[Congressional Record Volume 149, Number 81 (Wednesday, June 4, 2003)]
[Senate]
[Pages S7383-S7402]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
[[Page S7383]]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. ROCKEFELLER:
S. 1179. A bill to amend title XVIII of the Social Security Act to
expand Medicare benefits to prevent, delay, and minimize the
progression of chronic conditions, and develop national policies on
effective chronic condition care, and for other purposes; to the
Committee on Finance.
Mr. ROCKEFELLER. Mr. President, I come to the floor today to
introduce the Medicare Chronic Care Improvement Act of 2003. For the
last three decades, the Medicare program has fulfilled our promise to
care for older Americans who have spent a lifetime working and
contributing to our Nation's economy. Currently, 41 million seniors
depend on Medicare for critical health care assistance. Those seniors
have been asking Congress for many years to strengthen Medicare. This
Congress, we must respond by taking action. We must enact legislation
this year that fills the gaps in Medicare.
When Congress and President Johnson designed the Medicare program in
1965, they could not have foreseen the health care system that exists
today. New technology, advances in research and an aging population
have changed both what beneficiaries need and the system that is
responding to those needs. One of the unforseen implications of these
changes is a growing number of Americans living with chronic
conditions.
In 2000, over 45 percent of Americans had a chronic condition. That
number continues to grow and, by 2020, more than 48 percent or 157
million Americans, will have at least one chronic condition. Chronic
conditions encompass an array of health conditions that are persistent,
recurring, and cannot be cured. They include severely impairing
conditions like Alzheimer's disease, congestive heart failure, chronic
obstructive pulmonary disease, diabetes, depression, hypertension, and
arthritis.
Treating serious and disabling chronic conditions is the highest cost
and fastest growing segment of health care. People with chronic
conditions represent 78 percent of all health care spending. These
people are the heaviest users of home health care visits,
prescriptions, physician visits, and inpatient stays.
As we grow older, the chances of developing a chronic condition
increase. Thus, it should be no surprise that nearly 80 percent of
Medicare beneficiaries have at least one chronic condition and two-
thirds have two or more chronic conditions. However, the Medicare fee-
for-service program does not currently cover many of the services
needed to provide quality care to beneficiaries who are managing
complex chronic conditions.
To meet the needs of these individuals, our Medicare fee-for-service
system must reflect a person-centered, system-oriented approach to
care. Payers and providers who serve the same person must be empowered
to work together to help people with chronic conditions prevent, delay,
or minimize disease and disability progression and maximize their
health and well being.
That is why I am here to reintroduce a much needed solution--the
Medicare Chronic Care Improvement Act of 2003. This bill establishes a
comprehensive plan to improve and strengthen the Medicare fee-for-
service and Medicare+Choice systems by generating better health
outcomes for beneficiaries with chronic conditions and increasing
efficiency.
This bill would achieve these results by, first, helping to prevent,
delay, and minimize the progression of chronic conditions by
authorizing the Secretary of Health and Human Services to expand
coverage of preventive health benefits. The bill permits providers to
waive deductibles and co-payments for preventive and wellness services
currently covered by Medicare and streamlines the process of approving
new preventive benefits.
Second, this bill provides a person-centered, system-oriented
approach to care for this extremely vulnerable segment of our
population by expanding Medicare coverage to include assessment, care-
coordination, self-management services, and patient and family
caregiver education and counseling.
For more detail, I am also entering a section-by-section bill summary
into the Congressional Record following this statement.
The Medicare Chronic Care Improvement Act provides a comprehensive
solution to improving the quality of life and health for millions of
Americans who are struggling with serious and disabling chronic
conditions. Not only that, it has the potential to save the Medicare
program money, by better managing and treating chronic conditions
before costly complications result. That is good for seniors and good
for Medicare--a win-win situation.
It is time to step up to the plate and fulfill our obligation to our
Nation's most vulnerable citizens. Improving Medicare is the right
thing to do, but only if we do it the right way. I believe that this
bill is a critical component of the right recipe for strengthening the
Medicare program for today and tomorrow's beneficiaries. Unlike the
administration's Medicare reform plan, the Medicare Chronic Care
Improvement Act gives beneficiaries better care while maintaining
consumer choice and improving the program's efficiency. Because these
are the results that West Virginians want, I will fight to include the
provisions of this bill in any Medicare reform package that moves
through the Finance Committee or the Senate floor.
I would like the record to reflect that the following groups
publically support this legislation: Alzheimer's Association; American
Geriatrics Society; Center for Medicare Advocacy; Families USA; and
Medicare Rights Center.
National Chronic Care Consortium, representing such organizations as:
Aging and Disability Services Administration, State of Washington
(Olympia, WA); Aging in America, Inc (Bronx, NY); Albert Einstein
Healthcare Network (Philadelphia, PA); Area Agency on Aging 10B Inc.
(Akron, OH); Baylor Health Care System (Dallas, TX); Benjamin Rose
(Cleveland, OH); Beth Abraham Family of Health Services (Bronx, NY);
Blue Cross & Blue Shield of Minnesota (Eagan, MN); Carle Foundation
Hospital-Health Systems Research Center (Mahomet, IL); Catholic Health
Initiatives (Parker, CO); Centura Health (Denver, CO); Community Health
Partnership, Inc. (Eau Claire, WI); Fairview Health Services/Enbenezer
(Minneapolis, MN); Halleland Health Consulting (Minneapolis, MN);
Hebrew Home and Hospital (Hartford, CT); Highmark Blue Cross Blue
Shield (Pittsburgh, PA); Inglis Innovative Services (Philadelphia, PA);
Lancaster General Hospital (Lancaster, PA); Masonicare (Wallingford,
CT); Mercy Medical Center--North Iowa (Mason City, IA); MetroHealth
System (Cleveland, OH); Metropolitan Jewish Health System (Brooklyn,
NY); Minnesota Senior Health Options (MSHO) (St. Paul, MN); Motion
Picture and Television Fund (Woodland Hills, CA); Northeast Health
(Troy, NY); Presbyterian SeniorCare (Pittsburgh, PA); Saint Michael's
Hospital (Stevens Point, WI); SCAN (Long Beach, CA); Sierra Health
Services (Las Vegas, NV); Summa Health System (Akron, OH); Sutter
Health (Sacramento, CA); Total Longterm Care, Inc. (Denver, CO);
Upstate NY Network of the U.S. Dept. of Veterans Affairs, VISN 2
(Albany, NY); ViaHealth (Rochester, NY); Visiting Nurse Service of New
York (New York, NY); Volunteers of America National Services (Eden
Prairie, MN); and Wisconsin Partnership Program at Community Living
Alliance (Madison, WI).
I ask unanimous consent that the text of the bill and the summary be
printed in the Record.
There being no objection, the bill was ordered to be pirnted in the
Record, as follows:
S. 1179
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 ``Medicare
Chronic Care 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--BENEFITS TO PREVENT, DELAY, AND MINIMIZE THE PROGRESSION OF
CHRONIC CONDITIONS.
Subtitle A--Improving Access to Preventive Services
Sec. 101. Elimination of deductibles and coinsurance for existing
preventive health benefits.
Sec. 102. Institute of Medicine medicare prevention benefit study and
report.
Sec. 103. Authority to administratively provide for coverage of
additional preventive benefits.
[[Page S7384]]
Sec. 104. Coverage of an initial preventive physical examination.
Subtitle B--Medicare Coverage for Care Coordination and Assessment
Services
Sec. 111. Care coordination and assessment services.
Sec. 112. Care coordination and assessment services and quality
improvement program in Medicare+Choice plans.
Sec. 113. Improving chronic care coordination through information
technology.
Subtitle C--Additional Provisions
Sec. 121. Review of coverage standards.
TITLE II--INSTITUTE OF MEDICINE STUDY ON EFFECTIVE CHRONIC CONDITION
CARE
Sec. 201. Institute of Medicine medicare chronic condition care
improvement study and report.
TITLE I--BENEFITS TO PREVENT, DELAY, AND MINIMIZE THE PROGRESSION OF
CHRONIC CONDITIONS.
Subtitle A--Improving Access to Preventive Services
SEC. 101. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR
EXISTING PREVENTIVE HEALTH BENEFITS.
(a) In General.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l) is amended by inserting after subsection
(o) the following new subsection:
``(p) Deductibles and Coinsurance Waived for Preventive
Health Items and Services.--The Secretary shall not require
the payment of any deductible or coinsurance under subsection
(a) or (b), respectively, of any individual enrolled for
coverage under this part for any of the following preventive
health items and services:
``(1) Blood-testing strips, lancets, and blood glucose
monitors for individuals with diabetes described in section
1861(n).
``(2) Diabetes outpatient self-management training services
(as defined in section 1861(qq)(1)).
``(3) Pneumococcal, influenza, and hepatitis B vaccines and
administration described in section 1861(s)(10).
``(4) Screening mammography (as defined in section
1861(jj)).
``(5) Screening pap smear and screening pelvic exam (as
defined in paragraphs (1) and (2) of section 1861(nn),
respectively).
``(6) Bone mass measurement (as defined in section
1861(rr)(1)).
``(7) Prostate cancer screening test (as defined in section
1861(oo)(1)).
``(8) Colorectal cancer screening test (as defined in
section 1861(pp)(1)).
``(9) Screening for glaucoma (as defined in section
1861(uu)).
``(10) Medical nutrition therapy services (as defined in
section 1861(vv)(1)).''.
(b) Waiver of Coinsurance.--
(1) In general.--Section 1833(a)(1)(B) of the Social
Security Act (42 U.S.C. 1395l(a)(1)(B)) is amended to read as
follows: ``(B) with respect to preventive health items and
services described in subsection (p), the amounts paid shall
be 100 percent of the fee schedule or other basis of payment
under this title for the particular item or service,''.
(2) Elimination of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) of the
Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by
inserting after ``1861(s)(10)(A)'' the following: ``,
preventive health items and services described in section
1833(p),''.
(c) Waiver of Application of Deductible.--Section
1833(b)(1) of the Social Security Act (42 U.S.C. 1395l(b)(1))
is amended to read as follows: ``(1) such deductible shall
not apply with respect to preventive health items and
services described in subsection (p),''.
(d) Adding ``Lancet'' to Definition of DME.--Section
1861(n) of the Social Security Act (42 U.S.C. 1395x(n)) is
amended by striking ``blood-testing strips and blood glucose
monitors'' and inserting ``blood-testing strips, lancets, and
blood glucose monitors''.
(e) Conforming Amendments.--
(1) Elimination of coinsurance for clinical diagnostic
laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of
section 1833(a) of the Social Security Act (42 U.S.C.
1395l(a)) are each amended by inserting ``or which are
described in subsection (p)'' after ``assignment-related
basis''.
(2) Elimination of coinsurance for certain dme.--Section
1834(a)(1)(A) of the Social Security Act (42 U.S.C.
1395m(a)(1)(A)) is amended by inserting ``(or 100 percent, in
the case of such an item described in section 1833(p))''
after ``80 percent''.
(3) Elimination of deductibles and coinsurance for
colorectal cancer screening tests.--Section 1834(d) of the
Social Security Act (42 U.S.C. 1395m(d)) is amended--
(A) in paragraph (2)(C)--
(i) by striking ``(C) Facility payment limit.--'' and all
that follows through ``Notwithstanding subsections'' and
inserting the following:
``(C) Facility payment limit.--Notwithstanding
subsections'';
(ii) by striking ``(I) in accordance'' and inserting the
following:
``(i) in accordance'';
(iii) by striking ``(II) are performed'' and all that
follows through ``payment under'' and inserting the
following:
``(ii) are performed in an ambulatory surgical center or
hospital outpatient department,
payment under''; and
(iv) by striking clause (ii); and
(B) in paragraph (3)(C)--
(i) by striking ``(C) Facility payment limit.--'' and all
that follows through ``Notwithstanding subsections'' and
inserting the following:
``(C) Facility payment limit.--Notwithstanding
subsections''; and
(ii) by striking clause (ii).
(f) Effective Date.--The amendments made by this section
shall apply to services furnished on or after January 1,
2004.
SEC. 102. INSTITUTE OF MEDICINE MEDICARE PREVENTION BENEFIT
STUDY AND REPORT.
(a) Study.--
(1) In general.--The Secretary of Health and Human Services
shall contract with the Institute of Medicine of the National
Academy of Sciences to--
(A) conduct a comprehensive study of current literature and
best practices in the field of health promotion and disease
prevention among medicare beneficiaries, including the issues
described in paragraph (2); and
(B) submit the report described in subsection (b).
(2) Issues studied.--The study required under paragraph (1)
shall include an assessment of--
(A) whether each health promotion and disease prevention
benefit covered under the medicare program is medically
effective (as defined in subsection (d)(3));
(B) utilization by medicare beneficiaries of such benefits
(including any barriers to or incentives to increase
utilization);
(C) quality of life issues associated with such benefits;
and
(D) whether health promotion and disease prevention
benefits that are not covered under the medicare program that
would affect all medicare beneficiaries are likely to be
medically effective (as so defined).
(b) Reports.--
(1) Three-year report.--On the date that is 3 years after
the date of enactment of this Act, and each successive 3-year
anniversary thereafter, the Institute of Medicine of the
National Academy of Sciences shall submit to the President a
report that contains--
(A) a detailed statement of the findings and conclusions of
the study conducted under subsection (a); and
(B) the recommendations for legislation described in
paragraph (3).
(2) Interim report based on new guidelines.--If the United
States Preventive Services Task Force or the Task Force on
Community Preventive Services establishes new guidelines
regarding preventive health benefits for medicare
beneficiaries more than 1 year prior to the date that a
report described in paragraph (1) is due to be submitted to
the President, then not later than 6 months after the date
such new guidelines are established, the Institute of
Medicine of the National Academy of Sciences shall submit to
the President a report that contains a detailed description
of such new guidelines. Such report may also contain
recommendations for legislation described in paragraph (3).
(3) Recommendations for legislation.--The Institute of
Medicine of the National Academy of Sciences, in consultation
with the United States Preventive Services Task Force and the
Task Force on Community Preventive Services, shall develop
recommendations in legislative form that--
(A) prioritize the preventive health benefits under the
medicare program; and
(B) modify such benefits, including adding new benefits
under such program, based on the study conducted under
subsection (a).
(c) Transmission to Congress.--
(1) In general.--Subject to paragraph (2), on the day that
is 6 months after the date on which the report described in
paragraph (1) of subsection (b) (or paragraph (2) of such
subsection if the report contains recommendations in
legislative form described in subsection (b)(3)) is submitted
to the President, the President shall transmit the report and
recommendations to Congress.
(2) Regulatory action by the secretary of health and human
services.--If the Secretary of Health and Human Services has
exercised the authority under section 103(a) to adopt by
regulation one or more of the recommendations under
subsection (b)(3), the President shall only submit to
Congress those recommendations under subsection (b)(3) that
have not been adopted by the Secretary.
(3) Delivery.--Copies of the report and recommendations in
legislative form required to be transmitted to Congress under
paragraph (1) shall be delivered--
(A) to both Houses of Congress on the same day;
(B) to the Clerk of the House of Representatives if the
House is not in session; and
(C) to the Secretary of the Senate if the Senate is not in
session.
(d) Definition of medically effective.--In this section,
the term ``medically effective'' means, with respect to a
benefit or technique, that the benefit or technique has
been--
(1) subject to peer review;
(2) described in scientific journals; and
(3) determined to achieve an intended goal under normal
programmatic conditions.
SEC. 103. AUTHORITY TO ADMINISTRATIVELY PROVIDE FOR COVERAGE
OF ADDITIONAL PREVENTIVE BENEFITS.
(a) In General.--The Secretary of Health and Human Services
may by regulation adopt any or all of the legislative
recommendations developed by the Institute of Medicine of the
National Academy of Sciences, in consultation with the United
[[Page S7385]]
States Preventive Services Task Force and the Task Force on
Community Preventive Services in a report under section
102(b)(3) (relating to prioritizing and modifying preventive
health benefits under the medicare program and the addition
of new preventive benefits), consistent with subsection (b).
(b) Elimination of Cost-Sharing.--With respect to items and
services furnished under the medicare program that the
Secretary has incorporated by regulation under subsection
(a), the provisions of section 1833(p) of the Social Security
Act (relating to elimination of cost-sharing for preventive
benefits), as added by section 101(a), shall apply to those
items and services in the same manner as such section applies
to the items and services described in paragraphs (1) through
(10) of such section.
SEC. 104. COVERAGE OF AN INITIAL PREVENTIVE PHYSICAL
EXAMINATION.
(a) Coverage.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (U), by striking ``and'' at the end;
(2) in subparagraph (V), by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(W) an initial preventive physical examination (as
defined in subsection (ww));''.
(b) Services Described.--Section 1861 of such Act (42
U.S.C. 1395x) is amended by adding at the end the following
new subsection:
``Initial Preventive Physical Examination
``(ww) The term `initial preventive physical examination'
means physicians' services consisting of a physical
examination with the goal of health promotion and disease
detection and includes a history and physical exam, a health
risk appraisal, and health risk counseling, and laboratory
tests or other items and services as determined by the
Secretary in consultation with the United States Preventive
Services Task Force.''.
(c) Waiver of Deductible and Coinsurance.--
(1) Deductible.--The first sentence of section 1833(b) of
such Act (42 U.S.C. 1395l(b)) is amended--
(A) by striking ``and'' before ``(6)'', and
(B) by inserting before the period at the end the
following: ``, and (7) such deductible shall not apply with
respect to an initial preventive physical examination (as
defined in section 1861(ww))''.
(2) Coinsurance.--Section 1833(a)(1) of such Act (42 U.S.C.
1395l(a)(1)) is amended--
(A) in clause (N), by inserting ``(or 100 percent in the
case of an initial preventive physical examination, as
defined in section 1861(ww))'' after ``80 percent''; and
(B) in clause (O), by inserting ``(or 100 percent in the
case of an initial preventive physical examination, as
defined in section 1861(ww))'' after ``80 percent''.
(d) Payment as Physicians' Services.--Section 1848(j)(3) of
such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
``(2)(W),'' after ``(2)(S),''.
(e) Other Conforming Amendments.--Section 1862(a) of such
Act (42 U.S.C. 1395y(a)) is amended--
(1) in paragraph (1)--
(A) by striking ``and'' at the end of subparagraph (H);
(B) by striking the semicolon at the end of subparagraph
(I) and inserting ``, and''; and
(C) by adding at the end the following new subparagraph:
``(J) in the case of an initial preventive physical
examination (as defined in section 1861(ww)), which is
performed not later than 6 months after the date the
individual's first coverage period begins under part B;'';
and
(2) in paragraph (7), by striking ``or (H)'' and inserting
``(H), or (J)''.
(f) Effective Date.--The amendments made by this section
shall apply to services furnished on or after January 1,
2004, but only for individuals whose coverage period begins
on or after such date.
Subtitle B--Medicare Coverage for Care Coordination and Assessment
Services
SEC. 111. CARE COORDINATION AND ASSESSMENT SERVICES.
(a) Services Authorized.--Title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) is amended by adding at
the end the following new section:
``care coordination and assessment services
``Sec. 1897. (a) Purpose.--
``(1) In general.--The purpose of this section is to
provide the appropriate level and mix of follow-up care to an
individual with a chronic condition who qualifies as an
eligible beneficiary (as defined in paragraph (2)).
