. The Director of the National Institutes of Health
shall invite 1 representative of the Centers for Disease
Control and Prevention, 1 representative of the Food and Drug
Administration, and 1 representative of the Department of
Veterans Affairs to serve as such a member. Each ex officio
member of the Advisory Board may appoint an individual to
serve as that member's representative on the Advisory Board.
``(e) Liver Disease Research Action Plan.--
``(1) Development.--Not later than 15 months after the date
of the enactment of this section, the Advisory Board shall
develop (with appropriate support from the Director and staff
of the Center) a comprehensive plan for the conduct and
support of liver disease research to be known as the Liver
Disease Research Action Plan. The Advisory Board shall submit
the Plan to the Director of NIH and the head of each
institute or center within the National Institutes of Health
that funds liver disease research.
``(2) Content.--The Liver Disease Research Action Plan
shall identify scientific opportunities and priorities of
liver disease research necessary to increase understanding of
and to prevent, cure, and develop better treatment protocols
for liver diseases.
``(3) Revision.--The Advisory Board shall revise every 3
years the Liver Disease Research Action Plan, but shall meet
annually to review progress and to amend the Plan as may be
appropriate because of new scientific discoveries.''.
Mr. KENNEDY. Mr. President, It's a privilege to join my colleague,
Senator Kay Bailey Hutchison, in introducing this legislation to
address the growing problem of Hepatitis C. Senator Hutchison's
leadership has been essential in preparing this proposal to help
establish nationwide programs for Hepatitis C that have been so
effective in Texas. We are also indebted to the leadership of Senator
Smith, Senator Campbell, Senator Daschle, and many other colleagues on
both sides of the aisle for taking action to reduce the serious toll of
Hepatitis C on so many of our fellow citizens.
Hepatitis C is a rapidly growing health care crisis. More than 3.9
million Americans are infected with the virus, making it the nation's
most common blood-borne viral illness, and the numbers continue to
rise. 10,000 Americans die each year of chronic complications related
to the virus. Hepatitis C virus infection is a major cause of death in
AIDS patients, and nearly 40 percent of all HIV-positive people are
also infected with Hepatitis C virus.
Hepatitis C leads to life-threatening conditions, including cirrhosis
and liver cancer, which cost our country more than $600 million every
year. This bill supports liver disease research to encourage the
development of an effective vaccine against the virus.
Unlike Hepatitis A and B, there is currently no vaccine available to
prevent this epidemic. It is critical that infected individuals are
identified early, so that they can obtain treatment and take other
steps to reduce the likelihood that the disease will lead to permanent
liver damage or spread of the virus to others.
The bill we are introducing today takes a new approach to fighting
this virus by establishing a nationwide plan to provide the most
effective ways of prevention, control and medical management of
Hepatitis C. The bill also seeks to increase knowledge and awareness of
the infection by patients, health care professionals, and the public.
This strategy was successfully implemented in Texas. Public health
counseling and testing sites were established to reach people at high
risk for Hepatitis C, and to make referrals to health and social
services. In the first year, more than 13,000 clients received
counseling services, one-third of whom tested positive for Hepatitis C.
In addition, media campaigns were conducted to alert the public to the
dangers of Hepatitis C. The savings for Texas were estimated to be
almost $500,000 a year.
Using this model, the Department of Health and Human Service will
develop a plan to combat the Hepatitis C epidemic, with advice from the
public including physicians, researchers, patients, and advocates.
Confidential counseling and voluntary testing programs will be offered,
as well as immunization against Hepatitis A and B. Individuals at high
risk will be referred for further evaluation and management, including
treatment with anti-viral therapy.
Our bill calls for Hepatitis C coordinators, to be assigned by CDC,
at state, local, and tribal levels to carry out education and
supervision of local health care workers. The Liver Disease Research
Advisory Board will be established to assist and advise CDC on liver
disease research. A confidential database will be created to enhance
studies the epidemiology of the illness.
The fight against Hepatitis C must begin with the underserved
populations who are disproportionately affected by the virus,
especially minority populations, the uninsured, and veterans. We must
also do all we can to protect hemophiliacs, renal dialysis patients,
and AIDS patients.
Hepatitis C is a devastating disease, and this bill can be a major
step in fighting it. I look forward to working with my colleagues to
enact this bill into law.
Mr. JOHNSON. Mr. President, I rise today with my colleagues, Senators
Kennedy, Clinton, Daschle, Breaux, Jeffords, Biden, Dodd, Bingaman,
Hutchison, Campbell, Schumer, and Smith to introduce the Hepatitis C
Epidemic Control and Prevention Act of 2003. I thank my colleagues for
joining me in introducing this legislation that will improve the
prevention, control, and medical management of hepatitis C.
Hepatitis C is the most common chronic bloodborne viral infection in
the United States, and it is the seventh leading cause of death in our
country. Almost 4 million U.S. citizens are infected with hepatitis C,
and of those 2.7 million are chronically infected and at least 2.5
million do not receive any treatment, which results in the continued
spread of this devastating, yet preventable illness. The estimated
direct and indirect costs of hepatitis C infection are at least $600
million annually.
Symptoms of hepatitis C can include jaundice, fatigue, loss of
appetite, and abdominal pain. While this disease may be asymptomatic in
most patients initially, between 50 and 80 percent will develop a
chronic infection, and of these half will eventually develop cirrhosis
or cancer of the liver. While diagnostic tests are available to
identify the disease, there is no vaccine to prevent hepatitis C, which
makes prevention and control measures crucial to reducing its incidence
and prevalence.
The importance of improving hepatitis C prevention and control
activities was brought to my attention this past year by the family of
Christen Graeber Winter. Christen was from Aberdeen, SD, and passed
away 5 years ago at the age of 42. She had been very ill two decades
earlier and required a blood transfusion. Christen became very sick a
little over 5 years ago and was diagnosed with hepatitis C, a disease
that she had contracted from that blood transfusion that she had so
many years earlier. Christen died in 1998, and during the last months
of her life she remained as active as possible and was committed to
finishing up her bachelor's degree at Presentation College, even though
she was very ill.
Everyone who knew Christen said she was a warm and caring person, and
even towards the end of her life, she remained strong and was
determined not to burden others with her deteriorating health. After
her death, Christen's sister Carey started conducting research to learn
about hepatitis C. She knew nothing of the disease and was surprised to
learn how many people suffered from it. She learned that physicians are
largely unaware of hepatitis C and therefore cases often go undetected.
Carey is now a strong advocate of promoting increased funding for
education, treatment, and prevention of this disease and has helped me
understand how important it is that we in Congress establish the
programs and appropriate the funds necessary to prevent needless deaths
like the death of Christen.
The hepatitis C Epidemic Prevention and Control Act will help reduce
the number of people affected by this horrible illness and prevent
stories like Carey's sister from continuing. The bill requires that the
Department of Health and Human Services develop and implement an
integrated plan to combat
[[Page S7145]]
hepatitis C. While we know how to prevent the spread of this disease,
there have been limited programs to educate health professionals, at-
risk populations, and the general public on how to do so. This bill
will focus on increasing knowledge and awareness of such infections
among providers and patients.
In addition to education, surveillance, early detection, and
counseling are important tools that must be used in order to control
this disease. Less than 50 percent of local health departments
providing counseling and only 23 percent provide testing for hepatitis
C. This bill will require that CDC promote confidential testing
programs by working with State and local governments in order to catch
hepatitis C cases early. It will also provide access to important
counseling activities in a variety of private and public health care
settings to help patients reduce the risk of harm to themselves and
others.
This important legislation is supported by a tripartisan coalition of
my colleagues. We have recognized that hepatitis C is a preventable
disease that can be halted with a strong emphasis on prevention and
control. I do not want to see more cases like that of Carey's sister.
We have an opportunity to make a real difference here, and I urge the
Senate to support this bill.
______
By Mr. CONRAD (for himself and Mr. Dorgan):
S. 1146. A bill to implement the recommendations of the Garrison Unit
Tribal Advisory Committee by providing authorization for the
construction of a rural health care facility on the Fort Berthold
Indian Reservation, North Dakota; to the Committee on Indian Affairs.
Mr. CONRAD. Mr. President, I rise today, joined by my colleague
Senator Dorgan, to introduce the Three Affiliated Tribes Health
Facility Compensation Act. This legislation fulfills a longstanding
Federal commitment to the Three Affiliated Tribes of Fort Berthold in
my State of North Dakota.
In 1949, the Three Affiliated Tribes lost 156,000 acres of land, one-
quarter of its land base, for the construction of the Garrison Dam
along the Missouri River. Three hundred twenty five families--eighty
percent of the tribal membership--were forcibly relocated. Ninety-four
percent of the agricultural lands of these farmers and ranchers was
destroyed. The Indian Health Service's hospital at the community of
Elbowoods was completely flooded. At the time, the Federal Government
committed to replacing the hospital.
On May 10, 1985, then Interior Secretary Donald P. Hodel signed a
charter creating the Garrison Unit Joint Tribal Advisory Committee,
which was charged with examining the effects of the construction of the
Garrison Dam and Reservoir on the tribe and making recommendations on
compensation. In its final report released on May 23, 1986, the
committee found that the Three Affiliated Tribes were entitled to
financial compensation as well as the replacement of lost
infrastructure including its health facility. The committee
specifically noted that the replacement of the health facility was an
``emergency need.''
In 1992, Congress acted on some of the committee's recommendations by
passing the Three Affiliated Tribes and Standing Rock Sioux Tribe
Equitable Compensation Act. However, at the time, due to budget
limitations, Congress was not able to fulfill the commitments on
infrastructure replacement. The Senate Committee on Indian Affairs in
its report on the Act specifically noted that ``every effort should be
made by the Administration and Congress to provide additional federal
funding for these infrastructure priorities.'' More than 10 years
later, many of the infrastructure priorities still have not been met.
The legislative history on this matter is clear, a commitment was
made to the tribe that must be kept. The bill I am introducing will
authorize $20 million to construct for a health facility on the Fort
Berthold Indian Reservation to fulfill this longstanding promise to the
Three Affiliated Tribes.
Mrs. BOXER. Mr. President, today I am introducing a bill to increase
security and prevent terrorist attacks at our Nation's ports.
Ports are extremely important to our nation's economy, especially to
my State of California. The ports of LA, Long Beach, and Oakland handle
40 percent of our Nation's cargo and generate billions of dollars in
economic activity each year in California alone.
The tragic events of September 11 demonstrated that we needed to make
improvements in our nation's security. Our ports are no exception.
We have begun to make improvements. As a member of the Senate
Commerce Committee, I served as a conferee on the port security bill
that became law last November. This legislation mandated the creation
of national and regional port security plans and better coordination of
Federal, State, local, and private enforcement agencies. It also
established a grant program for port authorities, waterfront operators,
and state and local agencies to provide security infrastructure
improvements such as video cameras and more secure fencing. In
addition, it calls for the development of regulations to determine
secure areas in ports and to limit access through background checks and
a transportation security identification card.
This legislation was a good first step. But, we need to do more. And
I believe we should harness the best of our high-tech capabilities to
improve port security. That is why today I am introducing the High-Tech
Port Security Act.
This legislation has three high tech improvements for our nation's
ports.
First, the bill would require that all containers used in our
Nation's ports be blast resistant. The U.S. Department of Homeland
Security would develop a standard for such containers and would work
with shipping companies to ensure that all new containers are blast
resistant.
Second, the bill would require that all containers be inspected with
advanced technology before leaving our ports and entering our roads,
highways, and communities. The Department of Homeland Security would
establish a standard for cargo screening technology and ensure that
this technology is installed at all ports, so every incoming container
is screened before it leaves the port. This is extremely important
because currently only two to three percent of all containers are
inspected.
Third, this bill will focus protection on the Nation's largest ports
by establishing high tech command and control centers to coordinate and
monitor security at the 20 busiest ports in the United States.
The technologies needed to secure our Nation's vital ports are
available today, and they should start being used now. There is no time
to lose. The vulnerability of our seaports is no secret; it is a well
known gap in our homeland defense. This legislation will help close
that gap.
______
By Mrs. FEINSTEIN:
S. 1150. A bill to establish the Bob Hope American Patriot Award; to
the Committee on the Judiciary.
Mrs. FEINSTEIN. Mr. President, I rise today to introduce the Bob Hope
American Patriot Award Act of 2003. This legislation would create a
presidential commemorative award for an individual or organization that
demonstrates ``extraordinary love of this Nation and devotion to its
citizens in the form of true patriotism.''
In addition, this legislation would honor one of the most respected
figures in America, who for seven decades has served our Nation with
his talents in entertainment. As many are familiar, I am speaking today
of Bob Hope.
To celebrate Bob Hope's 100th birthday on May 29, 2003, this
legislation would give the President the opportunity to annually
recognize the wonderful trait of ``patriotism,'' so well exemplified by
Hope throughout his lifetime. Mr. Hope has long demonstrated that
entertainment can positively influence ``love of country and dedication
to the spiritual well-being of America's troops.''
A master of the skills of acting and singing, Bob Hope may be the
most talented and prolific entertainer of our time. Many of us will
recall his work in the series of ``Road'' films with Bing Crosby and
Dorothy Lamour. His expansive career has involved stage musical comedy,
motion pictures, and live appearances at the USO shows.
On May 6, 1941, Bob Hope began a 50-year service with the United
States Armed Forces, in which he did approximately 60 USO tours. He has
toured
[[Page S7146]]
U.S. military stations all over the world, including Germany, the South
Pacific, and Vietnam. Veterans and U.S. soldiers alike will always
remember his variety shows, which included skits, dancers, specialty
acts, and comedic monologues. These monologues were particularly
touching as they commiserated with the daily travails of a soldier's
life.
