[Congressional Record Volume 155, Number 70 (Thursday, May 7, 2009)]
[Senate]
[Pages S5283-S5295]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mrs. LINCOLN (for herself and Ms. Snowe):
  S. 997. A bill to amend the Internal Revenue Code of 1986 to provide 
income tax relief for families, and for other purposes; to the 
Committee on Finance.
  Mrs. LINCOLN. Mr. President, I rise to highlight the greatest 
resource of Arkansas. It is our people. It is the working families and 
the small businesses in their valiant fight against the current 
economic crisis.
  It is more important than ever before to give working families and 
businesses the tools they need to succeed in this world, to be 
competitive in the global marketplace and, more importantly, to be able 
to be successful on their own land. Hard work and entrepreneurship have 
fueled the Arkansas small business economy for decades, and we must 
ensure it remains that way in the future.
  That is why I have designed a package of tax cuts and Tax Code 
simplification measures that I call the Arkansas Plan, to help move our 
State and hard-working families forward. Together, these tax measures 
will allow working families and small businesses to get ahead and 
emerge from this economic crisis stronger and more competitive than 
ever before. These measures will encourage innovation and 
entrepreneurship, create new jobs, and lessen our dependence on foreign 
oil; as well as reduce the burden on working families and small 
businesses by simplifying our ever-complicated Tax Code.
  This week, I am focused on measures that will allow working families 
and small businesses to emerge from the economic crisis stronger and 
more competitive. I have reintroduced the Small Business Health Options 
Program, which would make health insurance more affordable, 
predictable, and accessible for small businesses and self-employed 
individuals. Our SHOP bill offers tax incentives to encourage States to 
reform the poorly functioning small group insurance market and 
encourages the development of State purchasing pools backstopped by a 
voluntary nationwide pool.
  The majority of uninsured Americans are self-employed individuals and 
employees of small businesses. Small businesses are the No. 1 source 
for jobs in our great State of Arkansas. Yet only 29 percent of 
businesses with fewer than 50 employees offer health insurance coverage 
because it is simply too expensive. Of the total uninsured population 
of Arkansas--more than 56 percent--approximately 295,000 Arkansans are 
employed by a firm with 100 or fewer employees.
  Our SHOP bill is a pragmatic model for larger health reform 
legislation that allows us to begin to address the needs of the 
millions of working uninsured Americans whose top priority is access to 
quality and affordable health care for their families. What we are 
looking for is to be able to give small businesses, their employees, 
and self-employed individuals the access to the same kind of quality 
and affordable health insurance we enjoy as Members of Congress.
  I think it is very doable. I am looking forward to continuing my work 
with Senator Snowe and others on a plan we have worked on for years 
now. Whether it is done independently or in the context of a larger 
health care reform package, it is time to do something for small 
businesses, their employees, and the self employed because they are the 
largest component of the uninsured that we could really do something 
substantively for.
  Another piece of my Arkansas plan is legislation to help Arkansas 
taxpayers who have seen their investments disappear as a result of the 
deteriorating economic conditions. My proposal would allow taxpayers to 
deduct up to $10,000--up from the $3,000 cap they have now--as the 
amount an individual can deduct annually for capital losses suffered.
  More than 100,000 Arkansans count on such investments. Arkansas 
families have seen the value of investments plummet during the current 
economic crisis. The resulting losses from the dramatic downturn in the 
market have been felt by all investors, but probably the hardest hit 
are those taxpayers who are at or near retirement age, who are counting 
on such funds for their retirement security. This gives them a little 
bit of ease.
  I have also introduced the Savings for Working Families Act, which 
would encourage low- and middle-income families to establish savings 
accounts for the purchase of a first home, a college education, or to 
start a business. These individual development accounts have a proven 
track record of success in Arkansas.
  In addition, today I introduce the Family Tax Relief Act to help the 
families of more than 140,000 Arkansas children afford the cost of 
childcare. If you look around this Nation at the hard-working 
Americans--particularly in Arkansas--who are in need of childcare, 
good-quality childcare, to be able to pay for it, this is a substantial 
difference in these economic times that helps them achieve that goal.
  Also, today I introduce a bill to update rules for S corporations so 
that businesses can access capital and have the opportunity to expand 
and create the much needed jobs Arkansans need.
  Together, I believe these bills will equip the working families and 
small businesses in our great State of Arkansas with the resources 
needed to navigate the current crisis.
  Next week, my Arkansas Plan will focus on encouraging American 
innovation and entrepreneurship to create new jobs here at home and 
lessen our dependence on foreign oil. I will introduce a series of 
energy, research and development, and workforce training

[[Page S5284]]

tax initiatives to accomplish this objective.
  The following week, I will look forward to introducing reform 
measures to simplify the Tax Code and reduce the burden of Arkansas' 
working families and businesses by working to build a tax structure 
that is fair and equitable for all Americans.
  I encourage my colleagues to look at these commonsense measures to 
see how they will benefit their own constituents in States across this 
great land.
  Throughout my career in the Senate, I have made Arkansas' working 
families and small businesses my top priorities. From my seat on the 
Senate Finance Committee, I will continue to work to bring our families 
the relief they need and business owners the tools they require to 
invest and grow and become successful and continue to be competitive.
  We have a great country, and each of us feels very particular about 
our State. I come from a seventh-generation Arkansas farm family. My 
home is precious to me. I reiterate what I started with, and that is 
that our greatest assets and resources in Arkansas are our people. They 
are hard working, innovative, and stalwart in coming together to help 
one another and help this country. Whether they are small business 
individuals or whether they serve in the armed services or whether they 
are teachers or whether they care for parents and the elderly, they are 
wonderful people, and they deserve our utmost attention, as do those in 
other States.
  I am willing to bet my colleagues that the Arkansas Plan, which I put 
together to benefit Arkansas small businesses and working families, 
will also benefit the working families in each of their States. I 
challenge you all to take a look at this and help me to move these 
initiatives forward on behalf of our working families and small 
businesses across this country.
                                 ______
                                 
      By Mr. BINGAMAN (for himself, Ms. Collins, and Ms. Stabenow):
  S. 999. A bill to increase the number of well-trained mental health 
service professionals (including those based in schools) providing 
clinical mental health care to children and adolescents, and for other 
purposes; to the Committee on Health, Education, Labor, and Pensions.
  Mr. BINGAMAN. Mr. President, I am introducing legislation today with 
Ms. Collins and Ms. Stabenow entitled Child Health Care Crisis Relief 
Act of 2009.
  This important legislation will address the national shortage of 
children's mental health professionals, including school-based 
professionals, by encouraging more individuals to enter these critical 
fields. The landmark 1999 Surgeon General's report on mental health 
brought a hidden mental health crisis to the attention of the U.S. 
public. According to that report, 13.7 million children in our 
country--about one in five--suffer from a diagnosable emotional or 
behavioral disorder. Such disorders as Anxiety Disorders, Attention-
Deficit/Hyperactivity Disorder, and Depression are among the most 
common in this age group. Yet more than \2/3\ of these children do not 
receive any treatment. Long waiting lists for children seeking 
services, including those in crisis, are not uncommon. The primary 
reason is that severe shortages exist in qualified mental health 
professionals, including child and adolescent psychiatrists, 
psychologists, social workers, and counselors. The President's New 
Freedom Commission on Mental Health also found that ``the supply of 
well-trained mental health professionals is inadequate in most areas of 
the country . . . particular shortages exist for mental health 
providers who serve children, adolescents, and older Americans.'' The 
situation is no better in our public schools, where children's mental 
health needs are often first identified. According to the National 
Center for Education Statistics within the Department of Education, 
there are approximately 479 students for each school counselor in U.S. 
schools, nearly twice the recommended ratio of 250 students for each 
counselor.
  The situation in my home State of New Mexico is a case in point. 
Estimates suggest that 56,000 children and adolescents in New Mexico 
have an emotional or behavioral disorder. Of these, roughly 20,000 have 
serious disturbances that impair their ability to fulfill the demands 
of everyday life. In 2009, there were a total of 55 child and 
adolescent psychiatrists in the entire State of New Mexico. The impact 
of this shortage on the affected children and their communities is 
disconcerting. Research shows that children with untreated emotional 
and behavioral disorders are at higher risk for school failure and 
dropping out of school, violence, drug abuse, suicide, and criminal 
activity. For New Mexico youth, the suicide rate is twice the national 
average, the fourth highest in the nation, and the third leading cause 
of death. By one estimate, roughly 1 in 7 youth in New Mexico detention 
centers are in need of mental health treatment that is just not 
available.
  New Mexico is not alone in its struggle to address the needs of these 
children. Nationwide, over 1,600 urban, suburban, and rural communities 
have been designated Mental Health Professional Shortage Areas by the 
Federal Government due to their severe lack of psychiatrists, 
psychologists, social workers, and other professionals to serve 
children and adults. Rural areas are especially hard hit. For example, 
in New Mexico there is one psychiatrist per 20,000 residents in rural 
areas, whereas in urban areas there is one per 3,000 residents. In 
rural and frontier counties, it is not unusual for the parents of a 
child in need of services to travel 60 to 90 miles to reach the nearest 
psychiatrist, psychologist, or other mental health provider.
  Finally, graduate programs providing the vital pipeline for the child 
mental health workforce have not sufficiently increased their funding, 
class sizes, and training programs to meet the ever growing need for 
these specialists. In the U.S., only 300 new child and adolescent 
psychiatrists are trained each year, despite projections by the Bureau 
of Health Professions that the shortage of child and adolescent 
psychiatrist will grow to 4,000 by the year 2020. Federal grant funding 
for graduate psychology education has also been significantly reduced 
in the past 2 years, which could reduce the numbers of child and 
adolescent psychologists entering the profession.
  Clearly something needs to be done to address this serious shortage 
in mental health professionals to meet the growing needs of our 
Nation's youth. It is for this reason that I rise today to offer the 
Child Health Care Crisis Relief Act of 2009. This bill creates 
incentives to help recruit and retain mental health professionals 
providing direct clinical care, and to help create, expand, and improve 
programs to train child mental health professionals. It provides loan 
repayments and scholarships for child mental health and school-based 
service professionals as well as internships and field placements in 
child mental health services and training for paraprofessionals who 
work in children's mental health clinical settings. The bill also 
provides grants to graduate schools to help develop and expand child 
and adolescent mental health programs. It restores the Medicare 
Graduate Medical Education Program funding for child and adolescent 
psychiatrists and extends the board eligibility period for residents 
and fellows from 4 years to 6 years. Across all mental health 
professions, priority for loan repayments, scholarships, and grants is 
given to individuals and programs serving children and adolescents in 
high-need areas.
  Finally, the Child Health Care Crisis Relief Act of 2009 requires the 
Secretary to prepare a report on the distribution and need for child 
mental health and school-based professionals, including disparities in 
the availability of services, on a State-by-State basis. This report 
will help Congress more clearly ascertain the mental health workforce 
needs that are facing our Nation.
  This important legislation has been endorsed by the following 
organizations: Alliance for Children and Families, American Academy of 
Child and Adolescent Psychiatry, American Academy of Pediatrics, 
American Association for Geriatric Psychiatry, American Association for 
Marriage and Family Therapy, American Counseling Association, American 
Group Psychotherapy Association, American Mental Health Counselors 
Association, American Orthopsychiatric Association,

[[Page S5285]]

American Psychiatric Association, American Psychiatric Nurses 
Association, American Psychological Association, Anxiety Disorders 
Association of America, Association for the Advancement of Psychology, 
Association for Ambulatory Behavioral Healthcare, Association for 
Behavioral Health and Wellness, Bazelon Center for Mental Health Law, 
Children and Adults with Attention-Deficit/Attention Disorder, Child & 
Adolescent Bipolar Foundation, Child Welfare League of America, 
Children and Adults with Attention-Deficit/Hyperactivity Disorder, 
Children's Healthcare Is a Legal Duty, Depression and Bipolar Support 
Alliance, Eating Disorders Coalition for Research Policy & Action, 
Mental Health America, National Alliance to Advance Adolescent Health, 
National Alliance on Mental Illness, National Association for 
Children's Behavioral Health, National Association of Pediatric Nurse 
Practitioners, National Association of Psychiatric Health Systems, 
National Association of School Psychologists, National Association of 
Social Workers, National Council for Community Behavioral Healthcare, 
National Federation of Families for Children's Mental Health, National 
Mental Health Awareness Campaign, Suicide Prevention Action Network 
USA, Therapeutic Communities of America, U.S. Psychiatric 
Rehabilitation Association, Witness Justice.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 999