``(2) Eligible beneficiary defined.--In this section, the
term `eligible beneficiary' means a beneficiary who--
``(A) has a serious and disabling chronic condition (as
defined in subsection(f)(1)); or
``(B) has four or more chronic conditions (as defined in
subsection (f)(4)).
``(b) Election of Care Coordination and Assessment
Services.--
``(1) In general.--On or after January 1, 2005, an eligible
beneficiary may elect to receive care coordination services
in accordance with the provisions of this section under
which, in appropriate circumstances, the eligible beneficiary
has health care services covered under this title managed and
coordinated by a care coordinator who is qualified under
subsection (e) to furnish care coordination services under
this section.
``(2) Revocation of election.--An eligible beneficiary who
has made an election under paragraph (1) may revoke that
election at any time.
``(c) Outreach.--The Secretary shall provide for the wide
dissemination of information to beneficiaries and providers
of services, physicians, practitioners, and suppliers with
respect to the availability of and requirements for care
coordination services under this section.
``(d) Care Coordination and Assessment Services
Described.--Care coordination services under this section
shall include the following:
``(1) Basic care coordination and assessment services.--
Except as otherwise provided in this section, eligible
beneficiaries who have made an election under this section
shall receive the following services:
``(A)(i) An initial assessment of an individual's medical
condition, functional and cognitive capacity, and
environmental and psychosocial needs.
``(ii) Annual assessments after the initial assessment
performed under clause (i), unless the physician or care
coordinator of the individual determines that additional
assessments are required due to sentinel health events or
changes in the health status of the individual that may
require changes in the plan of care developed for the
individual.
``(B) The development of an initial plan of care, and
subsequent appropriate revisions to that plan of care.
``(C) The management of, and referral for, medical and
other health services, including multidisciplinary care
conferences and coordination with other providers.
``(D) The monitoring and management of medications.
``(E) Patient education and counseling services.
``(F) Family caregiver education and counseling services.
``(G) Self-management services, including health education
and risk appraisal to identify behavioral risk factors
through self-assessment.
``(H) Consultations by telephone with physicians and other
appropriate health care professionals, including 24-hour
access to a care coordinator.
``(I) Coordination with the principal caregiver in the
home.
``(J) The managing and facilitating of transitions among
health care professionals and across settings of care,
including the following:
``(i) The pursuit the treatment option elected by the
individual.
``(ii) The inclusion of any advance directive executed by
the individual in the medical file of the individual.
``(K) Activities that facilitate continuity of care and
patient adherence to plans of care.
``(L) Information about, and referral to, community-based
services, including patient and family caregiver education
and counseling about such services, and facilitating access
to such services when elected.
``(M) Information about, and referral to, hospice services
and palliative care, including patient and family caregiver
education and counseling about hospice services and
palliative care, and facilitating transition to hospice when
elected.
``(N) Such other medical and health care services for which
payment would not otherwise be made under this title as the
Secretary determines to be appropriate for effective care
coordination, including the additional items and services as
described in paragraph (2).
``(2) Additional benefits.--The Secretary may specify
additional benefits for which payment would not otherwise be
made under this title that may be available to eligible
beneficiaries who have made an election under this section
(subject to an assessment by the care coordinator of an
individual beneficiary's circumstances and need for such
benefits) in order to encourage the receipt of, or to improve
the effectiveness of, care coordination services.
``(e) Care Coordinators.--
``(1) Requirement for Certification.--
``(A) In general.--In order to be qualified to furnish care
coordination and assessment services under this section, an
individual or entity shall be a health care professional or
entity (which may include physicians, physician group
practices, or other health care professionals or entities the
Secretary may find appropriate) who has been certified for a
period (as provided in subparagraph (B)) by the Secretary, or
by an organization recognized by the Secretary, as having met
such criteria as the Secretary may establish for the
furnishing of care coordination under this section (which may
include experience in the provision of care coordination or
primary care physician's services).
``(B) Period of certification.--The period of certification
for an individual referred to in subparagraph (A) is as
follows:
``(i) A one-year period for each of the first three years
of participation under this section.
``(ii) A three-year period thereafter.
``(2) Additional requirements.--
``(A) Submission of data.--A care coordinator shall comply
with such data collection and reporting requirements as the
Secretary determines necessary to assess the effect of care
coordination on health outcomes.
``(B) Participation in quality improvement program.--A care
coordinator shall participate in the quality improvement
program under paragraph (3).
[[Page S7386]]
``(C) Additional terms.--A care coordinator shall comply
with such other terms and conditions as the Secretary may
specify.
``(3) Quality improvement program.--
``(A) In general.--The Secretary shall establish a chronic
care quality assurance program to monitor and improve
clinical outcomes for beneficiaries with chronic conditions.
``(B) Elements of Program.--Under the program, the
Secretary shall--
``(i) establish standards to measure--
``(I) quality and performance of the care of chronic
conditions;
``(II) the continuity and coordination of care that
eligible beneficiaries under this section receive; and
``(III) both underutilization and overutilization of
services;
``(ii) provide to care coordinators periodic reports on
their performance on such measures; and
``(iii) make available information on quality and outcomes
measures to facilitate beneficiary comparison and choice of
care coordination options (in such form and on such quality
and outcomes measures as the Secretary determines to be
appropriate).
``(C) Review of claims.--
``(i) In general.--Subject to clause (ii), under the
program the Secretary shall make available to care
coordinators claims data relating to a beneficiary for whom
the coordinator coordinates care under this section for the
coordinator's review and subsequent appropriate follow-up
action.
``(ii) Authorization.--Data may only be provided to a care
coordinator under clause (i) if the eligible beneficiary
involved has given written authorization for such information
to be so provided.
``(4) Limitation on number of care coordinators.--Payment
may only be made under this section for care coordination
services furnished during a period to one care coordinator
with respect to an eligible beneficiary.
``(5) Payment for services.--
``(A) In general.--The Secretary shall establish payment
terms and conditions and payment rates for basic care
coordination and assessment services described in subsection
(d).
``(B) Payment methodology.--Payment under this section
shall be made in a manner that bundles payment for all care
coordination and assessment services furnished during a
period, as specified by the Secretary.
``(C) Codes.--The Secretary may establish new billing codes
to carry out the provisions of this paragraph.
``(f) Definitions.--In this section:
``(1) Serious and disabling chronic condition.--The term
`serious and disabling chronic condition' means, with respect
to an individual, that the individual has at least one
chronic condition and a licensed health care practitioner has
certified within the preceding 12-month period that--
``(A) the individual has a level of disability such that
the individual is unable to perform (without substantial
assistance from another individual) for a period of at least
90 days due to a loss of functional capacity--
``(i) at least 2 activities of daily living; or
``(ii) such number of instrumental activities of daily
living that is equivalent (as determined by the Secretary) to
the level of disability described in clause (i);
``(B) the individual has a level of disability equivalent
(as determined by the Secretary) to the level of disability
described in subparagraph (A); or
``(C) the individual requires substantial supervision to
protect the individual from threats to health and safety due
to severe cognitive impairment.
``(2) Activities of daily living.--The term `activities of
daily living' means each of the following:
``(A) Eating.
``(B) Toileting.
``(C) Transferring.
``(D) Bathing.
``(E) Dressing.
``(F) Continence.
``(3) Instrumental activities of daily living.--The term
`instrumental activities of daily living' means each of the
following:
``(A) Medication management.
``(B) Meal preparation.
``(C) Shopping.
``(D) Housekeeping.
``(E) Laundry.
``(F) Money management.
``(G) Telephone use.
``(H) Transportation use.
``(4) Chronic condition.--The term `chronic condition'
means an illness, functional limitation, or cognitive
impairment that--
``(A) lasts, or is expected to last, at least one year;
``(B) limits what a person can do; and
``(C) requires on-going medical care.
``(5) Beneficiary.--The term `beneficiary' means an
individual entitled to benefits under part A and enrolled
under part B, including an individual enrolled under the
Medicare+Choice program under part C.''.
(b) Coverage of Care Coordination and Assessment Services
as a Part B Medical Service.--
(1) In general.--Section 1861(s) of the Social Security Act
(42 U.S.C. 1395x(s)) is amended--
(A) in the second sentence, by redesignating paragraphs
(16) and (17) as clauses (i) and (ii); and
(B) in the first sentence--
(i) by striking ``and'' at the end of paragraph (14);
(ii) by striking the period at the end of paragraph (15)
and inserting ``; and''; and
(iii) by adding after paragraph (15) the following new
paragraph:
``(16) care coordination and assessment services furnished
by a care coordinator in accordance with section 1897.''.
(2) Conforming amendments.--Sections 1864(a) 1902(a)(9)(C),
and 1915(a)(1)(B)(ii)(I) of such Act (42 U.S.C. 1395aa(a),
1396a(a)(9)(C), and 1396n(a)(1)(B)(ii)(I)) are each amended
by striking ``paragraphs (16) and (17)'' each place it
appears and inserting ``clauses (i) and (ii) of the second
sentence''.
(3) Part b coinsurance and deductible not applicable to
care coordination and assessment services.--
(A) Coinsurance.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended--
(i) by striking ``and'' at the end of subparagraph (T); and
(ii) by inserting before the final semicolon ``, and (V)
with respect to care coordination and assessment services
described in section 1861(s)(16) that are furnished by, or
coordinated through, a care coordinator, the amounts paid
shall be 100 percent of the payment amount established under
section 1897''.
(B) Deductible.--Section 1833(b) of such Act (42 U.S.C.
1395l(b)) is amended--
(i) by striking ``and'' at the end of paragraph (5); and
(ii) by inserting before the final period ``, and (7) such
deductible shall not apply with respect to care coordination
and assessment services (as described in section
1861(s)(16))''.
(C) Elimination of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) of
such Act (42 U.S.C. 1395cc(a)(2)(A)), as amended by section
101(b)(2), is further amended by inserting after ``section
1833(p),'' the following: ``with respect to care coordination
and assessment services (as described in section
1861(s)(16)),''.
SEC. 112. CARE COORDINATION AND ASSESSMENT SERVICES AND
QUALITY IMPROVEMENT PROGRAM IN MEDICARE+CHOICE
PLANS.
Section 1852(e)(1) of the Social Security Act (42 U.S.C.
1395w-22(e)(1)) is amended by inserting before the period at
the end the following: ``, including a quality improvement
program for coordinated care services referred to in section
1897(e)(3)''.
SEC. 113. IMPROVING CHRONIC CARE COORDINATION THROUGH
INFORMATION TECHNOLOGY.
(a) Technology Improvement Grants.--
(1) In general.--The Secretary of Health and Human Services
(hereinafter in this section referred to as the
``Secretary'') shall make grants to eligible entities to
enable such entities to develop, implement, or train
personnel in the use of standardized clinical information
technology systems designed to--
(A) improve the coordination and quality of care furnished
to medicare beneficiaries with chronic conditions; and
(B) increase administrative efficiencies of such entities.
(2) Care coordinators as eligible entities.--In this
section, an eligible entity is a care coordinator who
furnishes care coordination services to medicare
beneficiaries under section 1897 of the Social Security Act.
(b) Eligibility.--To be eligible to receive a grant under
subsection (a), a care coordinator shall--
(1) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require, including a description of the
clinical information technology system that the care
coordinator intends to implement using amounts received under
the grant;
(2) provide assurances that are satisfactory to the
Secretary that such system, for which amounts are to be
expended under the grant, conforms to the standards
established by the Secretary under part C of title XI of the
Social Security Act, and such other standards as the
Secretary may specify; and
(3) furnish the Secretary with such information as the
Secretary may require to--
(A) evaluate the project for which the grant is made; and
(B) ensure that funding provided under the grant is
expended for the purposes for which it is made.
(c) Matching Requirement.--The Secretary may not make a
grant to a care coordinator under subsection (a) unless that
care coordinator agrees that, with respect to the costs to be
incurred by the care coordinator in carrying out the
activities for which the grant is being awarded, the care
coordinator will make available (directly or through
donations from public or private entities) non-Federal
contributions toward such costs in an amount equal to $1 for
each $1 of Federal funds provided under the grant.
(d) Reports to Congress.--
(1) Initial Report.--Not later than 18 months after the
first grant has been made under this section, the Secretary
shall submit an initial report to Congress containing the
information referred to in paragraph (3) as well as any
recommendations with respect to grants under this section.
(2) Final Report.--Not later than 6 months after the last
grant has been awarded (as determined by the Secretary) under
this section, the Secretary shall submit a final report to
Congress containing the information referred to in paragraph
(2) as well as any recommendations with respect to grants
under this section.
[[Page S7387]]
(3) Contents of report.--The reports under this subsection
shall include the following:
(A) A description of the number and nature of grants made
under this section.
(B) An evaluation of--
(i) improvements in the coordination and quality of care
furnished to beneficiaries with chronic conditions; and
(ii) increases in administrative efficiencies of care
coordinators.
(e) Authorization of Appropriations.--For each of fiscal
years 2005, 2006, and 2007, there are authorized to be
appropriated to the Secretary $10,000,000 to carry out the
program under this section.
Subtitle C--Additional Provisions
SEC. 121. REVIEW OF COVERAGE STANDARDS.
(a) Review.--With respect to determinations under section
1862(a)(1) of such Act (42 U.S.C. 1395y(a)(1)) (relating to
whether an item or service is reasonable and necessary for
the diagnosis or treatment of illness or injury for purposes
of payment under title XVIII of such Act), the Secretary of
Health and Human Services shall conduct a review of--
(1) regulations, policies, procedures, and instructions of
the Centers for Medicare & Medicaid Services for making those
determinations; and
(2) policies, procedures, local medical review policies,
manual instructions, interpretative rules, statements of
policy, and guidelines of general applicability of fiscal
intermediaries (under section 1816 of the Social Security Act
(42 U.S.C. 1395h)) and carriers under section 1842 of such
Act (42 U.S.C. 1395u) for making those determinations.
(b) Modification.--Insofar as the Secretary determines that
the Centers for Medicare & Medicaid Services, a fiscal
intermediary, or a carrier has misapplied such standard by
requiring that the item or service improve the condition of
the patient with respect to such illness or injury, the
Secretary shall take such corrective measures as are
appropriate to ensure the Centers, intermediary, or carrier
(as the case may be) applies the proper standard for making
such determinations.
(c) Report.--On the date that is 18 months after the date
of enactment of this Act, the Secretary shall submit to
Congress a report that contains--
(1) a detailed statement of the findings and conclusions of
the review conducted under subsection (a);
(2) a detailed statement of the modifications made under
subsection (b); and
(3) recommendations to avoid misapplication of the standard
in the future.
TITLE II--INSTITUTE OF MEDICINE STUDY ON EFFECTIVE CHRONIC CONDITION
CARE
SEC. 201. INSTITUTE OF MEDICINE MEDICARE CHRONIC CONDITION
CARE IMPROVEMENT STUDY AND REPORT.
(a) Study.--
(1) In general.--The Secretary of Health and Human Services
shall contract with the Institute of Medicine of the National
Academy of Sciences to--
(A) conduct a comprehensive study of the medicare program
to identify--
(i) factors that facilitate provision of effective care
(including, where appropriate, hospice care) for medicare
beneficiaries with chronic conditions; and
(ii) factors that impede provision of such care for such
beneficiaries,
including the issues studied under paragraph (2); and
(B) submit the report described in subsection (b).
(2) Issues studied.--The study required under paragraph (1)
shall--
(A) identify inconsistent clinical, financial, or
administrative requirements across provider and supplier
settings or professional services with respect to medicare
beneficiaries;
(B) identify requirements under the program imposed by law
or regulation that--
(i) promote costshifting across providers and suppliers;
(ii) impede provision of effective, seamless transitions
across health care settings, such as between hospitals,
skilled nursing facilities, home health services, hospice
care, and care in the home;
(iii) impose unnecessary burdens on such beneficiaries and
their family caregivers;
(iv) impede the establishment of administrative information
systems to track health status, utilization, cost, and
quality data across providers and suppliers and provider
settings;
(v) impede the establishment of clinical information
systems that support continuity of care across settings and
over time; or
(vi) impede the alignment of financial incentives among the
medicare program, the medicaid program, and group health
plans and providers and suppliers that furnish services to
the same beneficiary.
(b) Report.--On the date that is 18 months after the date
of enactment of this Act, the Institute of Medicine of the
National Academy of Sciences shall submit to Congress and the
Secretary of Health and Human Services a report that
contains--
(1) a detailed statement of the findings and conclusions of
the study conducted under subsection (a); and
(2) recommendations to improve provision of effective care
for medicare beneficiaries with chronic conditions.
______
By Mr. SANTORUM (for himself and Mr. Baucus):
S. 1180. A bill to amend the Internal Revenue Code of 1986 to modify
to work opportunity credit and the welfare-to-work credit; to the
Committee on Finance.
Mr. SANTORUM. Mr. President, I am pleased to join Senator Baucus in
the introduction of the Encouraging Work Act of 2003. The Work
Opportunity Tax Credit, WOTC, and Welfare-to-Work Tax Credit, W-t-W,
are tax incentives that encouraging employers to hire public assistance
recipients and other individuals with barriers to employment. The
combination of Welfare Reform passed by Congress in 1996 and the
assistance to employers found in the WOTC and W-t-W has enabled
expanded opportunity for many Americans. Yet more can be done.
Under present law, WOTC provides a 40 percent tax credit on the first
$6,000 of wages for those working at least 400 hours, or a partial
credit of 25 percent for those working 120-399 hours. W-t-W provides a
35 percent tax credit on the first $10,000 of wages for those working
400 hours in the first year. In the second year, the W-t-W credit is 50
percent of the first $10,000 of wages earned. WOTC and W-t-W are key
elements of welfare reform. A growing number of employers use these
programs in the retail, health care, hotel, financial services, food,
and other industries. These programs have helped over 2,200,000
previously dependent persons to find jobs.
Eligibility is limited to: 1. recipients of Temporary, Assistance to
Needy Families, TANF, in 9 of the 18 months ending on the hiring date;
2. individuals receiving Supplemental Security Income, SSI, benefits;
3. disabled individuals with vocational rehabilitation referrals; 4.
veterans on food stamps; 5. individuals aged 18-24 in households
receiving food stamp benefits; 6. qualified summer youth employees: 7.
low-income ex-felons; and 8. individuals ages 18-24 living in
empowerment zones or renewal communities. Eligibility for W-t-W is
limited to individuals receiving welfare benefits for 18 consecutive
months ending on the hiring date. More than 80 percent of WOTC and W-t-
W hires were previously dependent on public assistance programs. These
credits are both a hiring incentive, offsetting some of the higher
costs of recruiting, hiring, and retaining public assistance recipients
and other low-skilled individuals, and a retention incentive, providing
a higher reward for those who stay longer on the job.
Without action by Congress WOTC and W-t-W will expire on December 31,
2003. After seven years of experience with these programs, their value
has been well demonstrated. In 2001, the GAO issued a report that
indicated that employers have significantly changed their hiring
practices because of WOTC. With the resources provided by WOTC,
employers have provided job mentors, lengthened training periods,
engaged in recruiting outreach, and listed jobs or requested referrals
from public agencies or partnerships. WOTC and W-t-W have become a true
public-private partnership in which the Department of Labor, the
Internal Revenue Service, the states, and employers have forged
excellent working relationships.