Over the years, Bob Hope has received well-deserved recognition for
his dedication to our Nation. He has been honored with numerous awards,
including the Congressional Gold Medal, the Presidential Medal of
Freedom, and the Distinguished Service Medal from each of the branches
of the military. Several years ago, I co-sponsored legislation naming
him an Honorary Veteran for his humanitarian services to the U.S. Armed
Forces.
Bob Hope epitomizes true patriotism and service to our country, and I
cannot think of anybody better to name this new award after.
This legislation is important because it would not only carry on the
name of such an honorable figure, but would recognize future
individuals or organizations who have dedicated themselves to promoting
the values of freedom, democracy, and goodwill. This award would be the
first of its kind--honoring American civilians specifically for
patriotism.
This legislation would give the President the authority to annually
select either one individual or one organization to receive this
commemorative award at a White House ceremony. The President would also
be given the power to interpret the selection criteria and determine
the form that the award would take, such as a plaque, medal or flag.
I believe this legislation is timely and befitting of both Mr. Hope
and the great citizens of our Nation. In these challenging times, it is
important to encourage and recognize Americans who have given so much
to the cause of patriotism, asking for nothing in return.
My hope is that this award, established through this legislation,
will both carry on the wonderful legacy of Bob Hope and bring awareness
to the magnanimous spirit of our fellow citizens. I call on this body
to enact this legislation promptly.
______
By Mr. FEINGOLD:
S. 1151. A bill to rescind the Department of Veterans Affairs
memorandum of July 18, 2002, in which Directors of health service
networks in the Department of Veterans Affairs are directed to ensure
that no marketing activities to enroll new veterans occur within their
networks; to the Committee on Veterans' Affairs.
Mr. FEINGOLD. Mr. President, today I am introducing legislation that
would restore a valuable--and statutorily mandate--service to our
Nation's veterans and their families.
In July 2002, Department of Veterans Affairs Deputy Under Secretary
for Health for Operations and Management Laura Miller sent a memo to
Veterans Integrated Service Network Directors ordering them to ``ensure
that no marketing activities to enroll new veterans occur within
[their] networks.''
This memo cited an increased demand for VA health care services as
the reason for this change in policy. While it is clear that more
funding should be provided for VA health care and other programs, it is
inappropriate for the VA to institute a policy to stop making veterans
aware of the health care services for which they may be eligible.
I joined with a number of our colleagues last year in sending a
letter to the President asking that this policy be immediately
reversed. I regret that the VA's reply indicated that the Secretary of
Veterans Affairs stands by this policy, which remains in effect.
The bill that I am introducing today, Veterans Outreach Protection
Act, would rescind the policy issued in this memorandum and prohibit
the VA from using Federal funding to enforce this policy. This bill is
a companion to legislation introduced in the House by Congressman Paul
Kanjorski earlier this year.
I have long been concerned that tens of thousands of our veterans are
unaware of federal health care and other benefits for which they may be
eligible. We can and should do more to educate our veterans and their
families about these benefits, and to provide adequate funding to
ensure that all veterans who wish to take advantage of their benefits
are able to do so. Halting health care marketing activities is not the
answer. Our brave veterans have earned these benefits. The Federal
department that is charged with advocating for and providing benefits
to our veterans should not be allowed to continue to restrict health
care outreach activities.
In addition to this bill, I am currently working to draft legislation
to improve VA-wide outreach efforts. Our veterans and their families
have made great personal sacrifices to protect our freedoms. We owe
them a great debt of gratitude. Making sure that our veterans know
about the benefits that they have earned is an important first step in
starting to reply this debt.
I ask unanimous consent that the text of my bill be printed in the
Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
S. 1151
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 ``Veterans Outreach Protection
Act''.
SEC. 2. RESCISSION OF DEPARTMENT OF VETERANS AFFAIRS
MEMORANDUM.
(a) Rescission of Memorandum.--The memorandum of the
Department of Veterans Affairs dated July 18, 2002, from the
Deputy Under Secretary for Health for Operations and
Management with the subject ``Status of VHA Enrollment and
Associated Issues'' is hereby rescinded. Marketing activities
of Directors of health service networks (known as ``Veterans
Integrated Service Networks'') of the Department of Veterans
Affairs to enroll new veterans within their respective
networks shall be carried out without regard to such
memorandum.
(b) Funding Limitation.--No funds available to the
Department of Veterans Affairs may be used to carry out the
memorandum referred to in subsection (a) or otherwise to
implement the policy contained in that memorandum.
______
By Mr. McCAIN (for himself and Mr. Hollings):
S. 1152. A bill to reauthorize the United States Fire Administration,
and for other purposes; to the Committee on Commerce, Science, and
Transportation.
Mr. McCAIN. Mr. President, I am pleased to be joined this morning by
Senators Hollings in introducing legislation to reauthorize the United
States Fire Administration, USFA, for fiscal year 2004 through fiscal
year 2006. This legislation would also re-establish the position of the
U.S. Fire Administrator, which would serve in the new Department of
Homeland Security.
USFA's mission is to reduce the loss of life and property because of
fire and related emergencies. Each year, fire injures and kills more
Americans than all other natural disasters combined. Death rates by
fire in the Unites States are among the highest in the industrialized
world.
The U.S. Fire Administration utilizes a number of tools to fulfill
its mission. USFA's National Fire Data Center administers a national
system for collecting, analyzing, and disseminating data and
information on fire and other emergency incidents to state and local
governments and the fire community. The National Fire Academy, NFA, is
the premiere training academy for fire services. It is estimated that
since 1975, over 1.4 million firefighters and other first-responders
have benefitted from NFA training classes in emergency management, fire
prevention, and anti-terrorism. USFA also engages in research, testing,
and evaluation activities with public and private entities to promote
and improve fire and life safety. Finally, USFA administers the popular
Assistance to Firefighters Grant Program, which provides competitive
grants to local fire departments for training, wellness and fitness
programs, vehicles, firefighting equipment, and fire prevention.
The U.S. Fire Administrator plays an important role in our nation's
fire control policy and homeland security initiatives by serving as the
point-of-contact for the fire services. This position was eliminated in
last year's legislation that established the Department of Homeland
Security. On April 30, 2003, the Senate Committee on Commerce, Science,
and Transportation heard testimony from many of the major fire service
organizations regarding the importance of the U.S. Fire
[[Page S7147]]
Administrator position, and the need for the Administrator to serve as
a representative of the fire services within the Department of Homeland
Security. This legislation would re-establish this position.
Firefighting remains one of the most dangerous professions in the
Unites States. We rely on firefighters to aid us in fires, accidents,
and natural disasters. However, we have also witnessed the role that
firefighters play as the first responders on the scene of any possible
terrorist attack. It is important that we pass this legislation to
ensure that the Federal government continues its appropriate role in
helping our fire services adapt to this new challenge.
I urge my colleagues to support this legislation, and look forward to
working with them to ensure timely passage of this legislation. I also
ask unanimous consent that the text of the bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``United States Fire
Administration Reauthorization Act of 2003''.
SEC. 2. RE-ESTABLISHMENT OF POSITION OF UNITED STATES FIRE
ADMINISTRATOR.
Section 1513 of the Homeland Security Act of 2002 does not
apply to the position or office of Administrator of the
United States Fire Administration, who shall continue to be
appointed and compensated as provided by section 5(b) of the
Federal Fire Prevention and Control Act of 1974 (15 U.S.C.
2204(b)) after the functions vested by law in the Federal
Emergency Management Agency have been transferred to the
Directorate of Emergency Preparedness and Response in
accordance with section 503 of the Homeland Security Act of
2002.
SEC. 3. AUTHORIZATION OF APPROPRIATIONS.
Section 17(g)(1) of the Federal Fire Prevention and Control
Act of 1974 (15 U.S.C. 2216(g)(1)) is amended to read as
follows: ``(1) Except as otherwise specifically provided with
respect to the payment of claims under section 11 of this
Act, there are authorized to be appropriated to carry out the
purposes of this Act--
``(A) $52,000,000 for fiscal year 2004;
``(B) $53,560,000 for fiscal year 2005; and
``(C) $55,166,800 for fiscal year 2006.''.
______
By Mr. SPECTER (for himself and Mr. BOND):
S. 1153. A bill to amend title 38, United States Code, to permit
medicare-eligible veterans to receive an out-patient medication
benefit, to provide that certain veterans who receive such benefit are
not otherwise eligible for medical care and services from the
Department of Veterans Affairs, and for other purposes; to the
Committee on Veterans' Affairs.
Mr. SPECTER. Mr. President, I have sought recognition to explain the
provisions of the ``Veterans Prescription Drugs Assistance Act of
2003,'' a bill that I have introduced today to assist Medicare-eligible
veterans struggling with the costs of prescription medications.
I fully understand that Congress, and the President, are working very
hard on legislation to take on the larger issue of providing a
prescription drug benefit for all American seniors. I applaud that
effort, and I will continue to work with my colleagues to see that
Congress enacts legislation to help all seniors who struggle with the
ever-increasing costs of necessary medications. But in the meantime, as
Chairman of the Committee on Veterans Affairs, I offer legislation to
allow Medicare-eligible veterans to obtain prescription drugs from the
Department of Veterans Affairs, VA, at the significantly discounted
costs that VA, as a high-volume purchaser of prescriptions medications,
is able to secure in the marketplace.
Earlier this year, VA Secretary Anthony J. Principi was forced to
limit access to VA care by suspending new enrollments of non-service-
disabled middle and higher income veterans who were not enrolled for
care as of January 17, 2003. The Secretary was forced to so act because
the number of patients provided care by VA has more than doubled in
just five years. And as a result, VA's medical care system has been
overwhelmed and, as a consequence, VA has been unable to provide timely
access to healthcare for all veterans who have sought it and
appointment waiting times have grown to alarming levels. But in almost
every news story that followed the Secretary's difficult decision, it
was noted that many of the new enrollees who had overwhelmed VA's
capacity to provide care were Medicare-eligible veterans who were able
to get Medicare-financed care elsewhere--but who were seeking access to
the relatively generous prescription drug program provided to veterans
under VA care.
Currently, VA provides enrolled patients with prescription
medications for $7.00 for each 30-day supply. But to get such
prescriptions, the veteran must obtain the full range of medical care
from VA. This fact, coupled with the Secretary's decision to close
enrollment, means that veterans who are now--or who will be--eligible
for Medicare who had not enrolled for VA care prior to January 17,
2003, will be unable to access VA's generous prescription drug
benefits. This legislation would provide some relief for those
veterans. In addition, I anticipate that it may induce some VA-enrolled
Medicare-eligible veterans--those who were happy with their Medicare-
financed care but who enrolled for VA care to gain access to VA-
supplied drugs--to return to non-VA care with knowledge that they will
be able to get their non-VA prescriptions filled through VA. Enactment
of this provision, then, would reduce--not exacerbate--VA patient
backlog numbers.
The premise of this legislation is straightforward: VA fills and
distributes more than 100 million prescriptions each year for its 4.5
million veteran-patients. As a result, it has significant purchasing
power--power which, coupled with VA's formulary program, allows it to
negotiate very favorable prices for prescription drugs. According to
the National Association of Chain Drug Stores, the average ``cash
cost'' of a prescription in 2001 was $40.22. The average VA per-
prescription cost in 2001 was $22.87--almost 50 percent less. The
average per-prescription price paid by VA this year is up to just under
$25--a slower growth rate than the 6.7 percent annual growth
experienced in the population at large since 2001.
My purpose is to afford Medicare-eligible veterans access to such
discounts. I do not propose that VA be directed to supply drugs to all
Medicare-eligible veterans at VA expense, or even with a partial VA
subsidy. VA has stated that such a mandate would divert VA funding--
which, clearly, is already stretched to the limit--away from VA
priority patients: the service-connected, the poor, and those with
special needs. I accept VA's statement of concern; I accept and I
insist--that scarce funding be directed, first, to meet the needs of
priority patients. This legislation, therefore, requires that VA
recover the costs of drugs it supplies under this program from veterans
who bring their prescriptions from outside doctors to VA.
I do not propose to tell VA in this bill how to recover these costs.
VA is better positioned than I to make such judgments. Thus, my
legislation provides flexibility to VA to design and test payment
mechanisms to best accomplish cost recovery while still easing
veterans' access to the drugs they need. It might be that enrollment
fees, a copayment structure, or a simple ``cost-plus''--for
administrative expenses pricing format--or some combination of those
mechanisms--works best. And it might be that different approaches work
best in different regions of the country. I intend for the VA to
experiment with different pricing structures to determine what works
best. But I also intend that veterans get a break on prescription drug
pricing.
Those who would benefit from this program are World War II and Korean
War veterans who answered their country's call over 50 years ago. As
they age, many desperately need relief from high drug prices. My
purpose is not to disparage the drug companies; their discoveries have
truly been marvels. But that is precious little comfort to a Medicare
participant who, whatever the drug's overall utility might be, cannot
afford both the drug and food or shelter or heat. Many such persons
reside in the Commonwealth of Pennsylvania where, just last month, a
genuine titan in the industrial history of the United States, Bethlehem
Steel, ceased to exist. Many retired steelworkers who are also
veterans--and who never needed VA because of company-paid
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benefits--have lost their health insurance coverage and, with it,
prescription drug benefits. These people need a break. This bill could
provide it.
The premise of this legislation is simple: veteran access to VA
market-driven discounts. Yet, the assistance it could provide might be
profound. I do hope that Congress will find a way to provide
prescription drug benefits to all seniors. But for now, I urge my
colleagues to support this bill so that the problem might be solved--or
at least reduced--for seniors who served. They deserve it, and we
should do it.
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
Rcord, as follows:
S. 1153
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 ``Veterans Prescription Drugs
Assistance Act''.
SEC. 2. ELIGIBILITY OF MEDICARE-ELIGIBLE VETERANS FOR OUT-
PATIENT MEDICATION BENEFIT.
