[Congressional Record (Bound Edition), Volume 146 (2000), Part 13]
[Senate]
[Pages 19093-19115]
[From the U.S. Government Publishing Office, www.gpo.gov]



                     CHILDREN'S HEALTH ACT OF 2000

  Mr. LOTT. I ask unanimous consent that the health committee be 
discharged from further consideration of H.R. 4365 and the Senate then 
proceed to its immediate consideration.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report the bill by title.
  The assistant legislative clerk read as follows:

       A bill (H.R. 4365) to amend the Public Health Service Act 
     with respect to children's health.

  There being no objection, the Senate proceeded to consider the bill.


                           Amendment No. 4181

  Mr. LOTT. Senator Frist has an amendment at the desk and I ask for 
its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Mississippi [Mr. Lott], for Mr. Frist, 
     proposes an amendment numbered 4181.

  Mr. LOTT. Mr. President, I ask unanimous consent reading of the 
amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. FRIST. Mr. President, I am pleased that the Senate has passed 
today, H.R. 4365, the Children's Health Act of 2000, a comprehensive of 
several important children's health bills on which I and the rest of 
the Senate have spent a great amount of time over the past year and a 
half. These bills address a wide variety of critical children's health 
issues, including day care safety, maternal and infant health, 
pediatric public health promotion, pediatric research, and efforts to 
fight youth drug abuse and provide mental health services. 
Collectively, this comprehensive bill will form the backbone of efforts 
that will improve the health and safety of America's children well into 
the coming years.
  The bill which passed the Senate today includes two divisions, with 
Division A addressing issues regarding children's health, while 
Division B addresses youth drug abuse.
  Perhaps the most critical section in Division A of this bill are 
provisions relating to day care health and safety, which were included 
in S. 2263, the ``Children's Day Care Health and Safety Improvement 
Act,'' which I introduced with Senator Dodd on March 9, 2000. These 
provisions recognize that while more than 13 million children under the 
age of six spend some part of their day in day care, including 254,000 
children in Tennessee alone, evidence suggests a need to make these 
settings safer and improve the health of children in child care 
settings.
  The danger in child care settings has recently become evident in 
Tennessee. Tragically, within the span of 2 years, there have been 4 
deaths in child care settings in Memphis, and 1 in 5 child-care 
programs in the Nashville area were found to have potentially put the 
health and safety of children at risk during 1999. But this isn't just 
a Tennessee concern. It affects parents nationwide.
  For example, according to a Consumer Product Safety Commission Study, 
in 1997, 31,000 children ages four and younger were treated in hospital 
emergency rooms for injuries sustained in child care or school 
settings. Since 1990, more than 60 children have died in child care 
settings. This is unacceptable. The thousands of parents leaving their 
children in the hands of child care providers each day deserve 
reassurance that their children are safe.
  Further evidence of day care health and safety concerns were made 
clear in a recent study by the American Academy of Pediatrics which 
showed a disturbing trend among infants and Sudden Infant Death 
Syndrome (SIDS) in day care. The study examined 1,916 SIDS cases from 
1995 to 1997 in 11 states, and found that about 20 percent, 391 deaths, 
occurred in day care settings. Most troubling was the fact that in over 
half of the cases where caretakers placed children on their stomach, 
the children were usually put to sleep on their backs by their parents.
  Parents and advocates who are dedicated in helping to eliminate the 
incidence of SIDS have urged that child care providers be required to 
have SIDS risk reduction education. I agree, which is why I included 
provision in the bill to carry out several activities, including the 
use of health consultants to give health and safety advice to child 
care providers on important issues like SIDS prevention.
  Overall the bill provides $200 million to states, including $4.2 
million for my state of Tennessee, to help improve the health and 
safety of children in child care. The grants could be used for a number 
of activities, including child care provider training and education; 
inspections and criminal background checks for day care providers; 
enhancements to improve a facility's ability to serve children with 
disabilities; transportation safety procedures; and information for 
parents on choosing a safe and healthy day care setting. The funding 
could also be used to help child care facilities meet health and safety 
standards or employ health consultants to give health and safety advice 
to child care providers.
  As a father, my highest concern is the safety of my three sons, and I 
understand the fears that so many parents have. Parents shouldn't be 
afraid to leave their children in the care of a licensed child care 
facility. This bill helps ensure that our child care centers will be 
safer.
  The major portion of Division A are provisions which were included in 
the ``Children's Public Health Act of 2000'' which I introduced on July 
13, 2000 with Senators Jeffrods and Kennedy. Provisions in the 
``Children's Public Health Act of 2000'' address a wide range of 
children's health issues including maternal and infant health, 
pediatric health promotion, and pediatric research.
  Unintentional injuries are the leading cause of death for every age 
group between 1 and 19 years of age, comprising 26 deaths per 100,000 
children aged 1-14 and 62 deaths per 100,000 children aged 15-19. More 
than 1.5 million American children suffer a brain injury each year. 
Therefore, the bill reauthorizes and strengthens the Traumatic Brain 
Injury programs at the Centers for Disease Control and Prevention 
(CDC), the National Institutes of Health (NIH) and the Health Resources 
and Services Administration (HRSA).
  Because birth defects are the leading cause of infant mortality and 
are responsible for about 30 percent of all pediatric hospital 
admissions, the bill also focuses on maternal and infant health. This 
legislation establishes a National Center for Birth Defects and

[[Page 19094]]