But the challenges for employers and those looking for better
opportunities are real. The job skills of eligible persons leaving
welfare are sometimes limited, and the costs of recruiting, training,
and supervising low-skilled individuals cause many employers to look
elsewhere for employees. The weak economy and rising unemployment give
employers more hiring options. WOTC and W-t-W are proven incentives for
encouraging employers to seek employees from the targeted groups.
Despite the considerable success of WOTC and W-t-W, many vulnerable
individuals still need a boost in finding employment. This is
particularly true during periods of high unemployment. There are
several legislative changes that would strengthen these programs,
expand employment opportunities for needy individuals, and make the
programs more attractive to employers.
The Administration's FY 2004 budget proposes to simplify these
important employment incentives by combining them into one credit and
making the rules for computing the combined credits simpler. The
credits would be combined by creating a new welfare-to-work target
group under WOTC. The minimum employment periods and
[[Page S7388]]
credit rates for the first year of employment under the present work
opportunity tax credit would apply to W-t-W employees. The maximum
amount of eligible wages would continue to be $10,000 for W-t-W
employees and $6,000 for other target groups ($3,000 for summer youth).
In addition, the second year 50-percent credit under W-t-W would
continue to be available for W-t-W employees under the modified WOTC.
Under current law, only those ex-felons whose annual family income is
70 percent or less than the Bureau of Labor Statistics lower living
standard during the six months preceding the hiring date are eligible
for WOTC. The Administration's FY 2004 budget proposes to eliminate the
family income attribution rule.
Permanent extension would provide these programs with greater
stability, thereby encouraging more employers to participate, make
investments in expanding outreach to identify potential workers from
the targeted groups, and avoid the wasteful disruption of termination
and renewal. A permanent extension would also encourage the state job
services to invest the resources needed to make the certification
process more efficient and employer-friendly.
Current WOTC eligibility rules heavily favor the hiring of women
because single mothers are much more likely to be on welfare or food
stamps. Women constitute about 80 percent of those hired under the WOTC
program, but men from welfare households face the same or even greater
barriers to finding work. Increasing the age ceiling in the ``food
stamp category'' would greatly improve the job prospects for many
absentee fathers and other ``at risk'' males. This change would be
completely consistent with program objectives because many food stamp
households include adults who are not working, and more than 90 percent
of those on food stamps live below the poverty line.
The Work Opportunity Credit and Welfare-to-Work Credit have been
successful in moving traditionally hard-to-employ persons off welfare
and into the workforce, where they contribute to our economy. However,
employer participation in these important programs can be increased,
particularly among small and medium-sized employers. This is due to the
complexity of the credits and the fact that they are both only
temporary provisions of the tax code subject to renewal every year or
two. Small, medium, and even some large employers find it difficult to
justify developing the necessary infrastructure to administer and
participate in these programs when their continued existence beyond one
or two years is constantly in question.
This legislation will remedy this problem by combining WOTC and W-t-W
into one, more easily administered tax credit, and by making it a
permanent part of the tax code. Many organizations including the
National Council of Chain Restaurants, National Retail Federation, Food
Marketing Institute, National Association of Convenience Stores,
National Restaurant Association, American Hotel & Lodging Association,
National Roofing Contractors Association, National Association of Chain
Drug Stores, American Nursery and Landscape Association, and the
American Health Care Association support this legislation.
Representatives Amo Houghton, R-NY, and Charles Rangel, D-NY, have
introduced identical legislation in the House of Representatives. I
urge my colleagues to join us in supporting this legislation.
Mr. BAUCUS. Mr. President, I am pleased to join my colleague, Senator
Santorum, and my other Senate colleagues in introducing legislation to
permanently extend and improve upon the Work Opportunity and the
Welfare-to-Work tax credits. During this year's debate on the Jobs and
Growth Tax Reconciliation Act, I voted to extend these tax credits were
not included in the final conference agreement, but I continue to
strongly support the passage of legislation this year to make these
credits permanent and make several reforms in the programs to improve
their effectiveness.
Over the past seven years, the Work Opportunity Tax Credit, WOTC, and
the Welfare-to-Work, W-t-W, tax credit have helped over 2.2 million
public assistance dependent individuals enter the workforce. Both of
these important programs are scheduled to expire on December 31, 2003.
These hiring tax incentives have clearly demonstrated their
effectiveness in helping to level the job selection playing field for
low-skilled individuals by providing employers with additional
resources to help recruit, select, train and retain individuals with
significant barriers to work. Many vulnerable individuals still need a
boost in finding employment, and this is particularly critical during
periods of high unemployment. The weak economy and rising unemployment
give employers many more hiring options because of the larger pool of
experienced laid-off workers. Without an extension of these programs,
the task of transitioning from welfare-to-work will become even harder
for individuals reaching their welfare eligibility ceiling this year.
Because of the costs involved in setting up and administering a WOTC/
W-t-W program, employers have established massive outreach programs to
maximize the number of eligible persons in their hiring pool. The
States, in turn, have steadily improved the programs through improved
administration. WOTC has become an example of a true public-private
partnership design to assist the most needy. Without the additional
resources provided by these hiring tax incentives, few employers would
actively seek out this hard-to-employ population.
WOTC provides employers with a graduated tax credit equal to 25-
percent of the first $6,000 in wages for eligible individuals working
between 120 hours and 399 hours and a 40-percent tax credit on the
first $6,000 in wages for those working over 400 hours. The W-t-W tax
credit is geared toward long term welfare recipients and provides a 35-
percent tax credit on the first $10,000 in wages during the first year
of employment and a 50-percent credit on the first $10,000 for those
who stay on the job a second year.
In my own State of Montana many businesses take advantage of this
program, including large multinational firms and smaller family-owned
businesses. Those who truly benefit from the WOTC/W-t-W program,
however, are low-income families, under the Food Stamp Program and the
Aid to Families with Dependent Children, AFDC, and Temporary Assistance
for Needy Families, TANF, program, and also low income U.S. Veterans.
In Montana, more than 1,000 people were certified as eligible under the
WOTC program during the past 18 months, October 2001 through March
2003, including 476 Food Stamp recipients, 475 AFDC/TANF recipients,
and 52 U.S. veterans.
The bill we are introducing provides for a permanent program
extension of the two credits. After seven years of experience with WOTC
and W-t-W, we know that employers do respond to these important hiring
tax incentives. Permanent extension would provide these programs with
greater stability, thereby encouraging more employers to participate,
make investments in expanding outreach to identify potential workers
from the targeted groups, and avoid the wasteful disruption of
termination and renewal. A permanent extension would also encourage the
state job services to invest the resources needed to make the
certification process more efficient and employer-friendly.
The bill also includes a proposal to simplify the programs by
combining them into one credit and making the rules for computing the
combined credits simpler. This would be accomplished by creating a new
welfare-to-work target group under WOTC. The minimum employment periods
and credit rates for the first year of employment under present work
opportunity tax credit would apply to W-t-W employees. THe maximum
amount of eligible wages would continue to be $10,000 for W-t-W
employees. In addition, the second year 50-percent credit under W-t-W
would continue to be available for W-t-W employees under the modified
WOTC.
Finally, there are other changes in the bill that would extend these
benefits to more people and help them find work. Because of the
program's eligibility criteria, over 80 percent of those hired are
women leaving welfare. Since men generally are not eligible for TANF
benefits, the fathers of children on welfare receive little help in
finding work, even though they often face even greater barriers to work
than women
[[Page S7389]]
on welfare. We propose to help absentee fathers find work and provide
the resources to assume their family responsibilities by opening up
WOTC eligibility to anyone 39 years old or younger in families
receiving food stamps or residing in enterprise zones or empowerment
communities. Raising the eligibility limits in these two categories
will extend eligibility to hundreds of thousands of at-risk men.
I urge my colleagues to support this important piece of legislation.
______
By Mr. CORZINE (for himself, Mr. Lautenberg, and Mr. Akaka):
S. 1181. A bill to promote youth financial education; to the
Committee on Health, Education, Labor, and Pensions.
Mr. CORZINE. Mr. President, I rise today to introduce along with
Senators Lautenberg and Akaka the Youth Financial Literacy Act to call
attention to an important issue in education: teaching students the
basic principles of financial literacy to prepare them to be
responsible consumers. This legislation will give young Americans the
tools they need to succeed in this ever-changing economy.
Today, it is as important for young people to learn about staying out
of debt, maintaining good credit and building up their savings as it is
for them to learn about geography, science and history.
Far too many of our youth enter adulthood lacking basic financial
literacy skills, not knowing how to budget their wages or salaries or
build personal savings. A recent survey by the non-profit JumpStart
Coalition reveals that the only 21 percent of students between the ages
of 16 and 22 say they have taken a personal finance course at school.
The study also found that when high school seniors were tested on basic
financial literacy, they answered a mere 50.2 percent of the questions
correctly. That, is simply not acceptable.
Providing financial education to our nation's young people must be a
priority. Indeed it is time for our schools to make a more concerted
effort to prepare our children for success in new ways including their
future financial decision-making.
I am not alone in advocating the importance of financial literacy.
Federal Reserve Chairman Alan Greenspan has said, ``Improving basic
financial education at the elementary and secondary school levels is
essential to providing a foundation for financial literacy that can
help prevent younger people from making poor financial decisions.''
Today, I hope to elevate the discussion of this issue by introducing
the Youth Financial Education Act, which would provide $100 million in
grants to states to help them develop and implement financial education
programs in elementary and secondary schools, including helping to
prepare teachers to provide financial education. It would also
establish a national clearinghouse for instructional materials and
information regarding model financial education programs.
I am happy to report that in my state of New Jersey many have already
started the ball rolling on financial literacy education. My State
allows local schools the option of offering financial education in high
school, and the New Jersey Coalition for Financial Education is working
with the New Jersey Department of Education to develop and implement
core curriculum standards. I believe it is time for our Nation to
follow suit and begin to focus on the financial literacy education of
all young Americans.
We must not sit idly by while so many of our children lack financial
literacy. So I ask for my colleagues to join me in support of the Youth
Financial Literacy Act, which will ensure that our next generation is
prepared to meet the challenges of the new economy.
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. 1181
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. PROMOTING YOUTH FINANCIAL LITERACY.
Title IV of the Elementary and Secondary Education Act of
1965 (20 U.S.C. 7101 et seq.) is amended by adding at the end
the following:
``PART D--PROMOTING YOUTH FINANCIAL LITERACY
``SEC. 4401. SHORT TITLE AND FINDINGS.
``(a) Short Title.--This part may be cited as the `Youth
Financial Education Act'.
``(b) Findings.--Congress finds the following:
``(1) In order to succeed in our dynamic American economy,
young people must obtain the skills, knowledge, and
experience necessary to manage their personal finances and
obtain general financial literacy. All young adults should
have the educational tools necessary to make informed
financial decisions.
``(2) Despite the critical importance of financial literacy
to young people, the average student who graduates from high
school lacks basic skills in the management of personal
financial affairs. A nationwide survey conducted in 2002 by
the Jump$tart Coalition for Personal Financial Literacy
examined the financial knowledge of 4,024 12th graders. On
average, survey respondents answered only 50 percent of the
questions correctly. This figure is down from the 52 percent
average score in 2000 and the 57 percent average score in
1997.
``(3) An evaluation by the National Endowment for Financial
Education High School Financial Planning Program undertaken
jointly with the United States Department of Agriculture
Cooperative State Research, Education, and Extension Service
demonstrates that as little as 10 hours of classroom
instruction can impart substantial knowledge and affect
significant change in how teens handle their money.
``(4) State educational leaders have recognized the
importance of providing a basic financial education to
students in kindergarten through grade 12 by integrating
financial education into State educational standards, but by
2002 only 4 States required students to complete a course
that covered personal finance before graduating from high
school.
``(5) Teacher training and professional development are
critical to achieving youth financial literacy. Teachers
confirm the need for professional development in personal
finance education. In a survey by the National Institute for
Consumer Education, 77 percent of a State's economics
teachers revealed that they had never had a college course in
personal finance.
``(6) Personal financial education helps prepare students
for the workforce and for financial independence by
developing their sense of individual responsibility,
improving their life skills, and providing them with a
thorough understanding of consumer economics that will
benefit them for their entire lives.
``(7) Financial education integrates instruction in
valuable life skills with instruction in economics, including
income and taxes, money management, investment and spending,
and the importance of personal savings.
``(8) The consumers and investors of tomorrow are in our
schools today. The teaching of personal finance should be
encouraged at all levels of our Nation's educational system,
from kindergarten through grade 12.
``SEC. 4402. STATE GRANT PROGRAM.
``(a) Program Authorized.--The Secretary is authorized to
provide grants to State educational agencies to develop and
integrate youth financial education programs for students in
elementary schools and secondary schools.
``(b) State Plan.--
``(1) Approved state plan required.--To be eligible to
receive a grant under this section, a State educational
agency shall submit an application that includes a State
plan, described in paragraph (2), that is approved by the
Secretary.
``(2) State plan contents.--The State plan referred to in
paragraph (1) shall include--
``(A) a description of how the State educational agency
will use grant funds;
``(B) a description of how the programs supported by a
grant will be coordinated with other relevant Federal, State,
regional, and local programs; and
``(C) a description of how the State educational agency
will evaluate program performance.
``(c) Allocation of Funds.--
``(1) Allocation factors.--Except as otherwise provided in
paragraph (2), the Secretary shall allocate the amounts made
available to carry out this section pursuant to subsection
(a) to each State according to the relative populations in
all the States of students in kindergarten through grade 12,
as determined by the Secretary based on the most recent
satisfactory data.
``(2) Minimum allocation.--Subject to the availability of
appropriations and notwithstanding paragraph (1), a State
that has submitted a plan under subsection (b) that is
approved by the Secretary shall be allocated an amount that
is not less than $500,000 for a fiscal year.
``(3) Reallocation.--In any fiscal year an allocation under
this subsection--
``(A) for a State that has not submitted a plan under
subsection (b); or
``(B) for a State whose plan submitted under subsection (b)
has been disapproved by the Secretary;
shall be reallocated to States with approved plans under this
section in accordance with paragraph (1).
[[Page S7390]]
``(d) Use of Grant Funds.--
``(1) Required uses.--A grant made to a State educational
agency under this part shall be used--
``(A) to provide funds to local educational agencies and
public schools to carry out financial education programs for
students in kindergarten through grade 12 based on the
concept of achieving financial literacy through the teaching
of personal financial management skills and the basic
principles involved with earning, spending, saving, and
investing;
``(B) to carry out professional development programs to
prepare teachers and administrators for financial education;
and
``(C) to monitor and evaluate programs supported under
subparagraphs (A) and (B).
``(2) Limitation on administrative costs.--A State
educational agency receiving a grant under subsection (a) may
use not more than 4 percent of the total amount of the grant
in each fiscal year for the administrative costs of carrying
out this section.
``(e) Report to the Secretary.--Each State educational
agency receiving a grant under this section shall transmit a
report to the Secretary with respect to each fiscal year for
which a grant is received. The report shall describe the
programs supported by the grant and the results of the State
educational agency's monitoring and evaluation of such
programs.
``SEC. 4403. CLEARINGHOUSE.
``(a) Authority.--Subject to the availability of
appropriations, the Secretary shall make a grant to, or
execute a contract with, an eligible entity with substantial
experience in the field of financial education, such as the
Jump$tart Coalition for Personal Financial Literacy, to
establish, operate, and maintain a national clearinghouse (in
this part referred to as the `Clearinghouse') for
instructional materials and information regarding model
financial education programs and best practices.
``(b) Eligible Entity.--In this section, the term `eligible
entity' means a national nonprofit organization with a proven
record of--
``(1) cataloging youth financial literacy materials; and
``(2) providing support services and materials to schools
and other organizations that work to promote youth financial
literacy.
``(c) Application.--An eligible entity desiring to
establish, operate, and maintain the Clearinghouse shall
submit an application to the Secretary at such time, in such
manner, and accompanied by such information, as the Secretary
may reasonably require.
``(d) Basis and Term.--The Secretary shall make the grant
or contract authorized under subsection (a) on a competitive,
merit basis for a term of 5 years.
``(e) Use of Funds.--The Clearinghouse shall use the funds
provided under a grant or contract made under subsection
(a)--
``(1) to maintain a repository of instructional materials
and related information regarding financial education
programs for elementary schools and secondary schools,
including kindergartens, for use by States, localities, and
the general public;
``(2) to disseminate to States, localities, and the general
public, through electronic and other means, instructional
materials and related information regarding financial
education programs for elementary schools and secondary
schools, including kindergartens; and
``(3) to the extent that resources allow, to provide
technical assistance to States, localities, and the general
public on the design, establishment, and implementation of
financial education programs for elementary schools and
secondary schools, including kindergartens.
``(f) Consultation.--The chief executive officer of the
eligible entity selected to establish and operate the
Clearinghouse shall consult with the Department of the
Treasury and the Securities Exchange Commission with respect
to its activities under subsection (e).
``(g) Submission to Clearinghouse.--Each Federal agency or
department that develops financial education programs and
instructional materials for such programs shall submit to the
Clearinghouse information on the programs and copies of the
materials.
``(h) Application of Copyright Laws.--In carrying out this
section the Clearinghouse shall comply with the provisions of
title 17 of the United States Code.
``SEC. 4404. EVALUATION AND REPORT.
``(a) Performance Measures.--The Secretary shall develop
measures to evaluate the performance of programs assisted
under sections 4402 and 4403.
``(b) Evaluation According to Performance Measures.--
Applying the performance measures developed under subsection
(a), the Secretary shall evaluate programs assisted under
sections 4402 and 4403--
``(1) to judge their performance and effectiveness;
``(2) to identify which of the programs represent the best
practices of entities developing financial education programs
for students in kindergarten through grade 12; and
``(3) to identify which of the programs may be replicated
and used to provide technical assistance to States,
localities, and the general public.
``(c) Report.--For each fiscal year for which there are
appropriations under section 4407(a), the Secretary shall
transmit a report to Congress describing the status of the
implementation of this part. The report shall include the
results of the evaluation required under subsection (b) and a
description of the programs supported under section 4402.
``SEC. 4405. DEFINITIONS.
``In this part:
``(1) Financial education.--The term `financial education'
means educational activities and experiences, planned and
supervised by qualified teachers, that enable students to
understand basic economic and consumer principals, acquire
the skills and knowledge necessary to manage personal and
household finances, and develop a range of competencies that
will enable them to become responsible consumers in today's
complex economy.
``(2) Qualified teacher.--The term `qualified teacher'
means a teacher who holds a valid teaching certification or
is considered to be qualified by the State educational agency
in the State in which the teacher works.
``SEC. 4406. PROHIBITION.
``Nothing in this part shall be construed to authorize an
officer or employee of the Federal Government to mandate,
direct, or control a State, local educational agency, or
school's specific instructional content, curriculum, or
program of instruction, as a condition of eligibility to
receive funds under this part.
``SEC. 4407. AUTHORIZATION OF APPROPRIATIONS.
``(a) Authorization.--For the purposes of carrying out this
part, there are authorized to be appropriated $100,000,000
for each of the fiscal years 2004 through 2008.