(a) Restatement of Current Law on Drugs and Medications and
Provision of Out-Patient Medication Benefit.--Chapter 17 of
title 38, United States Code, is amended by inserting after
section 1710B the following new section:
``Sec. 1710C. Drugs and medications; vaccines
``(a)(1) The Secretary shall furnish to each veteran who is
receiving additional compensation or allowance under chapter
11 of this title, or increased pension as a veteran of a
period of war, by reason of being permanently housebound or
in need of regular aid and attendance, such drugs and
medicines as may be ordered on prescription of a duly
licensed physician as specific therapy in the treatment of
any illness or injury suffered by such veteran.
``(2) The Secretary shall continue to furnish such drugs
and medicines ordered under paragraph (1) to any such veteran
in need of regular aid and attendance whose pension payments
have been discontinued solely because such veteran's annual
income is greater than the applicable maximum annual income
limitation, but only so long as such veteran's annual income
does not exceed such maximum annual income limitation by more
than $1,000.
``(b)(1) Any medicare-eligible veteran may elect to be
furnished by the Secretary, on an out-patient basis, such
drugs and medicines as may be ordered on prescription of a
duly licensed physician as specific therapy in the treatment
of any illness or injury suffered by such veteran.
``(2) In this subsection, the term `medicare-eligible
veteran' means any veteran who--
``(A) is entitled to or enrolled in hospital insurance
benefits under part A of title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.); or
``(B) is enrolled in the supplementary medical insurance
program under part B of such title (42 U.S.C. 1395j et seq.).
``(3) The Secretary shall furnish to any veteran who makes
an election under paragraph (1), on an out-patient basis,
such drugs and medicines as may be ordered on prescription of
a duly licensed physician as specific therapy in the
treatment of any illness or injury suffered by such veteran.
``(4)(A) Notwithstanding any other provision of law and
except as provided in subparagraph (B), a veteran who makes
an election under paragraph (1) shall not be eligible for
care and services under this chapter during the year covered
by the election.
``(B) Subparagraph (A) shall not apply with respect to any
veteran who has a compensable service-connected disability.
``(5) The furnishing of drugs and medicines under this
subsection shall be subject to the provisions of section
1722A(b) of this title.
``(6)(A) An election under paragraph (1) shall be for a
calendar year, and shall be irrevocable for the year covered
by such election. An election may be renewed.
``(B) The Secretary shall prescribe the form, manner, and
timing of an election.
``(7) Before permitting a veteran to make an election under
paragraph (1), the Secretary shall provide the veteran such
educational materials and other information on the furnishing
and receipt of drugs and medicines under this subsection as
the Secretary considers appropriate to inform the veteran of
the benefits and costs of being furnished drugs and medicines
under this subsection, including materials and information on
the consequences of making an election under paragraph (1)
and on the fees, copayments, or other amounts required under
section 1722A(b) of this title for drugs and medicines
furnished under this subsection.
``(c)(1) In order to assist the Secretary of Health and
Human Services in carrying out national immunization programs
under other provisions of law, the Secretary may authorize
the administration of immunizations to eligible veterans who
voluntarily request such immunizations in connection with the
provision of care for a disability under this chapter in any
Department health care facility.
``(2) Any immunization under paragraph (1) shall be made
using vaccine furnished by the Secretary of Health and Human
Services at no cost to the Department. For such purpose,
notwithstanding any other provision of law, the Secretary of
Health and Human Services may provide such vaccine to the
Department at no cost.
``(3) Section 7316 of this title shall apply to claims
alleging negligence or malpractice on the part of Department
personnel granted immunity under such section.''.
(b) Copayment Requirements.--
(1) In general.--Section 1722A of such title is amended--
(A) in subsection (a)(1), by inserting ``(other than a
veteran covered by subsection (b))'' after ``require a
veteran'';
(B) by redesignating subsections (b), (c), and (d), as
subsections (c), (d), and (e), respectively;
(C) by inserting after subsection (a) the following new
subsection (b):
``(b)(1) In the case of a veteran who is furnished
medications on an out-patient basis under section 1710C(b) of
this title, the Secretary shall require the veteran to pay,
at the election of the Secretary, one or more of the
following:
``(A) An annual enrollment fee in an amount determined
appropriate by the Secretary.
``(B) A copayment for each 30-day supply of such
medications in an amount determined appropriate by the
Secretary.
``(C) An amount equal to the cost to the Secretary of such
medications, as determined by the Secretary.
``(2)(A) In determining the amounts to be paid by a veteran
under paragraph (1), and the basis of payment under one or
more subparagraphs of that paragraph, the Secretary shall
ensure that the total amount paid by veterans for medications
under that paragraph in a year is not less than the costs of
the Department in furnishing medications to veterans under
section 1710C(b) of this title during that year, including
the cost of purchasing and furnishing medications, and other
costs of administering that section.
``(B) The Secretary shall take appropriate actions to
ensure, to the maximum extent practicable, that amounts paid
by veterans under paragraph (1) in a year are equal to the
costs of the Department referred to in subparagraph (A) in
that year.
``(3) In determining amounts under paragraph (1), the
Secretary may take into account the following:
``(A) Whether or not the medications furnished are generic
medications or brand name medications.
``(B) Whether or not the medications are furnished by mail.
``(C) Whether or not the medications furnished are listed
on the National Prescription Drug Formulary of the
Department.
``(D) Any other matters the Secretary considers
appropriate.
``(4) The Secretary may from time to time adjust any amount
determined by the Secretary under paragraph (1), as
previously adjusted under this paragraph, in order to meet
the purpose specified in paragraph (2).''; and
(D) in subsection (d), as so redesignated--
(i) by striking ``subsection (a)'' and inserting
``subsections (a) and (b)''; and
(ii) by striking ``subsection (b)'' and inserting
``subsection (c)''.
(2) Deposit of collections in medical care collections
fund.--Paragraph (4) of section 1729A(b) of such title is
amended to read as follows:
``(4) Subsection (a) or (b) of section 1722A of this
title.''.
(c) Conforming Amendments.--(1) Section 1707 of such title
is amended by adding at the end the following new subsection:
``(c) Notwithstanding any other provision of law, a veteran
who makes an election authorized by section 1710C(b) of this
title (other than a veteran covered by paragraph (4)(B) of
that section) shall not, for the period of such election, be
eligible for care and services under this chapter, except as
provided in that section.''.
(2) Section 1712 of such title is amended by striking
subsections (d) and (e).
(d) Clerical Amendments.--(1) The heading for section 1712
of such title is amended to read as follows:
``Sec. 1712. Dental care''.
(2) The table of sections at the beginning of chapter 17 of
such title is amended--
(A) by inserting after the item relating to section 1710B
the following new item:
``1710C. Drugs and medications; vaccines.''; and
(B) by striking the item relating to section 1712 and
inserting the following new item:
``1712. Dental care.''.
Mr. BOND. Mr. President, I rise today to express my strong support
for the Veterans Prescription Drugs Assistance Act of 2003. As an
original co-sponsor, I am pleased to join my colleague, the Chairman of
the Veterans Affairs Committee, Senator Specter in introducing this
important legislation that addresses the medical care needs of
Medicare-eligible veterans. I applaud Senator Specter for his
leadership on this important issue.
For several years, many veterans have not been able to receive timely
health care from the Department of Veterans Affairs due to the long
waiting lines created by the huge demand for prescription drugs. Under
current policy, veterans are required to see a VA doctor before
receiving their medication even when they have already
[[Page S7149]]
had a prescription written by a privately licensed physician. This
policy has not only contributed to the long waiting lines, but it has
denied care to service-connected and lower income veterans. It is a
moral imperative that we correct this problem and I believe that this
legislation is a step in the right direction.
As Chair of the VA-HUD and Independent Agencies Appropriations
Subcommittee, my top priority is ensuring that the VA has adequate
funding to provide accessible and quality care for our Nation's
veterans. Unfortunately, despite record funding increases over the past
few years, veterans must still wait for several months to see a VA
doctor.
This past January, VA Secretary Principi had to take the unfortunate
but necessary step of closing new enrollments to middle and higher
income veterans who do not have service-connected disabilities. Many of
these so-called Priority 8 veterans have Medicare insurance but do not
have a prescription drug benefit. I recognize that the Congress and the
President are trying to address the prescription drug issue for all
American seniors and I will continue to fight to ensure that a Medicare
prescription drug bill is enacted. Nevertheless, I believe that we need
to raise awareness of the tragedy that many veterans suffer today to
ensure that no matter what occurs during this session of Congress, they
are not left behind.
This bill contains a number of important provisions but I highlight
one particular measure. As I mentioned earlier, current policy requires
veterans to see a VA doctor before having their prescription filled,
even if they have had already seen a private doctor. This legislation
allows eligible veterans to fill their prescriptions at the VA without
having to see a VA doctor. This not only greatly streamlines the
process and time for veterans to receive much-needed medications, but
it also provides relief to the waiting lines so that our higher
priority veterans can receive timely care. In other words, this
legislation is a win-win for all veterans.
This legislation may not be perfect but it is important to begin a
dialogue on the prescription drug needs of our nation's veterans. I
welcome my colleagues' comments and comments from the Administration. I
believe that we can resolve this matter this year. I thank my
colleagues for their attention to this matter and I look forward to
working with all of you over the next several weeks.
______
By Ms. SNOWE (for herself, Mr. Bond, and Mr. Burns):
S. 1154. A bill to provide for the reauthorization of programs
administered by the Small Business Administration that assist small
business concerns owned and controlled by women; and for other
purposes; to the Committee on Small Business and Entrepreneurship.
Ms. SNOWE. Mr. President, I rise to introduce the ``Women's Small
Business Programs Improvement Act of 2003'' in recognition of the
critical potential that women entrepreneurs hold for the Nation's
economic welfare. I am pleased to be joined by Senators Bond and Burns
in offering this important legislation.
Today, women own nearly a third of the Nation's small businesses--
totaling nearly 7 million women-owned enterprises that contribute
approximately $1.2 trillion to be economy annually. That number,
however, does not include jointly owned businesses in which women play
a major role but hold less than fifty percent of the ownership rights.
So, the actual number of women with significant roles in business goes
well beyond 7 million--and they are growing rapidly.
These figures reflect the successes that women entrepreneurs are
having despite facing the same challenges for the past twenty years--
access to business assistance, access to capital, and access to Federal
Government contract opportunities. The ``glass ceiling'' in corporate
America that led many women to start a small business has been
transformed into a another obstacle--``a glass doorway''--between women
who want to start and grow businesses and the lending and Federal
contract markets these women entrepreneurs seek to enter. Overcoming
these obstacles requires that women are provided the business
assistance tools they need, which we can ensure through the programs
and services established within the Small Business Administration, SBA,
specifically for women.
As the new Chair of the Committee on Small Business, I have been
carefully examining the SBA's programs with a particular focus on the
agency's initiatives that are intended to foster women-owned
businesses. During the past year, witnesses and participants of the
Committee's hearings and roundtables clearly identified the concerns of
women business owners: the lack of business assistance programs
for existing small businesses; scarcity of financial resources for
start-up or expansion; limited opportunities for Federal Government
contracts; and the need for specific research on women's business
ownership.
In addition, we heard concerns from the Women's Business Centers and
their advocates about the Women's Business Centers Sustainability
Grants Program, which sunsets in 2003. These centers have been
extraordinarily successful in providing assistance to women in all
walks of life--those who once received public assistance but now
operate businesses and create jobs; women transitioning from employee
to small business employer; and establish women-business owners who
create and manufacture products for sale at home and abroad. The
Centers nurture women entrepreneurs through business and financial
planning and help with critical issues like securing funding for
startup and expansion. Despite these successes, however, funding
questions have long plagued the program.
Adding to the information gained from its official activities, the
Committee staff also conducted a review of all SBA funded and sponsored
activities for women entrepreneurs, held discussions with women
business leaders, and obtained information in the process of preparing
for the reauthorization of SBA Non-Credit Programs.
Our findings support specific changes to ensure that the SBA will be
more accountable in its delivery of programs and services through the
Office of Women's Business Ownership. Specifically, based on the need
and the impressive record of the Women's Business Centers, there is
strong support for making the program permanent, provided that the SBA
streamlines the grants administration processes. Improvements in the
focus and operations for the National Women's Business Council and the
Women's Interagency Committee on Women's Business Enterprise would also
enhance their missions and ability to serve women entrepreneurs.
The bill I introduce today is designed to address these issues and
improve the programs and services that the SBA delivers across the
nation for women business owners through the Office of Women's Business
Ownership, the Women's Business Centers Program, the National Women's
Business Council, and the Interagency Committee on Women's Business
Enterprise. The key elements of the bill's improvements will provide
direction, consolidation and integration of existing programs that have
been previously created to offer opportunities for women through their
entrepreneurial endeavors.
The ``Women's Small Business Programs Improvement Act of 2003'' would
improve the entrepreneurial environment for women seeking assistance
and opportunity through Federal Government sponsored programs. A key to
the success of this bill is the integration of all internal and
external SBA programs and partnerships. The provisions in this bill are
timely and in response to the many concerns of women business owners
that I have received from my constituents in Maine and from across the
country through the Small Business Committee.
Additionally, the bill makes the Women's Business Center a permanent
program for existing eligible Centers so that women can depend on the
experienced services of small business long-term counseling and small
business education and training. The Centers have proven to be a great
value the communities they serve so we must ensure that their programs
and services continue to be available.
The ``Women's Small Business Programs Improvement Act of 2003''
ensure that women entrepreneurs at all stages of business ownership get
the assistance they need so that success
[[Page S7150]]
through business growth is more easily obtained. And it achieves that
goal, not by establish costly new initiatives, but by building on
successful establish programs within the SBA and improving their
delivery for the benefit of current and future women entrepreneurs.
As the Small Business Committee continues its work on legislation to
reauthorize the SBA, we will be addressing all of the agency's
programs. I look forward to working with my colleagues in the Senate to
ensure that the provisions of this bill are included so the growth of
women owned business in America can reach its full potential.