Developmental Disabilities at the CDC to collect, analyze, and 
distribute data on birth defects. In addition, the bill authorizes the 
Healthy Start program to reduce the rate of infant mortality and 
improve perinatal outcomes by providing grants to areas with a high 
incidence of infant mortality and low birth weight.
  Furthermore, over 3,000 women experience serious complications due to 
pregnancy. Two out of three will die from complications in their 
pregnancy. Therefore, the bill develops a national monitoring and 
surveillance program to better understand maternal complications and 
mortality, and to decrease the disparities among populations at risk of 
death and complications from pregnancy.
  The bill also combats some of the most common childhood diseases and 
conditions. For instance, it provides comprehensive asthma services and 
coordinates the wide range of asthma prevention programs in the federal 
government to address the most common chronic childhood disease, 
asthma, which affects nearly 5 million children.
  We also focus on childhood obesity, which has doubled in just the 
past 15 years, and produced 4.7 million seriously overweight children 
and adolescents ages 6-19 years. To address this epidemic, the bill 
supports state and community-based programs to promote good nutrition 
and increased physical activity among American youth.
  In examining the problems affecting children across the nation and in 
Tennessee, I was very concerned to learn that in Memphis, over 12 
percent of children under the age of 6 may have lead poisoning. Such 
poisoning can cause a variety of debilitating health problems, 
including seizure, and coma, and even death. Even at lower levels, lead 
can contribute to learning disabilities, loss of intelligence, 
hyperactivity, and behavioral problems. This bill includes physician 
education and training programs on current lead screening policies, 
tracks the percentage of children in the Health Centers program who are 
screened for lead poisoning, and conducts outreach and education for 
families at risk of lead poisoning,
  The May 2000 Surgeon General's report noted that oral health is 
inseparable from overall health, and that while a majority of the 
population has experienced great improvements in oral health, 
disparities affecting poor children and those who live in underserved 
areas represent 80 percent of all dental cavities in 20 percent of 
children. This bill encourages pediatric oral health by supporting 
community-based research and training to improve the understanding of 
etiology, pathogenesis, diagnoses, prevention, and treatment of 
pediatric oral, dental, and craniofacial diseases.
  Finally, the bill strengthens pediatric research efforts by 
establishing a Pediatric Research Initiative within the NIH to enhance 
collaborative efforts, provide increased support for pediatric 
biomedical research, and ensure that opportunities for advancement in 
scientific investigations and care for children are realized.
  I also want to highlight the critical issue of childhood research 
protections. Included in this bill are provisions to address safety 
issues in children's research by requiring the Secretary of HHS to 
review the current federal regulations for the protection of children 
participating in research, which address such issues as determining 
acceptable levels of risk and obtaining parental permission, and to 
report to Congress on how to ensure the highest standards of safety. 
Also, the provision requires that all HHS-funded and regulated research 
comply with these additional protections for children. During this 
year, the Senate Subcommittee on Public Health, which I chair, held two 
important hearings relating to gene therapy trials and human subject 
protections. The Subcommittee discovered that there was a lapse of 
protection for individuals participating as subjects in clinical trial 
research. Next Congress, I intend to make the further review and 
updating of human subject protections a major priority of the 
Subcommittee.
  Division B of the bill contains provisions which address the scourge 
upon children of drug abuse. The 1999 National Household Survey on Drug 
Abuse, conducted by the Substance Abuse and Mental Health Services 
Administration (SAMHSA), reported that 10.9 percent of youths age 12-17 
currently use illicit drugs. It further estimated that nearly 11.3 
percent of 12-17 year-old boys and 10.5 percent of 12-17 year-old girls 
used drugs in the past month. But just as important is the growth in 
alcohol abuse among our youth, as SAMHSA reports that 10.4 million 
current drinkers are younger than the legal drinking age of 21 and that 
more than 6.8 million engaged in binge drinking. Tragically, all of 
these numbers among youth substance abuse have risen since 1992.
  To address the tragedy of drug use by our children, the bill 
incorporates the ``Youth Drug and Mental Health Services Act,'' which I 
introduced with Senator Kennedy last spring and was first passed the 
Senate on November 3, 1999.
  The ``Youth Drug'' bill addresses the problem of youth substance 
abuse by reauthorizing and improving SAMHSA through a renewed focus on 
youth and adolescent substance abuse and mental health services, in 
conjunction with greater flexibility and new accountability for States 
for the use of federal funds.
  Created in 1992 to assist States in reducing the incidence of 
substance abuse and mental illness through prevention and treatment 
programs, SAMHSA provides funds to States for alcohol and drug abuse 
prevention and treatment programs and activities, as well as mental 
health services, with its block grants accounting for 40 percent and 15 
percent respectively of all substance abuse and community mental health 
services funding in the States. In my own State of Tennessee, SAMHSA 
provides more than 70 percent of overall funding for the Tennessee 
Department of Health's Bureau of Alcohol and Drug Abuse Services.
  This bill accomplishes six critical goals: (1) promotes State 
flexibility by easing outdated or unneeded requirements governing the 
expenditure of Federal block grants; (2) ensures State accountability 
by moving away from the present system's inefficiencies to a 
performance based system; (3) provides substance abuse treatment 
services and early intervention substance abuse services for children 
and adolescents; (4) helps local communities treat violent youth and 
minimize outbreaks of youth violence through partnerships among 
schools, law enforcement and mental health services; (5) ensures 
Federal funding for substance abuse or mental health emergencies; and 
(6) supports and expands programs providing mental health and substance 
abuse treatment services to homeless individuals.
  The bill also includes a number of other important provisions, 
including those to address how to treat individuals with co-occurring 
mental health and substance abuse disorders the proper and safe use of 
restraints and seclusions in mental health facilities, and important 
``charitable choice'' provision that permits Federal assistance for 
religious organizations providing substance abuse services. We know 
that no one approach works for everyone who needs and wants substance 
abuse treatment and that faith-based programs have strong records of 
successful rehabilitation. This provision will allow faith-based 
programs to continue to offer their assistance and expertise.
  The ``Youth Drug and Mental Health Services Act'' provides Tennessee 
and other states needed funds for community based programs helping 
individuals with substance abuse and mental health disorders, 
dramatically increasing State flexibility and ensuring that each State 
is able to address its unique needs. The bill provides a much needed 
focus on the troubling issue of drug use by our youth and helps local 
communities deal with the issue of children and violence.
  I would also like to highlight the ``Methamphetamine Anti-
Proliferation Act of 1999,'' which is sponsored by Senator Ashcroft and 
included in this comprehensive bill. This bill address the plague of 
methamphetamine which has severely impacted Tennessee, other southern 
states, the Mid-West, and Rocky Mountain states. Under these

[[Page 19095]]