``(b) Limitation on Funds for Clearinghouse.--The Secretary
may use not less than 2 percent and not more than 5 percent
of amounts appropriated under subsection (a) for each fiscal
year to carry out section 4403.
``(c) Limitation on Funds for Secretary Evaluation.--The
Secretary may use not more than $200,000 from the amounts
appropriated under subsection (a) for each fiscal year to
carry out subsections (a) and (b) of section 4404.
``(d) Limitation on Administrative Costs.--Except as
necessary to carry out subsections (a) and (b) of section
4404 using amounts described in subsection (c) of this
section, the Secretary shall not use any portion of the
amounts appropriated under subsection (a) for the costs of
administering this part.''.
______
By Mr. McCONNELL (for himself, Mrs. Feinstein, Mr. McCain, Mr.
Leahy, Mr. Specter, Mr. Kennedy, Ms. Mikulski, Mr. Kyl, Mr.
Daschle, Mr. Santorum, and Mr. Brownback):
S. 1182. A bill to sanction the ruling Burmese military junta, to
strengthen Burma's democratic forces and support and recognize the
National League of Democracy as the legitimate representative of the
Burmese people, and for other purposes; to the Committee on Foreign
Relations.
Mr. McCONNELL. Mr. President, while democracy activists in Burma have
been murdered, intimidated and harassed for well over a decade, the
blitzkrieg on freedom launched last weekend by the illegitimate State
Peace and Development Council--SPDC--killed and injured scores of
supporters from the National League for Democracy--NLD.
Democracy leader Aung San Suu Kyi and numerous other activists were
brutalized, arrested and today remain held incommunicado. Reports
indicate that Suu Kyi is being held in the Yemon military camp, 40
kilometers outside of Rangoon. It is believed she suffers from
lacerations to her face and a broken shoulder. The administration
should waste no time in gaining access to Suu Kyi to ensure her safety
and security.
I have come to the floor every day this week to draw attention to the
untenable situation in that country. On Monday, I urged the
administration to act promptly and decisively in support of democracy
in Burma. The State Department can take specific action without the
need for legislation--such as broadening visa restrictions, freezing
assets, and downgrading Burma's diplomatic status in Washington.
Mr. McCAIN. Will the Senator yield for a question?
Mr. McCONNELL. Yes.
Mr. McCAIN. I thank the Senator from Kentucky for his advocacy for,
not only one of the world's great, courageous figures, but also on
behalf of democracy and freedom in a small country far away.
Is the Senator from Kentucky aware of any action, or even any
statements being made by our friends in Asia, including ASEAN, and how
does he feel about that?
Mr. McCONNELL. I would say to my friend from Arizona, there will be a
regional ASEAN meeting in Phnom Penh on June 18 and 19. Secretary
Powell is scheduled to be there. I hope that will be an opportunity to
hear from the
[[Page S7391]]
other Asian, ASEAN countries, that maybe, for once, they will
understand what a pariah regime that is and work with us in a
coordinated fashion to impose sanctions that will actually mean
something in bringing down the regime.
Mr. McCAIN. If the Senator will yield for one further question, has
the Senator heard about a statement of the Japanese Foreign Minister
that basically is saying that everything was pretty well--the status
quo was pretty well satisfactory in Burma? And before I ask the Senator
to answer the question, I want to say again, I thank him for his
advocacy of many years, for the democratic movement in Burma, sometimes
known as Myanmar. I thank him and look forward to working with him.
I think the Congress can act, and I hope we can work in concert with
the administration.
Mr. McCONNELL. I thank my friend from Arizona. I understand the
Japanese may be reconsidering their statement of yesterday. There could
well be a subsequent statement today that might be more pleasing to the
Senator from Arizona and myself.
I thank him for being an extraordinary leader on this issue, as well,
and for agreeing to cosponsor the bill I am about to introduce.
I also might mention, I had an opportunity to talk with the Deputy
Secretary of State and Deputy Secretary of Defense today to encourage
them to take a very great interest and recommend the President take a
very great interest in this issue. The only way, obviously, we are
going to have an impact in Burma is for the United States to use the
kind of leadership only it can provide to rally the world around a
sanctions regime and tighten the noose around this regime and hopefully
this will be the beginning of that effort.
Mr. McCAIN. I thank my friend.
Mr. McCONNELL. The White House should utilize all authority at its
disposal to immediately sanction the junta, including banning imports
from Burma and raising the brutal crackdown on democracy before the
U.N. Security Council.
On Tuesday, I appealed to the international community to stand by the
people of Burma during their dark hour of need, and called upon the
world's democracies to act in support of Suu Kyi and her courageous
supporters. Elected representatives cannot stand by idly while
democracy in Burma is strangled by the SPDC.
Today, along with my colleagues Senators Feinstein, McCain, Leahy,
Specter, Kennedy, Mikulski, Kyl, Daschle, and Santorum, I am
introducing the ``Burmese Freedom and Democracy Act of 2003''. This act
recognizes that what is needed in Burma is fewer carrots and more
sticks.
Among other restrictions that I will describe shortly, the act
imposes an import ban on articles produced, mined, manufactured, grown,
or assembled in Burma. It prohibits the import of goods to the United
States produced by the SPDC, companies in which the junta has a
financial interest, and the SPDC's political arm, the Union Solidarity
Development Association--USDA.
Lest my colleagues forget, the USDA, under the direction of the
junta, orchestrated the recent terror in the townships that left scores
dead and Suu Kyi injured. They are Burma's fedayeen.
There are some who discount economic sanctions as a tool to coerce
and modify the behavior of repressive nations. According to their
argument, sanctions hurt the very people they are intended to help.
Sanctions in Burma will not rape ethnic girls and women, burn down
their villages and murder their brothers, husbands, and sons.
Sanctions in Burma will not impress children into the military, drug
them, and send them off to dangerous battlefields.
Sanctions in Burma will not use slave labor, nor will they profit
from an illicit narcotics trade that wreaks havoc among the region's
youth and contributes to an exploding HIV/AIDS rate along Burma's
borders.
Finally, sanctions in Burma will not attack peaceful supporters of
the NLD or democracy leader Aung San Suu Kyi, nor will they ever take a
single life by an act of violence.
The SPDC is guilty of committing the laundry list of heinous crimes
that I just described. Every single one of them is an assault on the
human rights and dignity of the Burmese people. Burma's junta is as
chronic an abuser of human rights as Kim Jong-Il in North Korea--and as
was the Taliban in Afghanistan and Saddam Hussein in Iraq.
The fact of the matter is that the import ban will impact a
negligible percentage of Burma's population. It will deny Burma the
ability to import some $350 million to $470 million worth of goods to
the United States--most of which are garments and textiles--thus
denying the SPDC legitimate revenue.
Unfortunately, the people of Burma reap almost no benefits from this
income. The SPDC is more interested in spending revenue on itself than
in investing in the welfare of the people of Burma.
With over one-quarter of Burma's imports currently destined for the
United States, the ban will hit the SPDC where it hurts most--in the
pocketbook and its public image.
South African Bishop Desmond Tutu, who knows a thing or two about
sanctions and repression, said of Burma earlier this week:
We urge freedom loving governments everywhere to impose
sanctions on this illegitimate regime. They worked for us in
South Africa. If applied conscientiously, they will work in
Burma too. Freeze the assets of the regime and impose
stringent travel restrictions on them and their supporters.
We need a regime change [in Burma].
I supported sanctions against the apartheid regime in South Africa
then, and I support sanctions against the military junta in Burma now.
Sanctions will empower Burma's democrats who have already
demonstrated their support for freedom by overwhelmingly electing the
NLD in the 1990 elections. These polls were never recognized by the
SPDC. Instead, the junta has spent the past decade trying to suffocate
the aspirations for democracy by all of Burma's people and imprisoning
their leader, Suu Kyi.
In addition to the import ban, the act also freezes the assets of the
SPDC in the United States and requires the U.S. to oppose and vote
against loans or other assistance proposed for Burma by international
financial institutions.
It expands the visa ban to former and present SPDC leadership and the
Union Solidarity Development Association and requires coordination with
the European Union's visa ban list. Let me be clear that the SPDC
leadership includes all officer-level individuals associated with the
regime.
Finally, the act requires the Secretary of State to promote greater
awareness of the abuses of the SPDC, requires the State Department to
more proactively promote awareness of U.S. policy toward Burma, and
encourages greater support for Burmese democracy activists.
Let me close with a few words and observations about Daw Aung San Suu
Kyi. Over the years, the daughter of the father of Burma's independence
has stood squarely between the people of Burma and the thuggish regime.
Against great odds and often in great danger, Suu Kyi has consistently
and successfully stared down SPDC generals and their military might.
She has never wavered--not once--in her support for democracy and the
rule of law for Burma.
Our thoughts and prayers continue to be with Suu Kyi and the people
she so ably represents. She is obviously the greatest hope for that
country.
I ask my colleagues: If America does not stand with Suu Kyi and the
NLD now, whither freedom and justice in Burma? Without us, it has no
chance.
Pressure, patience and persistence will bring political change to
Burma. Suu Kyi knows this in her heart and mind, as we all do. America
must lead. And if we do, others will rally.
I thank my friend from New Mexico. I yield the floor and ask
unanimous consent that the text of the bill be printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DOMENICI. Mr. President, I commend the distinguished majority
whip for his eloquent statement today and compliment him on his
persistence with reference to the cause of freedom and democracy in
Burma.
Mr. DASCHLE. Mr. President, for 6 days, Aung San Suu Kyi--the
courageous voice of democracy and freedom in Burma--has been in jail.
Her crime?
[[Page S7392]]
Support for reform and democracy in one of the world's most isolated
and repressive countries.
One of the world's great democrats is currently being held by a
military junta disingenuously named State Peace and Development
Council. Late last week, the Junta announced that it had Suu Kyi in
``protective custody.'' The truth, of course, is that she was beaten
with a bamboo pole and detained in an ambush that killed four of her
supporters. Several observers noted that her arrest is the latest in a
vicious and coordinated attack which has claimed 70 of her supporters.
This is evidence of the junta's deplorable disregard for
international standards of decency and for the people it rules. It also
tells us what we can expect from the junta. A year ago, after Suu Kyi
was released from her 15 year long detention, there was a glimmer of
hope for reform and democracy in Burma. Rather than re-engaging the
world, however, the junta holds fast to its failed policies of the
past.
The Special Envoy from the United Nations is scheduled to travel to
Burma this weekend as part of a larger effort to promote democracy. Yet
with its actions this past week, the SPDC confirms what we had all
feared--and what Suu Kyi warned: the military junta in power in Burma
cannot and will not take the necessary steps to bring about democracy
and freedom. I hope the UN Envoy will make clear his disappointment,
indeed the world's disappointment, with these latest developments.
Given the gravity of this situation in Burma, I am pleased to join
with Senators Feinstein and McConnell, among others, in introducing
legislation that underscores the depth of our concern and the strength
of our resolve in ensuring democracy in Burma. The bill would ban
imports from Burma, freeze SPDC assets in this country, tighten the
visa ban on Burmese officials, and urge specific diplomatic steps to
raise the importance of this issue with our friends in the
international community.
In the National Security Strategy, President Bush proclaimed that
``our first imperative is to clarify what we stand for: the United
States must defend liberty and justice because these principles are
right and true for all people everywhere. No nation owns these
aspirations, and no nation is exempt from them . . . We will champion
the cause of human dignity and oppose those who resist it.'' The SPDC
is doing everything it can to rob the Burmese people of liberty, of
justice, and of human dignity. It is time for the Senate to make clear
just where the United States stands in the face of this injustice.
Mrs. FEINSTEIN. Mr. President, I rise along with my distinguished
colleague from Kentucky, Senator McConnell, to introduce the Burmese
Freedom and Democracy Act of 2003, which would establish a complete
import ban on all products from Burma.
On May 30, Aung San Suu Kyi and at least 17 officials of the National
League for Democracy, NLD, were detained after a clash in the town of
Ye-u, after reportedly being attacked by members of the Union
Solidarity Development Association, a paramilitary organization created
by the ruling military junta, the State Peace and Development Council,
SPDC.
Four people were killed and 50 injured in the attacks. Aung San Suu
Kyi has been officially placed in ``protective custody'', but her
whereabouts remain unconfirmed.
Still more disturbing are reports in today's Washington Post that Suu
Kyi may have suffered a head wound and a broken arm in the attacks and
is possibly being held at a military hospital near Rangoon. The
military junta continues to insist that she is in good health and in a
``safe place'', yet they are unwilling to allow independent
verification of Suu Kyi's condition.
One year ago the military junta freed Suu Kyi following 19 months of
house arrest, while promising cooperation and dialogue toward political
accommodation. Had I discussed Burma on the floor of the Senate back
then, I would have sounded a note of cautious optimism, echoing Aung
San Suu Kyi's own statement that ``it's a new dawn for the country''.
But as the events of May 30 have so tragically illustrated, the SPDC
have broken every promise to work towards political dialogue and, in
fact, have launched a new campaign of repression.
Given the military regime's utter contempt for the welfare and safety
of its people and the repeated and ongoing human rights abuses against
Aung San Suu Kyi and the members of the NLD, I now feel we have no
choice but to strengthen the sanctions imposed in 1997.
The actions of the SPDC are simply outrageous and I join the State
Department, the United Nations and the many voices from around the
world in demanding that Suu Kyi and the others be released immediately,
and to allow the U.N. Special Rapporteur on Human Rights in Burma to
conduct an independent investigation into the attack on Aung San Suu
Kyi and her party.
Not content to stop with arresting the leadership of the NLD, the
regime has tightened its crackdown on the pro-democracy movement,
closing universities and shutting down at least six NLD offices. In
addition, two NLD leaders have been arrested on charges of
``subversion''.
Let us recall, the NLD overwhelmingly won Burma's national elections
in 1990. The NLD are Burma's rightful leaders, not the military junta
which seized power in 1988, crushing a widespread popular uprising.
Such actions are only the tip of the iceberg of the regime's
brutality. According to the Council on Foreign Relations Task Force
report on Burma, which both the Senator from Kentucky, and I had the
honor of serving on, gross human rights violations continue under the
SPDC: over 1,300 political prisoners are still in jail; the practice of
rape as a form of repression has been sanctioned by the Burmese
military; the use of forced labor is widespread; trafficking in young
boys and girls as sex slaves is rampant; the government engages in the
production and distribution of opium and methamphetamine.
In addition, the report notes that because of SPDC mismanagement, the
Burmese economy is in shambles, with poor rice harvests and, most
recently, a February 2003 financial crisis sparked by government
closure of private deposit companies.
In the face of such brutality it is imperative that the United States
take strong and decisive action to express our disapproval of the SPDC
and its tactics, and our support of those forces working for peace in
Burma.
The United States must act. Although in general I do not support the
use of trade embargoes as an effective instrument of foreign policy, in
certain circumstances and when faced with certain conditions I believe
they are necessary and proper and can, in fact, provide effective
leverage.
Burma, I believe, is such a case and an import ban is a proper and
much needed step to take.
Our legislation: imposes a complete ban on all imports from Burma
until the President determines and certifies to Congress that Burma has
made substantial and measurable progress on a number of democracy and
human rights issues; allows the President to waive the import ban
should he determine and notify Congress that it is in the national
security interests of the United States to do so; allows the President
to waive any provision of the bill found to be in violation of any
international obligations of the U.S. pursuant to World Trade
Organization dispute settlement procedures; freezes the assets of the
Burmese regime in the United States; directs United States executive
directors at international financial institutions to vote against loans
to the Burma; expands the visa ban against the past and present
leadership of the military junta; encourages the Secretary of State to
highlight the abysmal record of the SPDC in the international
community, and; authorizes the President to use all available resources
to assist democracy activists in Burma.
Both business and labor are united in support of a ban. The American
Apparel and Footwear Association, which represents apparel, footwear,
and sewn products companies and their suppliers, has called for a ban.
President and CEO Kevin M. Burke stated, ``The government of Burma
continues to abuse its citizens through force and intimidation, and
refuses to respect the basic human rights of its
[[Page S7393]]
people. AAFA believes this unacceptable behavior should be met with
condemnation from not only the international public community, but from
private industry as well.''
A number of stores, including Saks, Macy's, Bloomingdales, Ames, and
The Gap have already voluntarily stopped importing or selling goods
from Burma. The AFL-CIO and other labor groups also support a ban.
In addition, the international Labor Organization, for the first time
in its history, called on all ILO members to impose sanctions on Burma.
Such diversity in support of this legislation speaks volumes about
the brutality of the SPDC regime and its single-minded unwillingness to
take even a modest step towards democracy and national reconciliation.
Currently, Burma exports approximately $400 million in goods per year
to the United States. These exports are the regime's major source of
foreign currency. Rest assured, the regime will take notice if this
bill becomes law.
As events of the past few days have shown, all other avenues have
been tried and failed. There is no other resource but to introduce this
legislation, that would put pressure on the military junta to cease its
violations of human rights and respect the free will of the Burmese
people as expressed in the 1990 elections.
We must make a stand on the side of the people of Burma. I urge my
colleagues to support this bill.
I ask unanimous consent that the text of the bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1182
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 ``Burmese Freedom and
Democracy Act of 2003''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The State Peace and Development Council (SPDC) has
failed to transfer power to the National League for Democracy
(NLD) whose parliamentarians won an overwhelming victory in
the 1990 elections in Burma.
(2) The SPDC has failed to enter into meaningful, political
dialogue with the NLD and ethnic minorities and has dismissed
the efforts of United Nations Special Envoy Razali bin Ismail
to further such dialogue.
(3) According to the State Department's ``Report to the
Congress Regarding Conditions in Burma and U.S. Policy Toward
Burma'' dated March 28, 2003, the SPDC has become ``more
confrontational'' in its exchanges with the NLD.
(4) On May 30, 2003, the SPDC, threatened by continued
support for the NLD throughout Burma, brutally attacked NLD
supporters, killed and injured scores of civilians, and
arrested democracy advocate Aung San Suu Kyi and other
activists.
(5) The SPDC continues egregious human rights violations
against Burmese citizens, uses rape as a weapon of
intimidation and torture against women, and forcibly
conscripts child-soldiers for the use in fighting indigenous
ethnic groups.
(6) The SPDC has demonstrably failed to cooperate with the
United States in stopping the flood of heroin and
methamphetamines being grown, refined, manufactured, and
transported in areas under the control of the SPDC serving to
flood the region and much of the world with these illicit
drugs.
(7) The SPDC provides safety, security, and engages in
business dealings with narcotics traffickers under indictment
by United States authorities, and other producers and
traffickers of narcotics.
(8) The International Labor Organization (ILO), for the
first time in its 82-year history, adopted in 2000, a
resolution recommending that governments, employers, and
workers organizations take appropriate measures to ensure
that their relations with the SPDC do not abet the
government-sponsored system of forced, compulsory, or slave
labor in Burma, and that other international bodies
reconsider any cooperation they may be engaged in with Burma
and, if appropriate, cease as soon as possible any activity
that could abet the practice of forced, compulsory, or slave
labor.
(9) The SPDC has integrated the Burmese military and its
surrogates into all facets of the economy effectively
destroying any free enterprise system.