I ask unanimous consent that the text of the bill and a section-by-
section analysis be printed into the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
S. 1154
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 ``Women's Small Business
Programs Improvement Act of 2003''.
SEC. 2. OFFICE OF WOMEN'S BUSINESS OWNERSHIP.
Section 29(g) of the Small Business Act (15 U.S.C. 656(g))
is amended--
(1) in paragraph (2)--
(A) in subparagraph (B)(i), by striking ``in the areas of--
``(I) starting and operating''; and inserting the
following:
``to solve problems concerning operations, manufacturing,
technology, finance, international trade, and other
disciplines required for--
``(I) starting, operating, and growing'';
(B) in subparagraph (C), by inserting ``, the National
Women's Business Council, and the Association of Women's
Business Centers'' before the period at the end; and
(2) by adding at the end the following:
``(3) Programs and services for women-owned small
businesses.--The Assistant Administrator, in consultation
with the Association of Women's Business Centers, the
National Women's Business Council, and the Interagency
Committee on Women's Business Enterprise, shall develop
programs and services for women-owned businesses (as defined
in section 408 of the Women's Business Ownership Act of 1988
(15 U.S.C. 631 note)) that provide goods or services in the
areas of--
``(A) manufacturing;
``(B) technology;
``(C) professional services;
``(D) travel and tourism;
``(E) international trade; and
``(F) Federal Government contract business development.
``(4) Training.--The Administration shall provide
sufficient training for business ownership representatives
and technical representatives within the district offices of
the Administration to enable these staffs to carry out their
responsibilities under this section.''.
SEC. 3. WOMEN'S BUSINESS CENTER PROGRAM.
(a) Women's Business Center Grants Program.--Section 29 of
the Small Business Act (15 U.S.C. 656) is amended by striking
subsection (b) through (f) and inserting the following:
``(b) Grants Authorized.--
``(1) In general.--The Administration is authorized to
award grants, to be known as `Women's Business Center
Grants', to private nonprofit organizations to conduct 3-year
projects for the benefit of small business concerns owned and
controlled by women. At the end of the initial 3-year grant
period, and every 3 years thereafter, the grant recipient may
apply to renew the grant in accordance with this subsection
and subsection (e)(2).
``(2) Contract authority.--
``(A) In general.--The Administration may enter into annual
contracts with grant recipients under this subsection to
perform the services described under paragraph (3) only to
the extent and in the amount provided by appropriated funds.
``(B) Termination.--If any grant recipient under this
subsection does not fulfill its contractual obligations
during the 3-year period of the grant, the Administration may
terminate the grant.
``(3) Use of funds.--Grants awarded under paragraph (1)
shall be used to provide--
``(A) financial assistance, including training and
counseling in how to apply for and secure business credit and
investment capital, preparing and presenting financial
statements, and managing cash flow and other financial
operations of a business concern;
``(B) management assistance, including training and
counseling in how to plan, organize, staff, direct, and
control each major activity and function of a small business
concern; and
``(C) marketing assistance, including training and
counseling in identifying and segmenting domestic and
international market opportunities, preparing and executing
marketing plans, developing pricing strategies, locating
contract opportunities, negotiating contracts, and utilizing
varying public relations and advertising techniques.
``(4) Matching requirement.--
``(A) Women's business center grants.--As a condition of
receiving financial assistance under this section, the grant
recipient shall agree to obtain, after its application has
been approved and notice of award has been issued, cash
contributions from non-Federal sources as follows:
``(i) In the first and second years, 1 non-Federal dollar
for each 2 Federal dollars provided under the grant.
``(ii) In the third year, 1 non-Federal dollar for each
Federal dollar provided under the grant.
``(iii) In each renewal period, 1 non-Federal dollar for
each Federal dollar provided under the grant.
``(B) Form of non-federal contributions.--Not more than \1/
2\ of the non-Federal sector matching assistance may be in
the form of in-kind contributions that are budget line items
only, including office equipment and office space.
``(C) Failure to obtain non-federal funding.--If any grant
recipient fails to obtain the required non-Federal
contribution during any project, it shall not be eligible
thereafter for advance disbursements pursuant to subparagraph
(D) during the remainder of that project, or for any other
project for which it is or may be funded by the
Administration. Before approving assistance to the grant
recipient for any other projects, the Administration shall
specifically determine whether the Administration believes
that the grant recipient will be able to obtain the requisite
non-Federal funding and enter a written finding setting forth
the reasons for making such determination.
``(D) Form of federal contributions.--The financial
assistance authorized pursuant to this section may be made by
grant, contract, or cooperative agreement and may contain
such provision, as necessary, to provide for payments in lump
sum or installments, and in advance or by way of
reimbursement. The Administration may disburse up to 25
percent of each year's Federal share awarded to a grant
recipient after notice of the award has been issued and
before the non-Federal sector matching funds are obtained.
``(5) Application submission.--Each organization desiring a
grant under this subsection, shall submit to the
Administration an application that contains--
``(A) a certification that the applicant--
``(i) is a private nonprofit organization;
``(ii) employs an executive director or program manager to
manage the center; and
``(iii) as a condition of receiving a grant under this
subsection, agrees--
``(I) to receive a site visit as part of the final
selection process;
``(II) to undergo an annual programmatic and financial
examination; and
``(III) to the maximum extent practicable, to remedy any
problems identified pursuant to the site visit or examination
under subclauses (I) and (II);
``(B) information demonstrating that the applicant has the
ability and resources to meet the needs of the market to be
served by the women's business center site for which a grant
is sought, including the ability to comply with the matching
requirement under paragraph (4);
``(C) information relating to assistance provided by the
women's business center site for which a grant is sought in
the area in which the site is located, including--
``(i) the number of individuals assisted;
``(ii) the number of hours of counseling, training, and
workshops provided; and
``(iii) the number of startup business concerns created;
``(D) information demonstrating the effective experience of
the applicant in--
``(i) conducting financial, management, and marketing
assistance programs, as described under paragraph (3), which
are designed to teach or upgrade the business skills of women
who are business owners or potential business owners;
``(ii) providing training and services to a representative
number of women who are both socially and economically
disadvantaged; and
``(iii) using resource partners of the Administration and
other entities, such as universities;
``(E) a 3-year plan that projects the ability of the
women's business center site for which a grant is sought--
``(i) to serve women business owners or potential owners in
the future by improving training and counseling activities;
and
``(ii) to provide training and services to a representative
number of women who are both socially and economically
disadvantaged; and
``(F) any additional information that the Administration
may reasonably require.
``(6) Review and approval of applications.--
``(A) In general.--The Administration shall--
``(i) review each application submitted under paragraph (5)
based on the information provided in such paragraph and the
criteria set forth under subparagraph (B); and
``(ii) as part of the final selection process, conduct a
site visit at each women's business center for which a grant
is sought.
``(B) Selection criteria.--
``(i) In general.--The Administration shall evaluate and
rank applicants in accordance with predetermined selection
criteria that shall be stated in terms of relative
importance. Such criteria and their relative importance shall
be made publicly available and stated in each solicitation
for applications made by the Administration.
[[Page S7151]]
``(ii) Required criteria.--The selection criteria under
clause (i) shall include--
``(I) the experience of the applicant in conducting
programs or ongoing efforts designed to impart or upgrade the
business skills of women business owners or potential owners;
``(II) the ability of the applicant to commence a project
within a minimum amount of time;
``(III) the ability of the applicant to provide training
and services to a representative number of women who are both
socially and economically disadvantaged; and
``(IV) the location for the women's business center site
proposed by the applicant.
``(C) Record retention.--The Administration shall maintain
a copy of each application submitted under this subsection
for not less than 7 years.
``(7) Data collection.--Consistent with the annual report
to Congress under subsection (g), each women's business
center site that is awarded a grant shall, to the maximum
extent practicable, collect information relating to--
``(A) the number of individuals assisted;
``(B) the number of hours of counseling and training
provided and workshops conducted;
``(C) the number of startup business concerns formed;
``(D) any available gross receipts of assisted concerns;
and
``(E) the number of jobs created, maintained, or lost at
assisted concerns.
``(8) Savings provision.--Notwithstanding any other
provision of law, a contract or cooperative agreement, in
effect on the date of enactment of the Women's Small Business
Programs Improvement Act of 2003, that awards a
sustainability grant to a Women's Business Center, shall
remain in full force and effect under the terms, and for the
duration, of such contract or agreement.
``(c) Association of Women's Business Centers.--
``(1) Recognition.--The Administration shall recognize the
existence and activities of an association formed by the
Women's Business Centers to address matters of common
concern.
``(2) Consultation.--The Administration shall consult with
the association described under paragraph (1) to develop--
``(A) a request for proposal to deliver assistance under
this section;
``(B) a training program for the staff of the Women's
Business Centers; and
``(C) policies and procedures for governing the general
operations and administration of the Women's Business Center
Program.''.
(b) Conforming amendments.--Section 29 of the Small
Business Act (15 U.S.C. 656) is amended--
(1) by redesignating subsections (g), (h), (i), (j), and
(k) as subsections (d), (e), (f), (g), and (h), respectively.
(2) in subsection (e)(2), as redesignated by paragraph (1),
by striking ``to award a contract (as a sustainability grant)
under subsection (l) or'';
(3) in subsection (h), as redesignated by paragraph (1)--
(A) by amending paragraph (1) to read as follows:
``(1) In general.--There are authorized to be appropriated
to carry out the provisions of this section, to remain
available until expended--
``(A) $14,500,000 for fiscal year 2004;
``(B) $16,000,000 for fiscal year 2005; and
``(C) $17,500,000 for fiscal year 2006.''; and
(B) by striking paragraph (4); and
(4) by striking subsection (l).
SEC. 4. NATIONAL WOMEN'S BUSINESS COUNCIL.
(a) Cosponsorship Authority.--Section 406 of the Women's
Business Ownership Act of 1988 (15 U.S.C. 631 note) is
amended by adding at the end the following:
``(e) Cosponsorship Authority.--The Council is authorized
to enter into cosponsorship agreements with public and
private entities to carry out its duties under this
section.''.
(b) Membership.--Section 407 of the Women's Business
Ownership Act of 1988 (15 U.S.C. 631 note) is amended by
adding at the end the following:
``(j) Representation of Member Organizations.--
Notwithstanding subsection (b), a national women's business
organization or small business that is represented on the
Council may replace its representative member on the Council
at any time during the service term to which that member was
appointed.''.
(c) Establishment of Committees.--The Women's Business
Ownership Act of 1988 (15 U.S.C. 631 note) is amended by
inserting after section 407, the following new section:
``SEC. 408. COMMITTEES.
``(a) Establishment.--There are established within the
Council--
``(1) the Committee on Manufacturing, Technology, and
Professional Services;
``(2) the Committee on Travel, Tourism, and International
Trade; and
``(3) the Committee on Federal Procurement and Contracting.
``(b) Duties.--The Committees established under subsection
(a) shall perform such duties as the chairperson shall
direct.''.
(d) Repository for Historical Documents.--Section 409 of
the Women's Business Ownership Act of 1988 (15 U.S.C. 631
note) is amended by adding at the end the following:
``(c) Repository for Historical Documents.--The Council
shall establish a repository for historical documents
relating to women's ownership of small businesses in the
United States.''.
(e) Authorization of Appropriations.--Section 410(a) of the
Women's Business Ownership Act of 1988 (15 U.S.C. 631 note)
is amended by striking ``2001 through 2003, of which
$550,000'' and inserting ``2004 through 2006, of which 30
percent''.
SEC. 5. INTERAGENCY COMMITTEE ON WOMEN'S BUSINESS ENTERPRISE.
(a) Chairperson.--Section 403(b) of the Women's Business
Ownership Act of 1988 (15 U.S.C. 631 note) is amended--
(1) by striking ``Not later'' and inserting the following:
``(1) In general.--Not later''; and
(2) by adding at the end the following:
``(2) Vacancy.--In the event that a chairperson is not
appointed under paragraph (1), the Deputy Administrator of
the Small Business Administration shall serve as acting
chairperson of the Interagency Committee until a chairperson
is appointed under paragraph (1).''.
(b) Policy Advisory Group.--Section 401 of the Women's
Business Ownership Act of 1988 (15 U.S.C. 631 note) is
amended--
(1) by striking ``There'' and inserting the following:
``(a) In general.--There''; and
(2) by adding at the end the following:
``(b) Policy Advisory Group.--
``(1) Establishment.--There is established within the
Interagency Committee a Policy Advisory Group to assist the
chairperson in developing policies and programs under this
Act.
``(2) Membership.--The Policy Advisory Group shall be
composed of--
``(A) 1 representative from the Small Business
Administration;
``(B) 1 representative from the Department of Commerce;
``(C) 1 representative from the Department of Labor;
``(D) 1 representative from the Department of Defense;
``(E) 1 representative from the Association of Women's
Business Centers; and
``(F) 2 representatives from the National Women's Business
Council.''.
(c) Establishment of Subcommittees.--Section 401 of the
Women's Business Ownership Act of 1988 (15 U.S.C. 631 note),
as amended by subsection (b), is further amended by adding at
the end the following:
``(c) Subcommittees.--
``(1) Establishment.--There are established within the
Interagency Committee--
``(A) the Subcommittee on Manufacturing, Technology, and
Professional Services;
``(B) the Subcommittee on Travel, Tourism, and
International Trade; and
``(C) the Subcommittee on Federal Procurement and
Contracting.
``(2) Duties.--The Subcommittees established under
paragraph (1) shall perform such duties as the chairperson
shall direct.''.
SEC. 6. ANNUAL MANAGEMENT REPORT.
Section 29(g)(1) of the Small Business Act, as amended by
this Act, is further amended by striking ``The
Administration'' and inserting ``Not later than November 1st
of each year, the Administration''.