provisions, criminal penalties are increased for individuals who 
manufacture methamphetamine. The provisions also increase funding for 
law enforcement training and target high intensity methamphetamine 
trafficking areas.
  Finally the bill also tackles another devastating drug which has 
shown signs of increased use in our youth, the drug known as 
``Ecstasy.'' In short, the bill directs the Sentencing Commission to 
review and amend the Ecstasy guidelines to provide for increased 
penalties to reflect the seriousness of the offenses of trafficking in 
and importing Ecstasy and related drugs.
  Mr. President, this legislation which has passed the Senate today is 
a comprehensive, multifaceted attack on the numerous threats to our 
children's health. I am thankful for all my colleagues for their 
support and willingness to help the children of this nation. I would 
especially like to thank Senators Jeffords and Kennedy and 
Representatives Tom Bliley, Michael Bilirakis, John Dingell and Sherrod 
Brown, and their excellent staffs for all the hard work and dedication 
which has gone into this bill. I would also like to thank Mr. Bill 
Baird and Ms. Daphne Edwards, of the Office of Senate Legislative 
Counsel, for their tireless work and for their great expertise in 
drafting this comprehensive bill. I would also like to personally thank 
Mr. Joseph Faha, Director of Legislation and External Affairs of the 
Substance Abuse and Mental Health Service Administration as well as 
other member of the Department of Health of Human Services. Finally, I 
would like to thank my Staff Director, of the Public Health 
Subcommittees, Anne Phelps and my Health Policy Advisor, Dave Larson. 
Finally, I would like to thank the may groups advocating on behalf of 
children and parents and families who have worked so hard to bring this 
bill to fruition. I look forward to swift action in the House on this 
measure and it's enactment into law.
  Mr. KENNEDY. Mr. President, this legislation will help millions of 
children in the years ahead. It takes needed action to improve 
children's health by expanding pediatric research and taking specific 
steps to deal with a wide range of childhood illnesses, disorders, and 
injuries. It also reauthorizes the Substance Abuse and Mental Health 
Services Adminstration, which has an important role in reducing 
substance abuse and maintaining and improving the mental health of the 
nation's children and adolescents. Coordinated efforts in these areas 
can lead to significant benefits for all children.
  Senator Frist and I have worked closely with many of our Democratic 
and Republican colleagues on this important legislation. We have talked 
with experts and advocates in the children's health community and in 
the mental health and substance abuse treatment communities. This 
legislation will lead to significant progress in addressing many of 
today's most pressing pediatric public health problems.
  The legislation includes a variety of new and reauthorized children's 
health provisions. It represents a compromise with our colleagues in 
the House and addresses a wide range of pediatric public health issues 
raised by experts in the field and championed by numerous members from 
both sides of the aisle in both chambers.
  Division A of the bill focuses on general children's health. It 
includes programs to improve the health of pregnant women and prenatal 
outcomes, including prevention of birth defects and low birth weight. 
It establishes a new Center for Birth Defects and Developmental 
Disabilities at the Centers for Disease Control and Prevention, in 
order to focus the nation's activities more effectively in these 
important areas. It also directs the Secretary of the Department of 
Health and Human Services to expand public education efforts on folic 
acid consumption in order to decrease neural tube birth defects.
  The bill also deals with traumatic brain injury which is the leading 
cause of death and disability in young Americans. The Centers for 
Disease Control and Prevention has estimated that 5.3 million Americans 
are living with long-term, severe disability as a result of brain 
injuries, and each year 50,000 people die as a result of such injuries. 
The Children's Public Health Act revises and extends the authorization 
for a series of important programs that were enacted in 1996 to deal 
with these injuries. This reauthorization will assure continued 
progress toward understanding, treating and preventing them.
  In addition, the bill includes the long overdue reauthorization of 
the CDC's Injury Prevention and Control Programs. There are steps we 
should take to modernize this authority and increase the authorization 
levels, but it is welcome progress at last to renew its authorization.
  Improving and protecting the safety of child care facilities is also 
a high priority for Congress. This legislation creates a new program to 
improve the safety of children in child care settings, and to encourage 
child care providers to take steps to prevent illness and injuries and 
protect the health of the children they serve.
  It is said that the 21st century will be the century of life 
sciences. Our national health policy will have the benefit of brilliant 
new scientific discoveries that have already begun to change how we 
diagnose, treat and prevent countless conditions. The legislation 
creates a new grant program that focuses on inherited disorders. Based 
on legislation introduced last year that has the strong support of a 
broad-based coalition of both the genetics and public health 
communities, our bill provides funds for state or local public health 
departments to expand existing programs or initiate new programs that 
provide screening, counseling or health services to infants and 
children who have genetic conditions or are at risk for such 
conditions. It also establishes an Advisory Committee to assist the 
Secretary on these issues.
  The bill also takes a number of steps to address other prevalent 
childhood conditions. Asthma is the most common chronic childhood 
illness, affecting more than seven percent of all American children. 
The death rate for children with asthma increased by 78 percent between 
1980 and 1993, and asthma-related costs total nearly $2 billion 
annually in direct health care for children. The nation is handicapped 
by a lack of basic information on where and how asthma strikes, what 
triggers it, and how effectively the health care system is responding 
to those who suffer from this chronic disease. Our bill will provide 
greater asthma services to children, including mobile clinics and 
patient and family education, and it will help to reduce allergens in 
housing and public facilities.
  Poor nutrition and lack of physical activity are also hurting many 
American children and contributing to lifelong health problems. The 
nation spends $39 billion a year--equal to six percent of overall U.S. 
health care expenditures--on direct health care related to obesity. 
Twenty percent of American children--one in five--are overweight. 
Unhealthy eating habits and physical inactivity in childhood can lead 
to heart disease, cancer and other serious illnesses decades later. 
Children and adolescents who suffer from eating disorders, such as 
anorexia nervosa and bulimia, can have wide-ranging physical and mental 
health impairments. Our legislation establishes new grant programs to 
reduce childhood obesity and eating disorders, promote better 
nutritional habits among children, and encourage an appropriate level 
of physical activity for children and adolescents.
  The bill also requires the Secretary to study issues related to 
effective treatment for metabolic disorders, including PKU, and access 
to such treatments, in order to prevent worsening of these conditions. 
It is my hope that this study will be useful for employers, insurers, 
insurance commissioners and others who provide insurance or set 
coverage standards.
  Another major area where additional efforts are needed is dental 
care. Last May, the Surgeon General published a landmark report on oral 
health in America, emphasizing the need to consider oral health as an 
essential part of total health. There is no question that oral and 
dental health care should be included in primary care. Tooth decay

[[Page 19096]]