(10) Investment in Burmese companies and purchases from
them serve to provide the SPDC with currency that is used to
finance its instruments of terror and repression against the
Burmese people.
(11) On April 15, 2003, the American Apparel and Footwear
Association expressed its ``strong support for a full and
immediate ban on U.S. textiles, apparel and footwear imports
from Burma'' and called upon the United States Government to
``impose an outright ban on U.S. imports'' of these items
until Burma demonstrates respect for basic human and labor
rights of its citizens.
(12) The policy of the United States, as articulated by the
President on April 24, 2003, is to officially recognize the
NLD as the legitimate representative of the Burmese people as
determined by the 1990 election.
SEC. 3. BAN AGAINST TRADE THAT SUPPORTS THE MILITARY REGIME
OF BURMA.
(a) General Ban.--
(1) In general.--Notwithstanding any other provision of
law, until such time as the President determines and
certifies to Congress that Burma has met the conditions
described in paragraph (3), no article may be imported into
the United States that is produced, mined, manufactured,
grown, or assembled in Burma.
(2) Ban on imports from certain companies.--The import
restrictions contained in paragraph (1) shall apply to, among
other entities--
(A) the SPDC, any ministry of the SPDC, a member of the
SPDC or an immediate family member of such member;
(B) known narcotics traffickers from Burma or an immediate
family member of such narcotics trafficker;
(C) the Union of Myanmar Economics Holdings Incorporated
(UMEHI) or any company in which the UMEHI has a fiduciary
interest;
(D) the Myanmar Economic Corporation (MEC) or any company
in which the MEC has a fiduciary interest;
(E) the Union Solidarity and Development Association
(USDA); and
(F) any successor entity for the SPDC, UMEHI, MEC, or USDA.
(3) Conditions described.--The conditions described in this
paragraph are the following:
(A) The SPDC has made substantial and measurable progress
to end violations of internationally recognized human rights
including rape, and the Secretary of State, after
consultation with the ILO Secretary General and relevant
nongovernmental organizations, reports to the appropriate
congressional committees that the SPDC no longer
systematically violates workers rights, including the use of
forced and child labor, and conscription of child-soldiers.
(B) The SPDC has made measurable and substantial progress
toward implementing a democratic government including--
(i) releasing all political prisoners;
(ii) allowing freedom of speech and the press;
(iii) allowing freedom of association;
(iv) permitting the peaceful exercise of religion; and
(v) bringing to a conclusion an agreement between the SPDC
and the democratic forces led by the NLD and Burma's ethnic
nationalities on the transfer of power to a civilian
government accountable to the Burmese people through
democratic elections under the rule of law.
(C) Pursuant to the terms of section 706 of the Foreign
Relations Authorization Act, Fiscal Year 2003 (Public Law
107-228), Burma has not failed demonstrably to make
substantial efforts to adhere to its obligations under
international counternarcotics agreements and to take other
effective counternarcotics measures, including the arrest and
extradition of all individuals under indictment in the United
States for narcotics trafficking, and concrete and measurable
actions to stem the flow of illicit drug money into Burma's
banking system and economic enterprises and to stop the
manufacture and export of methamphetamines.
(4) Appropriate congressional committees.--In this
subsection, the term ``appropriate congressional committees''
means the Committees on Foreign Relations and Appropriations
of the Senate and the Committees on International Relations
and Appropriations of the House of Representatives.
(b) Waiver Authorities.--
(1) In general.--The President may waive the prohibitions
described in this section for any or all products imported
from Burma to the United States if the President determines
and notifies the Committees on Appropriations and Foreign
Relations of the Senate and the Committees on Appropriations
and International Relations of the House of Representatives
that to do so is in the national security interest of the
United States.
(2) International obligations.--The President may waive any
provision of this Act found to be in violation of any
international obligations of the United States pursuant to
any final ruling relating to Burma under the dispute
settlement procedures of the World Trade Organization.
(c) Duration of Trade Ban.--The President may terminate the
restrictions contained in this Act upon the request of a
democratically elected government in Burma, provided that all
the conditions in subsection (a)(3) have been met.
SEC. 4. FREEZING ASSETS OF THE BURMESE REGIME IN THE UNITED
STATES.
Not later than 60 days after the date of enactment of this
Act, the Secretary of the Treasury shall direct, and
promulgate regulations to the same, that any United States
financial institution holding funds belonging to the SPDC or
the assets of those individuals who hold senior positions in
the SPDC or its political arm, the Union Solidarity
Development Association, shall promptly report those assets
to the Office of Foreign Assets Control. The Secretary of the
Treasury may take such action as may be necessary to secure
such assets or funds.
[[Page S7394]]
SEC. 5. LOANS AT INTERNATIONAL FINANCIAL INSTITUTIONS.
The Secretary of the Treasury shall instruct the United
States executive director to each appropriate international
financial institution in which the United States
participates, to oppose, and vote against the extension by
such institution of any loan or financial or technical
assistance to Burma until such time as the conditions
described in section 3(a)(3) are met.
SEC. 6. EXPANSION OF VISA BAN.
(a) In General.--
(1) Visa ban.--The President is authorized to deny visas
and entry to the former and present leadership of the SPDC or
the Union Solidarity Development Association.
(2) Updates.--The Secretary of State shall coordinate on a
biannual basis with representatives of the European Union to
ensure that an individual who is banned from obtaining a visa
by the European Union for the reasons described in paragraph
(1) is also banned from receiving a visa from the United
States.
(b) Publication.--The Secretary of State shall post on the
Department of State's website the names of individuals whose
entry into the United States is banned under subsection (a).
SEC. 7. CONDEMNATION OF THE REGIME AND DISSEMINATION OF
INFORMATION.
(a) In General.--Congress encourages the Secretary of State
to highlight the abysmal record of the SPDC to the
international community and use all appropriate fora,
including the Association of Southeast Asian Nations Regional
Forum and Asian Nations Regional Forum, to encourage other
states to restrict financial resources to the SPDC and
Burmese companies while offering political recognition and
support to Burma's democratic movement including the National
League for Democracy and Burma's ethnic groups.
(b) United States Embassy.--The United States embassy in
Rangoon shall take all steps necessary to provide access of
information and United States policy decisions to media
organs not under the control of the ruling military regime.
SEC. 8. SUPPORT DEMOCRACY ACTIVISTS IN BURMA.
(a) In General.--The President is authorized to use all
available resources to assist Burmese democracy activists
dedicated to nonviolent opposition to the regime in their
efforts to promote freedom, democracy, and human rights in
Burma, including a listing of constraints on such
programming.
(b) Reports.--
(1) First report.--Not later than 3 months after the date
of enactment of this Act, the Secretary of State shall
provide the Committees on Appropriations and Foreign
Relations of the Senate and the Committees on Appropriations
and International Relations of the House of Representatives a
comprehensive report on its short- and long-term programs and
activities to support democracy activists in Burma, including
a list of constraints on such programming.
(2) Report on resources.--Not later than 6 months after the
date of enactment of this Act, the Secretary of State shall
provide the Committees on Appropriations and Foreign
Relations of the Senate and the Committees on Appropriations
and International Relations of the House of Representatives a
report identifying resources that will be necessary for the
reconstruction of Burma, after the SPDC is removed from
power, including--
(A) the formation of democratic institutions;
(B) establishing the rule of law;
(C) establishing freedom of the press;
(D) providing for the successful reintegration of military
officers and personnel into Burmese society; and
(E) providing health, educational, and economic
development.
______
By Mr. KYL (for himself and Mr. Wyden):
S. 1183. A bill to develop and deploy technologies to defeat Internet
jamming and censorship, and for other purposes; to the Committee on
Foreign Relations.
Mr. KYL. Mr. President, I ask unanimous consent that the ``Global
Internet Freedom Act of 2003'' be printed in today's Congressional
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1183
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 ``Global Internet Freedom Act
of 2003''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Freedom of speech, freedom of the press, and freedom of
association are fundamental characteristics of a free
society. The first amendment to the Constitution of the
United States guarantees that ``Congress shall make no law .
. . abridging the freedom of speech, or of the press; or the
right of the people peaceably to assemble.''. These
constitutional provisions guarantee the rights of Americans
to communicate and associate with one another without
restriction, including unfettered communication and
association via the Internet. Article 19 of the United
Nation's Universal Declaration of Human Rights explicitly
guarantees the freedom to ``receive and impart information
and ideas through any media and regardless of frontiers''.
(2) All people have the right to communicate freely with
others, and to have unrestricted access to news and
information, on the Internet.
(3) With nearly 10 percent of the world's population now
online, and more gaining access each day, the Internet stands
to become the most powerful engine for democratization and
the free exchange of ideas ever invented.
(4) Unrestricted access to news and information on the
Internet is a check on repressive rule by authoritarian
regimes around the world.
(5) The governments of Burma, Cuba, Laos, North Korea, the
People's Republic of China, Saudi Arabia, Syria, and Vietnam,
among others, are taking active measures to keep their
citizens from freely accessing the Internet and obtaining
international political, religious, and economic news and
information.
(6) Intergovernmental, nongovernmental, and media
organizations have reported the widespread and increasing
pattern by authoritarian governments to block, jam, and
monitor Internet access and content using methods that
include--
(A) firewalls, filters, and ``black boxes'';
(B) surveillance of e-mail messages and message boards;
(C) the use of particular words to identify content to be
monitored;
(D) ``stealth blocking'' individuals from visiting
websites;
(E) the development of ``black lists'' of users that visit
certain websites; and
(F) the denial of access to the Internet.
(7) The transmission of the Voice of America and Radio Free
Asia, as well as hundreds of news sources with an Internet
presence, are routinely being jammed by repressive
governments.
(8) Since the 1940s, the United States has deployed anti-
jamming technologies to make Voice of America and other
United States Government sponsored broadcasting available to
people in nations with governments that seek to block news
and information.
(9) The United States Government has thus far commenced
only modest steps to fund and deploy technologies to defeat
Internet censorship. As of January 2003, the Voice of America
and Radio Free Asia have committed a total of $1,000,000 for
technology to counter Internet jamming by the People's
Republic of China. This technology, which has been successful
in attracting 100,000 electronic hits per day from the
People's Republic of China, has been relied upon by Voice of
America and Radio Free Asia to ensure access to their
programming by citizens of the People's Republic of China,
but United States Government financial support for the
technology has lapsed. In most other countries there is no
meaningful United States support for Internet freedom.
(10) The success of United States policy in support of
freedom of speech, press, and association requires new
initiatives to defeat totalitarian and authoritarian controls
on news and information over the Internet.
SEC. 3. PURPOSES.
The purposes of this Act are--
(1) to adopt an effective and robust global Internet
freedom policy;
(2) to establish an office within the International
Broadcasting Bureau with the sole mission of countering
Internet jamming and blocking by repressive regimes;
(3) to expedite the development and deployment of
technology to protect Internet freedom around the world;
(4) to authorize the commitment of a substantial portion of
United States international broadcasting resources to the
continued development and implementation of technologies to
counter the jamming of the Internet;
(5) to utilize the expertise of the private sector in the
development and implementation of such technologies, so that
the many current technologies used commercially for securing
business transactions and providing virtual meeting space can
be used to promote democracy and freedom; and
(6) to bring to bear the pressure of the free world on
repressive governments guilty of Internet censorship and the
intimidation and persecution of their citizens who use the
Internet.
SEC. 4. DEVELOPMENT AND DEPLOYMENT OF TECHNOLOGIES TO DEFEAT
INTERNET JAMMING AND CENSORSHIP.
(a) Establishment of Office of Global Internet Freedom.--
There is established in the International Broadcasting Bureau
the Office of Global Internet Freedom (hereinafter in this
section referred to as the ``Office''). The Office shall be
headed by a Director who shall develop and implement a
comprehensive global strategy to combat state-sponsored and
state-directed jamming of the Internet and persecution of
those who use the Internet.
(b) Authorization of Appropriations.--There are authorized
to be appropriated to the Office $30,000,000 for each of the
fiscal years 2004 and 2005.
(c) Cooperation of Other Federal Departments and
Agencies.--The head of each department and agency of the
United States Government shall cooperate fully with, and
assist in the implementation of, the strategy developed by
the Director of the Office and
[[Page S7395]]
shall make such resources and information available to the
Director as is necessary for the achievement of the purposes
of this Act.
(d) Report to Congress.--
(1) In general.--On March 1 following the date of enactment
of this Act, and annually thereafter, the Director of the
Office shall submit to Congress a report on the status of
state interference with Internet use and of efforts by the
United States to counter such interference.
(2) Content.--Each report required by paragraph (1) shall--
(A) list the countries that pursue policies of Internet
censorship, blocking, and other abuses;
(B) provide information concerning the government agencies
or quasi-governmental organizations that implement Internet
censorship; and
(C) describe with the greatest particularity practicable
the technological means by which such blocking and other
abuses are accomplished.
(3) Forms of report.--In the discretion of the Director, a
report required by paragraph (1) may be submitted in both a
classified and a nonclassified form.
(e) Limitation on Authority.--Nothing in this Act shall be
interpreted to authorize any action by the United States to
interfere with foreign national censorship in furtherance of
legitimate law enforcement aims that is consistent with the
United Nation's Universal Declaration of Human Rights.
SEC. 5. SENSE OF CONGRESS.
It is the sense of Congress that the United States
should--
(1) publicly, prominently, and consistently denounce
governments that restrict, censor, ban, and block access to
information on the Internet;
(2) direct the United States Representative to the United
Nations to submit a resolution at the first annual meeting of
the United Nations Human Rights Commission after the date of
enactment of this Act that condemns all governments that
practice Internet censorship and deny individuals the freedom
to access and share information; and
(3) deploy, at the earliest practicable date, technologies
aimed at defeating state-directed Internet censorship and the
persecution of those who use the Internet.
______
By Mr. SMITH (for himself, Mrs Clinton, Mrs. Murray, Mr.
Fitzgerald, and Mr. Lautenberg):
S. 1184. A bill to establish a National Foundation for the Study of
Holocaust Assets; to the Committee on Banking, Housing, and Urban
Affairs.
Mr. SMITH. Mr. President, I rise today to introduce the Holocaust
Victims' Assets, Restitution Policy, and Remembrance Act of 2003. In
this effort, I am joined by my colleagues: Senator Clinton from New
York, Senator Murray from Washington, Senator, Lautenberg, from New
Jersey and Senator Dodd from Connecticut. I appreciate their support
for this important legislation.
We are motivated by a desire to achieve justice for Holocaust victims
and their families, and we recognize that if such justice is to be
attained, the United States must continue to lead the world by example.
The United States has provided leadership in this area ever since
American troops liberated the death camps in Nazi Germany. This
legislation recognizes that the struggle for justice requires continued
American leadership and that the Foundation is the appropriate
mechanism for that leadership.
The purpose of this act is to create a public/private Foundation
dedicated to supporting research and education in the area of
Holocaust-era assets and restitution policy and promoting innovative
solutions to restitution issues.
The need for the Foundation arises from the findings of the
Presidential advisory Commission on Holocaust Assets in the United
States. I was proud to serve as commissioner on that Commission. The
Commission identified several policy initiatives that require U.S.
leadership, including: creating mechanisms to assist claimants in
obtaining resolution of claims; supporting databases of victims' claims
for the restitution of personal property; reviewing the degree to which
other nations have adhered to agreements reached at international
conferences on Holocaust issues; synthesizing the work of other
national commissions throughout the world; supporting further research
and review of Holocaust-era assets; and disseminating information about
restitution programs to survivors and their families.
If the nations of the world are to be convinced of our lasting
commitment to justice for Holocaust victims and if continued work on
Holocaust assets issues is to be truly effective, the Foundation must
have the stamp of the Federal Government. But the Federal Government
cannot, and should not, perform these tasks by itself. It will
coordinate the efforts of the Federal Government, State governments,
the private sector and individuals here, and abroad, to help people
locate and identify assets who would otherwise have no ability to do
so. It will encourage policy makers to deal with contemporary
restitution issues, including how best to treat unclaimed assets.
Each passing day reveals the existence of still unclaimed assets.
This bill will create an institution able to provide the academic
center of research into this area of continuing importance. It will
also show that the United States is willing to ask of itself no less
than it asks of the international community.
The restitution of property is part of a larger process of obtaining
a measure of justice for the victims of Europe's major human disasters
of the 20th century--fascism and communism. Justice for these
individuals is long overdue. Having had justice delayed for so long,
they are entitled to expect that democratic governments will move
promptly to bring closure during their lifetimes.
I ask unanimous consent that the text of the Holocaust Victims'
assets, Restitution Policy, and Remembrance Act of 2003 be printed in
the Record.
S. 1184
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 ``Holocaust Victims' Assets,
Restitution Policy, and Remembrance Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The United States should continue to lead the
international effort to identify, protect, and return looted
assets taken by the Nazis and their collaborators from
victims of the Holocaust.
(2) The citizens of the United States should understand
exactly how the United States Government dealt with the
assets looted from victims of the Nazis that came into its
possession.
(3) The United States forces in Europe made extraordinary
efforts to locate and restitute assets taken by the Nazis and
their collaborators from victims of the Holocaust.
(4) However, the restitution policy formulated by the
United States and implemented in the countries in Europe
occupied by the United States had many inadequacies and fell
short of realizing the goal of returning stolen property to
the victims.
(5) As a result of these United States policies and their
implementation, there remain today many survivors or heirs of
survivors who have not had restored to them that which the
Nazis looted.
(6) The Presidential Advisory Commission on Holocaust
Assets in the United States, established in Public Law 105-
186, found the following:
(A) Despite the undertaking by United States agencies to
preserve, protect, and return looted assets, United States
restitution policy could never fully address the unimaginable
dimension and complexity of restituting assets to victims of
the Holocaust. Many inadequacies reveal that United States
authorities were driven by necessity, and practical concerns
of restitution commingled with conflicting interests,
priorities, and political considerations. Restitution
competed with, and was often subordinated to, the desire to
bring American troops home, the need to rebuild devastated
European economies, and provide humanitarian assistance to
millions of displaced persons, and the Cold War.
(B) With respect to many types of assets, the United States
followed international legal tradition and undertook only to
restore property to national governments, which it assumed
would be responsible for satisfying the claims of their
citizens. Because this practice excluded those who no longer
had a nation to represent their interests, or who had fallen
victim to the Nazi genocide, the United States also
designated certain ``successor organizations'' to sell
heirless and unclaimed property and apply the proceeds to the
care, resettlement, and rehabilitation of surviving victims.
This practice led many assets to be too hastily labeled as
heirless or unidentifiable, with the result that they were
assigned to the successor organizations, rather than returned
to their rightful owners.
(C) Far more regrettable is the United States failure to
adequately assist victims, heirs, and successor organizations
to identify victims' assets, instead relying upon them to
present their own claims, often within unrealistically short
deadlines, with the result that much victim property was
never recovered.
(D) Even when property was returned to individual owners or
their heirs, it was often only after protracted, cumbersome,
and expensive administrative proceedings that yielded
settlements far less than the full value of the assets
concerned.
(E) While the overall record of the United States is one in
which its citizens can legitimately take pride, even the most
farsighted
[[Page S7396]]
and best-intentioned policies intended to restitute stolen
property to its country of origin failed to realize the goal
of returning property to the victims who suffered the loss.