SEC. 7. EFFECTIVE DATE.
This Act, and the amendments made by this Act, shall take
effect on October 1, 2003.
____
The Women's Small Business Programs Improvement Act of 2003--
Explanation of Provisions
i. sba office of women's business ownership
This section of the bill reflects the Committee's
recognition of the achievements and challenges of women small
business owners. The hearings and reauthorization
roundtables, held during 2003, provided the opportunity to
identify the Small Business Administration (SBA) non-credit
programs that most interest or concern women advocates and
business owners.
Hearing witnesses and Roundtables participants identified
the following concerns held by women business owners:
The concern for the Women's Business Center Program's
sustainability grants pilot program that fund centers beyond
the maximum 5-year funding periods;
The need to expand the SBA non-credit programs
(Entrepreneurial Development and Government Contracting);
The need for current research on women-owned small
businesses;
The lack of progress for women to gain access to start-up
and expansion capital, and
The limited opportunities available to women-owned small
businesses for Federal government contracts.
In followup meetings and discussions, women business
advocates and leaders indicated their interests in positive
changes for the SBA sponsored programs through the Women's
Business Centers program, the National Women's Business
Council, and the Interagency Committee on Women's Business
Enterprise. The SBA Office of Women's Business Ownership is
in a position to take the ``real world problems'' faced by
women on a day-to-day basis and work with all of its partners
and public and private resources to expand its menu of
programs and services.
The bill will direct the SBA Office of Women's Business
Ownership to develop and make available new programs and
services for established women owned businesses--adding to
the SBA menu of small business start-up programs.
The new programs and services for women would assist women-
owned small business solve problems concerning business
operations, manufacturing, technology, finance, Federal
government contracting and international trade and other
disciplines required for starting, operating, and growing
small
[[Page S7152]]
business in changing economies. New programs would be based
on recommendations by the National Women's Business Council,
the Women's Business Centers, and the Interagency Committee
on Women's Business Enterprise, these programs and services
would be developed by the SBA in partnership with its funded
resource partners and private sector cosponsors.
The bill will direct the SBA to provide training for
District Office Women Business Ownership Representatives
(existing staff who carry out marketing and outreach
activities) and District Office of Technical Representatives
(existing staff who carry out grant programmatic and
financial oversight) and to provide resources for the
District Offices to carry out their responsibilities in
support of women's business ownership programs.
The bill will direct the SBA to submit a report on data
collections on women's programs and services to the Congress
no later than November 1st of each year.
The bill will direct the SBA to work with the Association
of Women's Business Centers, the National Women's Business
Council and the Interagency Committee on Women Business
Enterprise to develop marketing and outreach programs, as
well as procurement training programs, on Federal government
contracting and business development opportunities.
ii. women's business center program
The Women's Business Center Program, established in 1988,
provides long-term training and counseling to encourage small
business ownership through nonprofit organizations. The
competitive grant award programs is administered through the
SBA Headquarters Office of Women's Business Ownership (OWBO)
Grants Management Division, with oversight designated to the
SBA District Office Technical Representative. The Women's
Business Center program has been well received by the
recipient users and the program has been a tremendous
marketing and outreach tool for the SBA in recent years. The
SBA estimated in Fiscal Year 2002, the Women's Business
Center program had an approximate return of $161 for every $1
invested in the program.
The bill makes the Women's Business Centers a permanent
grant program with renewal options, replacing the Pilot
Sustainability Grants Program. The Pilot program sunsets in
2003.
Existing Women's Business Centers will be eligible to
submit proposals every 3 years. The program improvements are
modeled after the SBDC grant program and several provisions
contained in the Sustainability Grant Program. Eligibility
and evaluation criteria will be establish that encourages
existing productive Centers to continue to participate in the
program.
The bill recognizes the Association of Women's Business
Centers (AWBCs) and directs the SBA Office of Women's
Business Ownership to partner with the Association in
developing and administering the programs delivered through
the Centers (modeled after the SBA's current partnership with
the Association of Small Business Development Centers with
regard to the Small Business Development Center program).
The bill directs the SBA to streamline the reporting
requirements of the Centers recognizing the limited grant
award and limited human resources within the Centers.
iii. interagency committee on women's business enterprise
The Interagency Committee on Women's Business Enterprise
was created in 1977, as an interagency task force. By
Executive Order 112138, in May 1979, the name was changed to
the Interagency Council. In 1988, the Women's Business
Ownership Act (Public Law 100-533) replaced the Interagency
Council with a joint public-private sector National Women's
Business Council. The SBA Reauthorization and Amendment Act
of 1997 (Public Law 103-403) revised the Council's structure,
returning to all public-sector participants to comprise an
expanded Interagency Committee on Women's Business
Enterprise.
Under current law, there is no authorization for
appropriations to support the activities on the Interagency
Committee. Nor are there clear directives on the operations
and interaction of the Federal agency and department
representatives. The Federal agencies and departments
represented on the Interagency Committee allocate existing
personnel and resources to support participation on the
Interagency Committee. The Interagency Committee is required
to submit, through SBA, an annual report to the President and
Congress, but there is no record of such annual reports being
prepared or delivered for the past three years.
In addition, the President has not appointed a Chairperson
to carry out the mission of the Interagency Committee, and
therefore, it is inactive.
The bill will direct that the SBA Deputy Administrator
temporarily fulfill the needs of the Interagency Committee
Chair if vacant until the President makes an appointment.
When the Interagency Committee is active and a Chair is in
place, the SBA Office of Women's Business Ownership serves as
Co-Chair. This action will provide for the continuity of
activities and avoid the periods of time of inactivity.
The bill will direct the Interagency Committee to conduct
three official meetings each year:
In October to plan upcoming fiscal year activities;
In February to track year-to-date agency contracting goals;
and
In August to evaluate fiscal year progress and begin the
report process.
The bill creates a Policy Advisory Group consisting of
representatives from the SBA, the Department of Commerce, the
Department of Labor, the Department of Defense, Association
of Women's Business Centers, and two individuals and two
organizations that are members of the National Women's
Business Council. Creating the Policy Advisory Group will
return the Interagency to a mix of public/private members to
provide the energy and direction so badly needed to revive
the intent of the Interagency Committee.
The bill will create three subcommittees:
Subcommittee on Manufacturing, technology and Professional
Services;
Subcommittee on Travel and International Trade; and
Subcommittee on Procurement and Federal Contracting.
These subcommittees will create the opportunity for smaller
groups to work on specific issues. Each subcommittee will
meet once a quarter and report their minutes to the National
Women's Business Council, the SBA Office of Women's Business
Ownership, and the SBA Contract Assistance for Women Business
Ownership Office. In addition to the Policy Advisory Group
members, all Federal departments and agencies may participate
at will.
iv. national women's business council
The National Women's Business Council was created by the
Women's Business Ownership Act of 1988 to serve as an
advisory body because the Interagency Committee had been
criticized for inactivity. By separating the Council from the
Interagency Committee (1994 Act), the Council was able to
focus on its mission. The 1997 Reauthorization Act provided
for improved reporting duties and Council appointments.
The 1988 Act required the Council to conduct studies on
issues relating to women-owned businesses, including the
award of Federal prime contracts to women-owned businesses
and access to credit and investment capital by women
entrepreneurs. In general, the National Women's Business
Council's statutory mandate is broad and lacks an integration
with other women's business ownership programs.
Although the Council has not received its authorized level
of $1 million in funding, it has been required to designate
$550,000 of its appropriated funding to research studies. The
level of funding for Fiscal Year 2003 was $750,000. The
Administration has proposed a change in the amount that can
be spent on research studies--from a set amount of dollars
allocated to a 55 percentage of appropriated funds.
The bill supports full funding for the National Women's
Business Council and full authority for the Chairperson to
conduct the Council's activities. In addition, the bill
establishes an allocation of appropriated funds for research.
The change will provide the opportunity for the Council to
engage in activities, conferences and the development of
programs and services, at the direction of the Chairperson,
and be more pro-active in the years 2004 through 2006.
The bill creates three Sub-committees on the Council (which
parallel the new subcommittees that the bill establishes for
the Interagency Committee on Women's Business Enterprise):
Subcommittee on Manufacturing, Technology and Professional
Services;
Subcommittee on Travel and International Trade; and
Subcommittee on Procurement and Federal Contracting.
These subcommittees will create the opportunity for smaller
groups to work on specific issues and interact with the
Interagency Committee on Women's Business Enterprise and the
SBA Office of Women's Business Ownership. Recognizing that
the membership of the Council includes very active business
owners and leaders, rather than establish official meetings
for the Committees, the participants may participate via
conference calls or video conferencing.
The bill will provide the Council with cosponsorship
authority. The SBA advised the Council in 2003 that the
Council did not have sufficient authority to engage in
cosponsored activities (such conferences, training
activities, and materials). The inability to engage in
cosponsored activities would seriously impede the works of
the Council in the future. It is through cosponsored
activities, partially funded by the private-sector or other
government agencies, that the Council is able to conduct
research as well as produce activities for women-owned small
businesses.
The bill will clarify the membership representation. At
present, there is a problem with the interpretation of
Council membership as applied to an organization, business or
individual. Clarification language is needed to allow an
organization or business to change the names of individuals
representing the organization or business on the Council
without interruption.
The bill directs the Council to establish a repository, at
the direction of the Chairperson, of information and research
on women's entrepreneurship.
______
By Mr. GRASSLEY:
S. 1155. A bill to repeal section 801 of the Revenue Act of 1916; to
the Committee on Finance.
[[Page S7153]]
Mr. GRASSLEY. Mr. President, today I am introducing a bill to bring
the United States into compliance with its obligations under the World
Trade Organization.
The basic thrust of the bill is simple--it repeals section 801 of the
Revenue Act of 1916 which the WTO Appellate Body found to be
inconsistent with our responsibilities under Article VI of the GATT
1994 and the WTO Antidumping Agreement. Repealing section 801 will
therefore bring the United States into conformity with its WTO
obligations.
Section 801, which has been referred to as the Antidumping Act of
1916, allows private parties to sue importers of dumped imports in U.S.
district courts, and also establishes criminal liability for importing
dumped goods. While the provision is seldom used, there are several
recent court cases pending in the United States where litigants have
sued under the Antidumping Act of 1916.
I am introducing this legislation because I believe it is important
that the United States comply with its WTO obligations. While we may
not agree with each and every decision that comes out of the WTO, we
should not pick and choose which decisions we will comply with. The
bottom line is that the United States benefits greatly from a rules-
based world trading system. We have had considerable success in
bringing down foreign import barriers, and this has resulted in
increased trade, economic growth, and more jobs right here in the
United States. When we comply with adverse decisions we only strengthen
our position in other cases where we challenge the impermissible import
restraints of our trading partners, such as the de facto biotechnology
moratorium adopted by the European Union, which continues to hurt
farmers in Iowa and is now under challenge before the WTO. I want other
countries to comply when we win, so I think it is important to comply
when we lose.
I would also like to point out an important aspect of the bill I am
introducing. The bill brings us into compliance with our WTO
obligations, but it does not apply retroactively. I think retroactive
application of repeal would be wrong in this case for a number of
reasons.
First, the U.S. Supreme Court has held that under the constitutional
due process standard, retroactive application of economic legislation
is acceptable only where it is justified by a rational legislative
purpose. To my knowledge, no one has yet articulated any reason, let
alone a rational legislative purpose, for depriving litigants in U.S.
courts of the opportunity for final adjudication of their disputes in
this case. In fact, the Appellate Body Ruling itself does not call for
a retroactive repeal of section 801 in order for the United States to
conform to its WTO obligations. It seems to me that no rational
legislative purpose is served by retroactive repeal of section 801 when
the Appellate Body Report does not ask for retroactive repeal and the
Administration has not explained why retroactive repeal is necessary.
The Supreme Court has also held that the justification for
prospective application of legislation may not suffice for retroactive
application of the same legislation. The justification for repeal of
section 801 is to conform to our WTO obligations; again, if WTO
compliance does not call for retroactive repeal, then the justification
for repealing section 801 should not extend to a retroactive repeal of
this provision.
Second, the administration and Congress have consistently taken the
position that retroactive repeal is not necessary to ensure compliance
with our WTO obligations in all cases, particularly in cases dealing
with U.S. trade remedy laws. The Joint Report of the Committee of
Finance, Committee on Agriculture, Nutrition, and Forestry, Committee
on Government Affairs of the U.S. Senate which accompanied the
legislation implementing the Uruguay Round Agreements Act explicitly
noted that compliance with WTO panels in trade remedy cases applied
prospectively only. The Joint Report continued that prospective
application ``is consistent with the general principle in the GATT, and
in the future WTO, that panel decisions do not have retroactive
effect.''
This principle is fully consistent with the text of the WTO agreement
itself. Article 19.1 of the Dispute Settlement Understanding states
only that ``{w here a panel or the Appellate Body concludes that a
measure is inconsistent with a covered agreement, it shall recommend
that the Member concerned bring the measure into conformity with that
Agreement. In addition to its recommendations, the panel or Appellate
Body may suggest ways in which the Member concerned could implement the
recommendations.'' Thus, the text of the WTO calls only for ``bringing
the measure into conformity'' and not retroactive application of an
Appellate Body decision.
To my knowledge, this is the position which has consistently been
taken by the U.S. Government and the WTO Appellate Body. In fact, with
the exception of one aberrant decision by a panel in the case of
Australian Automotive Leather, WTO panels and the Appellate Body have
continued to adhere to the general principle that retroactive
compliance measures are inappropriate.