is the most common childhood infectious disease, and it can lead to 
devastating consequences, including problems with eating, learning and 
speech. Twenty-five percent of children in the United States suffer 80 
percent of the tooth decay, with significant racial and age 
disparities. The number of dentists in the country has been declining 
since 1990, and is projected to continue to decline through the year 
2020.
  According to a 1995 report by the Inspector General, only one in five 
Medicaid-eligible children receive dental services annually, and the 
shortage of dentists exacerbates the problem of unmet needs. Yet tooth 
decay is largely preventable. More effective efforts to educate parents 
and children about the causes of tooth decay--and initiatives to 
prevent and treat it--can lead to lasting public health improvements. 
Our legislation includes a variety of approaches to deal with this 
silent epidemic, including a new grant program to improve the 
understanding of prevention, diagnosis, and treatment of pediatric oral 
diseases and conditions, and grants to increase community-wide 
fluoridation and school-based dental sealant programs. It also directs 
the Secretary to undertake a coordinated oral health initiative to fund 
innovative activities to improve the oral health of low-income 
children.
  Research has long shown that childhood lead poisoning can have 
devastating effects on children, causing reduced IQ and attention span, 
stunted growth, behavior problems, and reading and learning 
disabilities. Yet too many children remain unscreened and untreated, 
and adequate services often are not available for children with 
elevated levels of lead in their blood. There is no excuse for not 
taking greater steps to eliminate childhood lead poisoning. Our bill 
includes screening for early detection and treatment, professional 
education and training programs, and outreach and education activities 
for at-risk children.
  Pediatric research discoveries promote and maintain health throughout 
a child's life span, and also contribute significantly to new insights 
that aid in the prevention and treatment of illnesses among adults. A 
growing body of evidence shows that risk factors for conditions such as 
coronary artery disease and stroke begin in childhood and persist 
through adulthood. Congress has a strong record of promoting basic and 
clinical research, and the steps taken in this legislation continue 
that priority with a special focus on children.
  The legislation establishes a pediatric research initiative, 
authorized at $50 million annually, that will increase support for 
pediatric biomedical research at the National Institutes of Health, 
including an increase in collaborative efforts among multidisciplinary 
fields in areas that are promising for children. The legislation also 
requires coordination with the Food and Drug Administration to increase 
the number of pediatric clinical trials, and to provide greater 
information on safer and more effective use of prescription drugs in 
children.
  Children have unique health care needs. They are not simply small 
adults. Nothing is more important to the future health of America's 
children than maintaining a steady supply of pediatricians, pediatric 
specialists and pediatric-focused scientists.
  Our legislation takes several important steps to improve the growth 
and development of a pediatric-focused medical community. It enhances 
support through the NIH expressly for training and career development 
activities of pediatric researchers, including establishing a loan 
repayment program for health care professionals who focus on pediatric 
research.
  It revises and extends the authorization of a program enacted last 
year to support graduate medical education at independent children's 
hospitals. These hospitals train half of all pediatric specialists, and 
30 percent of all pediatricians. However, because GME activities have 
historically been supported by Medicare and because these hospitals 
serve very few Medicare patients, they have traditionally received very 
little federal financial support for this important and costly 
activity. As a result, children's hospitals are struggling to maintain 
the important training, pediatric research, and primary and specialty 
care services that they provide. Children's hospitals should be treated 
like all other teaching hospitals when it comes to support for their 
GME activities. I have sponsored other legislation to guarantee full 
funding each year, without being subject to the appropriations process. 
That proposal has been included in the Balanced Budget Refinement Act 
of 2000. It is awaiting consideration in the Finance Committee, and I 
hope it will be enacted this year.
  The bill also authorizes a new long-term study to monitor and 
evaluate health and development of children through adulthood. The kind 
of information that will be obtained by this study is long-overdue, and 
I look forward to its results.
  The bill also takes two steps to protect children who participate in 
clinical trials and other research. It requires all HHS-regulated and 
funded research to comply with current pediatric-specific human subject 
protection regulations. This provision is supported by the FDA and 
industry alike, and it is an important step toward assuring full public 
confidence in life-saving research activities. In addition, it requires 
the Secretary to review those regulations and report on their adequacy 
and recommendations, if any, for changes within six months. Our 
committee intends to look more broadly at the issue of human subject 
protections next year, and this report will help inform those 
discussions.
  Finally, this legislation also includes a variety of directives to 
increase activities at public health agencies on specific disorders and 
diseases affecting children. Children living with autism, Fragile X, 
diabetes, arthritis, muscular dystrophy, epilepsy, cystic fibrosis, and 
a number of other conditions have much to be grateful for today. We all 
have the highest hopes that the provisions in this bill will lead to 
successful efforts to combat these debilitating and often deadly 
conditions.
  Division B of the bill will enable the Substance Abuse and Mental 
Health Services Administration to meet the mental health and substance 
abuse needs of communities through its successful existing programs and 
through new and innovative initiatives.
  The recent National Household Survey on Drug Abuse indicates that we 
have made important progress in combating substance abuse, especially 
among the nation's youth. The goal of this legislation is to build on 
that progress with expanded prevention and treatment services. Several 
of the bill's provisions come from the Mental Health Early 
Intervention, Treatment, and Prevention Act, which Senator Domenici and 
I introduced in re-
sponse to the Surgeon General's groundbreaking Report on Mental Health. 
These provisions take needed steps to give the mentally ill the 
services they need.
  This legislation is the product of bi-partisan cooperation, and I 
especially commend Senator Frist for his leadership in bringing 
everyone together. His efforts have helped ensure that the measure we 
pass today is an effective response to the mental illness and substance 
abuse problems we face.
  Over the past two decades, we have made great progress in determining 
the causes of mental illnesses and developing strategies to treat them. 
We have also begun to understand the biological basis of substance 
abuse. Despite these scientific advances, mental illness and substance 
abuse continue to be a national crisis. One in five Americans will 
experience some form of mental illness this year--and two-thirds of 
them will not seek treatment. Substance abuse costs the country an 
estimated $270 billion in annual economic costs, and it leads to 
unacceptable violence, injury, and HIV infection in our communities.
  Too often, patients with mental illness are denied the state-of-the-
art treatment that would be available if their illnesses were physical 
instead of mental. We have failed to provide them with the services 
they need to meet the overwhelming obstacles they face. We have not 
made an adequate effort to help them overcome their addictions.

[[Page 19097]]

The bill we pass today is intended to correct these injustices.
  It will provide treatment to those who desperately need it and 
prevention services to those at risk. Much of the bill focuses on the 
unique needs of youths, adolescents, and young adults. It provides 
services for children of substance abusers, training for teachers to 
recognize the symptoms of mental illness, and a suicide prevention 
program for children and youth. In addition, it provides a range of 
community services for children with serious emotional disturbances and 
for youth offenders. Agencies will receive funding to study and treat 
post-traumatic stress disorder in children. The bill also provides 
funds to coordinate welfare and mental health services for children who 
would benefit from this approach.
  For homeless individuals, the bill provides expanded mental health 
and substance abuse services, along with transition assistance. For 
residents of treatment facilities, it offers protections from the 
inappropriate and often harmful use of seclusion and restraints. The 
bill will help to divert persons with mental illness from the criminal 
justice system, which for too long has served as a dumping-ground, and 
give them the services they need. It will provide special treatment for 
those who suffer simultaneously from mental illness and addiction. It 
will also provide funds to designate facilities as emergency mental 
health centers, especially in underserved areas. In all the services 
included, there will be a special emphasis on meeting the unique needs 
of specific cultures and ethnic groups, and on giving states the 
flexibility they need to address the concerns of their individual 
communities.
  For too long, we have blamed the mentally ill and those addicted to 
alcohol and other drugs for their behavior, rather than extending a 
helping hand. Recent scientific advances have opened new windows onto 
the biochemical basis of mental illness and addictive behavior. This 
legislation will ensure that these advances are translated into 
practical services for those who need them. By creating this more 
effective framework to deliver appropriate services, we will help many 
more individuals to re-enter society as productive members, and do much 
more to dispel the stigma of diseases that affect the mind.
  This legislation deserves to be a major public health priority for 
the nation. Congress should send the President this legislation before 
the end of this session.
  I ask unanimous consent that the summary of the legislation be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

    The Children's Health Act of 2000: Division A--Children's Health

                            Title I--Autism

       Under this provision, the Director of NIH shall expand, 
     intensify, and coordinate the activities of the NIH with 
     respect to research on autism. The Director of NIH will 
     establish not less than 5 Centers of Excellence on autism 
     research. Each center will conduct basic and clinical 
     research into the cause, diagnosis, early detection, 
     prevention, control and treatment of autism, including 
     research in the fields of developmental neurobiology, 
     genetics and psychopharmacology. The Director shall provide 
     for the coordination of information among centers. The 
     Director shall provide for a program under which samples of 
     tissues and genetic materials that are of use in research on 
     autism are made available for this research.
       The provision also establishes 3 CDC regional centers of 
     excellence in autism and pervasive developmental 
     disabilities, to collect and analyze information on the 
     number, incidence, and causes of autism and related 
     developmental disabilities. The Secretary shall also 
     establish a program to provide information on autism to 
     health professionals and the general public, and establish a 
     committee to coordinate all activities within HHS concerning 
     autism.

         Title II--Research and Development Regarding Fragile X

       Instructs the National Institute of Child Health and Human 
     Development to expand, intensify, and coordinate research on 
     Fragile X and authorizes the development of coordinated 
     Fragile X research centers.

          Title III--Juvenile Arthritis and Related Conditions

       Requires the National Institute of Arthritis and 
     Musculoskeletal and Skin Diseases to expand and intensify 
     research concerning juvenile arthritis. Directs HHS to 
     evaluate whether the supply of pediatric rheumatologists is 
     adequate to meet the health care needs of children with 
     arthritis.