(F) In many instances, policy and circumstance combined and
led to results that can be improved upon now, to provide a
modicum of justice to Holocaust victims and their heirs and
in memory of those who did not survive.
(7) The United States Government should promote both the
review of Holocaust-era assets in Federal, State, and private
institutions, and the return of such assets to victims or
their heirs.
(8) The best way to achieve this is to create a single
institution to serve as a centralized repository for research
and information about Holocaust-era assets.
(9) Enhancing these policies will also assist victims of
future armed conflicts around the world.
(10) The Government of the United States has worked to
address the consequences of the National Socialist era with
other governments and nongovernmental organizations,
including the Conference on Jewish Material Claims Against
Germany, which has worked since 1951 with the Government of
the United States and with other governments to accomplish
material restitution of the looted assets of Holocaust
victims, wherever those assets were identified, and has
played a major role in allocating restitution funds and funds
contributed by the United States and other donor countries to
the Nazi Persecutee Relief Fund.
SEC. 3. ESTABLISHMENT AND PURPOSES.
(a) Establishment.--There is established a National
Foundation for the Study of Holocaust Assets (in this Act
referred to as the ``Foundation'').
(b) Purposes.--The purposes of the Foundation are--
(1) to serve as a centralized repository for research and
information about Holocaust-era assets by--
(A) compiling and publishing a comprehensive report that
integrates and supplements where necessary the research on
Holocaust-era assets prepared by various countries'
commissions on the Holocaust;
(B) working with the Department of State's Special Envoy
for Holocaust Issues to review the degree to which foreign
governments have implemented the principles adopted at the
Washington Conference on Holocaust-era Assets and the Vilnius
International Forum on Holocaust-era Looted Cultural
Property, and should encourage the signatories that have not
yet implemented those principles to do so; and
(C) collecting and disseminating information about
restitution programs around the world;
(2) to create tools to assist individuals and institutions
to determine the ownership of Holocaust victims' assets and
to enable claimants to obtain the speedy resolution of their
personal property claims by--
(A) ensuring the implementation of the agreements entered
into by the Presidential Advisory Commission on Holocaust
Assets in the United States with the American Association of
Museums and the Association of Art Museum Directors to
provide for the establishment and maintenance of a searchable
central registry of Holocaust-era cultural property in the
United States, beginning with European paintings and Judaica;
(B) funding grants to museums, libraries, universities, and
other institutions that hold Holocaust-era cultural property
and adhere to the agreements referred to in subparagraph (A),
to conduct provenance research;
(C) encouraging the creation and maintenance of mechanisms
such as an Internet-based, searchable portal of Holocaust
victims' claims for the restitution of personal property;
(D) funding a cross match of records developed by the 50
States of escheated property from the Holocaust era against
databases of victims' names and publicizing the results of
this effort;
(E) assisting State governments in the preservation and
automation of records of unclaimed property that may include
Holocaust-era property; and
(F) regularly publishing lists of Holocaust-era artworks
returned to claimants by museums in the United States;
(3) to work with private sector institutions to develop and
promote common standards and best practices for research and
information gathering on Holocaust-era assets by--
(A) promoting and monitoring banks' implementation of the
suggested best practices developed by the Presidential
Advisory Commission on Holocaust Assets in the United States
and the New York Bankers' Association;
(B) promoting the development of common standards and best
practices for research by United States corporations into
their records concerning whether they conducted business with
Nazi Germany in the period preceding the onset of hostilities
in December 1941;
(C) encouraging the International Commission on Holocaust
Era Insurance Claims (ICHEIC) to prepare a report on the
results of its claims process; and
(D) promoting the study and development of policies
regarding the treatment of cultural property in circumstances
of armed conflict; and
(4) other purposes the Board considers appropriate.
SEC. 4. BOARD OF DIRECTORS.
(a) Membership and Terms.--The Foundation shall have a
Board of Directors (in this Act referred to as the
``Board''), which shall consist of 17 members, each of whom
shall be a United States citizen.
(b) Appointment.--Members of the Board shall be appointed
as follows:
(1) Nine members of the Board shall be representatives of
government departments, agencies and establishments,
appointed by the President, by and with the advice and
consent of the Senate as follows:
(A) One representative each from the Department of State,
Department of Justice, Department of the Treasury, Department
of the Army, National Archives and Records Administration,
and Library of Congress.
(B) One representative each from the United States
Holocaust Memorial Council, National Gallery of Art, and
National Foundation on the Arts and Humanities.
(2) Eight members of the Board shall be individuals who
have a record of demonstrated leadership relating to the
Holocaust or in the fields of commerce, culture, or
education, appointed by the President, by and with the advice
and consent of the Senate, after consideration of the
recommendations of the congressional leadership, as follows:
(A) Two members each shall be appointed after consideration
of the recommendations of the Majority Leader of the Senate
and after consideration of the recommendations of the
Minority Leader of the Senate.
(B) Two members each shall be appointed after consideration
of the recommendations of the Speaker of the House of
Representatives and after consideration of the
recommendations of the Minority Leader of the House of
Representatives.
(c) Chairman.--The President shall appoint a Chair from
among the members of the Board.
(d) Quorum and Voting.--A majority of the membership of the
Board shall constitute a quorum for the transaction of
business. Voting shall be by simple majority of those members
voting.
(e) Meetings and Consultations.--The Board shall meet at
the call of the Chairman at least twice a year. Where
appropriate, members of the Board shall consult with relevant
agencies of the Federal Government, and with the United
States Holocaust Memorial Council and Museum.
(f) Reimbursements.--Members of the Board shall serve
without pay, but shall be reimbursed for the actual and
necessary traveling and subsistence expenses incurred by them
in the performance of the duties of the Foundation.
SEC. 5. OFFICERS AND EMPLOYEES.
(a) Executive Director.--The Foundation shall have an
Executive Director appointed by the Board and such other
officers as the Board may appoint. The Executive Director and
the other officers of the Foundation shall be compensated at
rates fixed by the Board and shall serve at the pleasure of
the Board.
(b) Employees.--Subject to the approval of the Board, the
Foundation may employ such individuals at such rates of
compensation as the Executive Director determines
appropriate.
(c) Volunteers.--Subject to the approval of the Board, the
Foundation may accept the services of volunteers in the
performance of the functions of the Foundation.
SEC. 6. FUNCTION AND CORPORATE POWERS.
The Foundation--
(1) may conduct business in the United States and abroad;
(2) shall have its principal offices in the District of
Columbia or its environs; and
(3) shall have the power--
(A) to accept, receive, solicit, hold, administer, and use
any gift, devise, or bequest, either absolutely or in trust,
of real or personal property or any income therefrom, or
other interest therein;
(B) to acquire by purchase or exchange any real or personal
property or interest therein;
(C) to sell, donate, lease, invest, reinvest, retain, or
otherwise dispose of any real or personal property or income
therefrom;
(D) to enter into contracts or other arrangements with
public agencies, private organizations, and other persons,
and to make such payments as may be necessary to carry out
its purposes; and
(E) to do any and all acts necessary and proper to carry
out the purposes of the Foundation.
SEC. 7. REPORTING REQUIREMENTS.
The Foundation shall, as soon as practicable after the end
of each fiscal year, transmit to Congress a report of its
proceedings and activities during that fiscal year, including
a full and complete statement of its receipts, expenditures,
and investments, and a description of all acquisition and
disposal of real property.
SEC. 8. ADMINISTRATIVE SERVICES AND SUPPORT.
The Secretary of the Treasury, the Secretary of Education,
the Secretary of State, and the heads of any other Federal
agencies may provide personnel, facilities, and other
administrative services to the Foundation.
SEC. 9. SUNSET PROVISION.
The Foundation shall exist until September 30, 2013, at
which time the Foundation's functions and research materials
and products shall be transferred to the United States
Holocaust Memorial Museum, or to other appropriate entities,
as determined by the Board.
SEC. 10. AUTHORIZATION OF APPROPRIATIONS.
(a) Authorization.--There are authorized to be appropriated
to the Foundation such
[[Page S7397]]
sums as may be necessary to carry out this Act.
(b) Limitation.--No funds appropriated to carry out this
Act may be used to pay attorneys' fees in the pursuit of
private claims.
______
By Mr. THOMAS (for himself, Mr. Harkin, Mr. Domenici, Mr.
Bingaman, Mr. Roberts, Mr. Dayton, Mr. Smith, Ms. Cantwell, Mr.
Inouye, Mr. Burns, Mr. Johnson, Mr. Enzi, Mrs. Lincoln, Ms.
Collins, Mr. Daschle, Mr. Hagel, and Mr. Conrad):
Mr. THOMAS. Mr. President, I am pleased to rise today to introduce
the ``Rural Provider Equity Act of 2003'' with Senator Harkin and other
members of the Senate Rural Health Caucus. This legislation
comprehensively addresses the Medicare payment issues of rural
physicians, rural health clinics, ambulance providers, home health
agencies, community health centers, mental health providers and other
critical mid-level clinicians.
The current Medicare program has many payment formula disparities
that are biased against rural providers, which result in them being
paid significantly less than their urban counterparts for the same
services. The geographic inequities that exist within the Medicare
program continually put rural providers at a disadvantage and adversely
affect seniors; access to a quality health care in these communities.
Many physicians are being forced to limit the number of Medicare
patients they serve because of poor reimbursement rates. The ``Rural
Providers Equity Act'' is necessary to adequately pay physicians to
they can continue caring for the elderly. In addition to establishing a
work geographic index of 1.0, physicians practicing in federally
designated Health Professional Shortage Areas will automatically start
receiving the Medicare ten percent bonus payment to which they are
entitled.
In recognition of the difficulties rural and frontier communities
face in recruiting and retaining primary care clinicians; this
legislation includes a provision providing tax exemptions to National
Health Service Corps, NHSC, loan-repayments. The NHSC provides
scholarships, loan-repayments, and stipends for clinicians who agree to
serve in nationally designated underserved urban and rural communities.
In the current NHSC loan program, recipients are given money to offset
their tax liabilities. If this money was made available, more
clinicians would be able to participate in the program and care for the
underserved.
Home health care agencies and ambulance services are critical
elements of the continuum of care in rural areas. These providers face
unique circumstances in the distances they are required to travel to
provide services. The current Medicare payment system does not make
adequate adjustments to reflect the reality of rural and frontier
health care. The ``Rural Provider Equity Act of 2003'' recognizes the
situation of these providers by increasing their Medicare payments to
better cover their costs of providing services to seniors.
By caring for folks in underserved areas, rural health clinics and
community health centers are a key component of the rural health care
delivery system. As not every small town can sustain a hospital, we
need to ensure these types of facilities are paid adequately and are
provided enough flexibility to meet the health care needs of the
communities they serve.
The ``Rural Providers Equity Act of 2003'' also permits mental health
counselors and marriage and family therapists to bill Medicare for
services provided to seniors. This will result in an increased choice
of mental health providers for seniors and enhance their ability to
access mental health services where they live.
Rural seniors are often forced to travel long distances to utilize
the services of mental health providers currently recognized by the
Medicare program. Rural communities have difficulty recruiting and
retaining providers, especially mental health providers. In many small
towns, a mental health counselor or a marriage and family therapist is
the only mental health care provider in the area. Medicare law--as it
exists today--compounds the situation because only psychiatrists,
clinical psychologists, clinical social workers and clinical nurse
specialists are able to bill Medicare for their services.
Virtually all of Wyoming is designated a mental health professional
shortage area and will greatly benefit from this legislation. Wyoming
has 174 psychologists, 37 psychiatrists and 263 clinical social workers
for a total of 474 Medicare eligible mental health providers. Enactment
of this provision will more than double the number of mental health
providers available to seniors in my state with the addition of 528
mental health counselors and 61 marriage and family therapists
currently licensed in the state.
Health care in rural America is at a critical juncture, and Congress
must act now so providers receive this down payment towards Medicare
equity to ensure rural seniors continue to have access to the health
care services they deserve. I urge all my colleagues interested in
rural health to cosponsor the ``Rural Provider Equity Act of 2003.''
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. 1185
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT;
TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Rural
Provider Equity Act of 2003''.
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act an amendment is
expressed in terms of an amendment to or repeal of a section
or other provision, the reference shall be considered to be
made to that section or other provision of the Social
Security Act.
(c) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; amendments to Social Security Act; table of
contents.
Sec. 2. Rural physician reimbursement improvements.
Sec. 3. Physician assistant, nurse practitioner, and clinical nurse
specialist improvements.
Sec. 4. Rural health clinic improvements.
Sec. 5. Extension of temporary increase for home health services
furnished in a rural area.
Sec. 6. Rural community health center improvements.
Sec. 7. Ensuring appropriate coverage of ambulance services under
ambulance fee schedule.
Sec. 8. Rural mental health care accessibility improvements.
Sec. 9. Rural health services research improvements.
Sec. 10. Exclusion for loan payments under National Health Service
Corps loan repayment program.
Sec. 11. Virtual pharmacist consultation service demonstration
projects.
SEC. 2. RURAL PHYSICIAN REIMBURSEMENT IMPROVEMENTS.
(a) Medicare Incentive Payment Program Improvements.--
(1) Procedures for secretary, and not physicians, to
determine when bonus payments under medicare incentive
payment program should be made.--Section 1833(m) (42 U.S.C.
1395l(m)) is amended--
(A) by inserting ``(1)'' after ``(m)''; and
(B) by adding at the end the following new paragraph:
``(2) The Secretary shall establish procedures under which
the Secretary, and not the physician furnishing the service,
is responsible for determining when a payment is required to
be made under paragraph (1).''.
(2) Educational program regarding the medicare incentive
payment program.--The Secretary of Health and Human Services
shall establish and implement an ongoing educational program
to provide education to physicians under the medicare program
on the medicare incentive payment program under section
1833(m) of the Social Security Act (42 U.S.C. 1395l(m)).
(3) Ongoing study and annual report on the medicare
incentive payment program.--
(A) Ongoing study.--The Secretary of Health and Human
Services shall conduct an ongoing study on the medicare
incentive payment program under section 1833(m) of the Social
Security Act (42 U.S.C. 1395l(m)). Such study shall focus on
whether such program increases the access of medicare
beneficiaries who reside in an area that is designated (under
section 332(a)(1)(A) of the Public Health Service Act (42
U.S.C. 254e(a)(1)(A))) as a health professional shortage area
to physicians' services under the medicare program.
(B) Annual reports.--Not later than 1 year after the date
of enactment of this Act, and annually thereafter, the
Secretary of Health and Human Services shall submit to
Congress a report on the study conducted under subparagraph
(A), together with recommendations for such legislation and
administrative actions as the Secretary considers
appropriate.
(b) Physician Fee Schedule Wage Index Revision.--Section
1848(e)(1) (42 U.S.C. 1395w-4(e)(1)) is amended--
[[Page S7398]]
(1) in subparagraph (A), by striking ``subparagraphs (B)
and (C)'' and inserting ``subparagraphs (B), (C), and (E)'';
and
(2) by adding at the end the following new subparagraph:
``(E) Floor for work geographic indices.--
``(i) In general.--After calculating the work geographic
indices in subparagraph (A)(iii) for a year (beginning with
2004), the Secretary shall increase the work geographic index
for the year to the applicable floor index for the year for
any locality for which such geographic index is less than
such applicable floor index.
``(ii) Applicable floor index.--For purposes of clause (i),
the term `applicable floor index' means--
``(I) 0.900 for services furnished during 2004;
``(II) 1.000 for services furnished during 2005 and
subsequent years.''.
SEC. 3. PHYSICIAN ASSISTANT, NURSE PRACTITIONER, AND CLINICAL
NURSE SPECIALIST IMPROVEMENTS.
(a) Broadening Medicare Beneficiaries Access to Home Health
Services and Hospice Care.--Section 1861(r) (42 U.S.C.
1395f(x)) is amended by adding at the end the following new
sentences: ``For purposes of sections 1814(a)(2)(C),
1814(a)(7)(B), 1835(a)(2)(A), 1861(m), 1861(dd), and
1895(c)(1), the term `physician' includes a nurse
practitioner, a clinical nurse specialist, and a physician
assistant (as such terms are defined in subsection (aa)(5))
who does not have a direct or indirect employment
relationship with the home health agency or hospice program
(as the case may be), and is legally authorized to perform
the services of a nurse practitioner, a clinical nurse
specialist, or a physician assistant (as the case may be) in
the jurisdiction in which the services are performed. For
purposes of the preceding sentence, the provisions of section
1833(a)(1)(O) shall continue to apply with respect to amounts
paid for services furnished by such a nurse practitioner, a
clinical nurse specialist, and a physician assistant.''.
(b) Skilled Nursing Facilities.--Section 1819(b)(6) (42
U.S.C. 1395i-3(b)(6)) is amended--
(1) in the paragraph heading, by inserting ``or nurse
practitioner'' after ``Physician''; and
(2) in subparagraph (A), by inserting ``or nurse
practitioner, including approving in writing a recommendation
that an individual be admitted to a skilled nursing facility,
admitting an individual to a skilled nursing facility, and
performing the initial admitting assessment and all visits
thereafter'' before the semicolon.
(c) Effective Date.--The amendments made by this section
shall take effect on January 1, 2004.
SEC. 4. RURAL HEALTH CLINIC IMPROVEMENTS.
(a) Improvement in Rural Health Clinic Reimbursement Under
Medicare.--Section 1833(f) (42 U.S.C. 1395l(f)) is amended--
(1) in paragraph (1), by striking ``, and'' at the end and
inserting a semicolon;
(2) in paragraph (2)--
(A) by striking ``in a subsequent year'' and inserting ``in
1989 through 2002''; and
(B) by striking the period at the end and inserting a
semicolon; and
(3) by adding at the end the following new paragraphs:
``(3) in 2003, at $82 per visit; and
``(4) in a subsequent year, at the limit established under
this subsection for the previous year increased by the
percentage increase in the MEI (as so defined) applicable to
primary care services (as so defined) furnished as of the
first day of that year.''.
(b) Exclusion of Certain Rural Health Clinic and Federally
Qualified Health Center Services From the Medicare
Prospective Payment System for Skilled Nursing Facilities.--
(1) In general.--Section 1888(e)(2)(A) (42 U.S.C.
1395yy(e)(2)(A)) is amended--
(A) in clause (i)(II), by striking ``clauses (ii) and
(iii)'' and inserting ``clauses (ii), (iii), and (iv)''; and
(B) by adding at the end the following new clause:
``(iv) Exclusion of certain rural health clinic and
federally qualified health center services.--Services
described in this clause are--
``(I) rural health clinic services (as defined in paragraph
(1) of section 1861(aa)); and
``(II) Federally qualified health center services (as
defined in paragraph (3) of such section);
that would be described in clause (ii) if such services were
not furnished by an individual affiliated with a rural health
clinic or a Federally qualified health center.''.
(2) Effective date.--The amendments made by subsection (a)
shall apply to services furnished on or after January 1,
2003.
SEC. 5. EXTENSION OF TEMPORARY INCREASE FOR HOME HEALTH
SERVICES FURNISHED IN A RURAL AREA.