The panel ruling in Australian Automotive Leather is instructive. The
WTO Dispute Settlement Body adopted a panel report that recommended the
Australian recipient of a subsidy pay back the entire amount of the $30
million Australian dollar subsidy it had received. This recommendation
went far beyond what the United States asked for. The United States
sought only the return of the prospective value of the subsidy that the
Australian automotive leather company had received. The United States
argued that repayment of the entire subsidy was inappropriate and
ultimately settled the dispute with Australia in a deal that required
the automotive leather company to pay back $7.2 million Australian
dollars to the Government of Australia, which reflected the prospective
value of the subsidy. Thus, both U.S. law and U.S. trade policy conform
to the general principle that compliance measures should be prospective
in nature.
Finally, I believe that as a general matter, attempts at retroactive
compliance with WTO rulings can make for bad trade policy. The intent
of the rules-based trading system established under the WTO is to bring
Members into compliance so that going forward international trade can
be conducted on a level playing field. There is just no telling where
efforts at retroactive compliance may lead. While in this instance the
retroactive repeal of section 801 may seem clear-cut to some, it could
set a dangerous precedent for future cases. Imagine if the WTO
Appellate Body required or the U.S. Government advocated for
retroactive application of a measure repealing the Extraterritorial
Income Act/Foreign Sales Corporation tax regime. The result would be
ludicrous.
Rather than foster the establishment of a level playing field,
efforts at retroactive compliance may well distort markets to an extent
even greater than the underlying measure that was found to be WTO
inconsistent. We need to carefully consider whether retroactive repeal
of a statutory provision is appropriate. I believe that considerations
of judicial precedent, legislative intent, established practice under
the GATT and the WTO, as well as good trade policy, all mitigate
against the retroactive repeal of section 801.
I call upon my colleagues to support this bill repealing section 801.
Passing the bill will bring us into compliance with our WTO
obligations, demonstrate our continued commitment to the rules-based
trading system, and strengthen our position in future cases where we
prove successful in challenging impermissible import restraints erected
by our trading partners.
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. 1155
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. REPEAL OF ANTIDUMPING PROVISION OF REVENUE ACT OF
1916.
(a) Repeal.--Section 801 of the Act entitled ``An Act to
increase the revenue, and for other purposes'', approved
September 8, 1916 (15 U.S.C. 72), is repealed.
(b) Effect of Repeal.--The repeal made by subsection (a)
shall not affect any action under section 801 of the Act
referred to in
[[Page S7154]]
subsection (a) that was commenced before the date of the
enactment of this Act and is pending on such date.
______
By Mr. SPECTER:
S. 1156. A bill to amend title 38, United States Code, to improve and
enhance the provision of long-term health care for veterans by the
Department of Veterans Affairs, to enhance and improve authorities
relating to the administration of personnel of the Department of
Veterans Affairs, and for other purposes; to the Committee on Veterans'
Affairs.
Mr. SPECTER. Mr. President, I have sought recognition to explain
briefly the provisions of the ``Department of Veterans Affairs Long-
Term Care and Personnel Authorities Enhancement Act of 2003,'' a bill
that I have introduced today.
Title I of the bill would extend through calendar year 2008
authorities that now specify that the Department of Veterans Affairs,
VA, will provide to veterans enrolled for VA medical care outpatient-
based long-term care services, such as Adult Day Health Care, Home
Health Aide assistance, Non-Institutional Respite Care, and Home-based
Primary Care. These services provide alternatives to institutional care
and, in many cases, they obviate the need for institutional care by
allowing veterans to remain in their own homes with care-giving
assistance provided by VA.
In addition, this bill would lower, from 70 percent to 50 percent,
the threshold level of service-connected disability that would qualify
a veteran for highest-priority for institutional care should he or she
need it. VA currently provides highest-priority access to hospital and
outpatient clinic-based care to veterans who have suffered a service-
connected disability rated by VA as 50 percent disabling or higher.
Highest-priority access to inpatient-based long-term care services,
however, is only granted by law to veterans who are 70 percent or more
disabled, unless such care is needed specifically to treat a less-
disabling service-connected disability. When this provision of law was
enacted in 1999, Congress set the threshold for priority access to
nursing home care at 70 percent, rather than at 50 percent, due
primarily to concerns that a lower threshold--which was actively
considered--might cause VA to be faced with an unforeseen level of
demand that could not be met. Since then, however, VA has reported that
``there was only a small increase in the numbers of veterans 70 percent
service-connected or greater who were estimated to need nursing home
care but who actually received that care from VA.'' In light of that, I
see no compelling reason to continue distinguishing between nursing
home care and all other types of care that are made available to 50
percent or higher service-connected veterans on a highest-priority
basis. This bill would provide, in effect, that hospital care,
outpatient clinic-based care, and nursing home care will equally be
made available to all such enrolled veterans.
Title I of the bill would also make technical changes to VA authority
to contract for nursing home and adult day health care services by
allowing VA to enter into agreements with providers under standards
similar to those allowed by Medicare. According to VA, these changes
will allow a greater number of smaller community-based providers to
contract with VA by reducing the regulatory burdens placed upon them as
a condition to contracting eligibility.
Title II of the bill authorizes major construction for long-term care
facilities in Beckley, WV and Lebanon, PA. Each of these states has a
substantial elderly population and each is need of expansion to their
VA long-term care programs.
Title III of the bill would change current law to allow VA to more
easily hire and retain certain clinical staff members. Under current
law, VA hires many clinical professionals, such as physicians and
nurses, under streamlined authorities set forth in title 38 of U.S.
Code. But other key clinical professionals, such as clinical social
workers, psychologists, and pharmacists, may only be hired through the
standard ``civil service'' authorities specified in Title 5, U.S. Code.
Further, members of such professions may only be paid and promoted in
accordance with the standard civil service General Schedule, GS, pay
scale. The process of hiring staff under these procedures is arduous
and lengthy, consuming three months or more and placing VA at great
competitive disadvantage in securing the services of best qualified
candidates. This bill would convert many of these positions into
``hybrid Title 38'' status and permit VA greatly increased hiring and
promotion flexibility, and compensation at special, locally-based, pay
scales. Such clinicians, however, would retain their standard civil
service grievance, vacation, and discipline protections.
Title III of the bill also contains provisions to correct a long-
standing inequity relating to retirement benefits for certain part-time
VA nurses; to expand a successful pilot program allowing for contract-
physician disability compensation medical examinations; and to afford
certain wage-grade canteen workers an opportunity to compete favorably
for VA employment.
I urge my colleagues to support this legislation.
Mr. President, 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. 1156
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 ``Department of Veterans
Affairs Long-Term Care and Personnel Authorities Enhancement
Act of 2003''.
TITLE I--EXTENSION AND ENHANCEMENT OF AUTHORITIES
SEC. 101. EXTENSION AND MODIFICATION OF CERTAIN HEALTH CARE
AUTHORITIES.
(a) Treatment of Noninstitutional Extended Care Services as
Medical Services.--Section 1701(a)(10)(A) of title 38, United
States Code, is amended by striking ``December 31, 2003'' and
inserting ``December 31, 2008''.
(b) Required Nursing Home Care.--(1) Subsection (a) of
section 1710A of such title is amended by striking ``70
percent'' and inserting ``50 percent''.
(2) Subsection (c) of such section is amended by striking
``December 31, 2003'' and inserting ``December 31, 2008''.
SEC. 102. ENHANCED AGREEMENT AUTHORITY FOR PROVISION OF
NURSING HOME CARE AND ADULT DAY HEALTH CARE IN
NON-DEPARTMENT OF VETERANS AFFAIRS FACILITIES.
Section 1720 of title 38, United States Code, is amended--
(1) in subsection (c)--
(A) by designating the existing text as paragraph (2); and
(B) by inserting before paragraph (2), as so designated,
the following new paragraph (1):
``(1) In furnishing nursing home care or adult day health
care under this section, the Secretary may enter into
agreements for furnishing such care utilizing such
authorities relating to agreements for the provision of
services under section 1866 of the Social Security Act (42
U.S.C. 1395cc) that the Secretary considers appropriate.'';
and
(2) in subsection (f)(1)(B), by inserting ``or agreement''
after ``contract'' each place it appears.
TITLE II--CONSTRUCTION AUTHORIZATION
SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.
The Secretary of Veterans Affairs may carry out the
following major medical facility projects, with each project
to be carried out in an amount not to exceed the amount
specified for that project:
(1) Construction of a long-term care facility in Lebanon,
Pennsylvania, $14,500,000.
(2) Construction of a long-term care facility in Beckley,
West Virginia, $20,000,000.
SEC. 202. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated
for the Secretary of Veterans Affairs for fiscal year 2004
for the Construction, Major Projects, account, a total of
$34,500,000 for the projects authorized in paragraphs (1) and
(2) of section 201.
(b) Limitation.--The projects authorized in section 201 may
only be carried out using--
(1) funds appropriated for fiscal year 2004 pursuant to the
authorization of appropriations in subsection (a);
(2) funds appropriated for Construction, Major Projects,
for a fiscal year before fiscal year 2004 that remain
available for obligation; and
(3) funds appropriated for Construction, Major Projects,
for fiscal year 2004 for a category of activity not specific
to a project.
TITLE III--PERSONNEL
SEC. 301. MODIFICATION OF AUTHORITIES ON APPOINTMENTS OF
PERSONNEL IN THE VETERANS HEALTH
ADMINISTRATION.
(a) Positions Treatable as Hybrid Status Positions.--
Section 7401 of title 38, United States Code, is amended--
(1) in paragraph (2), by striking ``Psychologists'' and all
that follows through ``other scientific'' and inserting
``Other scientific''; and
[[Page S7155]]
(2) by striking paragraph (3) and inserting the following
new paragraph (3):
``(3) Audiologists, speech pathologists, and audiologist-
speech pathologists, biomedical engineers, certified or
registered respiratory therapists, dietitians, licensed
physical therapists, licensed practical or vocational nurses,
medical instrument technicians, medical records
administrators or specialists, medical records technicians,
medical technologists, nuclear medicine technologists,
occupational therapists, occupational therapy assistants,
orthotist-prosthetists, pharmacists, pharmacy technicians,
physical therapy assistants, prosthetic representatives,
psychologists, diagnostic radiologic technicians, therapeutic
radiologic technicians, social workers, and personnel in such
other positions as the Secretary designates (subject to
section 7403(f)(4) of this title) for purposes of this
paragraph as necessary for the medical care of veterans.''.
(b) Report on Proposal To Designate Additional Positions as
Hybrid Status Positions.--Section 7403(f) of such title is
amended by adding at the end the following new paragraph:
``(4) Not later than 45 days before the date on which the
Secretary proposes to designate a position as a position
necessary for the medical care of veterans for which
appointment may be made under section 7401(3) of this title,
the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a
report on the proposed designation.''.
(c) Temporary, Part-Time, and Without Compensation
Appointments.--Section 7405 of such title is amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking subparagraphs (B) and (C)
and inserting the following new subparagraphs:
``(B) Positions listed in section 7401(3) of this title.
``(C) Librarians.''; and
(B) in paragraph (2), by striking subparagraph (B) and
inserting the following new subparagraph (B):
``(B) Positions listed in section 7401(3) of this title.'';
and
(2) in subsection (c)(1), by striking ``section 7401(1)''
and inserting ``paragraphs (1) and (3) of section 7401''.
(d) Authority for Additional Pay for Certain Health Care
Professionals.--Section 7454(b)(1) of such title is amended
by striking ``certified or registered'' and all that follows
through ``occupational therapists,'' and inserting
``individuals in positions listed in section 7401(3) of this
title,''.
SEC. 302. COVERAGE OF EMPLOYEES OF VETERANS' CANTEEN SERVICE
UNDER ADDITIONAL EMPLOYMENT LAWS.
Section 7802(5) is amended by inserting before the
semicolon the following: ``. Employees and personnel under
this clause may be considered for appointment in Department
positions in the competitive service in the same manner that
Department employees in the competitive service are
considered for transfer to such positions. An employee or
individual appointed as personnel under this clause who is
appointed to a Department position under the authority of the
preceding sentence shall be treated as having a career
appointment in such position once such employee or individual
meets the three-year requirement for career tenure (with any
previous period of employment or appointment in the Service
being counted toward satisfaction of such requirement)''.
SEC. 303. EFFECTIVE DATE OF MODIFICATION OF TREATMENT FOR
RETIREMENT ANNUITY PURPOSES OF CERTAIN PART-
TIME SERVICE OF CERTAIN DEPARTMENT OF VETERANS
AFFAIRS HEALTH-CARE PROFESSIONALS.
(a) Effective Date.--The effective date of the amendment
made by section 132 of the Department of Veterans Affairs
Health Care Programs Enhancement Act of 2001 (Public Law 107-
135; 115 Stat. 2454) shall be as follows:
(1) January 23, 2002, in the case of health care
professionals referred to in subsection (c) of section 7426
of title 38, United States Code (as so amended), who retire
on or after that date.
(2) The date of the enactment of this Act, in the case of
health care professionals referred to in such subsection (c)
who retired before January 23, 2002, but after April 7, 1986.
(b) Recomputation of Annuity.--The Office of Personnel
Management shall recompute the annuity of each health-care
professional described in the first sentence of subsection
(c) of section 7426 of title 38, United States Code (as so
amended), who retired before January 23, 2002, but after
April 7, 1986, in order to take into account the amendment
made by section 132 of the Department of Veterans Affairs
Health Care Programs Enhancement Act of 2001. Such
recomputation shall be effective only with respect to
annuities paid after the date of the enactment of this Act,
and shall apply beginning the first day of the first month
beginning after the date of the enactment of this Act.
SEC. 304. PERMANENT AUTHORITY FOR USE OF CONTRACT PHYSICIANS
FOR DISABILITY EXAMINATIONS.
(a) Permanent Authority.--Section 504 of the Veterans'
Benefits Improvements Act of 1996 (Public Law 104-275; 110
Stat. 3341; 38 U.S.C. 5101 note) is amended--
(1) in subsection (a), by striking ``may conduct a pilot
program'' and all that follows through ``may be made by'' and
inserting ``may carry out examinations with respect to the
medical disability of applicants for benefits under the laws
administered by the Secretary through''; and
(2) in subsection (c), by striking ``the pilot program
under''.