       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 ``Child Health Care Crisis 
     Relief Act of 2009''.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (1) The Center for Mental Health Services estimates that 20 
     percent or 13,700,000 of the Nation's children and 
     adolescents have a diagnosable mental disorder, and about \2/
     3\ of these children and adolescents do not receive mental 
     health care.
       (2) According to ``Mental Health: A Report of the Surgeon 
     General'' in 1999, there are approximately 6,000,000 to 
     9,000,000 children and adolescents in the United States 
     (accounting for 9 to 13 percent of all children and 
     adolescents in the United States) who meet the definition for 
     having a serious emotional disturbance.
       (3) According to the Center for Mental Health Services, 
     approximately 5 to 9 percent of United States children and 
     adolescents meet the definition for extreme functional 
     impairment.
       (4) According to the Surgeon General's Report, there are 
     particularly acute shortages in the numbers of mental health 
     service professionals serving children and adolescents with 
     serious emotional disorders.
       (5) According to the National Center for Education 
     Statistics in the Department of Education, there are 
     approximately 479 students for each school counselor in 
     United States schools, which ratio is almost double the 
     recommended ratio of 250 students for each school counselor.
       (6) According to the Bureau of Health Professions in 2000, 
     the demand for the services of child and adolescent 
     psychiatry is projected to increase by 100 percent by 2020.
       (7) The development and application of knowledge about the 
     impact of disasters on children, adolescents, and their 
     families has been impeded by critical shortages of qualified 
     researchers and practitioners specializing in this work.
       (8) According to the Bureau of the Census, the population 
     of children and adolescents in the United States under the 
     age of 18 is projected to grow by more than 40 percent in the 
     next 50 years from 70,000,000 to more than 100,000,000 by 
     2050.
       (9) There are approximately 7,000 child and adolescent 
     psychiatrists in the United States. Only 300 child and 
     adolescent psychiatrists complete training each year.
       (10) According to the Department of Health and Human 
     Services, racial and ethnic minority representation is 
     lacking in the mental health workforce. Although 12 percent 
     of the United States population is African-American, only 2 
     percent of psychologists, 2 percent of psychiatrists, and 4 
     percent of social workers are African-American providers. 
     Moreover, there are only 29 Hispanic mental health 
     professionals for every 100,000 Hispanics in the United 
     States, compared with 173 non-Hispanic white providers per 
     100,000.
       (11) According to a 2006 study in the Journal of the 
     American Academy of Child and Adolescent Psychiatry, the 
     national shortage of child and adolescent psychiatrists 
     affects poor children and adolescents living in rural areas 
     the hardest.
       (12) According to the Department of Health and Human 
     Services, the ``U.S. mental health system is not well 
     equipped to meet the needs of racial and ethnic minority 
     populations.''. This is quite evident in access to care 
     issues involving racial and ethnic minority children. Studies 
     have shown that there are striking racial and ethnic 
     differences in the utilization of mental health services 
     among children and youth. Overall, mental health services 
     meet the needs of 31 percent of non-minority children, but 
     only 13 percent of minority children.
       (13) According to the National Center for Mental Health and 
     Juvenile Justice, 70 percent of youth involved in State and 
     local juvenile justice systems throughout the country suffer 
     from mental disorders, with at least 20 percent experiencing 
     symptoms so severe that their ability to function is 
     significantly impaired.
       (14) The Institute of Medicine, in Improving the Quality of 
     Health Care for Mental and Substance-Use Disorders, Quality 
     Chasm Series (2006) recommended that clinicians and patients 
     communicate effectively and share information to ensure 
     quality care, which is enhanced with education programs that 
     allow families and consumers to share information with mental 
     health providers about the lived experience of mental 
     illness.

     SEC. 3. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS TO IMPROVE 
                   CHILD AND ADOLESCENT MENTAL HEALTH CARE.

       Part E of title VII of the Public Health Service Act (42 
     U.S.C. 294n et seq.) is amended by adding at the end the 
     following:

          ``Subpart 3--Child and Adolescent Mental Health Care

     ``SEC. 775. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS TO 
                   IMPROVE CHILD AND ADOLESCENT MENTAL HEALTH 
                   CARE.

       ``(a) Loan Repayments for Child and Adolescent Mental 
     Health Service Professionals.--
       ``(1) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may establish a program of entering into 
     contracts on a competitive basis with eligible individuals 
     under which--
       ``(A) the eligible individual agrees to be employed full-
     time for a specified period (which shall be not less than 2 
     years) in providing mental health services to children and 
     adolescents; and
       ``(B) the Secretary agrees to make, during not more than 3 
     years of the period of employment described in subparagraph 
     (A), partial or total payments on behalf of the individual on 
     the principal and interest due on the undergraduate and 
     graduate educational loans of the eligible individual.
       ``(2) Eligible individual.--For purposes of this section, 
     the term `eligible individual' means an individual who--
       ``(A) is receiving specialized training or clinical 
     experience in child and adolescent mental health in 
     psychiatry, psychology, school psychology, behavioral 
     pediatrics, psychiatric nursing, social work, school social 
     work, marriage and family therapy, school counseling, or 
     professional counseling and has less than 1 year remaining 
     before completion of such training or clinical experience; or
       ``(B)(i) has a license or certification in a State to 
     practice allopathic medicine, osteopathic medicine, 
     psychology, school psychology, psychiatric nursing, social 
     work, school social work, marriage and family therapy, school 
     counseling, or professional counseling; and
       ``(ii)(I) is a mental health service professional who 
     completed (but not before the end of the calendar year in 
     which this section is enacted) specialized training or 
     clinical experience in child and adolescent mental health 
     described in subparagraph (A); or
       ``(II) is a physician who graduated from (but not before 
     the end of the calendar year in which this section is 
     enacted) an accredited child and adolescent psychiatry 
     residency or fellowship program in the United States.
       ``(3) Additional eligibility requirements.--The Secretary 
     may not enter into a contract under this subsection with an 
     eligible individual unless--
       ``(A) the individual is a United States citizen or a 
     permanent legal United States resident; and
       ``(B) if the individual is enrolled in a graduate program 
     (including a medical residency or fellowship), the program is 
     accredited, and the individual has an acceptable level of 
     academic standing (as determined by the Secretary).
       ``(4) Priority.--In entering into contracts under this 
     subsection, the Secretary shall give priority to applicants 
     who--
       ``(A) are or will be working with high-priority populations 
     for mental health in a Health Professional Shortage Area 
     (HPSA), Medically Underserved Area (MUA), or Medically 
     Underserved Population (MUP);
       ``(B) have familiarity with evidence-based methods and 
     cultural and linguistic competence in child and adolescent 
     mental health services;
       ``(C) demonstrate financial need; and
       ``(D) are or will be working in the publicly funded sector, 
     particularly in community mental health programs described in 
     section 1913(b)(1).
       ``(5) Meaningful loan repayment.--If the Secretary 
     determines that funds appropriated for a fiscal year to carry 
     out this subsection are not sufficient to allow a meaningful 
     loan repayment to all expected applicants, the Secretary 
     shall limit the

[[Page S5286]]

     number of contracts entered into under paragraph (1) to 
     ensure that each such contract provides for a meaningful loan 
     repayment.
       ``(6) Amount.--
       ``(A) Maximum.--For each year that the Secretary agrees to 
     make payments on behalf of an individual under a contract 
     entered into under paragraph (1), the Secretary may agree to 
     pay not more than $35,000 on behalf of the individual.
       ``(B) Consideration.--In determining the amount of payments 
     to be made on behalf of an eligible individual under a 
     contract to be entered into under paragraph (1), the 
     Secretary shall consider the eligible individual's income and 
     debt load.
       ``(7) Applicability of certain provisions.--The provisions 
     of sections 338E and 338F shall apply to the program 
     established under paragraph (1) to the same extent and in the 
     same manner as such provisions apply to the National Health 
     Service Corps Loan Repayment Program established in subpart 
     III of part D of title III.
       ``(8) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $10,000,000 
     for each of fiscal years 2010 through 2014.
       ``(b) Scholarships for Students Studying to Become Child 
     and Adolescent Mental Health Service Professionals.--
       ``(1) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may establish a program to award scholarships 
     on a competitive basis to eligible students who agree to 
     enter into full-time employment (as described in paragraph 
     (4)(C)) as a child and adolescent mental health service 
     professional after graduation or completion of a residency or 
     fellowship.
       ``(2) Eligible student.--For purposes of this subsection, 
     the term `eligible student' means a United States citizen or 
     a permanent legal United States resident who--
       ``(A) is enrolled or accepted to be enrolled in an 
     accredited graduate program that includes specialized 
     training or clinical experience in child and adolescent 
     mental health in psychology, school psychology, psychiatric 
     nursing, behavioral pediatrics, social work, school social 
     work, marriage and family therapy, school counseling, or 
     professional counseling and, if enrolled, has an acceptable 
     level of academic standing (as determined by the Secretary); 
     or
       ``(B)(i) is enrolled or accepted to be enrolled in an 
     accredited graduate training program of allopathic or 
     osteopathic medicine in the United States and, if enrolled, 
     has an acceptable level of academic standing (as determined 
     by the Secretary); and
       ``(ii) intends to complete an accredited residency or 
     fellowship in child and adolescent psychiatry or behavioral 
     pediatrics.
       ``(3) Priority.--In awarding scholarships under this 
     subsection, the Secretary shall give--
       ``(A) highest priority to applicants who previously 
     received a scholarship under this subsection and satisfy the 
     criteria described in subparagraph (B); and
       ``(B) second highest priority to applicants who--
       ``(i) demonstrate a commitment to working with high-
     priority populations for mental health in a Health 
     Professional Shortage Area (HPSA), Medically Underserved Area 
     (MUA), or Medically Underserved Population (MUP) and to 
     students from high-priority populations;
       ``(ii) have familiarity with evidence-based methods in 
     child and adolescent mental health services;
       ``(iii) demonstrate financial need; and
       ``(iv) are or will be working in the publicly funded 
     sector, particularly in community mental health programs 
     described in section 1913(b)(1).
       ``(4) Requirements.--The Secretary may award a scholarship 
     to an eligible student under this subsection only if the 
     eligible student agrees--
       ``(A) to complete any graduate training program, 
     internship, residency, or fellowship applicable to that 
     eligible student under paragraph (2);
       ``(B) to maintain an acceptable level of academic standing 
     (as determined by the Secretary) during the completion of 
     such graduate training program, internship, residency, or 
     fellowship; and
       ``(C) to be employed full-time after graduation or 
     completion of a residency or fellowship, for not less than 
     the number of years for which a scholarship is received by 
     the eligible student under this subsection, in providing 
     mental health services to children and adolescents.
       ``(5) Use of scholarship funds.--A scholarship awarded to 
     an eligible student for a school year under this subsection 
     may be used only to pay for tuition expenses of the school 
     year, other reasonable educational expenses (including fees, 
     books, and laboratory expenses incurred by the eligible 
     student in the school year), and reasonable living expenses, 
     as such tuition expenses, reasonable educational expenses, 
     and reasonable living expenses are determined by the 
     Secretary.
       ``(6) Amount.--The amount of a scholarship under this 
     subsection shall not exceed the total amount of the tuition 
     expenses, reasonable educational expenses, and reasonable 
     living expenses described in paragraph (5).
       ``(7) Applicability of certain provisions.--The provisions 
     of sections 338E and 338F shall apply to the program 
     established under paragraph (1) to the same extent and in the 
     same manner as such provisions apply to the National Health 
     Service Corps Scholarship Program established in subpart III 
     of part D of title III.
       ``(8) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $5,000,000 
     for each of fiscal years 2010 through 2014.
       ``(c) Clinical Training Grants for Professionals.--
       ``(1) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, in cooperation with the Administrator of the 
     Substance Abuse and Mental Health Services Administration, 
     may establish a program to award grants on a competitive 
     basis to accredited institutions of higher education or 
     accredited professional training programs to establish or 
     expand internships or other field placement programs for 
     students receiving specialized training or clinical 
     experience in child and adolescent mental health in 
     psychiatry, psychology, school psychology, behavioral 
     pediatrics, psychiatric nursing, social work, school social 
     work, marriage and family therapy, school counseling, or 
     professional counseling.
       ``(2) Priority.--In awarding grants under this subsection, 
     the Secretary shall give priority to applicants that--
       ``(A) have demonstrated the ability to collect data on the 
     number of students trained in child and adolescent mental 
     health and the populations served by such students after 
     graduation;
       ``(B) have demonstrated familiarity with evidence-based 
     methods in child and adolescent mental health services;
       ``(C) have programs designed to increase the number of 
     professionals serving high-priority populations and to 
     applicants who come from high-priority communities and plan 
     to serve in Health Professional Shortage Areas (HPSA), 
     Medically Underserved Areas (MUA), or Medically Underserved 
     Populations (MUP); and
       ``(D) offer curriculum taught collaboratively with a family 
     on the consumer and family lived experience or the importance 
     of family-professional partnership.
       ``(3) Requirements.--The Secretary may award a grant to an 
     applicant under this subsection only if the applicant agrees 
     that--
       ``(A) any internship or other field placement program 
     assisted under the grant will prioritize cultural and 
     linguistic competency;
       ``(B) students benefitting from any assistance under this 
     subsection will be United States citizens or permanent legal 
     United States residents;
       ``(C) the institution will provide to the Secretary such 
     data, assurances, and information as the Secretary may 
     require; and
       ``(D) with respect to any violation of the agreement 
     between the Secretary and the institution, the institution 
     will pay such liquidated damages as prescribed by the 
     Secretary by regulation.
       ``(4) Application.--The Secretary shall require that any 
     application for a grant under this subsection include a 
     description of the applicant's experience working with child 
     and adolescent mental health issues.
       ``(5) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $10,000,000 
     for each of fiscal years 2010 through 2014.
       ``(d) Progressive Education Grants for Paraprofessionals.--
       ``(1) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, in cooperation with the Administrator of the 
     Substance Abuse and Mental Health Services Administration, 
     may establish a program to award grants on a competitive 
     basis to State-licensed mental health nonprofit and for-
     profit organizations (including accredited institutions of 
     higher education) to enable such organizations to pay for 
     programs for preservice or in-service training of 
     paraprofessional child and adolescent mental health workers.
       ``(2) Definition.--For purposes of this subsection, the 
     term `paraprofessional child and adolescent mental health 
     worker' means an individual who is not a mental health 
     service professional, but who works at the first stage of 
     contact with children and families who are seeking mental 
     health services.
       ``(3) Priority.--In awarding grants under this subsection, 
     the Secretary shall give priority to applicants that--
       ``(A) have demonstrated the ability to collect data on the 
     number of paraprofessional child and adolescent mental health 
     workers trained by the applicant and the populations served 
     by these workers after the completion of the training;
       ``(B) have familiarity with evidence-based methods in child 
     and adolescent mental health services;
       ``(C) have programs designed to increase the number of 
     paraprofessional child and adolescent mental health workers 
     serving high-priority populations; and
       ``(D) provide services through a community mental health 
     program described in section 1913(b)(1).
       ``(4) Requirements.--The Secretary may award a grant to an 
     organization under this subsection only if the organization 
     agrees that--
       ``(A) any training program assisted under the grant will 
     prioritize cultural and linguistic competency;
       ``(B) the organization will provide to the Secretary such 
     data, assurances, and information as the Secretary may 
     require; and