(a) In General.--Section 508(a) of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000
(114 Stat. 2763A-533), as enacted into law by section 1(a)(6)
of Public Law 106-554, is amended--
(1) in the heading, by striking ``24-Month Increase
Beginning April 1, 2001'' and inserting ``In General'';
(2) by striking ``April 1, 2003'' and inserting ``April 1,
2004''; and
(3) by inserting before the period at the end the
following: ``(or 5 percent in the case of such services
furnished on or after April 1, 2003, and before April 1,
2004)''.
(b) Conforming Amendment.--Section 547(c)(2) of the
Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 (114 Stat. 2763A-553), as enacted into
law by section 1(a)(6) of Public Law 106-554, is amended by
striking ``the period beginning on April 1, 2001, and ending
on September 30, 2002,'' and inserting ``a period under such
section''.
(c) Retroactive Application.--The amendments made by this
section shall apply with respect to home health services
furnished in a rural area on or after April 1, 2003.
SEC. 6. RURAL COMMUNITY HEALTH CENTER IMPROVEMENTS.
(a) Delivery of Medicare-Covered Primary and Preventive
Services at Federally Qualified Health Centers.--
(1) Coverage of medicare-covered ambulatory services by
fqhcs.--Section 1861(aa)(3) (42 U.S.C. 1395x(aa)(3)) is
amended to read as follows:
``(3) The term `Federally qualified health center services'
means--
``(A) services of the type described in subparagraphs (A)
through (C) of paragraph (1), and such other services
furnished by a Federally qualified health center for which
payment may otherwise be made under this title if such
services were furnished by a health care provider or health
care professional other than a Federally qualified health
center; and
``(B) preventive primary health services that a center is
required to provide under section 330 of the Public Health
Service Act,
when furnished to an individual as a patient of a Federally
qualified health center and such services when provided by a
health care provider or health care professional employed by
or under contract with a Federally qualified health center
shall be treated as billable visits for purposes of payment
to the Federally qualified health center.''.
(2) Ensuring fqhc reimbursement under hospital and skilled
nursing facility prospective payment systems.--Section
1862(a)(14) (42 U.S.C. 1395y(a)) is amended by inserting
``Federally qualified health center services,'' after
``qualified psychologist services,''.
(3) Technical corrections.--Clauses (i) and (ii)(II) of
section 1861(aa)(4)(A) (42 U.S.C. 1395x(aa)(4)(A)) are each
amended by striking ``(other than subsection (h))''.
(4) Effective dates.--The amendments made--
(A) by paragraphs (1) and (2) shall apply to services
furnished on or after January 1, 2004; and
(B) by paragraph (3) shall take effect on the date of
enactment of this Act.
(b) Providing Safe Harbor for Certain Collaborative Efforts
That Benefit Medically Underserved Populations.--
(1) In general.--Section 1128B(b)(3) (42 U.S.C. 1320a-
7(b)(3)) is amended--
(A) in subparagraph (E), by striking ``and'' after the
semicolon at the end;
(B) in subparagraph (F), by striking the period at the end
and inserting ``; and''; and
(C) by adding at the end the following new subparagraph:
``(G) any remuneration between a public or nonprofit
private health center entity described under clause (i) or
(ii) of section 1905(l)(2)(B) and any individual or entity
providing goods, items, services, donations or loans, or a
combination thereof, to such health center entity pursuant to
a contract, lease, grant, loan, or other agreement, if such
agreement contributes to the ability of the health center
entity to maintain or increase the availability, or enhance
the quality, of services provided to a medically underserved
population served by the health center entity.''.
(2) Rulemaking for exception for health center entity
arrangements.--
(A) Establishment.--
(i) In general.--The Secretary of Health and Human Services
(in this paragraph referred to as the ``Secretary'') shall
establish, on an expedited basis, standards relating to the
exception described in section 1128B(b)(3)(G) of the Social
Security Act, as added by paragraph (1), for health center
entity arrangements to the antikickback penalties.
(ii) Factors to consider.--The Secretary shall consider the
following factors, among others, in establishing standards
relating to the exception for health center entity
arrangements under clause (i):
(I) Whether the arrangement between the health center
entity and the other party results in savings of Federal
grant funds or increased revenues to the health center
entity.
(II) Whether the arrangement between the health center
entity and the other party restricts or limits a patient's
freedom of choice.
(III) Whether the arrangement between the health center
entity and the other party protects a health care
professional's independent medical judgment regarding
medically appropriate treatment.
The Secretary may also include other standards and criteria
that are consistent with the intent of Congress in enacting
the exception established under this section.
(B) Interim final effect.--No later than 180 days after the
date of enactment of this Act, the Secretary shall publish a
rule in the Federal Register consistent with the factors
under subparagraph (A)(ii). Such rule shall be effective and
final immediately on an interim basis, subject to such change
and revision, after public notice and opportunity (for a
period of not more than 60 days) for public
[[Page S7399]]
comment, as is consistent with this paragraph.
SEC. 7. ENSURING APPROPRIATE COVERAGE OF AMBULANCE SERVICES
UNDER AMBULANCE FEE SCHEDULE.
(a) Air Ambulance Service.--
(1) Coverage.--Section 1834(l) (42 U.S.C. 1395m(l)) is
amended--
(A) by redesignating paragraph (8), as added by section
221(a) of Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000 (114 Stat. 2763A-486), as enacted
into law by section 1(a)(6) of Public Law 106-554, as
paragraph (9); and
(B) by adding at the end the following new paragraph:
``(10) Ensuring appropriate coverage of air ambulance
services.--
``(A) In general.--The regulations described in section
1861(s)(7) shall ensure that air ambulance services (as
defined in subparagraph (C)) are reimbursed under this
subsection at the air ambulance rate if the air ambulance
service--
``(i) is medically necessary based on the health condition
of the individual being transported at or immediately prior
to the time of the transport; and
``(ii) complies with equipment and crew requirements
established by the Secretary.
``(B) Medically necessary.--An air ambulance service shall
be considered to be medically necessary for purposes of
subparagraph (A)(i) if such service is requested--
``(i) by a physician or a hospital in accordance with the
physician's or hospital's responsibilities under section 1867
(commonly known as the `Emergency Medical Treatment and
Active Labor Act');
``(ii) as a result of a protocol established by a State or
regional emergency medical service (EMS) agency;
``(iii) by a physician, nurse practitioner, physician
assistant, registered nurse, or emergency medical responder
who reasonably determines or certifies that the patient's
condition is such that the time needed to transport the
individual by land or the lack of an appropriate ground
ambulance, significantly increases the medical risks for the
individual; or
``(iv) by a Federal or State agency to relocate patients
following a natural disaster, an act of war, or a terrorist
attack.
``(C) Air ambulance services defined.--For purposes of this
paragraph, the term `air ambulance service' means fixed wing
and rotary wing air ambulance services.''.
(2) Conforming Amendment.--Section 1861(s)(7) (42 U.S.C.
1395x(s)(7)) is amended by inserting ``, subject to section
1834(l)(10),'' after ``but''.
(b) Ground Ambulance Service.--
(1) Payment rates.--
(A) In general.--Section 1834(l)(3) (42 U.S.C. 1395m(l)(3))
is amended to read as follows:
``(3) Payment rates.--
``(A) In general.--Subject to any adjustment under
subparagraph (B) and paragraph (9) and the full payment of a
national mileage rate pursuant to paragraph (2)(E), in
establishing such fee schedule, the following rules shall
apply:
``(i) Payment rates in 2003.--
``(I) Ground ambulance services.--In the case of ground
ambulance services furnished under this part in 2003, the
Secretary shall set the payment rates under the fee schedule
for such services at a rate based on the average costs (as
determined by the Secretary on the basis of the most recent
and reliable information available) incurred by full cost
ambulance suppliers in providing nonemergency basic life
support ambulance services covered under this title, with
adjustments to the rates for other ground ambulance service
levels to be determined based on the rule established under
paragraph (1). For the purposes of the preceding sentence,
the term `full cost ambulance supplier' means a supplier for
which volunteers or other unpaid staff comprise less than 20
percent of the supplier's total staff and which receives less
than 20 percent of space and other capital assets free of
charge.
``(II) Other ambulance services.--In the case of ambulance
services not described in subclause (I) that are furnished
under this part in 2003, the Secretary shall set the payment
rates under the fee schedule for such services based on the
rule established under paragraph (1).
``(ii) Payment rates in subsequent years for all ambulance
services.--In the case of any ambulance service furnished
under this part in 2004 or any subsequent year, the Secretary
shall set the payment rates under the fee schedule for such
service at amounts equal to the payment rate under the fee
schedule for that service furnished during the previous year,
increased by the percentage increase in the Consumer Price
Index for all urban consumers (United States city average)
for the 12-month period ending with June of the previous
year.
``(B) Adjustment in rural rates.--For years beginning with
2004, the Secretary, after taking into consideration the
recommendations contained in the report submitted under
section 221(b)(3) the Medicare, Medicaid, and SCHIP Benefits
Improvements and Protection Act of 2000, shall adjust the fee
schedule payment rates that would otherwise apply under this
subsection for ambulance services provided in low density
rural areas based on the increased cost (if any) of providing
such services in such areas.''.
(B) Conforming amendment.--Section 221(c) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act
of 2000 (114 Stat. 2763A-487), as enacted into law by section
1(a)(6) of Public Law 106-554, is repealed.
(2) Use of medical conditions for coding ambulance
services.--Section 1834(l)(7) (42 U.S.C. 1395m(l)(7)) is
amended to read as follows:
``(7) Coding system.--
``(A) In general.--The Secretary shall, in accordance with
section 1173(c)(1)(B), establish a system or systems for the
coding of claims for ambulance services for which payment is
made under this subsection, including a code set specifying
the medical condition of the individual who is transported
and the level of service that is appropriate for the
transportation of an individual with that medical condition.
``(B) Medical conditions.--The code set established under
subparagraph (A) shall--
``(i) take into account the list of medical conditions
developed in the course of the negotiated rulemaking process
conducted under paragraph (1); and
``(ii) notwithstanding any other provision of law, be
adopted as a standard code set under section 1173(c).''.
(c) Effective Date.--The amendments made by this section
shall apply to services furnished on or after the date of the
enactment of this Act.
SEC. 8. RURAL MENTAL HEALTH CARE ACCESSIBILITY IMPROVEMENTS.
(a) Interdisciplinary Grant Program.--Subpart I of part D
of title III of the Public Health Service Act (42 U.S.C. 254b
et seq.) is amended by adding at the end the following new
section:
``SEC. 330L. INTERDISCIPLINARY GRANT PROGRAM.
``(a) Program Authorized.--The Director of the Office of
Rural Health Policy (of the Health Resources and Services
Administration) shall award grants to eligible entities to
establish interdisciplinary training programs that include
significant mental health training in rural areas for certain
health care providers.
``(b) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means a
public university or other educational institution that
provides training for mental health care providers or primary
health care providers.
``(2) Mental health care provider.--The term `mental health
care provider' means--
``(A) a physician with postgraduate training in a residency
program of psychiatry;
``(B) a licensed psychologist (as defined by the Secretary
for purposes of section 1861(ii) of such Act (42 U.S.C.
1395x(ii)));
``(C) a clinical social worker (as defined in section
1861(hh)(1) of such Act (42 U.S.C. 1395x(hh)(1)); or
``(D) a clinical nurse specialist (as defined in section
1861(aa)(5)(B) of such Act (42 U.S.C. 1395x(aa)(5)(B))).
``(3) Primary health care provider.--The term `primary
health care provider' includes family practice, internal
medicine, pediatrics, obstetrics and gynecology, geriatrics,
and emergency medicine physicians as well as physician
assistants and nurse practitioners.
``(4) Rural area.--The term `rural area' means a rural area
as defined in section 1886(d)(2)(D) of the Social Security
Act, or such an area in a rural census tract of a
metropolitan statistical area (as determined under the most
recent modification of the Goldsmith Modification, originally
published in the Federal Register on February 27, 1992 (57
Fed. Reg. 6725)), or any other geographical area that the
Director designates as a rural area.
``(c) Duration.--Grants awarded under subsection (a) shall
be awarded for a period of 5 years.
``(d) Use of Funds.--An eligible entity that receives a
grant under subsection (a) shall use funds received through
such grant to administer an interdisciplinary, side-by-side
training program for mental health care providers and primary
health care providers, that includes providing, under
appropriate supervision, health care services to patients in
underserved, rural areas without regard to patients' ability
to pay for such services.
``(e) Application.--An eligible entity desiring a grant
under subsection (a) shall submit an application to the
Director at such time, in such manner, and containing such
information as the Director may reasonably require,
including--
``(1) a description of the activities which the eligible
entity intends to carry out using amounts provided under the
grant;
``(2) a description of the manner in which the activities
funded under the grant will meet the mental health care needs
of underserved rural populations within the State; and
``(3) a description of the network agreement with
partnering facilities.
``(f) Evaluations; Report.--Each eligible entity that
receives a grant under this section shall submit to the
Director of the Office of Rural Health Policy (of the Health
Resources and Services Administration) an evaluation
describing the programs authorized under this section and any
other information that the Director deems appropriate. After
receiving such evaluations, the Director shall submit to the
appropriate committees of Congress a report describing such
evaluations.
``(g) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $100,000,000
for fiscal year 2002 and such sums as may be necessary for
each of the fiscal years 2003 through 2006.''.
[[Page S7400]]
(b) Coverage of Marriage and Family Therapist Services and
Mental Health Counselor Services Under Part B of the Medicare
Program.--
(1) Coverage of services.--
(A) In general.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2))
is amended--
(i) in subparagraph (U), by striking ``and'' after the
semicolon at the end;
(ii) in subparagraph (V)(iii), by inserting ``and'' after
the semicolon at the end; and
(iii) by adding at the end the following new subparagraph:
``(W) marriage and family therapist services (as defined in
subsection (ww)(1)) and mental health counselor services (as
defined in subsection (ww)(3));''.
(B) Definitions.--Section 1861 (42 U.S.C. 1395x) is amended
by adding at the end the following new subsection:
``Marriage and Family Therapist Services; Marriage and Family
Therapist; Mental Health Counselor Services; Mental Health Counselor
``(ww)(1) The term `marriage and family therapist services'
means services performed by a marriage and family therapist
(as defined in paragraph (2)) for the diagnosis and treatment
of mental illnesses, which the marriage and family therapist
is legally authorized to perform under State law (or the
State regulatory mechanism provided by State law) of the
State in which such services are performed, as would
otherwise be covered if furnished by a physician or as an
incident to a physician's professional service, but only if
no facility or other provider charges or is paid any amounts
with respect to the furnishing of such services.
``(2) The term `marriage and family therapist' means an
individual who--
``(A) possesses a master's or doctoral degree which
qualifies for licensure or certification as a marriage and
family therapist pursuant to State law;
``(B) after obtaining such degree has performed at least 2
years of clinical supervised experience in marriage and
family therapy; and
``(C) in the case of an individual performing services in a
State that provides for licensure or certification of
marriage and family therapists, is licensed or certified as a
marriage and family therapist in such State.
``(3) The term `mental health counselor services' means
services performed by a mental health counselor (as defined
in paragraph (4)) for the diagnosis and treatment of mental
illnesses which the mental health counselor is legally
authorized to perform under State law (or the State
regulatory mechanism provided by the State law) of the State
in which such services are performed, as would otherwise be
covered if furnished by a physician or as incident to a
physician's professional service, but only if no facility or
other provider charges or is paid any amounts with respect to
the furnishing of such services.
``(4) The term `mental health counselor' means an
individual who--
``(A) possesses a master's or doctor's degree in mental
health counseling or a related field;
``(B) after obtaining such a degree has performed at least
2 years of supervised mental health counselor practice; and
``(C) in the case of an individual performing services in a
State that provides for licensure or certification of mental
health counselors or professional counselors, is licensed or
certified as a mental health counselor or professional
counselor in such State.''.
(C) Provision for payment under part b.--Section
1832(a)(2)(B) (42 U.S.C. 1395k(a)(2)(B)) is amended by adding
at the end the following new clause:
``(v) marriage and family therapist services and mental
health counselor services;''.
(D) Amount of payment.--Section 1833(a)(1) (42 U.S.C.
1395l(a)(1)) is amended--
(i) by striking ``and (U)'' and inserting ``(U)''; and
(ii) by inserting before the semicolon at the end the
following: ``, and (V) with respect to marriage and family
therapist services and mental health counselor services under
section 1861(s)(2)(W), the amounts paid shall be 80 percent
of the lesser of the actual charge for the services or 75
percent of the amount determined for payment of a
psychologist under subparagraph (L)''.
(E) Exclusion of marriage and family therapist services and
mental health counselor services from skilled nursing
facility prospective payment system.--
(i) In general.--Section 1888(e)(2)(A) (42 U.S.C.
1395yy(e)(2)(A)), as amended by section 4(b)(1)(B), is
amended--
(I) in clause (i)(II), by striking ``clauses (ii), (iii),
and (iv)'' and inserting ``clauses (ii), (iii), (iv), and
(v)''; and
(II) by adding at the end the following new clause:
``(v) Exclusion of marriage and family therapist services
and mental health counselor services.--Services described in
this clause are marriage and family therapist services (as
defined in subsection (ww)(1)) and mental health counselor
services (as defined in section 1861(ww)(3)).''.
(ii) Effective date.--The amendments made by clause (i)
shall apply to services furnished on or after January 1,
2003.
(F) Inclusion of marriage and family therapists and mental
health counselors as practitioners for assignment of
claims.--Section 1842(b)(18)(C) (42 U.S.C. 1395u(b)(18)(C))
is amended by adding at the end the following new clauses:
``(vii) A marriage and family therapist (as defined in
section 1861(ww)(2)).
``(viii) A mental health counselor (as defined in section
1861(ww)(4)).''.
(b) Coverage of Certain Mental Health Services Provided in
Certain Settings.--
(1) Rural health clinics and federally qualified health
centers.--Section 1861(aa)(1)(B) (42 U.S.C. 1395x(aa)(1)(B))
is amended by striking ``or by a clinical social worker (as
defined in subsection (hh)(1)),'' and inserting ``, by a
clinical social worker (as defined in subsection (hh)(1)), by
a marriage and family therapist (as defined in subsection
(ww)(2)), or by a mental health counselor (as defined in
subsection (ww)(4)),''.
(2) Hospice programs.--Section 1861(dd)(2)(B)(i)(III) (42
U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by inserting ``or
a marriage and family therapist (as defined in subsection
(ww)(2))'' after ``social worker''.
(c) Authorization of Marriage and Family Therapists To
Develop Discharge Plans for Post-Hospital Services.--Section
1861(ee)(2)(G) (42 U.S.C. 1395x(ee)(2)(G)) is amended by
inserting ``marriage and family therapist (as defined in
subsection (ww)(2)),'' after ``social worker,''.
(d) Effective Date.--The amendments made by this subsection
shall apply with respect to services furnished on or after
January 1, 2004.
SEC. 9. RURAL HEALTH SERVICES RESEARCH IMPROVEMENTS.
(a) In General.--Section 711(b) (42 U.S.C. 912(b)) is
amended--
(1) in paragraph (3), by striking ``and'' after the comma
at the end;
(2) in paragraph (4), by striking the period at the end and
inserting ``, and''; and
(3) by adding at the end the following new paragraph:
``(5) have the authority to administer grants to support
rural health services research.''.
(b) Effective Date.--The amendments made by subsection (a)
shall take effect on January 1, 2004.