     Title IV--Reducing Burden of Diabetes Among Children and Youth

       Directs the Secretary, acting through the CDC, to develop a 
     sentinel system to collect incidence and prevalence data on 
     juvenile diabetes. Requires NIH to conduct or support long-
     term epidemiology studies to investigate the causes and 
     characteristics of juvenile diabetes, and to support regional 
     clinical research centers for the prevention, detection, 
     treatment and cure of juvenile diabetes. Provides for 
     research and development of prevention strategies.

                 Title V--Asthma Services for Children

       This provision authorizes the Secretary to award grants to 
     provide comprehensive asthma services to children, equip 
     mobile health care clinics, conduct patient and family 
     education on asthma management, and identify children 
     eligible for Medicaid, the State Children's Health Insurance 
     Program, and other children's health programs. This provision 
     amends the Preventive Health and Health Services Block Grant 
     program to provide for the establishment, operation, and 
     coordination of effective and cost-efficient systems to 
     reduce the prevalence of asthma and asthma-related illnesses, 
     especially among children, by reducing the level of exposure 
     to allergens through the use of integrated pest management.
       This provision also requires the National Heart Lung and 
     Blood Institute, through the National Asthma Education 
     Prevention Program Coordinating Committee, to identify all 
     federal programs that carry out asthma-related activities, 
     develop a Federal plan for responding to asthma in 
     consultation with appropriate federal agencies, professional 
     and voluntary health organizations, and recommend ways to 
     strengthen and improve the coordination of asthma-related 
     Federal activities. CDC will collect and publish data on the 
     prevalence of children suffering from asthma in each State, 
     as well as mortality data at the national level.

             Title VI--Birth Defects Prevention Activities

       This provision expands CDC's folic acid education program 
     to prevent birth defects. In partnership with the States and 
     local, public, and private entities, CDC shall expand an 
     education and public awareness campaign; conduct research to 
     identify effective strategies for increasing folic acid 
     consumption by women of reproductive capacity; evaluate the 
     effectiveness of these strategies; and conduct research to 
     increase our understanding of the effects of folic acid in 
     preventing birth defects.
       This provision elevates the Division of Birth Defects and 
     Developmental Disabilities to a National Center for Birth 
     Defects and Developmental Disabilities within CDC. The 
     purpose of this Center would be to collect, analyze, and 
     distribute data on birth defects and developmental 
     disabilities including information on causes, incidence, and 
     prevalence; conduct applied epidemiological research on the 
     prevention of such defects and disabilities; and provide 
     information to the public on proven prevention activities.

 Title VII--Early Detection, Diagnosis and Treatment Regarding Hearing 
                            Loss in Infants

       Authorizes grants or cooperative agreements to develop 
     statewide newborn and infant hearing screening, evaluation 
     and intervention programs and systems, and provide technical 
     assistance to State agencies. Directs the NIH to continue a 
     program of research and development on the efficacy of new 
     screening techniques and technology. Provides for federal 
     coordination with State and local agencies, consumer groups, 
     national medical, health, and education organizations. 
     Coordinated activities shall include policy recommendations 
     and development of a data collection system.

                   Title VIII--Children and Epilepsy

       Authorizes the agencies of HHS to expand current epilepsy 
     surveillance activities; implement public and professional 
     education activities; enhance research initiatives; and 
     strengthen partnerships with government agencies and 
     organizations that have experience addressing the health 
     needs of people with disabilities. Authorizes demonstration 
     projects in medically underserved areas, to improve access to 
     health services regarding seizures, to encourage early 
     detection and treatment in children.

         Title IX--Safe Motherhood and Infant Health Promotion

       The provision authorizes the Secretary of HHS to develop a 
     national surveillance program to better understand the burden 
     of maternal complications and mortality and to decrease the 
     disparities among populations at risk of death and 
     complications from pregnancy. The provision allows the 
     Secretary to expand the Pregnancy Risk Assessment Monitoring 
     System to provide surveillance and data collection in each 
     State. Furthermore, the provision would expand research 
     concerning risk factors, prevention

[[Page 19098]]

     strategies, and the roles of the family, health care 
     providers, and the community in safe motherhood. The 
     provision also authorizes public education campaigns on 
     healthy pregnancy, education programs for health care 
     providers, and activities to promote community support 
     services for pregnant women. Finally, the provision 
     authorizes grant funding for research initiatives and 
     programs to prevent drug, alcohol, and tobacco use among 
     pregnant women.

                 Title X--Pediatric Research Initiative

       This provision establishes a Pediatric Research Initiative 
     within the National Institutes of Health to enhance 
     collaborative efforts, provide increased support for 
     pediatric biomedical research, and ensure that expanding 
     opportunities for advancement in scientific investigations 
     and care for children are realized.
       The Secretary of HHS will make available enhanced support 
     for activities relating to the training and career 
     development of pediatric researchers, including general 
     authority for loan repayment of a portion of education loans.
       This provision also requires that all HHS-funded and 
     regulated research comply with current pediatric-specific 
     human subject protection regulations. (Currently FDA-
     regulated research is not required to comply).
       National Institute of Child Health and Human Development is 
     authorized to convene and direct a consortium of federal 
     agencies, including CDC and EPA, to develop and implement a 
     prospective cohort study to evaluate the effects of both 
     chronic and intermittent external influences on human 
     development, and to investigate basic mechanisms of 
     developmental disorders and environmental factors, both risk 
     and protective, that influence growth and developmental 
     processes. The study will incorporate behavioral, emotional, 
     educational, and contextual consequences to enable a complete 
     assessment of the physical, chemical, biological and 
     psychosocial environmental influences on children's well-
     being. The study shall gather data on environmental 
     influences and outcomes until at least age 21, shall include 
     diverse populations, and shall consider health disparities.

                    Title XI--Childhood Malignancies

       Directs the Secretary of HHS, through CDC and NIH, to study 
     risk factors that affect or cause childhood cancers and carry 
     out projects to improve outcomes for children with cancer and 
     resultant secondary conditions. Provides for the expansion of 
     current data collection and support for CDC's National Limb 
     Loss Information Center.

                     Title XII--Adoption Awareness

       This title authorizes the Secretary of HHS to make grants 
     to adoption organizations to train the staff of eligible 
     health centers in providing adoption information and 
     referrals based on guidelines developed by the adoption 
     community. The Secretary, through the Health Resources and 
     Services Administration and the Agency for Healthcare 
     Research and Qaulity, shall evaluate the effectiveness of the 
     training program as well as the extent to which such training 
     complies with federal requirements which may apply to 
     eligible health centers, to provide adoption information and 
     referrals on an equal basis with all other courses of action 
     included in nondirective pregnancy options counseling.
       The Secretary shall carry out a national campaign to 
     provide information to the public about adoption of children 
     with special needs. Additionally, the Secretary shall make 
     grants to provide assistance to adoption support groups and 
     carry out studies to identify components that lead to 
     favorable long-term outcomes for families that adopt children 
     with special needs.