(b) Repeal of Limitation and Obsolete Authority.--That
section is further amended--
(1) by striking subsections (b) and (d); and
(2) by redesignating subsection (c), as amended by
subsection (a) of this section, as subsection (b).
(c) Conforming Amendment.--The heading for that section is
amended to read as follows:
``SEC. 504. AUTHORITY FOR USE OF CONTRACT PHYSICIANS FOR
DISABILITY EXAMINATIONS.''.
______
By Mr. BROWNBACK (for himself, Mr. Dodd, Mr. Stevens, Mr. Akaka,
Mr. Allard, Mr. Allen, Mr. Biden, Mrs. Boxer, Mr. Campbell, Mr.
Chafee, Mrs. Clinton, Ms. Collins, Mr. Cornyn, Mr. Corzine, Mr.
Daschle, Mr. DeWine, Mrs. Dole, Mr. Durbin, Mr. Edwards, Mr.
Frist, Mr. Graham of Florida, Mr. Graham of South Carolina, Mr.
Grassley, Mr. Hollings, Mrs. Hutchison, Mr. Jeffords, Mr.
Kennedy, Mr. Kerry, Ms. Landrieu, Mr. Lautenberg, Mr. Levin,
Mr. Lieberman, Mrs. Lincoln, Mr. Lott, Ms. Mikulski, Mr.
Miller, Mr. Nelson of Nebraska, Mr. Nelson of Florida, Mr.
Pryor, Mr. Reid, Mr. Santorum, Mr. Schumer, Mr. Smith, Ms.
Stabenow, Mr. Craig, and Mr. Leahy):
S. 1157. A bill to establish within the Smithsonian Institution the
National Museum of African American History and Culture, and for other
purposes; to the Committee on Rules and Administration.
Mr. BROWNBACK. Mr. President, over 200 years ago, there was a dream
that was America for a group of individuals who were brought to our
shores in shackles. A dream so powerful that compelled a race of people
to fight for the liberty of others when they were in bondage
themselves. A dream that not only served as a catalyst for physical
liberation in the African-American community but removed societal
shackles from our culture and enabled us to realize the ideals set
before us in the constitution--that all men are created equal under
God.
Today, we celebrate this magnificent history. A history of people's
quest for freedom that shaped this Nation into a symbol of freedom and
democracy around the world. I am proud to stand here today with my
colleagues and introduce once again to this body a bill that will
create the National Museum of African American History and Culture.
I would specifically like to thank Senator Dodd, who is committed to
honoring this history and has worked hard to get us to this point
today. I look forward to working with him on this bill.
I would also like to thank Senator Ted Stevens for his leadership and
commitment to this project as well. It means a great deal to have his
support and I am grateful.
Senator Santorum has always been a supporter of this legislation and
has given unwavering enthusiasm to this project since the 107th
Congress. I look forward to working with him as well to finally
complete this museum.
And I am grateful to all of the original cosponsors of this bill--
this is fantastic.
Mr. President, the national Museum of African American History and
Culture Presidential Commission--signed into law by President Bush,
stated that the time is now. Indeed the time is now to honor this
incredible history that has shaped this great Nation.
I thank the Presidential Commission for their hard work and effort in
recommending to Congress that we should build this museum and that
there is sufficient interest in the philanthropic community to
financially support this museum and that there are sufficient artifacts
to fill this museum.
So many Americans will be able to share in the celebration of this
museum--a uniquely American museum one that we can celebrate. I
remember when I met with the dean of the Afro-
[[Page S7156]]
American studies at Howard University.
He told me of a story about his grandfather who finished a bowl the
day the Emancipation Proclamation was authorized.
His grandfather decided to keep the bowl because it no longer was the
property of a slave master but the man who made it--his grandfather.
Mr. President, the dean has this bowl in his home--an incredible
piece of history and I am sure there are many more pieces out there
waiting for a home--a national home.
Today, we are not just introducing a bill, we are completing a piece
of American history by introducing the National Museum of African
American History and Culture, which will create a museum to honor
African-American contributions to this Nation--which is an
extraordinary story of sacrifice and triumph.
This bill will create this museum within the Smithsonian
Institution--America's premier museum complex. We have worked very had
with the Smithsonian Institution to craft a bill that will compliment
their programs--and indeed we have done just that.
This bill is very similar to the American Indian Museum, slated to
open next year. And I know that the Smithsonian Institution will create
another national treasure one that tells the story of African-Americans
in this country--a proud history, a rich history.
This bill charges the board of regents of the Smithsonian Institution
along with the Council of the National Museum to plan, build and
construct a museum dedicated to celebrating nationally African-American
history--which is American history.
In addition, this bill charges the Board of Regents with choosing a
site on or adjacent to the national mall for the location of the
museum.
Additionally, the bill establishes an education and program liaison
section designed to work with educational institutions and museums
across the country in order to promote African-American history.
Finally, the bill sets forth a Federal-private partnership for
funding the museum and authorizes $17 million for the first year in
order to begin implementation of the museum council, which will be
comprised from a mixture of leading African-Americans from the museum,
historical, and business communities.
Mr. President, it has been well over 70 years since the first
commission was formed to seek ways to honor nationally the
contributions of African-Americans.
It has always been my hope that this museum will not only showcase
nationally the accomplishments of African-Americans--which are great--
but will also serve as a catalyst for racial reconciliation for our
Nation. Indeed we have triumphed over our difficulties in this area,
but we must continue to do more.
I do not pretend that this museum is a panacea for racial
reconciliation. It is, however, a productive step in recognizing the
important contributions and the debt all Americans owe to African-
Americans.
Dr. Martin Luther King, Jr. once expressed his desire for this
Nation, ``that the dark clouds of [misconceptions] will soon pass away
and the deep fog of misunderstanding will be lifted from our fear-
drenched communities and in some not too distant tomorrow the radiant
stars of love and brotherhood will shine over our great nation with all
their scintillating beauty.'' We are one step closer today--God bless.
Mr. President, I ask unanimous consent that the bill be printed in
the Record after my remarks.
There being no objection, the bill was ordered to printed in the
Record, as follows:
S. 1156
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 ``National Museum of African
American History and Culture Act''.
SEC. 2. FINDINGS.
Congress finds that--
(1) since its founding, the United States has grown into a
symbol of democracy and freedom around the world, and the
legacy of African Americans is rooted in the very fabric of
the democracy and freedom of the United States;
(2) there exists no national museum within the Smithsonian
Institution located on the National Mall that--
(A) is devoted to the documentation of African American
life, art, history, and culture; and
(B) encompasses, on a national level--
(i) the period of slavery;
(ii) the era of reconstruction;
(iii) the Harlem renaissance;
(iv) the civil rights movement; and
(v) other periods associated with African American life,
art, history, and culture; and
(3) a National Museum of African American History and
Culture would be dedicated to the collection, preservation,
research, and exhibition of African American historical and
cultural material reflecting the breadth and depth of the
experiences of individuals of African descent living in the
United States.
SEC. 3. DEFINITIONS.
In this Act:
(1) Board of regents.--The term ``Board of Regents'' means
the Board of Regents of the Smithsonian Institution.
(2) Council.--The term ``Council'' means the National
Museum of African American History and Culture Council
established by section 5.
(3) Museum.--The term ``Museum'' means the National Museum
of African American History and Culture established by
section 4.
(4) Secretary.--The term ``Secretary'' means the Secretary
of the Smithsonian Institution.
SEC. 4. ESTABLISHMENT OF MUSEUM.
(a) Establishment.--There is established within the
Smithsonian Institution a museum to be known as the
``National Museum of African American History and Culture''.
(b) Purpose.--The purpose of the Museum shall be to provide
for--
(1) the collection, study, and establishment of programs
relating to African American life, art, history, and culture
that encompass--
(A) the period of slavery;
(B) the era of reconstruction;
(C) the Harlem renaissance;
(D) the civil rights movement; and
(E) other periods of the African American diaspora;
(2) the creation and maintenance of permanent and temporary
exhibits documenting the history of slavery in America and
African American life, art, history, and culture during the
periods referred to in paragraph (1);
(3) the collection and study of artifacts and documents
relating to African American life, art, history, and culture;
and
(4) collaboration between the Museum and other museums,
historically black colleges and universities, historical
societies, educational institutions, and other organizations
that promote the study or appreciation of African American
life, art, history, or culture, including collaboration
concerning--
(A) development of cooperative programs and exhibitions;
(B) identification, management, and care of collections;
and
(C) training of museum professionals.
SEC. 5. COUNCIL.
(a) Establishment.--There is established within the
Smithsonian Institution a council to be known as the
``National Museum of African American History and Culture
Council''.
(b) Duties.--
(1) In general.--The Council shall--
(A) make recommendations to the Board of Regents concerning
the planning, design, and construction of the Museum;
(B) advise and assist the Board of Regents on all matters
relating to the administration, operation, maintenance, and
preservation of the Museum;
(C) recommend annual operating budgets for the Museum to
the Board of Regents;
(D) report annually to the Board of Regents on the
acquisition, disposition, and display of objects relating to
African American life, art, history, and culture; and
(E) adopt bylaws for the operation of the Council.
(2) Principal responsibilities.--The Council, subject to
the general policies of the Board of Regents, shall have sole
authority to--
(A) purchase, accept, borrow, and otherwise acquire
artifacts and other property for addition to the collections
of the Museum;
(B) loan, exchange, sell, and otherwise dispose of any part
of the collections of the Museum, but only if the funds
generated by that disposition are used for--
(i) additions to the collections of the Museum; or
(ii) programs carried out under section 7(a); and
(C) specify criteria with respect to the use of the
collections and resources of the Museum, including policies
on programming, education, exhibitions, and research with
respect to--
(i) the life, art, history, and culture of African
Americans;
(ii) the role of African Americans in the history of the
United States from the period of slavery to the present; and
(iii) the contributions of African Americans to society.
(3) Other responsibilities.--The Council, subject to the
general policies of the Board of Regents, shall have
authority--
(A) to provide for preservation, restoration, and
maintenance of the collections of the Museum; and
(B) to solicit, accept, use, and dispose of gifts,
bequests, and devises of services and
[[Page S7157]]
property, both real and personal, for the purpose of aiding
and facilitating the work of the Museum.
(c) Composition and Appointment.--
(1) In general.--The Council shall be composed of 19 voting
members as provided under paragraph (2).
(2) Voting members.--The Council shall include the
following voting members:
(A) The Secretary of the Smithsonian Institution.
(B) 1 member of the Board of Regents, appointed by the
Board of Regents.
(C) 17 individuals appointed by the Board of Regents--
(i) taking into consideration individuals recommended by
organizations and entities that are committed to the
advancement of knowledge of African American life, art,
history, and culture; and
(ii) taking into consideration individuals recommended by
the other members of the Council.
(3) Initial appointments.--The Board of Regents shall make
initial appointments to the Council under paragraph (2) not
later than 180 days after the date of enactment of this Act.
(4) Special rule for certain members.--Of the total number
of members of the Council appointed under subparagraph (C) of
paragraph (2), not fewer than 9 shall be of African-American
descent.
(d) Terms.--
(1) In general.--Except as provided in this subsection,
each appointed member of the Council shall be appointed for a
term of 6 years.
(2) Initial appointees.--As designated by the Board of
Regents at the time of appointment, of the voting members
first appointed under subparagraph (C) of subsection (c)(2)--
(A) 6 members shall be appointed for a term of 2 years;
(B) 6 members shall be appointed for a term of 4 years; and
(C) 5 members shall be appointed for a term of 6 years.
(3) Reappointment.--A member of the Council may be
reappointed, except that no individual may serve on the
Council for a total of more than 2 terms.
(4) Vacancies.--
(A) In general.--A vacancy on the Council--
(i) shall not affect the powers of the Council; and
(ii) shall be filled in the same manner as the original
appointment was made.
(B) Term.--Any member of the Council appointed to fill a
vacancy occurring before the expiration of the term for which
the member's predecessor was appointed shall be appointed for
the remainder of that term.
(e) Compensation.--
(1) In general.--Except as provided in paragraph (2), a
member of the Council shall serve without pay.
(2) Travel expenses.--A member of the Council shall be
allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for an employee of an agency
under subchapter I of chapter 57 of title 5, United States
Code, while away from the home or regular place of business
of the member in the performance of the duties of the
Council.
(f) Chairperson.--By a majority vote of its voting members,
the Council shall elect a chairperson from its members.
(g) Meetings.--
(1) In general.--The Council shall meet at the call of the
chairperson or on the written request of a majority of the
voting members of the Council, but not fewer than twice each
year.
(2) Initial meetings.--During the 1-year period beginning
on the date of the first meeting of the Council, the Council
shall meet not fewer than 4 times for the purpose of carrying
out the duties of the Council under this Act.
(h) Quorum.--A majority of the voting members of the
Council holding office shall constitute a quorum for the
purpose of conducting business, but a lesser number may
receive information on behalf of the Council.
(i) Voluntary Services.--Notwithstanding section 1342 of
title 31, United States Code, the chairperson of the Council
may accept for the Council voluntary services provided by a
member of the Council.
SEC. 6. DIRECTOR AND STAFF OF THE MUSEUM.
(a) Director.--
(1) In general.--The Museum shall have a Director who shall
be appointed by the Secretary, taking into consideration
individuals recommended by the Council.
(2) Duties.--The Director shall manage the Museum subject
to the policies of the Board of Regents.
(b) Staff.--The Secretary may appoint 2 additional
employees to serve under the Director, except that such
additional employees may be appointed without regard to the
provisions of title 5, United States Code, governing
appointments in the competitive service.