SEC. 10. EXCLUSION FOR LOAN PAYMENTS UNDER NATIONAL HEALTH
SERVICE CORPS LOAN REPAYMENT PROGRAM.
(a) In General.--Section 117 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
subsection:
``(e) Loan Payments Under National Health Service Corps
Loan Repayment Program.--Gross income shall not include any
amount received under section 338B(g) of the Public Health
Service Act.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to amounts received by an individual in taxable
years beginning after December 31, 2002.
SEC. 11. VIRTUAL PHARMACIST CONSULTATION SERVICE
DEMONSTRATION PROJECTS.
(a) Definitions.--In this section:
(1) Demonstration project.--The term ``demonstration
project'' means a demonstration project established by the
Secretary under subsection (b)(1).
(2) Drug.--The term ``drug'' means any drug or biological
(as those terms are defined in section 1861(t) of the Social
Security Act (42 U.S.C. 1395x(t)), regardless of whether
payment may be made for such drug or biological under the
medicare program.
(3) Eligible beneficiary.--The term ``eligible
beneficiary'' means an individual enrolled under part B of
the medicare program for whom a drug is being prescribed.
(4) Eligible originating site.--The term ``eligible
originating site'' means the site at which a health care
provider (as defined by the Secretary) is located at the time
a drug is prescribed which may be--
(A) the office of a physician (as defined in section
1861(r) of the Social Security Act (42 U.S.C. 1395x(r))) or a
practitioner (as described in section 1842(b)(18)(C) of such
Act (42 U.S.C. 1395u(b)(18)(C)));
(B) a rural health clinic (as defined in section
1861(aa)(2) of the Social Security Act (42 U.S.C.
1395x(aa)(2)));
(C) a hospital (as defined in section 1861(e) of such Act
(42 U.S.C. 1395x(e))) located in a rural area (as defined in
section 1886(d)(2) of such Act (42 U.S.C. 1395ww(d)(2)));
(D) a critical access hospital (as defined in section
1861(mm)(1) of such Act (42 U.S.C. 1395x(mm)(1)));
(E) a community mental health center (as described in
section 1861(ff)(2)(B) of such Act (42 U.S.C.
1395x(ff)(2)(B))); or
(F) a sole community hospital (as defined in section
1886(d)(5)(D)(iii) of such Act).
(5) Eligible pharmacist.--The term ``eligible pharmacist''
means a pharmacist who meets such requirements as the
Secretary may establish for purposes of the demonstration
projects and who is a full-time employee of a school of
pharmacy.
(6) Medicare program.--The term ``medicare program'' means
the health benefits program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(7) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(8) Virtual pharmacist consultation service.--The term
``virtual pharmacist consultation service'' means
professional consultations furnished by an eligible
pharmacist and any additional service specified by the
Secretary that is furnished by such a pharmacist.
(b) Virtual Pharmacist Consultation Service Demonstration
Projects.--
[[Page S7401]]
(1) Establishment.--The Secretary shall establish
demonstration projects in accordance with the provisions of
this section to provide virtual pharmacist consultation
services with respect to drugs being prescribed to eligible
beneficiaries.
(2) Participation.--Any eligible pharmacist located at a
school of pharmacy may furnish virtual pharmacist
consultation services under the demonstration projects and
any eligible originating site that does not have a pharmacist
on staff may participate in the demonstration projects on a
voluntary basis.
(c) Payment for Virtual Pharmacist Consultation Services.--
(1) In general.--The Secretary shall pay for virtual
pharmacist consultation services that are furnished via a
telecommunications system by an eligible pharmacist with
respect to a drug that is being prescribed to an eligible
beneficiary.
(2) Payment amount.--
(A) Eligible pharmacists at schools of pharmacy.--The
Secretary shall pay an amount determined by the Secretary for
purposes of the demonstration projects to an eligible
pharmacist who furnishes a virtual pharmacist consultation
service while such pharmacist is located at a school of
pharmacy that furnishes a virtual pharmacist consultation
service with respect to a drug prescribed to an eligible
beneficiary.
(B) Facility fee for eligible originating site.--If the
Secretary determines that it is appropriate, the Secretary
may pay the eligible originating site a facility fee
determined by the Secretary for purposes of the demonstration
projects which may not exceed the facility fee determined
under section 1834(m)(2)(B) of the Social Security Act (42
U.S.C. 1395m(m)(2)(B)).
(3) No beneficiary charges.--An eligible beneficiary may
not be charged any amount by an eligible pharmacist, eligible
originating site, the Secretary or any other individual or
entity for a virtual pharmacist service furnished under a
demonstration project.
(d) Conduct of Demonstration Projects.--
(1) Demonstration areas.--
(A) In general.--The Secretary shall conduct demonstration
projects in 5 demonstration areas selected on the basis of
proposals submitted under subparagraph (B). Such
demonstration areas shall be geographically disparate.
(B) Proposals.--The Secretary shall accept proposals to
furnish virtual pharmacist consultation services under the
demonstration projects from any school of pharmacy that is
able to furnish virtual pharmacist services to an underserved
rural area.
(2) Duration.--The Secretary shall complete the
demonstration projects by the date that is 3 years after the
date on which the first demonstration project is implemented.
(e) Report to Congress.--Not later than the date that is 6
months after the date on which the demonstration projects
end, the Secretary shall submit to Congress a report on the
demonstration projects together with such recommendations for
legislation or administrative action as the Secretary
determines is appropriate.
(f) Waiver of Medicare Requirements.--The Secretary shall
waive compliance with such requirements of the medicare
program to the extent and for the period the Secretary finds
necessary to conduct the demonstration projects.
(g) Authorization of Appropriations.--There are authorized
to be appropriated such sums as may be necessary to carry out
the demonstration projects under this section, including such
sums as may be necessary to develop, implement, and evaluate
such projects.
______
By Mrs. CLINTON:
S. 1187. A bill to amend the Federal Meat Inspection Act and the
Poultry Products Inspection Act to require that ready-to-eat meat or
poultry products that are not produced under a scientifically validated
program to address Listeria monocytogenes be required to bear a label
advising pregnant women and other at-risk consumers of the
recommendations of the Department of Agriculture and the Food and Drug
Administration regarding consumption of ready-to-eat products, and for
other purposes; to the Committee on Agriculture, Nutrition, and
Forestry.
Mrs. CLINTON. 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. 1187
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 ``At-Risk Consumer Protection
Through Food Safety Labeling Act''.
SEC. 2. FINDINGS.
Congress finds that--
(1) consumption of food contaminated with microbial
pathogens such as bacteria, parasites, viruses, and their
toxins causes an estimated 76,000,000 illnesses, 325,000
hospitalizations, and 5,000 deaths each year in the United
States;
(2) Government economists estimate that illnesses from
Campylobacter, Salmonella, E. coli O157:H7, E. coli non-
O157:H7 STEC, Listeria, and Toxoplasma gondii cause
$6,900,000,000 in medical costs, lost productivity, and
premature death in the United States each year;
(3) in particular, Listeria monocytogenes is the cause of
2,500 illnesses and 500 deaths annually, with economic costs
of $2,300,000,000;
(4) people that face relatively higher risks from foodborne
illness and associated complications include the very young,
the very old, pregnant women, and the immunocompromised, such
as persons with AIDS and cancer;
(5) outbreaks of foodborne illness are becoming
increasingly widespread in both geographic area and duration,
making detection and containment difficult;
(6) in 1998, following a major listeriosis outbreak from
deli meats, many ready-to-eat meat and poultry processors
established Listeria testing programs, but others have no
Listeria testing and control program at all, giving them an
unfair advantage in production costs over firms that are
taking steps to protect public health;
(7)(A) in 1989, the Secretary of Agriculture established a
performance standard allowing zero tolerance for Listeria
monocytogenes that prohibits detectable levels of the
pathogen in ready-to-eat meat and poultry products; and
(B) a performance standard for Listeria monocytogenes of
nondetectable levels in ready-to-eat meat products--
(i) is appropriate to protect at-risk consumers (including
pregnant women) (referred to in this section as ``at-risk
consumers'') from severe health consequences or death from
exposure to Listeria monocytogenes; and
(ii) is necessary to provide an adequate safety margin for
at-risk consumers;
(8) in February 2001, the Secretary of Agriculture proposed
regulations establishing performance standards for the
production of processed meat and poultry products, including
requirements for controlling Listeria monocytogenes, but, in
the time since the public comment period closed in September
2001, little progress has been made in finalizing the
regulation;
(9) in 2002, an outbreak of foodborne listeriosis linked to
ready-to-eat turkey deli meat in Pennsylvania, New York, New
Jersey, Delaware, Maryland, Connecticut, and Michigan--
(A) sickened 53 persons;
(B) killed 8 persons; and
(C) caused at least 3 pregnant women to suffer miscarriages
or stillbirths;
(10) in a March 21, 2003, speech to the North American Meat
Processors, Food Safety and Inspection Service Administrator
Dr. Gary McKee said the agency's December 2002 directive
outlining Listeria testing procedures for agency inspectors
is only an interim measure;
(11) to ensure the safety of at-risk consumers, ready-to-
eat meat and poultry products not produced under a
scientifically validated program to address Listeria
monocytogenes should be required to bear a label advising at-
risk consumers of the Government's recommendations not to
consume ready-to-eat meat and poultry products without
heating the products until steaming hot; and
(12) all data generated through scientifically validated
programs to address Listeria monocytogenes should be shared
with the Department of Agriculture and used to improve
scientific research regarding the safety of ready-to-eat
foods.
SEC. 3. READY-TO-EAT MEAT PRODUCTS.
(a) In General.--Section 7 of the Federal Meat Inspection
Act (21 U.S.C. 607) is amended by adding at the end the
following:
``(g) Ready-To-Eat Meat Products.--
``(1) Definitions.--In this subsection:
``(A) At-risk consumer.--The term `at-risk consumer'
includes a pregnant woman.
``(B) Ready-to-eat meat product.--The term `ready-to-eat
meat product' means a meat product that has been processed so
that the meat product may be safely consumed without further
preparation by the consumer, that is, without cooking or
application of some other lethality treatment to destroy
pathogens.
``(2) Labeling requirement.--Except as provided in
paragraph (3) or (4), a ready-to-eat meat product shall bear
a label advising consumers that an at-risk consumer--
``(A) should not consume the ready-to-eat meat product
unless the ready-to-eat meat product is heated until steaming
hot; or
``(B) should follow such other instructions as the
Secretary may prescribe in accordance with health guidelines
and recommendations published by the Secretary and the
Secretary of Health and Human Services.
``(3) Exemptions for producers.--On the motion of the
Secretary or on petition of a producer of a ready-to-eat meat
product, the Secretary, after notice and opportunity for a
public hearing, shall, by regulation applicable to all
producers of the ready-to-eat meat product or by order
applicable to a particular producer of the ready-to-eat meat
product, provide an exemption from the requirement of
paragraph (2) if--
``(A) in the case of a ready-to-eat meat product that the
Secretary determines presents a low risk to at-risk
consumers, the producer--
``(i) has a scientifically validated program (as determined
by the Secretary) to control Listeria monocytogenes; and
[[Page S7402]]
``(ii) makes all Listeria control program records
(including the results of any testing of plant environment,
food-contact surfaces, or meat product) available for
inspection by the Secretary; or
``(B) in the case of any ready-to-eat meat product that the
Secretary determines presents a greater risk to at-risk
consumers, the producer of the ready-to-eat meat product has
a scientifically valid program to address Listeria
monocytogenes under which the producer--
``(i) tests food-contact surfaces for Listeria
monocytogenes--
``(I) at least once every 2 days of production; and
``(II) if a food-contact surface tests positive--
``(aa) at least 3 times per day until the surface tests
negative on 3 consecutive days; or
``(bb) in accordance with such other regimen as the
Secretary may specify;
``(ii) tests the plant environment in the ready-to-eat meat
processing area for the Listeria species--
``(I) at least once every 2 days of production; and
``(II) if any part of the plant environment in the ready-
to-eat meat processing area tests positive--
``(aa) at least 3 times per day until the plant environment
tests negative on 3 consecutive days; or
``(bb) in accordance with such other regimen as the
Secretary may specify;
``(iii)(I) tests final products for Listeria monocytogenes
at least 5 times per month to measure the effectiveness of
the Listeria control program; and
``(II) if any food-contact surface tests positive, conducts
daily testing of the meat product from the line found to be
positive until the surface tests negative for 3 days;
``(iv) makes all control program records (including the
results of any testing of plant environment, food-contact
surfaces, or meat product) available for inspection by the
Secretary; and
``(v) meets any other requirement that the Secretary may
specify.
``(4) Exemptions for distributors.--On the motion of the
Secretary or on petition of a distributor of a ready-to-eat
meat product, the Secretary, after notice and opportunity for
a public hearing, shall, by regulation applicable to all
distributors of the ready-to-eat meat product or by order
applicable to a particular distributor of the ready-to-eat
meat product, provide an exemption from the requirement of
paragraph (2) if--
``(A) the distributor has purchasing specifications
incorporating the requirements of paragraph (3); and
``(B) the Secretary determines that the suppliers of the
distributor are in compliance with paragraph (3).
``(5) Reports by the secretary.--Not later than 3 years
after the date of enactment of this section, and at least
triennially thereafter, the Secretary shall compile and
disseminate information from records made available under
paragraphs (3)(A)(ii), (3)(B)(iv), and (4) to Federal
agencies, universities, and other research institutions and
other entities, as appropriate (excluding any such
proprietary or confidential information as is protected from
disclosure), for the purpose of furthering scientific
research.
``(6) Performance standard.--A performance standard of the
Secretary that provides zero tolerance for detectable levels
of Listeria monocytogenes in ready-to-eat meats--
``(A) shall not be modified to permit any detectable level
of Listeria monocytogenes in any ready-to-eat meat product;
and
``(B) shall be based on scientifically validated testing
methods for the detection of Listeria monocytogenes, as
determined by the Secretary.''.
(b) Misbranding.--Section 1(n) of the Federal Meat
Inspection Act (21 U.S.C. 601(n)) is amended--
(1) in paragraph (11), by striking ``or'' at the end;
(2) in paragraph (12), by striking the period at the end
and inserting ``; or''; and
(3) by adding at the end the following:
``(13) if it is a ready-to-eat meat product that is
required to bear a label under section 7(g), and it does not
bear such a label.''.
SEC. 4. READY-TO-EAT POULTRY PRODUCTS.
(a) In General.--Section 8 of the Poultry Products
Inspection Act (21 U.S.C. 457) is amended by adding at the
end the following:
``(e) Ready-To-Eat Poultry Products.--
``(1) Definitions.--In this subsection:
``(A) At-risk consumer.--The term `at-risk consumer'
includes a pregnant woman.
``(B) Ready-to-eat poultry product.--The term `ready-to-eat
poultry product' means a poultry product that has been
processed so that the poultry product may be safely consumed
without further preparation by the consumer, that is, without
cooking or application of some other lethality treatment to
destroy pathogens.
``(2) Labeling requirement.--Except as provided in
paragraph (3) or (4), a ready-to-eat poultry product shall
bear a label advising consumers that an at-risk consumer--
``(A) should not consume the ready-to-eat poultry product
unless the ready-to-eat poultry product is heated until
steaming hot; or
``(B) should follow such other instructions as the
Secretary may prescribe in accordance with health guidelines
and recommendations published by the Secretary and the
Secretary of Health and Human Services.
``(3) Exemptions for producers.--On the motion of the
Secretary or on petition of a producer of a ready-to-eat
poultry product, the Secretary, after notice and opportunity
for a public hearing, shall, by regulation applicable to all
producers of the ready-to-eat poultry product or by order
applicable to a particular producer of the ready-to-eat
poultry product, provide an exemption from the requirement of
paragraph (2) if--
``(A) in the case of a ready-to-eat poultry product that
the Secretary determines presents a low risk to at-risk
consumers, the producer--
``(i) has a scientifically validated program (as determined
by the Secretary) to control Listeria monocytogenes; and
``(ii) makes all Listeria control program records
(including the results of any testing of plant environment,
food-contact surfaces, or poultry product) available for
inspection by the Secretary; or
``(B) in the case of any ready-to-eat poultry product that
the Secretary determines presents a greater risk to at-risk
consumers, the producer of the ready-to-eat poultry product
has a scientifically valid program to address Listeria
monocytogenes under which the producer--
``(i) tests food-contact surfaces for Listeria
monocytogenes--
``(I) at least once every 2 days of production; and
``(II) if a food-contact surface tests positive--
``(aa) at least 3 times per day until the surface tests
negative on 3 consecutive days; or
``(bb) in accordance with such other regimen as the
Secretary may specify;
``(ii) tests the plant environment in the ready-to-eat
poultry processing area for the Listeria species--
``(I) at least once every 2 days of production; and
``(II) if any part of the plant environment in the ready-
to-eat poultry processing area tests positive--
``(aa) at least 3 times per day until the plant environment
tests negative on 3 consecutive days; or
``(bb) in accordance with such other regimen as the
Secretary may specify;
``(iii)(I) tests final products for Listeria monocytogenes
at least 5 times per month to measure the effectiveness of
the Listeria control program; and
``(II) if any food-contact surface tests positive, conducts
daily testing of the poultry product from the line found to
be positive until the surface tests negative for 3 days;
``(iv) makes all control program records (including the
results of any testing of plant environment, food-contact
surfaces, or poultry product) available for inspection by the
Secretary; and
``(v) meets any other requirement that the Secretary may
specify.
``(4) Exemptions for distributors.--On the motion of the
Secretary or on petition of a distributor of a ready-to-eat
poultry product, the Secretary, after notice and opportunity
for a public hearing, shall, by regulation applicable to all
distributors of the ready-to-eat poultry product or by order
applicable to a particular distributor of the ready-to-eat
poultry product, provide an exemption from the requirement of
paragraph (2) if--
``(A) the distributor has purchasing specifications
incorporating the requirements of paragraph (3); and
``(B) the Secretary determines that the suppliers of the
distributor are in compliance with paragraph (3).
``(5) Reports by the secretary.--Not later than 3 years
after the date of enactment of this section, and at least
triennially thereafter, the Secretary shall compile and
disseminate information from records made available under
paragraphs (3)(A)(ii), (3)(B)(iv), and (4) to Federal
agencies, universities, and other research institutions and
other entities, as appropriate (excluding any such
proprietary or confidential information as is protected from
disclosure), for the purpose of furthering scientific
research.
``(6) Performance standard.--A performance standard of the
Secretary that provides zero tolerance for detectable levels
of Listeria monocytogenes in ready-to-eat poultry products--
``(A) shall not be modified to permit any detectable level
of Listeria monocytogenes in any ready-to-eat poultry
product; and
``(B) shall be based on scientifically validated testing
methods for the detection of Listeria monocytogenes, as
determined by the Secretary.''.
(b) Misbranding.--Section 4(h) of the Poultry Products
Inspection Act (21 U.S.C. 453(h)) is amended--
(1) in paragraph (11), by striking ``or'' at the end;
(2) in paragraph (12), by striking the period at the end
and inserting ``; or''; and
(3) by adding at the end the following:
``(13) if it is a ready-to-eat poultry product that is
required to bear a label under section 8(e), and it does not
bear such a label.''.
____________________