                   Title XIII--Traumatic Brain Injury

       This provision reauthorizes the Traumatic Brain Injury Act 
     of 1996 to extend the authority for CDC to support research 
     into strategies for the prevention of TBI and to implement 
     public information and education programs for the prevention 
     of traumatic brain injuries. CDC will support additional data 
     collection and development of State TBI registries. NIH 
     research is expanded to include cognitive disorders and 
     neurobehavioral consequences arising from TBI. The bill 
     authorizes HRSA to make grants for new and expanded community 
     support services. Grants may be used to educate consumers and 
     families, train professionals, improve case management, 
     develop best practices in the areas of family support, return 
     to work, and housing for people with traumatic brain injury. 
     HRSA shall also make grants to protection and advocacy 
     systems, to provide services to individuals with traumatic 
     brain injury. This title also reauthorizes CDC's injury 
     prevention and control programs to 2005.

             Title XIV--Child Care Safety and Health Grants

       To address the need for increased safety of child care 
     facilities, the Secretary of HHS shall provide grants to 
     States to carry out activities related to the improvement of 
     the health and safety of children in child care settings. 
     Grants may be used for two or more of the following 
     activities: train and educate child care providers to prevent 
     injuries and illnesses and to promote health-related 
     practices; strengthen and enforce child care provider 
     licensing, regulation, and registration; rehabilitate child 
     care facilities to meet health and safety standards; provide 
     health consultants to give health and safety advice to child 
     care providers; enhance child care providers' ability to 
     serve children with disabilities; conduct criminal background 
     checks on child care providers; provide information to 
     parents on choosing a safe and healthy setting for their 
     children; or improve the safety of transportation of children 
     in child care.

                   Title XV--Healthy Start Initiative

       Healthy Start, which was created as a demonstration project 
     in 1991, is authorized in this bill for the first time. The 
     Healthy Start program is designed to reduce the rate of 
     infant mortality and improve perinatal outcomes by providing 
     grants to areas with a high rate of infant mortality and low 
     birth weight infants. This provision also authorizes a new 
     grant program to conduct and support research and provide 
     additional services to enhance access to health care for 
     pregnant women and infants.

                         Title XVI--Oral Health

       This provision requires HHS to support community-based 
     research to identify interventions that reduce the burden and 
     transmission of oral, dental and craniofacial diseases in 
     high risk populations, and develop clinical approaches for 
     pediatric assessment. HHS is authorized to fund innovative 
     oral health activities to decrease the incidence of baby 
     bottle and early childhood tooth decay, and to increase 
     utilization of pediatric dental services in children under 6.
       The Secretary of HHS is authorized to provide grants to 
     States to increase community water fluoridation and to 
     provide school-based dental sealant services to children in 
     low income areas. This provision also authorizes HHS to 
     provide for the development of school-based dental sealant 
     programs to improve the access of children to sealants. 
     Finally, HHS shall make grants to dental training 
     institutions and community-based programs, as well as those 
     operated by the Indian Health Service, to develop oral health 
     promotion programs and to increase utilization of dental 
     services by children eligible for such services under a 
     federal health program.

                  Title XVII--Vaccine-Related Programs

       Modifies the Vaccine Injury Compensation Program, to allow 
     compensation for those who suffer an adverse reaction to the 
     rota virus. This provision provides compensation if a vaccine 
     causes an injury that requires hospitalization and surgical 
     intervention. Additionally, the preventive health services 
     childhood immunization program is reauthorized to 2005.

                        Title XVIII--Hepatitis C

       Authorizes HHS to implement a national system to determine 
     the incidence of hepatitis C virus infection, and to assist 
     the States in determining the prevalence of HCV infection. 
     Also authorizes HHS to identify, counsel and offer testing to 
     individuals who are at risk of HCV infection, and to develop 
     public and professional education programs for the detection 
     and control of HCV infection. Provides for improvements in 
     clinical laboratory procedures regarding Hepatitis C.

            Title XIX--NIH Initiative on Autoimmune Diseases

       The Director of NIH shall expand, intensify, and coordinate 
     the activities of NIH with respect to autoimmune diseases.

 Title XX--Graduate Medical Education Programs in Children's Hospitals

       This provision makes technical corrections to the pediatric 
     GME program, which supports training activities in 
     freestanding children's hospitals, and extends its 
     authorization through fiscal year 2005.

  Title XXI--Special Needs of Children Regarding Organ Transplantation

       Requires HHS to implement organ donation policies that 
     recognize the unique needs of children. HHS shall carry out 
     studies and demonstration projects to improve rates of organ 
     donation and determine the unique needs of children. HHS 
     shall conduct a study to determine the costs of 
     immunosupressive drugs for children who have received 
     transplants and the extent to which public and private health 
     insurance plans cover these costs.

                Title XXII--Muscular Dystrophy Research

       NIH will expand and increase coordination in activities 
     with respect to research on muscular dystrophies.

         Title XXIII--Children and Tourette Syndrome Awareness

       HHS will implement public and professional education 
     programs on Tourette Syndrome, with a particular emphasis on 
     children.

                Title XXIV--Childhood Obesity Prevention

       This provision authorizes the CDC to support the 
     development, implementation, and evaluation of state and 
     community-based programs to promote good nutrition and 
     increased physical activity. States would be required to 
     develop comprehensive, inter-agency school- and community-
     based approaches to encourage and promote nutrition

[[Page 19099]]

     and physical activity in local communities, with technical 
     support from CDC.
       The CDC will coordinate and conduct research to improve our 
     understanding of the relationship between physical activity, 
     diet, health, and other factors that contribute to obesity. 
     Research will also focus on developing and evaluating 
     effective strategies for the prevention and treatment of 
     obesity and eating disorders, as well as study the prevalence 
     and cost of childhood obesity and its effects into adulthood.
       The CDC in collaboration with State and local health, 
     nutrition, and physical activity experts, will develop a 
     nationwide public education campaign regarding the health 
     risks associated with poor nutrition and physical inactivity, 
     and will promote effective ways to incorporate good eating 
     habits and regular physical activity into daily living.
       The CDC, in collaboration with HRSA, will develop and carry 
     out a program to train health professionals in effective 
     strategies to better identify, assess, and counsel (or refer) 
     patients with obesity, an eating disorder, or who are at risk 
     of becoming obese or developing an eating disorder. They will 
     also develop and carry out a program to train educators and 
     child care professionals in effective strategies to teach 
     children and their families about ways to improve dietary 
     habits and levels of physical activity.

   Title XXV--Early Detection and Treatment Regarding Childhood Lead 
                               Poisoning

       This provision requires HRSA to report annually to the 
     Congress on the percentage of children in the Health Centers 
     program who are screened for lead poisoning, and requires 
     HRSA to work with the CDC and HCFA to conduct physician 
     education and training programs on current lead screening 
     policies. CDC will issue recommendations and establish 
     requirements for its grantees to ensure uniform reporting of 
     blood lead levels from laboratories to State and local health 
     departments and to improve data linkages between health 
     departments and federally funded benefit programs.
       This provision authorizes new funding through the Maternal 
     and Child Health Block Grant to states with a demonstrated 
     need to conduct outreach and education for families at risk 
     of lead poisoning, provide individual family education 
     designed to reduce exposures to children with elevated blood 
     lead levels, implement community environmental interventions, 
     and ensure continuous quality measurement and improvement 
     plans for communities committed to comprehensive lead 
     poisoning prevention.