[[Page S5287]]

       ``(C) with respect to any violation of the agreement 
     between the Secretary and the organization, the organization 
     will pay such liquidated damages as prescribed by the 
     Secretary by regulation.
       ``(5) Application.--The Secretary shall require that any 
     application for a grant under this subsection include a 
     description of the applicant's experience working with 
     paraprofessional child and adolescent mental health workers.
       ``(6) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $5,000,000 
     for each of fiscal years 2010 through 2014.
       ``(e) Child and Adolescent Mental Health Program 
     Development Grants.--
       ``(1) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may establish a program to increase the 
     number of well-trained child and adolescent mental health 
     service professionals in the United States by awarding grants 
     on a competitive basis to accredited institutions of higher 
     education to enable the institutions to establish or expand 
     accredited graduate child and adolescent mental health 
     programs.
       ``(2) Priority.--In awarding grants under this subsection, 
     the Secretary shall give priority to applicants that--
       ``(A) demonstrate familiarity with the use of evidence-
     based methods in child and adolescent mental health services;
       ``(B) provide experience in and collaboration with 
     community-based child and adolescent mental health services;
       ``(C) have included normal child development curricula; and
       ``(D) demonstrate commitment to working with high-priority 
     populations.
       ``(3) Use of funds.--Funds received as a grant under this 
     subsection may be used to establish or expand any accredited 
     graduate child and adolescent mental health program in any 
     manner deemed appropriate by the Secretary, including by 
     improving the course work, related field placements, or 
     faculty of such program.
       ``(4) Requirements.--The Secretary may award a grant to an 
     accredited institution of higher education under this 
     subsection only if the institution agrees that--
       ``(A) any child and adolescent mental health program 
     assisted under the grant will prioritize cultural and 
     linguistic competency;
       ``(B) the institution will provide to the Secretary such 
     data, assurances, and information as the Secretary may 
     require; and
       ``(C) with respect to any violation of the agreement 
     between the Secretary and the institution, the institution 
     will pay such liquidated damages as prescribed by the 
     Secretary by regulation.
       ``(5) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $15,000,000 
     for each of fiscal years 2010 through 2014.
       ``(f) Definitions.--In this section:
       ``(1) Specialized training or clinical experience in child 
     and adolescent mental health.--The term `specialized training 
     or clinical experience in child and adolescent mental health' 
     means training and clinical experience that--
       ``(A) is part of or occurs after completion of an 
     accredited graduate program in the United States for training 
     mental health service professionals;
       ``(B) consists of not less than 500 hours of training or 
     clinical experience in treating children and adolescents; and
       ``(C) is comprehensive, coordinated, developmentally 
     appropriate, and of high quality to address the unique ethnic 
     and cultural diversity of the United States population.
       ``(2) High-priority population.--The term `high-priority 
     population' means--
       ``(A) a population in which there is a significantly 
     greater incidence than the national average of--
       ``(i) children who have serious emotional disturbances; or
       ``(ii) children who are racial, ethnic, or linguistic 
     minorities; or
       ``(B) a population consisting of individuals living in a 
     high-poverty urban or rural area.
       ``(3) Mental health service professional.--The term `mental 
     health service professional' means an individual with a 
     graduate or postgraduate degree from an accredited 
     institution of higher education in psychiatry, psychology, 
     school psychology, behavioral pediatrics, psychiatric 
     nursing, social work, school social work, marriage and family 
     counseling, school counseling, or professional counseling.''.

     SEC. 4. AMENDMENTS TO SOCIAL SECURITY ACT TO IMPROVE CHILD 
                   AND ADOLESCENT MENTAL HEALTH CARE.

       (a) Increasing Number of Child and Adolescent Psychiatry 
     Residents Permitted to Be Paid Under the Medicare Graduate 
     Medical Education Program.--Section 1886(h)(4)(F) of the 
     Social Security Act (42 U.S.C. 1395ww(h)(4)(F)) is amended by 
     adding at the end the following new clause:
       ``(iii) Increase allowed for training in child and 
     adolescent psychiatry.--In applying clause (i), there shall 
     not be taken into account such additional number of full-time 
     equivalent residents in the field of allopathic or 
     osteopathic medicine who are residents or fellows in child 
     and adolescent psychiatry as the Secretary determines 
     reasonable to meet the need for such physicians as 
     demonstrated by the 1999 report of the Department of Health 
     and Human Services entitled `Mental Health: A Report of the 
     Surgeon General'.''.
       (b) Extension of Medicare Board Eligibility Period for 
     Residents and Fellows in Child and Adolescent Psychiatry.--
     Section 1886(h)(5)(G) of the Social Security Act (42 U.S.C. 
     1395ww(h)(5)(G)) is amended--
       (1) in clause (i), by striking ``and (v)'' and inserting 
     ``(v), and (vi)''; and
       (2) by adding at the end the following new clause:
       ``(vi) Child and adolescent psychiatry training programs.--
     In the case of an individual enrolled in a child and 
     adolescent psychiatry residency or fellowship program 
     approved by the Secretary, the period of board eligibility 
     and the initial residency period shall be the period of board 
     eligibility for the specialty of general psychiatry, plus 2 
     years for the subspecialty of child and adolescent 
     psychiatry.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to residency training years beginning on or after 
     July 1, 2010.

     SEC. 5. CHILD MENTAL HEALTH PROFESSIONAL REPORT.

       (a) Study.--The Administrator of the Health Resources and 
     Services Administration (in this section referred to as the 
     ``Administrator'') shall study and make findings and 
     recommendations on--
       (1) the distribution and need for child mental health 
     service professionals, including with respect to specialty 
     certifications, practice characteristics, professional 
     licensure, racial and ethnic background, practice types, 
     locations, education, and training; and
       (2) a comparison of such distribution and need, including 
     identification of disparities, on a State-by-State basis.
       (b) Report.--Not later than 2 years after the date of 
     enactment of this Act, the Administrator shall submit to the 
     Congress and make publicly available a report on the results 
     of the study required by subsection (a), including with 
     respect to findings and recommendations on disparities among 
     the States.

     SEC. 6. REPORTS.

       (a) Transmission.--The Secretary of Health and Human 
     Services shall transmit a report described in subsection (b) 
     to Congress--
       (1) not later than 3 years after the date of enactment of 
     this Act; and
       (2) not later than 5 years after the date of enactment of 
     this Act.
       (b) Contents.--The reports transmitted to Congress under 
     subsection (a) shall address each of the following:
       (1) The effectiveness of the amendments made by, and the 
     programs carried out under, this Act in increasing the number 
     of child and adolescent mental health service professionals 
     and paraprofessional child and adolescent mental health 
     workers.
       (2) The demographics of the individuals served by such 
     increased number of child and adolescent mental health 
     service professionals and paraprofessional child and 
     adolescent mental health workers.
                                 ______
                                 
      By Mr. REED:
  S. 1003. A bill to increase immunization rates; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. REED. Mr. President, today I introduce the Immunization 
Improvement Act of 2009. The recent outbreak of H1N1 influenza makes 
this legislation timelier than ever before. While a vaccine has not yet 
been developed to protect us against this flu strain, one is currently 
in the works. This outbreak is a reminder of the important role that 
immunizations provide in protecting us against harmful or even deadly 
viruses, like the measles, polio, and seasonal human influenza.
  Vaccinations have been proven to be clinically effective in improving 
health, and providing population-based immunity. Routine childhood 
immunizations, for example, prevent over 14 million individual cases of 
disease and over 33,500 deaths over the lifetime of children born in 
any given year.
  However, significant and persistent gaps in public and private health 
insurance coverage of immunizations remain. Approximately 11 percent of 
young children and 21 percent of adolescents are underinsured for 
immunizations. Nearly 2/3 of adults are underinsured for 
immunizations--17 percent are uninsured. Each year, vaccine-preventable 
diseases cause the deaths of more than 42,000 people and hundreds of 
thousands of cases of illness.
  Congress will soon embark upon meaningful health care reform. This 
debate will provide the opportunity for us to eliminate the obstacles--
lack of insurance and high cost-sharing--to accessing routine 
immunizations. We must shift to a system that will make routine 
preventive care, like immunizations, affordable.
  In fact, it is in the best interest of Government and society to 
ensure coverage of routine vaccinations, as these preventive 
vaccinations currently result in an annual cost savings of $10 billion 
in direct medical costs and over $40 billion in indirect societal 
costs.

