[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

[[Page S7148]]

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.)

                          ____________________