             Title XXVI--Screening for Heritable Disorders

       Amends the Public Health Service Act to enhance, improve or 
     expand the ability of State and local public health agencies 
     to provide screening, counseling or health care services to 
     newborns and children having or at risk for heritable 
     disorders. This provision also creates an advisory committee 
     to provide advice and recommendations to the Secretary for 
     the development of grant administration policies and 
     priorities, and to enhance the ability of the Secretary to 
     reduce mortality or morbidity from heritable disorders.

              Title XXVII--Pediatric Research Protections

       This provision addresses critical safety issues in 
     children's research by requiring the Secretary of HHS to 
     review the current federal regulations for the protection of 
     children participating in research, which address such issues 
     as determining acceptable levels of risk and obtaining 
     parental permission, and to report to Congress on how to 
     update them to ensure the highest standards of safety.

                 Title XXVIII--Miscellaneous Provisions

       This provision would require the NIH Director to report to 
     Congress within 180 days of enactment on activities conducted 
     and supported by the NIH during FY 2000 with respect to rare 
     diseases in children and the activities that are planned to 
     be conducted and supported by the NIH with respect to such 
     diseases during the FY 2001-2005. This provision also 
     requires HHS to study issues related to access to effective 
     treatment for metabolic disorders, including PKU. Results of 
     the study shall be made available to public health agencies, 
     Medicaid, insurance commissioners, and other interested 
     parties.

           DIVISION B--YOUTH DRUG AND MENTAL HEALTH SERVICES

       This division reauthorizes programs within the Substance 
     Abuse and Mental Health Services Administration (SAMHSA) to 
     improve mental health and substance abuse services for 
     children and adolescents, implement proposals giving States 
     more flexibility in the use of block grant funds with 
     accountability based on performance, and consolidate 
     discretionary grant authorities to give the Secretary more 
     flexibility to respond to the needs of those who need mental 
     health and substance abuse services. It also provides a 
     waiver from the requirements of the Narcotic Addict Treatment 
     Act that would permit qualified physicians to dispense or 
     prescribe schedule III, IV, or V narcotic drugs or 
     combinations of such drugs approved by FDA for the treatment 
     of heroin addiction. It also provides a comprehensive 
     strategy to combat Methamphetamine use.

     Title XXXI--Provisions Relating to Services for Children and 
                              Adolescents


                  Section 3101--Children and Violence

       Authorizes $100 million for the Secretary to make grants to 
     public entities in consultation with the Attorney General and 
     the Secretary of Education to assist local communities in 
     developing ways to assist children in dealing with violence. 
     Four different types of grants are permitted under the 
     authority: grants to provide financial support to enable the 
     communities to implement the programs; to provide technical 
     assistance to local communities; to provide technical 
     assistance in the development of policies; and to assist in 
     the creation of community partnerships among the schools, law 
     enforcement and mental health services. Grantees would have 
     to ensure that they will carry out six activities which 
     include: security of the school; educational reform to deal 
     with violence; review and updating of school policies to deal 
     with violence; alcohol and drug abuse prevention and early 
     intervention; mental health prevention and treatment 
     services; and early childhood development and psychosocial 
     services. However, Federal funding is available for 
     prevention, early intervention, and treatment services.
       Authorizes $50 million for the Secretary to develop 
     knowledge with regard to evidence-based practices for 
     treating psychiatric disorders resulting from witnessing or 
     experiencing domestic, school and community violence and 
     terrorism. Establishes centers of excellence to provide 
     technical assistance to communities in dealing with the 
     emotional burden of domestic, school and community violence 
     and terrorism if and when they occur.


                    Section 3102--Emergency Response

       Permits the Secretary to use up to 2.5% of the funds 
     appropriated for discretionary grants for responding to 
     emergencies. The authority would permit an objective review 
     instead of peer review. This would permit an expedited 
     process for making awards. The Secretary is required to 
     define an emergency in the Federal Register subject to public 
     comment.
       The section also includes language that provides additional 
     confidentiality protection for the information collected from 
     individuals who participate in national surveys conducted by 
     the Substance Abuse and Mental Health Services 
     Administration.


             Section 3103--High Risk Youth Reauthorization

       Reauthorizes the High Risk Youth Program, which provides 
     funds to public and non-profit private entities to establish 
     programs for the prevention of drug abuse among high risk 
     youth.


   Section 3104--Substance Abuse Treatment Services for Children and 
                              Adolescents

       Authorizes $40 million for the Secretary to make grants, 
     contracts or cooperative agreement to public and non-profit 
     private entities including American Indian tribes and tribal 
     organizations for the purpose of providing substance abuse 
     treatment services for children and adolescents. Priority is 
     given to applicants who can apply evidenced based and cost 
     effective methods, coordinate services with other social 
     service agencies, provide a continuum of care dependent on 
     the needs of the individual, provide treatment that is gender 
     specific and culturally appropriate, involve and work with 
     families of those in treatment, and provide aftercare.
       Authorizes $20 million for the Secretary to make grants, 
     contracts or cooperative agreements to public and non-profit 
     private entities including local educational agencies for the 
     purposes of providing early intervention substance abuse 
     services for children and adolescents. Under the provision, 
     priority is given to applicants who demonstrate an ability to 
     screen for and assess the level of involvement of children in 
     substance abuse, make appropriate referrals, provide 
     counseling and ancillary services, and who develop a network 
     with other social agencies. Requires the Secretary to ensure 
     geographical distribution of awards.
       Authorizes $4 million to create centers of excellence to 
     assist States and local jurisdictions in providing 
     appropriate care for adolescents who are involved with the 
     juvenile justice system and have a serious emotional 
     disturbance.
       Authorizes $10 million for the Secretary to make grants, 
     contracts, or cooperative agreements to carry out school 
     based as well as community based programs to prevent the use 
     of methamphetamine and inhalants.


   Section 3105--Comprehensive Community Services for Children With 
                     Serious Emotional Disturbance

       This program was begun in 1994 to provide seed money to 
     local communities to develop systems of care for children 
     with serious emotional disturbances thus improving the 
     quality of care and increasing the likelihood that these 
     children would remain in local communities rather than being 
     sent to residential facilities. This section reauthorizes 
     this program through fiscal year 2002 and provides an 
     authority for the Secretary to waive certain requirements for 
     territories and American Indian tribes.
       This section also would extend some grants under this 
     program to 6 years. The intent of

[[Page 19100]]

     the program is to provide seed funding for comprehensive 
     systems of care. Unfortunately, many successful programs have 
     had a difficult time ensuring their continuation without 
     Federal support. This provision would give them an additional 
     year to secure that support.


        Section 3106--Services for Children of Substance Abusers

       Improves coordination by transferring this program from 
     Health Resources and Services Administration (HRSA) to SAMHSA 
     and authorizes the Secretary to make grants to public and 
     non-profit private entities to provide the following services 
     to children of substance abusers: periodic evaluations, 
     primary pediatric care, other health and mental health 
     services, therapeutic interventions, preventive counseling, 
     counseling related to witnessing of chronic violence, 
     referrals for and assistance in establishing eligibility for 
     services under other programs, and other developmental 
     services. Grantees would also provide services to families 
     where one or both of the parents are substance abusers. The 
     program requires that grantees match Federal funds with funds 
     from other sources.
       The program is authorized at $50 million through fiscal 
     year 2002 and the authority is updated to include changes 
     that have occurred since fiscal year 1992 when it was first 
     authorized: e.g. developing connection to the Temporary 
     Assistance for Needy Families (TANF) and the Children's 
     Health Insurance Program (CHIP) programs.