[[Page S5288]]

Expanding immunization coverage will enhance these savings over the 
long term.
  The Immunization Improvement Act would remove barriers to 
immunization. First, it would enable states to access routine 
vaccinations for adults at a discount negotiated by the Federal 
Government. Currently, 36 States and New York City are able to buy 
vaccines using the Federal discount, but these contracts are about to 
expire. The Immunization Improvement Act would ensure that states can 
continue to purchase adult vaccines under CDC contracts. It would also 
provide for Medicaid coverage of adult immunizations that are 
recommended for routine use and prohibit any cost-sharing for them.
  There are a host of routinely recommended vaccinations for the 
Medicare population, as well. Unfortunately, Medicare Part B only 
covers influenza, pneumonia, and hepatitis B vaccines. Medicare 
beneficiaries are eligible for additional vaccines that are covered by 
Part D, but few of these vaccines are covered by prescription drug 
plans. Moreover, physicians have difficulties billing plans for the 
incurred costs. As such, the Medicare Payment Advisory Commission, 
MedPAC, has recommended that all immunizations recommended for routine 
use among the Medicare population be covered under Part B. The 
Immunization Improvement Act would codify that recommendation.
  Inadequate reimbursement for administering immunizations also 
prevents children, adolescents, and adults from receiving necessary 
vaccinations. According to the National Vaccine Advisory Committee, the 
Centers for Medicare and Medicaid Services, CMS, and CDC should review 
and update the maximum allowable fees for administering routine 
vaccinations, and publish and update the actual fees for vaccination 
administration paid by each State--in an effort to encourage 
consistency across state lines. This legislation would also reimburse 
providers for administering vaccines to children who are eligible for 
vaccination through the Vaccines for Children program, but not 
Medicaid. This would enable both uninsured and underinsured children to 
become vaccinated in an effort to get all children vaccinated.
  Finally, as we look to reform our health care system, we must also 
hold private health insurers accountable for covering vaccinations 
recommended for routine use--without any cost-sharing. The Immunization 
Improvement Act would require this coverage upon the enactment of 
health reform.
  Given the current circumstances, it is evident that vaccinations can 
and truly do eradicate the spread of preventable diseases. However, we 
must do more to ensure comprehensive coverage of immunizations. It is 
my hope that my colleagues will join me in supporting this legislation.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1003

       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 
     ``Immunization Improvement Act of 2009''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. State authority to purchase recommended vaccines for adults.
Sec. 4. Demonstration program to improve immunization coverage.
Sec. 5. Reauthorization of immunization program.
Sec. 6. Inclusion of recommended immunizations under part B of the 
              Medicare program with no beneficiary cost-sharing.
Sec. 7. Medicaid coverage of recommended adult immunizations.
Sec. 8. Vaccine administration fees.
Sec. 9. Health insurance coverage for recommended immunizations.
Sec. 10. Immunization information systems.
Sec. 11. Reports.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Immunizations recommended for routine use have been 
     proven to be clinically effective in improving health and 
     preventing the spread of disease. Routine childhood 
     immunizations prevent over 14,000,000 cases of disease and 
     over 33,500 deaths over the lifetime of children born in any 
     given year. In addition to protecting individuals from 
     disease, immunization provides population-based (herd) 
     immunity.
       (2) An economic evaluation of the impact of seven vaccines 
     routinely given as part of the childhood immunization 
     schedule found that the vaccines are cost-effective. Over the 
     lifetime of children born in any given year, these 
     immunizations result in an annual cost savings of 
     $10,000,000,000 in direct medical costs and over 
     $40,000,000,000 in indirect societal costs.
       (3) There are significant and persistent gaps in public and 
     private health insurance coverage of immunizations. About 11 
     percent of young children and 21 percent of adolescents are 
     underinsured for immunizations. Among adults, 59 percent are 
     underinsured and 17 percent are completely uninsured for 
     immunizations. According to the Institute of Medicine, even 
     those with insurance increasingly have to pay higher 
     deductibles and copayments for immunizations.
       (4) Each year, vaccine-preventable diseases cause the 
     deaths of more than 42,000 people and hundreds of thousands 
     cases of illness.
       (5) In 2003, the Institute of Medicine's Committee on the 
     Evaluation of Vaccine Purchase Financing made the following 
     conclusions:
       (A) Current public and private financing strategies for 
     immunization have had substantial success, especially in 
     improving immunization rates for young children. However, 
     significant disparities remain in assuring access to 
     recommended vaccines across geographic and demographic 
     populations.
       (B) Many young children, adolescents, and high-risk adults 
     have no or limited insurance for recommended vaccines. Gaps 
     and fragmentation in insurance benefits create barriers for 
     both vulnerable populations and clinicians that can 
     contribute to lower immunization rates.

     SEC. 3. STATE AUTHORITY TO PURCHASE RECOMMENDED VACCINES FOR 
                   ADULTS.

       Section 317 of the Public Health Service Act (42 U.S.C. 
     247b) is amended by adding at the end the following:
       ``(l) Authority to Purchase Recommended Vaccines for 
     Adults.--
       ``(1) In general.--The Secretary may negotiate and enter 
     into contracts with manufacturers of vaccines for the 
     purchase and delivery of vaccines for adults otherwise 
     provided vaccines under grants under this section.
       ``(2) State purchase.--A State may obtain adult vaccines 
     (subject to amounts specified to the Secretary by the State 
     in advance of negotiations) through the purchase of vaccines 
     from manufacturers at the applicable price negotiated by the 
     Secretary under this subsection.''.

     SEC. 4. DEMONSTRATION PROGRAM TO IMPROVE IMMUNIZATION 
                   COVERAGE.

       Section 317 of the Public Health Service Act (42 U.S.C. 
     247b), as amended by section 3, is further amended by adding 
     at the end the following:
       ``(m) Demonstration Program to Improve Immunization 
     Coverage.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall establish a demonstration program to award grants to 
     States to improve the provision of recommended immunizations 
     for children, adolescents, and adults through the use of 
     evidence-based, population-based interventions for high-risk 
     populations.
       ``(2) State plan.--To be eligible for a grant under 
     paragraph (1), a State shall submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require, including a State 
     plan that describes the interventions to be implemented under 
     the grant and how such interventions match with local needs 
     and capabilities, as determined through consultation with 
     local authorities.
       ``(3) Use of funds.--Funds received under a grant under 
     this subsection shall be used to implement interventions that 
     are recommended by the Task Force on Community Preventive 
     Services (as established by the Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention) 
     or other evidence-based interventions, including--
       ``(A) providing immunization reminders or recalls for 
     target populations of clients, patients, and consumers;
       ``(B) educating targeted populations and health care 
     providers concerning immunizations in combination with one or 
     more other interventions;
       ``(C) reducing out-of-pocket costs for families for 
     vaccines and their administration;
       ``(D) carrying out immunization-promoting strategies for 
     participants or clients of public programs, including 
     assessments of immunization status, referrals to health care 
     providers, education, provision of on-site immunizations, or 
     incentives for immunization;
       ``(E) providing for home visits that promote immunization 
     through education, assessments of need, referrals, provision 
     of immunizations, or other services;
       ``(F) providing reminders or recalls for immunization 
     providers;
       ``(G) conducting assessments of, and providing feedback to, 
     immunization providers; or
       ``(H) any combination of one or more interventions 
     described in this paragraph.
       ``(4) Consideration.--In awarding grants under this 
     subsection, the Secretary shall consider any reviews or 
     recommendations of the Task Force on Community Preventive 
     Services.

[[Page S5289]]

       ``(5) Evaluation.--Not later than 3 years after the date on 
     which a State receives a grant under this subsection, the 
     State shall submit to the Secretary an evaluation of progress 
     made toward improving immunization coverage rates among high-
     risk populations within the State.
       ``(6) Report to congress.--Not later than 4 years after the 
     date of enactment of the Immunization Improvement Act of 
     2009, the Secretary shall submit to Congress a report 
     concerning the effectiveness of the demonstration program 
     established under this subsection together with 
     recommendations on whether to continue and expand such 
     program.
       ``(7) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection, such sums as 
     may be necessary for each of fiscal years 2010 through 
     2014.''.

     SEC. 5. REAUTHORIZATION OF IMMUNIZATION PROGRAM.

       Section 317(j) of the Public Health Service Act (42 U.S.C. 
     247b(j)) is amended--
       (1) in paragraph (1), by striking ``for each of the fiscal 
     years 1998 through 2005''; and
       (2) in paragraph (2), by striking ``after October 1, 
     1997,''.

     SEC. 6. INCLUSION OF RECOMMENDED IMMUNIZATIONS UNDER PART B 
                   OF THE MEDICARE PROGRAM WITH NO BENEFICIARY 
                   COST-SHARING.

       (a) In General.--Paragraph (10) of section 1861(s) of the 
     Social Security Act (42 U.S.C. 1395x(s)) is amended to read 
     as follows:
       ``(10) vaccines recommended for routine use by the Advisory 
     Committee on Immunization Practices (an advisory committee 
     established by the Secretary, acting through the Director of 
     the Centers for Disease Control and Prevention) and their 
     administration;''.
       (b) Conforming Amendments.--
       (1) Section 1833 of the Social Security Act (42 U.S.C. 
     1395l) is amended, in each of subsections (a)(1)(B), 
     (a)(2)(G), (a)(3)(A), (b)(1), by striking ``1861(s)(10)(A)'' 
     or ``1861(s)(10)(B)'' and inserting ``1861(s)(10)'' each 
     place it appears.
       (2) Section 1842(o)(1)(A)(iv) of the Social Security Act 
     (42 U.S.C. 1395u(o)(1)(A)(iv)) is amended by striking 
     ``subparagraph (A) or (B) of''.
       (3) Section 1847A(c)(6) of the Social Security Act (42 
     U.S.C. 1395w-3a(c)(6)) is amended by striking subparagraph 
     (G).
       (4) Section 1860D-2(e)(1) of the Social Security Act (42 
     U.S.C. 1395w-102(e)(1)) is amended by striking ``a vaccine'' 
     and all that follows through ``its administration) and''.
       (5) Section 1861(ww)(2)(A) of the Social Security Act (42 
     U.S.C. 1395x(ww)(2)(A))) is amended by striking 
     ``Pneumococcal, influenza, and hepatitis B'' and inserting 
     ``Any''.
       (6) Section 1866(a)(2)(A) of the Social Security Act (42 
     U.S.C. 1395cc(a)(2)(A)) is amended by striking 
     ``1861(s)(10)(A)'' and inserting ``1861(s)(10)''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to vaccines administered on or after January 1, 
     2010.

     SEC. 7. MEDICAID COVERAGE OF RECOMMENDED ADULT IMMUNIZATIONS.