(c) Pay.--The employees appointed by the Secretary under
subsection (b) may be paid without regard to the provisions
of chapter 51 and subchapter III of chapter 53 of title 5,
United States Code, relating to classification of positions
and General Schedule pay rates.
SEC. 7. OFFICE OF EDUCATION AND LIAISON PROGRAMS.
(a) In General.--
(1) Establishment.--There is established within the Museum
the Office of Education and Liaison Programs.
(2) Functions.--The Office of Education and Liaison
Programs shall--
(A) carry out educational programs relating to African
American life, art, history, and culture, including--
(i) programs using digital, electronic, and interactive
technologies; and
(ii) programs carried out in collaboration with elementary
schools, secondary schools, and postsecondary schools; and
(B) consult with the Director of the Institute of Museum
and Library Services concerning the grant and scholarship
programs carried out under subsection (b).
(b) Grant and Scholarship Programs.--
(1) In general.--In consultation with the Council and the
Office of Education and Liaison Programs, the Director of the
Institute of Museum and Library Services shall establish--
(A) a grant program with the purpose of improving
operations, care of collections, and development of
professional management at African American museums;
(B) a grant program with the purpose of providing
internship and fellowship opportunities at African American
museums;
(C) a scholarship program with the purpose of assisting
individuals who are pursuing careers or carrying out studies
in the arts, humanities, and sciences in the study of African
American life, art, history, and culture;
(D) in cooperation with other museums, historical
societies, and educational institutions, a grant program with
the purpose of promoting the understanding of modern-day
practices of slavery throughout the world; and
(E) a grant program under which an African-American museum
(including a nonprofit education organization the primary
mission of which is to promote the study of African-American
diaspora) may use the funds provided under the grant to
increase an endowment fund established by the museum (or
organization) as of May 1, 2003, for the purposes of--
(i) enhancing educational programming; and
(ii) maintaining and operating traveling educational
exhibits.
(2) Authorization of appropriations.--There are authorized
to be appropriated to the Director of the Institute of Museum
and Library Services to carry out this subsection--
(A) $15,000,000 for fiscal year 2004; and
(B) such sums as are necessary for each fiscal year
thereafter.
SEC. 8. BUILDING FOR THE NATIONAL MUSEUM OF AFRICAN AMERICAN
HISTORY AND CULTURE.
(a) In General.--
(1) Location.--
(A) In general.--Not later than 18 months after the date of
the enactment of this Act, the Board of Regents shall
designate a site for the Museum.
(B) Sites for consideration.--In designating a site under
subparagraph (A), the Board of Regents shall select from
among the following sites in the District of Columbia:
(i) The area bounded by Constitution Avenue, Pennsylvania
Avenue, and 1st and 3rd Streets, Northwest.
(ii) The Arts and Industries Building of the Smithsonian
Institution, located on the National Mall at 900 Jefferson
Drive, Southwest, Washington, District of Columbia.
(iii) The area bounded by Constitution Avenue, Madison
Drive, and 14th and 15th Streets, Northwest.
(iv) The site known as the ``Liberty Loan site'', located
on 14th Street Southwest at the foot of the 14th Street
Bridge.
(C) Availability of site.--
(i) In general.--A site described in subparagraph (B) shall
remain available until the date on which the Board of Regents
designates a site for the Museum under subparagraph (A)(i).
(ii) Transfer to smithsonian institution.--Except with
respect to a site described in clause (i) or (ii) of
subparagraph (B), if the site designated for the Museum is in
an area that is under the administrative jurisdiction of a
Federal agency, as soon as practicable after the date on
which the designation is made, the head of the Federal agency
shall transfer to the Smithsonian Institution administrative
jurisdiction over the area.
(D) Consultation.--The Board of Regents shall carry out its
duties under this paragraph in consultation with--
(i) the Chair of the National Capital Planning Commission;
(ii) the Chair of the Commission on Fine Arts;
(iii) the Chair and Vice Chair of the Presidential
Commission referred to in section 10;
(iv) the Chair of the Building and Site Subcommittee of the
Presidential Commission referred to in section 10; and
(v) the Chairman and Ranking Member of each of--
(I) the Committee on Rules and Administration of the
Senate;
(II) the Committee on House Administration of the House of
Representatives;
(III) the Committee on Transportation and Infrastructure of
the House of Representatives;
(IV) the Committee on Appropriations of the House of
Representatives; and
(V) the Committee on Appropriations of the Senate.
(2) Consideration.--The Board of Regents shall take into
consideration the recommendations of the Council concerning
the planning, design, and construction of the Museum.
[[Page S7158]]
(3) Construction of building.--The Board of Regents, in
consultation with the Council, may plan, design, and
construct a building for the Museum, which shall be located
at the site designated by the Board of Regents under this
paragraph.
(b) Cost Sharing.--The Board of Regents shall pay--
(1) 50 percent of the costs of carrying out this section
from Federal funds; and
(2) 50 percent of the costs of carrying out this section
from non-Federal sources.
(c) Authorization of Appropriations.--There are authorized
to be appropriated such sums as are necessary to carry out
this section.
SEC. 9. CONGRESSIONAL BUDGET ACT COMPLIANCE.
Authority under this Act to enter into contracts or to make
payments shall be effective in any fiscal year only to the
extent provided in advance in an appropriations Act, except
as provided under section 11(b).
SEC. 10. CONSIDERATION OF RECOMMENDATIONS OF PRESIDENTIAL
COMMISSION.
In carrying out their duties under this Act, the Council
and the Board of Regents shall take into consideration the
reports and plans submitted by the National Museum of African
American History and Culture Plan for Action Presidential
Commission under the National Museum of African American
History and Culture Plan for Action Presidential Commission
Act of 2001 (Public Law 107-106).
SEC. 11. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to
the Smithsonian Institution to carry out this Act, other than
sections 7(b) and 8--
(1) $17,000,000 for fiscal year 2004; and
(2) such sums as are necessary for each fiscal year
thereafter.
(b) Availability.--Amounts made available under subsection
(a) shall remain available until expended.
Mr. DODD. Mr. President, I rise to join with my colleague, Senator
Brownback, in introducing legislation to create a National Museum of
African American History and Culture within the Smithsonian
Institution.
This legislation will help ensure that the compelling stories and
invaluable contributions of African-Americans to our national fabric
will no longer be ignored, but shared with all Americans, indeed, all
peoples of the world.
Senator Brownback introduced similar legislation in the last
Congress, and I was pleased to be an original cosponsor of that bill.
During my tenure as chairman of the Senate Rules Committee, I was
pleased to work with my colleagues to pass legislation to establish the
Presidential Commission on the National Museum of African American
History and Culture Action Plan.
That Presidential Commission spent a year traveling across the
nation, and at more than 50 meetings, heard the voices of African-
Americans calling for a national place to tell their individual and
collective stories. This long overdue legislation will provide such a
place.
In their report issued last month, the Presidential Commission
identified a mission statement for the proposed museum that states, in
part:
The museum will give voice to the centrality of the African
American experience and will make it possible for all people
to understand the depth, complexity, and promise of the
American experience.
It is that very goal of completing the American story of our quest
for freedom and truth by publicly incorporating the experience and
contributions of African Americans--that is the essence of this
legislation. This museum offers the promise and hope that all Americans
can come to understand the full story of how this nation was formed.
Since 1929, efforts have been made to recognize the contributions and
unique history of Americans of African descent. This museum offers an
historic opportunity to document, preserve, and educate this history
for generations to come. It is past time that we publicly acknowledge
and incorporate the African American experience into our collective
identity and this museum will provide the appropriate means for
accomplishing that goal.
In brief, within 18 months of enactment, the Smithsonian Board of
Regents will choose a site for this museum from among four sites listed
in the bill. The bill directs that, prior to the selection, the Board
of Regents will consult with the National Capital Planning Commission,
the chairman of the Presidential Commission, Congressional oversight
committees, and others.
In the meantime, the Smithsonian Board of Regents will appoint a 19
member council, comprised of leaders within the African-American
community and others, to advise the regents on the development, design
and construction of the museum. The museum will include exhibits and
programs relating to all aspects of African American life, art,
history, and culture from the time of slavery through present day.
The museum will also provide leadership to other museums and will
collaborate with historically black colleges and universities and
educational organizations to ensure the integrity of the exhibits and
programming and to broaden the reach of its story and mission.
I am honored to be the lead Democratic sponsor of this legislation,
and I look forward to working with my colleagues on the Rules Committee
to seeing this bill enacted this year.
______
By Mr. BINGAMAN (for himself, Mr. Daschle, Mrs. Boxer, and Mrs.
Lincoln):
S. 1159. A bill to provide for programs and activities to improve the
health of Hispanic individuals, and for other purposes; to the
Committee on Finance.
Mr. BINGAMAN. Mr. President, today, I am introducing a bill with
Senators Daschle, Boxer, and Lincoln that will be jointly introduced by
Representatives Ciro Rodriguez, Hilda Solis, and others in the House of
Representatives entitled the ``Hispanic Health Improvement Act of
2003.'' This bill addresses the tremendous health disparities that
confront the Hispanic community in our Nation.
Even if you know the statistics, they remain shocking. Over one-
third, a 35 percent of Hispanic adults lack health insurance. Despite
that passage of the Children's Health Insurance Program, 27 percent of
Latino children remain uninsured, which is sharp comparison to 9
percent of white, 18 percent of black and 17 percent of Asian/Pacific
Islander children.
In testimony before the Senate Health, Education, Labor and Pensions
Committee on September 23, 2002, on Hispanic health issues, Dr. Glenn
Flores, chair of the Latin Consortium of the American Academy of
Pediatrics Center for Child Health Research, added: ``Among uninsured
poor children in the U.S., Latinos outnumber all other racial/ethnic
groups, including whites: there are 1 million poor, uninsured Latino
children, compared with 766,000 white, and 533,000 African-American
poor, uninsured children. Although 1999 marked the first time in many
years that the proportion of uninsured Latino children actually
decreased (from 30 percent to 27 percent), recent national data suggest
that outreach efforts to enroll Latino children have largely been
unsuccessful. A Kaiser Commission report found that only 26 percent of
parents of eligible uninsured children said that they had ever talked
to someone or received information about Medicaid enrollment, and 46
percent of Spanish-speaking parents were unsuccessful at enrolling
their uninsured children in Medicaid because materials were unavailable
in Spanish.''
In order to address the lack of health care coverage, the legislation
would expand CHIP to cover pregnant women and parents of children
enrolled in CHIP. The legislation provides $50 million in grants to
community-based groups to improve outreach and enrollment of children
in Medicaid and CHIP with the grants targeted to Hispanic communities.
In addition, the bill eliminates a number of enrollment barriers
within Medicaid.
And finally, it provides States the option to enroll legal immigrant
pregnant women and children in Medicaid or CHIP. This comes from
legislation introduced by Senator Graham earlier in this Congress.
In addition to poor coverage rates, according to the Centers for
Disease Control and Prevention, or CDC, the Hispanic population has
morbidity and mortality rates that more often than not exceed that of
any other ethnic groups. For example, age-adjusted mortality rates for
diabetes are over 50 percent higher among Hispanic persons than non-
Hispanic whites. HIV infection rates are over 3 times those of non-
Hispanic whites. Tuberculosis rates among Latino children are 13 times
that of whites.
The legislation addresses these problems in a number of ways. In the
area
[[Page S7159]]
of access and affordability, our bill requires an annual report to
Congress on how federal programs are responding to improve the health
status of Hispanic individuals with respect to diabetes, cancer,
asthma, HIV infection, AIDS, substance abuse, and mental health. The
bill provides $100 million for targeted diabetes prevention, education,
school-based programs, and screening activities in the Hispanic
community.
In addition, the legislation specifically addresses the problems
facing communities along the U.S.-Mexico border, a 2,000-mile stretch
of land that contains 11 million people, 5 of the 7 poorest
metropolitan statistical areas in the country, and disease rates in
some areas that are extraordinary. If the region were a state, the
border would rank 1st in the number of uninsured, last in terms of per
capita income, and 1st in a number of diseases.
As Dr. Francisco Cigarroa, president of the University of Texas
Health Sciences Center at San Antonio, noted in testimony at the
hearing last year on Hispanic health, ``Germs respect no INS
regulations. We truly must work with our neighbors to the South if we
are to avoid a major influx of new conditions and diseases. It can be
seen so clearly on a map. Just as there are `rivers of commerce' there
are `rivers of infectious disease' and though they may start at the
Border, they are eventually seen all the way to the northern Border
that we share with Canada.''
In response, the bill provides $200 million to border communities to
improve health services and infrastructure along the U.S.-Mexico
border.
The numbers I have cited thus far indicate what we do know. Almost as
much of a concern is what we do not know with respect to the status of
Hispanic health in this Nation. According to one study, only 22 percent
of all articles published in major medical journals included non-
English-speaking patients.
The bill provides funding to do additional research and work on
reducing health disparities in this Nation. The various provisions
include efforts to improve the recruitment and retention of Hispanic
health professionals and programs that support training health
professionals who can provide culturally competent and linguistically
appropriate care. With respect to training more minority health
professionals, Dr. Cigarroa said at last year's hearing, ``We should do
this because it is the smart thing to do. If we fail to take steps to
address the gap between the health of the majority population and the
health of the Nation's rapidly growing minority populations, we are on
a court leading to a collision. We are far too great a nation to allow
this to happen.''
Representative Ciro Rodriguez, chairman of the Congressional Hispanic
Caucus, and I, have worked together on this legislation to respond to
the challenge before us with regard to coverage, access, and health
disparities in the last Congress and have reintroduced the bill with
the hope to move it forward this year.
Before closing, it should be noted that while the legislation puts
forth a number of initiatives to address what are disproportionately
Hispanic problems, each section of the bill, including those to reduce
the number of uninsured and to improve access to care, would improve
the overall health of our entire Nation regardless of race or
ethnicity.
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:
(The bill was not available at time of printing.)
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