       (a) Mandatory Coverage of Recommended Immunizations for 
     Adults.--Section 1905(a)(4) of the Social Security Act (42 
     U.S.C. 1396d(a)(4)) is amended--
       (1) by striking ``and'' before ``(C)''; and
       (2) by inserting after the semicolon the following: ``and 
     (D) with respect to an adult individual, vaccines recommended 
     for routine use by the Advisory Committee on Immunization 
     Practices (an advisory committee established by the 
     Secretary, acting through the Director of the Centers for 
     Disease Control and Prevention) and their administration;''.
       (b) Prohibition on Cost-Sharing.--
       (1) In general.--Section 1916 of the Social Security Act 
     (42 U.S.C. 1396o), as amended by section 5006(a)(1)(A) of 
     division B of Public Law 111-5, is amended--
       (A) in subsection (a), by striking ``and (j)'' and 
     inserting ``, (j), and (k)''; and
       (B) by adding at the end the following:
       ``(k) The State plan shall require that no provider 
     participating under the State plan may impose a copayment, 
     cost sharing charge, or similar charge for vaccines or their 
     administration that the State is required to provide under 
     sections 1902(a)(10)(A) and 1905(a)(4)(D).''.
       (2) Technical and conforming amendment.--The second 
     sentence of section 1916A(a)(1) of such Act (42 U.S.C. 1396o-
     1(a)(1)) is amended by striking ``or (i)'' and inserting 
     ``(i), (j), or (k)''.
       (c) Allowing for Medicaid Rebates.--Section 1927(k)(2)(B) 
     of such Act (42 U.S.C. 1396r-8(k)(2)(B)) is amended by 
     striking ``, other than a vaccine'' and inserting 
     ``(including vaccines described in section 1905(a)(4)(D) but 
     excluding qualified pediatric vaccines under section 1928)''.
       (d) Effective Date.--
       (1) In general.--Except as provided in paragraphs (2) and 
     (3), the amendments made by this section take effect on 
     October 1, 2010.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     legislation in order for the plan to meet the additional 
     requirements imposed by the amendments made by this section, 
     the State plan shall not be regarded as failing to comply 
     with the requirements of such title solely on the basis of 
     its failure to meet these additional requirements before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of the 
     session is considered to be a separate regular session of the 
     State legislature.
       (3) Medicaid rebates.--The amendment made by subsection (c) 
     takes effect on October 1, 2010, and applies to rebate 
     agreements entered into under section 1927 of the Social 
     Security Act (42 U.S.C. 1396r-8) on or after that date.

     SEC. 8. VACCINE ADMINISTRATION FEES.

       (a) Review of Federally Established Maximum Allowable 
     Administrative Fees.--Not later than October 1, 2010, the 
     Administrator of the Centers for Medicare & Medicaid Services 
     and the Director of the Centers for Disease Control and 
     Prevention, jointly shall--
       (1) review the regional maximum charge for vaccine 
     administration for each State established under the Vaccines 
     for Children program under section 1928 of the Social 
     Security Act (42 U.S.C. 1396s) to determine the 
     appropriateness and adequacy of such rates; and
       (2) update such rates, as appropriate, based on the results 
     of such review and taking into account all appropriate costs 
     related to the administration of vaccines under that program.
       (b) Federal Reimbursement for Vaccine Administration for 
     Non-Medicaid Vaccine-Eligible Children.--
       (1) In general.--Section 1928 of the Social Security Act 
     (42 U.S.C. 1396s) is amended--
       (A) in subsection (a)(1)(B), by inserting ``and is entitled 
     to receive reimbursement for any fee imposed by the provider 
     for the administration of such vaccine consistent with 
     subsection (c)(2)(C) (not to exceed the amount applicable 
     under clause (iv) of such subsection) to a federally vaccine-
     eligible child who is described in clause (ii), (iii), or 
     (iv) of subsection (b)(2),'' after ``delivery to the 
     provider,'';
       (B) in subsection (a)(2), by adding at the end the 
     following new subparagraph:
       ``(d) Reimbursement for vaccine administration for non-
     medicaid eligible children.--The Secretary shall pay each 
     State such amounts as are necessary for the State to 
     reimburse each program-registered provider in the State for 
     an administration fee imposed consistent with subsection 
     (c)(2)(C) (not to exceed the amount applicable under clause 
     (iv) of such subsection) for the administration of a 
     qualified pediatric vaccine to a federally vaccine-eligible 
     child who is described in clause (ii), (iii), or (iv) of 
     subsection (b)(2).'';
       (C) in subsection (c)(2)(C), by adding at the end the 
     following new clause:
       ``(IV) In the case of a federally vaccine-eligible child 
     who is described in clause (ii), (iii), or (iv) of subsection 
     (b)(2), the State shall pay the provider an amount equal to 
     the administration fee established under the State plan 
     approved under this title for the administration of a 
     qualified pediatric vaccine to a medicaid-eligible child.''; 
     and
       (D) by striking subsection (g).
       (2) Conforming amendments.--Section 1928 of such Act (42 
     U.S.C. 1396s), as amended by paragraph (1), is amended--
       (A) by redesignating subsection (h) as subsection (g);
       (B) in subsection (a)(1)(A), by striking ``(h)(8)'' and 
     inserting ``(g)(8)''; and
       (C) in subsection (b)(2)(A)(iv), by striking ``(h)(3)'' and 
     inserting ``(g)(3)''.

     SEC. 9. HEALTH INSURANCE COVERAGE FOR RECOMMENDED 
                   IMMUNIZATIONS.

       (a) Amendments to the Public Health Service Act.--
       (1) Group health coverage.--Subpart 2 of part A of title 
     XXVII of the Public Health Service Act (42 U.S.C. 300gg-4 et 
     seq.) is amended by adding at the end the following:

     ``SEC. 2708. COVERAGE OF RECOMMENDED IMMUNIZATIONS.

       ``A group health plan, and a health insurance issuer 
     offering group health insurance coverage, shall provide for 
     coverage, without the application of deductibles, 
     coinsurance, or copayments, of vaccines recommended for 
     routine use by the Advisory Committee on Immunization 
     Practices (as established by the Secretary, acting through 
     the Director of the Centers for Disease Control and 
     Prevention) and their administration.''.
       (2) Individual health insurance coverage.--Subpart 2 of 
     part B of title XXVII of the Public Health Service Act (42 
     U.S.C. 300gg-51 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 2754. COVERAGE OF RECOMMENDED IMMUNIZATIONS.

       ``The provisions of section 2708 shall apply to health 
     insurance coverage offered by a health insurance issuer in 
     the individual market in the same manner as such provisions 
     apply to health insurance coverage offered by a health 
     insurance issuer in connection with a group health plan in 
     the small or large group market.''.
       (b) Amendments to ERISA.--
       (1) In general.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 is 
     amended by adding at the end the following:

     ``SEC. 715. COVERAGE OF RECOMMENDED IMMUNIZATIONS.

       ``A group health plan, and a health insurance issuer 
     offering group health insurance coverage, shall provide for 
     coverage, without the application of deductibles, 
     coinsurance,

[[Page S5290]]

     or copayments, of vaccines recommended for routine use by the 
     Advisory Committee on Immunization Practices (as established 
     by the Secretary, acting through the Director of the Centers 
     for Disease Control and Prevention) and their 
     administration.''.
       (2) Technical amendments.--
       (A) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is 
     amended by striking ``section 711'' and inserting ``sections 
     711 and 715''.
       (B) The table of contents in section 1 of such Act is 
     amended by inserting after the item relating to section 713 
     the following new item:

``Sec. 715. Coverage of recommended immunizations.''.
       (c) Internal Revenue Code Amendments.--
       (1) In general.--Subchapter B of chapter 100 of the 
     Internal Revenue Code of 1986 is amended--
       (A) in the table of sections, by inserting after the item 
     relating to section 9813 the following new item:

``Sec. 9814. Coverage of recommended immunizations.'';
     and
       (B) by inserting after section 9813 the following:

     ``SEC. 9814. COVERAGE OF RECOMMENDED IMMUNIZATIONS.

       ``A group health plan, and a health insurance issuer 
     offering group health insurance coverage, shall provide for 
     coverage, without the application of deductibles, 
     coinsurance, or copayments, of vaccines recommended for 
     routine use by the Advisory Committee on Immunization 
     Practices (as established by the Secretary, acting through 
     the Director of the Centers for Disease Control and 
     Prevention) and their administration.''.
       (d) Exception for Collective Bargaining Agreements.--
     Nothing in this section shall be construed to preempt any 
     provision of a collective bargaining agreement that is in 
     effect on the date of enactment of this section.
       (e) Effective Date.--The amendments made by this section 
     shall apply to plan years beginning with the first plan year 
     during which the Congressional Budget Office determines that 
     any health reform legislation enacted by Congress will 
     provide health insurance coverage to 95 percent or more of 
     the population of the United States.

     SEC. 10. IMMUNIZATION INFORMATION SYSTEMS.

       (a) Health Information Technology Infrastructure.--Section 
     3011(a) of the Public Health Service Act (as added by section 
     13301 of the American Recovery and Reinvestment Act of 2009) 
     is amended by adding at the end the following:
       ``(8) Improvement and expansion of immunization information 
     systems (as defined in section 3000), including activities 
     to--
       ``(A) support the integration and linkage of such systems 
     with electronic birth records, health care providers, other 
     preventive health services information systems, and health 
     information exchanges;
       ``(B) support interstate data exchange;
       ``(C) ensure that such systems are interoperable with 
     electronic health record systems;
       ``(D) provide technical support, such as training, data 
     reporting, data quality and completeness review, and decision 
     support, to immunization providers to integrate the use of 
     such systems;
       ``(E) develop, in consultation with manufacturers, vendors, 
     and specialty professional organizations, continuing 
     education materials relating to the use of such systems;
       ``(F) ensure that such systems can provide complete and 
     accurate data to monitor immunization coverage, uptake, and 
     the impact of shortages in the population served within their 
     jurisdiction; and
       ``(G) ensure the privacy, confidentiality, and security of 
     all data and data exchanges with such systems.''.
       (b) State Grants.--Section 3013(d) of the Public Health 
     Service Act (as added by section 13301 of the American 
     Recovery and Reinvestment Act of 2009) is amended--
       (1) in paragraph (9), by striking ``and'' at the end;
       (2) by redesignating paragraph (10) as paragraph (11); and
       (3) by inserting after paragraph (9), the following:
       ``(10) improving and expanding immunization information 
     systems (as defined in section 3000); and''.
       (c) Definition.--Section 3000 of the Public Health Service 
     Act (as added by section 13301 of the American Recovery and 
     Reinvestment Act of 2009) is amended--
       (1) by redesignating paragraphs (9) through (14) as 
     paragraphs (10) through (15), respectively; and
       (2) by inserting after paragraph (8), the following:
       ``(9) Immunization information system.--The term 
     `immunization information system' means an immunization 
     registry or a confidential, population-based, computerized 
     information system that collects vaccination data within a 
     geographic area, consolidates vaccination records from 
     multiple health care providers, generates reminder and recall 
     notifications, and is capable of exchanging immunization 
     information with health care providers.''.

     SEC. 11. REPORTS.

       (a) Costs of Public and Private Vaccine Administration.--
     Not later than 5 years after the date of enactment of this 
     Act, and every 5 years thereafter, the Director of the 
     Centers for Disease Control and Prevention jointly with the 
     Administrator of the Centers for Medicare & Medicaid Services 
     shall collect and publish data relating to the costs 
     associated with public and private vaccine administration, 
     including the costs associated with the delivery of vaccines, 
     activities such as reporting data to immunization registries, 
     and maintenance of appropriate storage requirements for 
     vaccines.
       (b) Section 317 Immunization Program.--Not later than 
     February 1, 2010, and each February 1 thereafter, the 
     Director of the Centers for Disease Control and Prevention 
     shall submit to Congress a report concerning the size and 
     scope of the appropriations needed for each fiscal year for 
     vaccine purchases, vaccination infrastructure, vaccine 
     administration, and vaccine safety under section 317 of the 
     Public Health Service Act (42 U.S.C. 247b).
       (c) Annual Publication of State-Established Administrative 
     Fees Under Medicaid.--Beginning October 1, 2009, and annually 
     thereafter, the Administrator of the Centers for Medicare & 
     Medicaid Services and the Director of the Centers for Disease 
     Control and Prevention, jointly shall make publicly available 
     the administrative fee established under each State Medicaid 
     program for administering a qualified pediatric vaccine to a 
     vaccine-eligible child under the Vaccines for Children 
     program under section 1928 of the Social Security Act (42 
     U.S.C. 1396s) with the State and Federal contribution for 
     such fee separately identified.
                                 ______
                                 
      By Mr. DURBIN:
  S. 1006. A bill to require a supermajority shareholder vote to 
approve excessive compensation of any employee of a publicly-traded 
company; to the Committee on Banking, Housing, and Urban Affairs.
  Mr. DURBIN. Mr. President, Americans have every right to be outraged 
over the recent bonuses given to employees of the group within AIG that 
led to that company's collapse. American taxpayers have provided $185 
billion--and counting--to save a firm that has been deemed ``too 
interconnected to fail.''
  It is unacceptable that millions of those taxpayer dollars have been 
handed over to some of the executives who caused this disaster in the 
first place. If there is a constitutional way to reclaim those bonuses, 
I support it.
  But it is important to remember that executive compensation practices 
have been out of control for many years. While the wages and benefits 
of middle class workers have stagnated, CEO compensation has exploded.
  According to the Economic Policy Institute's ``State of Working 
America,'' in 1965 U.S. CEOs at major companies made 24 times the pay 
of an average worker. By 2005, CEOs earned 262 times the pay of an 
average worker.
  The comparison between CEOs and minimum wage workers is even starker. 
In 1965 U.S. CEOs at major companies made 51 times the pay of workers 
earning the minimum wage. By 2005, CEOs earned 821 times the pay of 
workers earning the minimum wage.
  These comparisons are important not because they could be used to 
incite calls for class warfare, but because the American people deserve 
an honest accounting of the activities of the corporations that touch 
their lives in so many ways. Every American deserves an honest wage for 
honest work. And every American, from the top of the corporate ladder 
to the bottom, deserves to know whether they are being compensated 
fairly--whether they are sharing in the rewards of the company's work 
or whether their labors are mainly fueling ever more extravagant pay 
for the top executives.
  We have lost the balance we once had in America. Executive pay has 
soared, while pay for many s has not even kept pace with their 
productivity increases. It's not surprising that there is widespread 
fury when CEOs get it wrong. After all, they have a hand in setting 
their own salaries. But recently, the anger of the average American 
worker has boiled over because so many CEOs have gotten it so wrong. 
That outcome is not healthy for our economy, and it's not healthy for 
our society.
  If companies want to pay their executives handsomely for excellent 
performance, they should be able to do that. They should be able to 
compete for top talent. But the shareholders should be looking over 
their shoulders as they adopt excessive pay structures, and the 
taxpayers shouldn't be subsidizing the resulting income disparities.
  To restore some balance, the shareholders of a corporation should 
have to approve lucrative compensation packages. And, the companies 
shouldn't receive a tax deduction for handing out excessive pay.

[[Page S5291]]

  That is why today I am introducing two bills--the Excessive Pay 
Shareholder Approval Act S. 1006, and the Excessive Pay Capped 
Deduction Act, S. 1007.
  The Excessive Pay Shareholder Approval Act would require a 
supermajority--60 percent--vote of the shareholders to approve a 
compensation structure in which any employee receives more than 100 
times more than the average employee of that company. Corporations 
could pay executives whatever they think is appropriate, but 
shareholders would have to OK packages that are 100 times as large as 
the average worker earns. This bill would require greater transparency 
in compensation and would encourage companies to think about how they 
pay their lower-paid workers, not just how they reward the people at 
the top.
  Similarly, the Excessive Pay Capped Deduction Act would limit the 
normal tax deduction for compensation for executives to 100 times the 
compensation of the average worker at that company. Again, corporations 
could pay executives whatever they decide is appropriate, but they 
could not claim limitless tax benefits for doing so. This bill also 
would encourage companies to look at their entire compensation 
structure, and it would protect taxpayers.
  Here is an example. If the average worker at a company earned, 
including wages, paid leave, supplemental pay, and retirement, the same 
amount as the average worker nationwide in December of 2008, that 
worker would have earned around $50,000. At that company, a 
supermajority of shareholders would be required to approve pay packages 
larger than $5 million and that company could not deduct compensation 
in excess of $5 million.
  How many companies would this affect? According to the research firm 
The Corporate Library, in 2007 the median compensation for CEOs of S&P 
500 companies was $8.8 million. Therefore, if these companies are only 
paying average wages across the rest of the company, many of them would 
be affected by this legislation. Many would not.
  From our founding, this country has benefitted from a sense of unity 
and balance that has brought Americans together in good times and in 
bad. If the rewards handed out by our leading corporations flow 
excessively to the very wealthy while leaving middle-class families 
behind, we risk losing that sense of common purpose. The uproar over 
AIG bonuses showed very clearly the corrosive effects of compensation 
packages that appear to be disconnected from the reality that the 
average family faces day in and day out.
  The two bills I am introducing today would help to restore some of 
the balance we have lost, by ensuring greater accountability for the 
disparities in compensation for corporate leaders and the average 
workers they employ, and by protecting taxpayers when a company's 
compensation packages reach extreme levels.
  I urge my colleagues to support both bills.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1006

       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 ``Excessive Pay Shareholder 
     Approval Act''.

     SEC. 2. AMENDMENT TO THE SECURITIES EXCHANGE ACT OF 1934.

       (a) In General.--Section 16 of the Securities Exchange Act 
     of 1934 (15 U.S.C. 78n) is amended by adding at the end the 
     following new subsection:
       ``(h) Annual Shareholder Approval of Executive 
     Compensation.--
       ``(1) In general.--The compensation for an employee of an 
     issuer in any single taxable year may not exceed an amount 
     equal to 100 times the average compensation for services 
     performed by all employees of that issuer during such taxable 
     year, unless not fewer than 60 percent of the shareholders 
     have voted to approve such compensation (through a proxy or 
     consent or authorization for an annual or other meeting of 
     the shareholders, occurring within the preceding 18 months).
       ``(2) Proxy contents.--Proxy materials for a shareholder 
     vote required by paragraph (1) shall include--
       ``(A) the amount of compensation paid to the lowest paid 
     employee of the issuer;
       ``(B) the amount of compensation paid to the highest paid 
     employee of the issuer;
       ``(C) the average amount of compensation paid to all 
     employees of the issuer;
       ``(D) the number of employees of the issuer who are paid 
     more than 100 times the average amount of compensation for 
     all employees of the issuer; and
       ``(E) the total amount of compensation paid to employees 
     who are paid more than 100 times the average amount of 
     compensation for all employees of the issuer.
       ``(3) Definition of compensation.--
       ``(A) In general.--For purposes of this subsection, the 
     term `compensation' includes wages, salary, fees, 
     commissions, fringe benefits, deferred compensation, 
     retirement contributions, options, bonuses, property, and any 
     other form of remuneration that the Commission determines is 
     appropriate, in consultation with the Secretary of the 
     Treasury.
       ``(B) Part-time and part-year employees.--In the case of 
     any employee which is a part-time employee of the issuer, or 
     which is not employed by the issuer for a full taxable year, 
     the compensation of such employee shall be calculated for 
     purposes of this subsection on an annualized basis.''.
       (b) Deadline for Rulemaking.--Not later than 1 year after 
     the date of enactment of this Act, the Securities and 
     Exchange Commission shall issue any final rules and 
     regulations required to carry out section 16(h) of the 
     Securities Exchange Act of 1934, as added by this section.
                                 ______
                                 
      By Mr. DURBIN:
  S. 1007. A bill to amend the Internal Revenue Code of 1986 to deny a 
deduction for excessive compensation of any employee of an employer; to 
the Committee on Banking, Housing, and Urban Affairs.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1007

       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 ``Excessive Pay Capped 
     Deduction Act of 2009''.

     SEC. 2. DENIAL OF DEDUCTION FOR PAYMENTS OF EXCESSIVE 
                   COMPENSATION.

       (a) In General.--Section 162 of the Internal Revenue Code 
     of 1986 is amended by inserting after subsection (h) the 
     following new subsection:
       ``(i) Excessive Compensation.--
       ``(1) In general.--No deduction shall be allowed under this 
     chapter for any excessive compensation for any employee of 
     the taxpayer.
       ``(2) Excessive compensation.--For purposes of this 
     subsection, the term `excessive compensation' means, with 
     respect to any employee, the amount by which the compensation 
     for services performed by such employee during the taxable 
     year exceeds the amount which is equal to 100 times the 
     amount of the average compensation for services performed by 
     all employees of the taxpayer during the taxable year.
       ``(3) Other definitions and special rules.--
       ``(A) Compensation.--
       ``(i) In general.--For purposes of this subsection, the 
     term `compensation' includes wages, salary, fees, 
     commissions, fringe benefits, deferred compensation, 
     retirement contributions, options, bonuses, property, and any 
     other form of remuneration that the Secretary determines is 
     appropriate.
       ``(ii) Part-time and part-year employees.--In the case of 
     any employee which is a part-time employee of the taxpayer or 
     which is not employed by the taxpayer for a full taxable 
     year, the compensation of such employee shall be calculated 
     for purposes of this subparagraph on an annualized basis.
       ``(B) Employer.--All persons treated as a single employer 
     under subsection (a) or (b) of section 52 or subsection (m) 
     or (o) of section 414 shall be treated as a single taxpayer 
     for purposes of this subsection.
       ``(4) Reporting.--Each employer that provides any excessive 
     compensation to any employee during a taxable year shall file 
     a report with the Secretary with respect to such taxable year 
     including--
       ``(A) the amount of compensation of the employee of the 
     taxpayer receiving the lowest amount of compensation during 
     such taxable year,
       ``(B) the amount of compensation of the employee of the 
     taxpayer receiving the highest amount of compensation during 
     such taxable year,
       ``(C) the average compensation of all employees of the 
     taxpayer during such taxable year,
       ``(D) the number of employees of the taxpayer who are 
     receiving compensation that is more than 100 times the 
     average compensation of all employees of the taxpayer during 
     such taxable year, and
       ``(E) the amounts of compensation of the employees 
     described in subparagraph (D) during such taxable year.

     Such report shall be filed at such time and in such manner as 
     the Secretary may require.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after the date of the 
     enactment of this Act.

[[Page S5292]]

                                 ______
                                 
      By Mrs. SHAHEEN (for herself, Mr. Gregg, and Mr. Kohl):
  S. 1008. A bill to amend title 10, United States Code, to limit 
requirements of separation pay, special separation benefits, and 
voluntary separation incentive from members of the Armed Forces 
subsequently receiving retired or retainer pay; to the Committee on 
Armed Services.
  Mrs. SHAHEEN. Mr. President, I rise today to introduce the Military 
Retirement Pay Fairness Act of 2009. I want to thank my colleague, 
Senator Gregg, for cosponsoring this important legislation.
  The Military Retirement Pay Fairness Act addresses a critical issue 
that impacts our nation's veterans. Certain service members who receive 
special separation pay must have that benefit recouped if they later 
re-enlist and become eligible for a pension. Under current law, the 
Department of Defense, DOD, is bound by a statutory formula for 
recouping that benefit and cannot change the amount it recoups each 
month, even if it results in severe financial hardship for our nation's 
veterans. In fact, many veterans are currently in dire financial 
straits because of this unnecessarily harsh formula. This legislation 
will fix the formula and provide these veterans with much needed 
financial relief.
  I would like to talk about one particular veteran who brought this 
issue to my attention. Sgt. Wayne Merritt of Dover, New Hampshire 
served in the Air Force for nearly 14 years until the end of the Cold 
War, when the Defense Department began to draw down its forces. At 
DOD's encouragement, Mr. Merritt took a one-time Special Separation 
Benefit, and then started working in the private sector.
  But in 1996, Sgt. Merritt decided to serve his country once again, 
joining the New Hampshire Air National Guard. When Sgt. Merritt retired 
in 2006, he became eligible for a pension that provided him and his 
family with enough to help pay the bills, especially his monthly 
mortgage payments.
  However, just a couple of months ago, Sgt. Merritt had his life 
turned upside down when he got a letter in the mail from the Defense 
Department. The letter said that, within a few weeks, DOD would begin 
recouping his separation benefit by withholding more than half of his 
pension each month until the full amount is paid back.
  Sgt. Merritt was shocked. He planned his family budget around a 
pension payment he had been receiving each month for nearly 2 years, 
only to get a letter saying that, in a few weeks, it would be reduced 
by more than half. Sgt. Merritt suddenly found himself in a position 
where he couldn't make ends meet and make his mortgage payments. In 
fact, he was so concerned that he contacted a real estate agent to talk 
about selling his home.
  Sgt. Merritt contacted DOD, asking if there was anything that could 
be done to work out a manageable monthly payment plan. Sgt. Merritt did 
not ask for the amount to be forgiven, but simply asked DOD to be 
flexible and work out a payment plan that he could afford. DOD told him 
that there was nothing it could do to help, citing a statute that tied 
its hands.
  On behalf of Sgt. Merritt, I contacted DOD and spoke to 
Undersecretary Robert Hale. He told me that DOD doesn't have a choice--
it must recoup over half of his income because the formula in the 
statute dictates the rate. The result is that Sgt. Merritt, and over 
1,000 veterans in similar situations across the country, face financial 
hardship as a result of an unfair rule. As each month goes by, DOD has 
to garnish over half of Sgt. Merritt's pension payments.
  I do not believe that Congress intends to treat our Nation's veterans 
this way. That is why I am introducing legislation today that would 
provide a simple and straightforward solution. Instead of an 
unnecessarily harsh formula, our bill will provide DOD with the 
flexibility it needs to develop manageable monthly payment plans that 
do not impose undue financial hardship on service members. In addition, 
DOD would be required to consult with the service member to create a 
monthly payment plan, taking into account a veteran's financial 
situation when determining how much should be recouped each month. To 
make sure these payment plans are manageable, DOD would only be able to 
recoup, at the most, 25 percent of the veteran's monthly pension check 
until the benefit is repaid.
  This legislation would also address other problems with pension 
recoupment.
  It would provide service members with adequate notice of the 
recoupment so that they have time to prepare for the loss of income. 
Sgt. Merritt received his letter just weeks before DOD garnished over 
half of his pension pay. This legislation ensures that service members 
have at least 90 days notice before recoupment begins.
  Finally, the legislation would also give the Secretary of Defense the 
flexibility to ensure that no veteran will be left destitute from this 
recoupment. We need to recognize that financial circumstances change 
over time. If recouping the benefit would cause a severe financial 
hardship, the Secretary of Defense should be able to waive that amount.
  This legislation is critical. Each month, over 1,000 veterans face 
circumstances similar to Sgt. Merritt's. Undersecretary Robert Hale 
told me that while he sympathizes with these veterans, he has no legal 
recourse to change the amount it recoups every month. This legislation 
provides DOD with the flexibility it needs to ensure that we do not 
punish veterans who have made the courageous decision to serve their 
country again.
  I'm glad that this effort has the support of DOD, as well as veterans 
organizations like the Veterans of Foreign Wars, VFW, and the Military 
Officers Association of America, MOAA.
  I want to thank Senator Gregg for his support of this important, 
common sense legislation. I also want to thank my fellow New Hampshire 
delegation member, Carol Shea-Porter, for introducing companion 
legislation in the House. I urge my colleagues to join me in addressing 
these important issues.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1008

       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 ``Military Retired Pay 
     Fairness Act of 2009''.

     SEC. 2. LIMITATIONS ON RECOUPMENT OF SEPARATION PAY, SPECIAL 
                   SEPARATION BENEFITS, AND VOLUNTARY SEPARATION 
                   INCENTIVE FROM MEMBERS SUBSEQUENTLY RECEIVING 
                   RETIRED OR RETAINER PAY.

       (a) Separation Pay and Special Separation Benefits.--
     Section 1174(h)(1) of title 10, United States Code, is 
     amended--
       (1) by inserting ``(A)'' after ``(1)'';
       (2) in subparagraph (A), as so designated, by striking ``so 
     much of such pay as is based on the service for which he 
     received separation pay under this section or separation pay, 
     severance pay, or readjustment pay under any other provision 
     of law'' and inserting ``an amount, in such schedule of 
     monthly installments as the Secretary of Defense shall 
     specify taking into account the financial ability of the 
     member to pay and avoiding the imposition of undue financial 
     hardship on the member and member's dependents,''; and
       (3) by adding at the end the following new subparagraphs:
       ``(B) The amount deducted under subparagraph (A) from a 
     payment of retired or retainer pay may not exceed 25 percent 
     of the amount of the member's retired or retainer pay for 
     that month unless the member requests or consents to 
     deductions at an accelerated rate. The Secretary concerned 
     shall consult with the member regarding the repayment rate to 
     be imposed, taking into account the financial ability of the 
     member to pay and avoiding the imposition of an undue 
     hardship on the member and the member's dependents.
       ``(C) The deduction of amounts from the retired or retainer 
     pay of a member under this paragraph may not commence until 
     the date that is 90 days after the date on which the 
     Secretary concerned notifies the member of the deduction of 
     such amounts under this paragraph. Any notice under this 
     subparagraph shall be designed to provide clear and 
     comprehensive information on the deduction of amounts under 
     this paragraph, including information on the determination of 
     the amount and period of installments under this paragraph.
       ``(D) The Secretary concerned may waive the deduction of 
     amounts from the retired or retainer pay of a member under 
     this paragraph if the Secretary determines that deduction of 
     such amounts would result in a financial hardship for the 
     member.''.
       (b) Voluntary Separation Incentive.--Section 1175(e)(3) of 
     such title is amended--
       (1) in subparagraph (A), by striking ``so much of such pay 
     as is based on the service

[[Page S5293]]

     for which he received the voluntary separation incentive'' 
     and inserting ``an amount, in such schedule of monthly 
     installments as the Secretary of Defense shall specify taking 
     into account the financial ability of the member to pay and 
     avoiding the imposition of undue financial hardship on the 
     member and member's dependents,'';
       (2) by redesignating subparagraph (B) as subparagraph (C);
       (3) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) The amount deducted under subparagraph (A) from a 
     payment of retired or retainer pay may not exceed 25 percent 
     of the amount of the member's retired or retainer pay for 
     that month unless the member requests or consents to 
     deductions at an accelerated rate. The Secretary concerned 
     shall consult with the member regarding the repayment rate to 
     be imposed, taking into account the financial ability of the 
     member to pay and avoiding the imposition of an undue 
     hardship on the member and the member's dependents.''; and
       (4) by adding at the end the following new subparagraphs:
       ``(D) The deduction of amounts from the retired or retainer 
     pay of a member under this paragraph may not commence until 
     the date that is 90 days after the date on which the 
     Secretary concerned notifies the member of the deduction of 
     such amounts under this paragraph. Any notice under this 
     subparagraph shall be designed to provide clear and 
     comprehensive information on the deduction of amounts under 
     this paragraph, including information on the determination of 
     the amount and period of installments under this paragraph.
       ``(E) The Secretary concerned may waive the deduction of 
     amounts from the retired or retainer pay of a member under 
     this paragraph if the Secretary determines that deduction of 
     such amounts would result in a financial hardship for the 
     member.''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on the first day of the first month 
     beginning on or after the date of the enactment of this Act 
     and apply to deductions made from the retired or retainer pay 
     of members of the uniformed services for that month and 
     subsequent months.
                                 ______
                                 
      By Mr. AKAKA (for himself, Mr. Cochran, Mr. Dodd, and Mr. 
        Durbin):
  S. 1010. A bill to establish a National Foreign Language Coordinator 
Council; to the Committee on Health, Education, Labor, and Pensions.
  Mr. AKAKA. Mr. President, I am pleased to reintroduce the National 
Foreign Language Coordination Act with my colleagues Senators Cochran, 
Dodd, and Durbin. Through sustained leadership and a coordinated plan 
of action, our bill aims to increase the number of individuals with 
foreign language skills and cultural understanding.
  Globalization has made the world smaller and Americans must be better 
equipped, with language skills and cultural knowledge, not only to 
survive in it, but to prosper. Whether it is: competing on the world 
market to provide goods and services, cross cultural exchanges between 
educators and business people of different countries, or allied 
military or diplomatic operations to make the world more secure and 
peaceful, all of these efforts require communication to succeed.
  It took the tragic events of 9-11 to bring attention to our shortage 
of foreign language speakers. Many of you know about the emergency call 
for linguists following the attacks. Unfortunately, this was not 
surprising. The fact that only 9.3 percent of all Americans speak both 
their native languages and another language fluently, compared with 56 
percent of people in the European Union, is cause for alarm.
  Our national security continues to be at risk without enough foreign 
language proficient individuals. Counterterrorism intelligence will go 
untranslated, or be so late as to lose its usefulness, if we do not 
have more foreign language experts. Foreign language skills are also 
vitally important to preserve the economic competitiveness of the U.S. 
Globalization forces some Americans to compete for jobs in a 
marketplace no longer limited by borders. According to the Committee 
for Economic Development, the lack of foreign language skills and 
international knowledge results in embarrassing and costly cultural 
blunders for companies. In fact, the Committee reports that American 
companies lose an estimated $2 billion a year due to inadequate 
cultural understanding.
  Many of the Federal Government's efforts to address language needs in 
the U.S. over the past 40 years have come in reaction to international 
events. We do not have a proactive policy.
  In 1958, the National Defense Education Act was passed in response to 
the Soviet Union's first space launch. We were determined to win the 
space race and make certain that the U.S. never came up short again in 
math, science, technology, or foreign languages. That act was a great 
success, but in the late 70s its foreign language programs merged into 
larger education reform measures and lost their prominence. The results 
are clear. In 1979, the President's Commission on Foreign Language and 
International Studies said that ``Americans' incompetence in foreign 
languages is nothing short of scandalous, and it is becoming worse.''
  After 9-11, Congress and the administration once again took action to 
address language shortfalls, but I fear that these efforts will prove 
to be only a band-aid and not a complete cure to the Nation's recurring 
foreign language needs. Despite the administration's efforts to 
implement new programs and policies to address our language shortfalls, 
I fear that without sustained leadership and a coordinated effort among 
all Federal agencies, state and local governments, the private sector, 
and academia, we will remain where we are today: scrambling to find 
linguists after another major international event. We must be prepared 
to avoid another 9-11 type shortage.
  Together we must commit to build and maintain language expertise and 
relationships with people from all across the world--whether or not the 
languages they speak are considered critical at the time--and to ensure 
that we have the infrastructure in place to prevent catastrophic 
events--or at least be prepared to respond to them. To this end, there 
needs to be one person in the Executive Branch who will lead the cross-
agency efforts to better understand America's language needs for the 
next 5, 15, or 20 years, and to figure out how to address those needs. 
This leadership must be comprehensive, as no one sector--Government, 
industry, or academia--has all of the needs for language and cultural 
competency, or all of the solutions.
  The Bush administration's National Security Language Initiative was a 
good first step at coordinating efforts among the Intelligence 
Directorate and the Departments of Defense, Education, and State to 
address our national security language needs. However, we must ensure 
that this effort will continue, bring in the advice of all Federal 
agencies and stakeholders, and address our economic security needs.
  The legislation we introduce today would set us on the right course 
by implementing a key recommendation of the 2004 Department of Defense, 
DOD, National Language Conference and echoed by Department of Defense 
sponsored State language roadmap summits which is to establish a 
National Foreign Language Coordination Council, chaired by a National 
Language Advisor. An integrated foreign language strategy and sustained 
leadership within the Federal Government is needed to address the lack 
of foreign language proficient speakers in government, academia and the 
private sector. Just as I have advocated the need for deputy 
secretaries for management at the Departments of Defense and Homeland 
Security to direct and sustain management leadership, I envision a 
National Language Advisor to be responsible for maintaining and leading 
a cooperative effort to strengthen our foreign language capabilities. 
Without such a coordinated strategy in the world in which we live, I 
fear that the country's national and economic security will be at 
greater risk.
  Specifically, our bill ensures that the key recommendations of the 
DOD National Language Conference be implemented by having strong 
leadership that will develop policies and programs that build the 
Nation's language and cultural understanding capability; engage 
Federal, State, and local agencies and the private sector in solutions; 
develop language skills in a wide range of critical languages; 
strengthen our education system, programs, and tools in foreign 
languages and cultures; and, integrate language training into career 
fields and increasing the number of language professionals.
  To strengthen the role of the U.S. in the world, our country must 
ensure that there are sufficient numbers of individuals who are 
proficient in languages other than English. Increasing foreign language 
skills enhances national security and economic prosperity.

[[Page S5294]]

  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1010

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``National Foreign Language 
     Coordination Act of 2009''.

     SEC. 2. ESTABLISHMENT OF NATIONAL FOREIGN LANGUAGE 
                   COORDINATION COUNCIL.

       (a) Establishment.--There is established in the Executive 
     Office of the President a National Foreign Language 
     Coordination Council (in this Act referred to as the 
     ``Council''), directed by a National Language Advisor (in 
     this Act referred to as the ``Advisor'') appointed by the 
     President.
       (b) Membership.--The Council shall consist of the following 
     members or their designees:
       (1) The Advisor, who shall serve as the chairperson of the 
     Council.
       (2) The Secretary of Education.
       (3) The Secretary of Defense.
       (4) The Secretary of State.
       (5) The Secretary of Homeland Security.
       (6) The Attorney General.
       (7) The Director of National Intelligence.
       (8) The Secretary of Labor.
       (9) The Secretary of Commerce.
       (10) The Secretary of Health and Human Services.
       (11) The Director of the Office of Personnel Management.
       (12) The heads of such other Federal agencies as the 
     Council considers appropriate.
       (c) Responsibilities.--
       (1) In general.--The Council shall be charged with--
       (A) overseeing, coordinating, and implementing continuing 
     national security and education language initiatives;
       (B) not later than 18 months after the date of enactment of 
     this Act, developing a national foreign language strategy, 
     building upon efforts such as the National Security Language 
     Initiative, the National Language Conference, the National 
     Defense Language Roadmap, the Language Continuum of the 
     Department of State, and others, in consultation with--
       (i) State and local government agencies;
       (ii) academic sector institutions;
       (iii) foreign language related interest groups;
       (iv) business associations, including industry;
       (v) heritage associations; and
       (vi) other relevant stakeholders;
       (C) conducting a survey of the status of Federal agency 
     foreign language and area expertise and agency needs for such 
     expertise; and
       (D) monitoring the implementation of such strategy 
     through--
       (i) application of current and recently enacted laws; and
       (ii) the promulgation and enforcement of rules and 
     regulations.
       (2) Strategy content.--The strategy developed under 
     paragraph (1) shall include--
       (A) recommendations for amendments to title 5, United 
     States Code, in order to improve the ability of the Federal 
     Government to recruit and retain individuals with foreign 
     language proficiency and provide foreign language training 
     for Federal employees;
       (B) the long term goals, anticipated effect, and needs of 
     national security language initiatives;
       (C) identification of crucial priorities across all 
     sectors;
       (D) identification and evaluation of Federal foreign 
     language programs and activities, including--
       (i) any duplicative or overlapping programs that may impede 
     efficiency;
       (ii) recommendations on coordination;
       (iii) program enhancements; and
       (iv) allocation of resources so as to maximize use of 
     resources;
       (E) needed national policies and corresponding legislative 
     and regulatory actions in support of, and allocation of 
     designated resources to, promising programs and initiatives 
     at all levels (Federal, State, and local), especially in the 
     less commonly taught languages that are seen as critical for 
     national security and global competitiveness during the next 
     20 to 50 years;
       (F) effective ways to increase public awareness of the need 
     for foreign language skills and career paths in all sectors 
     that can employ those skills, with the objective of 
     increasing support for foreign language study among--
       (i) Federal, State, and local leaders;
       (ii) students;
       (iii) parents;
       (iv) elementary, secondary, and postsecondary educational 
     institutions; and
       (v) employers;
       (G) recommendations for incentives for related educational 
     programs, including foreign language teacher training;
       (H) coordination of cross-sector efforts, including public-
     private partnerships;
       (I) coordination initiatives to develop a strategic posture 
     for language research and recommendations for funding for 
     applied foreign language research into issues of national 
     concern;
       (J) identification of and means for replicating best 
     practices at all levels and in all sectors, including best 
     practices from the international community; and
       (K) recommendations for overcoming barriers in foreign 
     language proficiency.
       (d) Submission of Strategy to President and Congress.--Not 
     later than 18 months after the date of enactment of this Act, 
     the Council shall prepare and submit to the President and the 
     relevant committees of Congress the strategy required under 
     subsection (c).
       (e) Meetings.--The Council may hold such meetings, and sit 
     and act at such times and places, as the Council considers 
     appropriate, but shall meet in formal session not less than 2 
     times a year. State and local government agencies and other 
     organizations (such as academic sector institutions, foreign 
     language-related interest groups, business associations, 
     industry, and heritage community organizations) shall be 
     invited, as appropriate, to public meetings of the Council at 
     least once a year.
       (f) Staff.--
       (1) In general.--The Advisor may--
       (A) appoint, without regard to the provisions of title 5, 
     United States Code, governing the competitive service, such 
     personnel as the Advisor considers necessary; and
       (B) compensate such personnel without regard to the 
     provisions of chapter 51 and subchapter III of chapter 53 of 
     that title.
       (2) Detail of government employees.--Upon request of the 
     Council, any Federal Government employee may be detailed to 
     the Council without reimbursement, and such detail shall be 
     without interruption or loss of civil service status or 
     privilege.
       (3) Experts and consultants.--With the approval of the 
     Council, the Advisor may procure temporary and intermittent 
     services under section 3109(b) of title 5, United States 
     Code.
       (4) Travel expenses.--Council members and staff shall be 
     allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Council.
       (5) Security clearance.--
       (A) In general.--Subject to subparagraph (B), the 
     appropriate Federal agencies or departments shall cooperate 
     with the Council in expeditiously providing to the Council 
     members and staff appropriate security clearances to the 
     extent possible pursuant to existing procedures and 
     requirements.
       (B) Exception.--No person shall be provided with access to 
     classified information under this section without the 
     appropriate required security clearance access.
       (6) Compensation.--The rate of pay for any employee of the 
     Council (including the Advisor) may not exceed the rate 
     payable for level V of the Executive Schedule under section 
     5316 of title 5, United States Code.
       (g) Powers.--
       (1) Delegation.--Any member or employee of the Council may, 
     if authorized by the Council, take any action that the 
     Council is authorized to take in this Act.
       (2) Information.--
       (A) Council authority to secure.--The Council may secure 
     directly from any Federal agency such information, consistent 
     with Federal privacy laws, including The Family Educational 
     Rights and Privacy Act (20 U.S.C. 1232g) and Department of 
     Education's General Education Provisions Act (20 U.S.C. 
     1232(h)), the Council considers necessary to carry out its 
     responsibilities.
       (B) Requirement to furnish requested information.--Upon 
     request of the Advisor, the head of such agency shall furnish 
     such information to the Council.
       (3) Donations.--The Council may accept, use, and dispose of 
     gifts or donations of services or property.
       (4) Mail.--The Council may use the United States mail in 
     the same manner and under the same conditions as other 
     Federal agencies.
       (h) Conferences, Newsletter, and Website.--In carrying out 
     this Act, the Council--
       (1) may arrange Federal, regional, State, and local 
     conferences for the purpose of developing and coordinating 
     effective programs and activities to improve foreign language 
     education;
       (2) may publish a newsletter concerning Federal, State, and 
     local programs that are effectively meeting the foreign 
     language needs of the nation; and
       (3) shall create and maintain a website containing 
     information on the Council and its activities, best practices 
     on language education, and other relevant information.
       (i) Annual Report.--Not later than 90 days after the date 
     of the enactment of this Act, and annually thereafter, the 
     Council shall prepare and transmit to the President and the 
     relevant committees of Congress a report that describes--
       (1) the activities of the Council;
       (2) the efforts of the Council to improve foreign language 
     education and training; and
       (3) impediments to the use of a National Foreign Language 
     program, including any statutory and regulatory restrictions.
       (j) Establishment of a National Language Advisor.--
       (1) In general.--The National Language Advisor appointed by 
     the President shall be a nationally recognized individual 
     with credentials and abilities across the sectors to be 
     involved with creating and implementing long-term solutions 
     to achieving national foreign language and cultural 
     competency.
       (2) Responsibilities.--The Advisor shall--

[[Page S5295]]

       (A) develop and monitor the implementation of a national 
     foreign language strategy, built upon the efforts of the 
     National Security Language Initiative, across all sectors;
       (B) establish formal relationships among the major 
     stakeholders in meeting the needs of the Nation for improved 
     capabilities in foreign languages and cultural understanding, 
     including Federal, State, and local government agencies, 
     academia, industry, labor, and heritage communities; and
       (C) coordinate and lead a public information campaign that 
     raises awareness of public and private sector careers 
     requiring foreign language skills and cultural understanding, 
     with the objective of increasing interest in and support for 
     the study of foreign languages among national leaders, the 
     business community, local officials, parents, and 
     individuals.
       (k) Encouragement of State Involvement.--
       (1) State contact persons.--The Council shall consult with 
     each State to provide for the designation by each State of an 
     individual to serve as a State contact person for the purpose 
     of receiving and disseminating information and communications 
     received from the Council.
       (2) State interagency councils and lead agencies.--Each 
     State is encouraged to establish a State interagency council 
     on foreign language coordination or designate a lead agency 
     for the State for the purpose of assuming primary 
     responsibility for coordinating and interacting with the 
     Council and State and local government agencies as necessary.
       (l) Congressional Notification.--The Council shall provide 
     to Congress such information as may be requested by Congress, 
     through reports, briefings, and other appropriate means.
       (m) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as necessary to carry out this 
     Act.

                                 ______
                                 
      By Mr. REID (for Mr. Rockefeller (for himself, Mr. Byrd, Mr. 
        Bayh, Mr. Begich, Mr. Nelson, of Nebraska, Mr. Whitehouse, and 
        Mr. Levin)):
  S. 1012. A bill to require the Secretary of the Treasury to mint 
coins in commemoration of the centennial of the establishment of 
Mother's Day; to the Committee on Banking, Housing, and Urban Affairs.
  Mr. ROCKEFELLER. Mr. President, I rise today to introduce the 
Mother's Day Centennial Coin Commemorative Coin Act. I am proud to have 
the senior Senator from West Virginia, Senator Byrd, as an original 
cosponsor given that this is a special event for our state. We are 
joined by Senators Bayh, Begich, Ben Nelson, Whitehouse and Levin.
  In 1908, a West Virginian woman by the name of Anna Jarvis petitioned 
her local church to declare May 9th as Mother's Day. Within 6 years, 
the holiday became nationally recognized. Now, more than 100 years 
after that first Mother's Day, we have the opportunity to commemorate 
the centennial of this great holiday and further recognize the millions 
of American mothers whose essential role in life cannot be overstated.
  The legislation I am introducing today would recognize the centennial 
of Mother's Day by authorizing the Treasury to mint commemorative 
Mother's Day coins. Profits generated from the sale of the coins would 
be donated to Susan G. Komen for the Cure and The National Osteoporosis 
Foundation. Susan G. Komen for the Cure has raised more than $1 billion 
for breast cancer research since 1982, and the National Osteoporosis 
Foundation is considered our Nation's leading voluntary health 
organization. Thousands of women have benefited from the efforts of 
these organizations and they are well deserving of our support.
  These coins will not only raise awareness of the proud history of 
Mother's Day, but will help improve the health of thousands of our 
Nation's mothers. Therefore, I encourage my colleagues to reflect upon 
their relationships with the mothers in their lives, and join me in 
supporting this legislation to recognize the past century's worth of 
noble women and help ensure the health of those to come in the next 
century.

                          ____________________