               Section 3107--Services for Youth Offenders

       Authorizes $40 million for the Secretary to make grants, 
     contracts or cooperative agreements to State and local 
     juvenile justice agencies to help such agencies provide 
     aftercare services for youth offenders who have or are at 
     risk of a serious emotional disturbance and who have been 
     discharged from juvenile justice facilities. The funds may be 
     used for planning, coordinating and implementing these 
     services.


   Section 3108--Grants for strengthening families through community 
                              partnerships

       Provides for grants to develop and implement model 
     substance abuse prevention programs and substance abuse 
     prevention services for individuals in high risk families.


                    Section 3109--Underage Drinking

       Authorizes $25 million for the Secretary to make awards of 
     grants, cooperative agreements or contracts to public and 
     nonprofit private entities, including Indian tribes and 
     tribal organizations to enable such entities to develop plans 
     for and to carry out school based and community based 
     programs for the prevention of alcoholic beverages 
     consumption by individuals who have not attained the legal 
     drinking age.


   Section 3110--Services for Individuals with Fetal Alcohol Syndrome

       Authorizes $25 million for the Secretary to make grants, 
     cooperative agreement or contracts with public or nonprofit 
     private entities including Indian tribes and tribal 
     organizations to provide services to individuals diagnosed 
     with fetal alcohol syndrome or alcohol related birth defects. 
     The funds can be used for screening and testing; mental 
     health, health or substance abuse services; vocational 
     services; housing assistance; and parenting skills.
       Authorizes $5 million for the Secretary to make grants, 
     cooperative agreements or contracts to public or nonprofit 
     private entities for the purposes of establishing not more 
     than 4 centers of excellence to study techniques for the 
     prevention of fetal alcohol syndrome and alcohol related 
     birth defects and adaptations of innovative clinical 
     interventions and service delivery improvements.


                    Section 3111--Suicide Prevention

       The provision authorizes $75 million for the Secretary to 
     make grants, contracts or cooperative agreement to public and 
     nonprofit private entities to establish programs to reduce 
     suicide deaths in the United States among children and 
     adolescents. The provision requires collaboration among 
     various agencies with the Department of Health and Human 
     Services. Findings from the programs are then to be 
     disseminated to public and private entities.


                    Section 3112--General Provisions

       This provision amends the sections that establish the 
     responsibilities of the Centers for Substance Abuse 
     Treatment, Substance Abuse Prevention and the Mental Health 
     Services to include an emphasis on children. In the case of 
     the Center for Mental Health Services it would require the 
     Director to collaborate with the Attorney General and the 
     Secretary of Education on programs that assist local 
     communities in developing programs to address violence among 
     children in schools.

           Title XXXII--Provisions Relating to Mental Health


  Section 3201--Priority Mental Health Needs of Regional and National 
                              Significance

       In 1996, the appropriation committees started a practice 
     which they have continued through fiscal year 1999 of 
     appropriating funds to SAMHSA's general authority (Section 
     501) instead of specific programs. This section codifies what 
     the appropriations committees have done by repealing several 
     specific authorities related to mental health services in 
     favor of a broad authority that gives the Secretary more 
     flexibility in responding to individuals in need of mental 
     health services. It would authorize four types of grants: (1) 
     knowledge development and application grants which are used 
     to develop more information on how best to serve those in 
     need; (2) training grants to disseminate the information that 
     the agency garners through its knowledge development; (3) 
     targeted capacity response which enables the agency to 
     respond to service needs in local communities; and (4) 
     systems change grants and grants to support family and 
     consumer networks in States. Repealed in this section are 
     sections 303, 520A and 520B of the Public Health Service Act 
     and section 612 of the Stewart B. McKinney Act.
       This section includes a provision that would permit 
     $6,000,000 of the first $100,000,000 appropriated to the 
     program and 10 percent of all funds above $100,000,000 to be 
     given competitively to States to assist them in developing 
     data infrastructures for collecting and reporting on 
     performance measures.
       This section also addresses the importance of the interface 
     between mental health services and primary care.


      Section 3202--Grants for the Benefit of Homeless Individuals

       The section reauthorizes the Grants for the Benefit of 
     Homeless Individuals program which provides grants to develop 
     and expand mental health and substance abuse treatment 
     services to homeless individuals. Preference is maintained 
     for organizations that provide integrated primary health 
     care, substance abuse and mental health services to homeless 
     individuals, programs that demonstrate effectiveness in 
     serving homeless individuals, and programs that have 
     experience in providing housing for individuals who are 
     homeless.


 Section 3203--Projects for Assistance in Transition from Homelessness 
                                 (PATH)

       This section reauthorizes the PATH program which provides 
     funds to States under a formula for the provision of mental 
     health services to homeless individuals. Preference is 
     maintained for organizations with demonstrated effectiveness 
     in serving homeless veterans. The section also provides an 
     authority for the Secretary to waive certain requirements for 
     territories.


   Section 3204--Community Mental Health Services (CMHS) Performance 
                          Partnership Program

       The Community Mental Health Services Block Grant is a 
     formula program under which funds are distributed to States 
     for the provision of community based mental health services 
     for adults with a serious mental illness and children with a 
     serious emotional disturbance. This program and the Substance 
     Abuse Prevention and Treatment Block Grant provide funds to 
     States to provide services. State accountability under these 
     programs is built on State expenditure of funds.
       Provisions in this section and other sections of this bill 
     provide for the first steps in increasing State flexibility 
     in the use of funds while establishing an accountability 
     system based on performance. In this section, the number of 
     elements that States must include in their plan for use of 
     CMHS Block Grant funds are reduced from 12 to 5, thus 
     providing additional flexibility for the States and reduced 
     administrative costs.
       This section also expands the responsibilities of the 
     already existing State Planning Councils. Under current law, 
     these councils are required to review and comment on State 
     plans for use of CMHS Block Grant funds. Under this provision 
     they would also be required to review and comment on State 
     reports on the outcomes of their activities.
       One provision within current law requires States to 
     maintain their financial support for providing community 
     based mental health services at an average of what they spent 
     over the past two years. This requirement discourages States 
     from adding one time infusions of funds into community mental 
     health services since it would increase the States' 
     maintenance of effort requirement. This provision would 
     indicate that an infusion of funds of a non-recurring nature 
     for a singular purpose may be exempt from the calculation of 
     the maintenance of effort requirement.
       Current law allows for the Secretary to set a date for the 
     submission of grant applications. Applications must include a 
     plan on how the State intends to use the funds and a report 
     on how funds were spent the previous year. A provision in 
     this section would establish that State plans for use of 
     funds must be submitted by September 1 of the fiscal year 
     prior to the fiscal year for which the State is seeking funds 
     and the reports by the following December 1.
       The section also makes changes to the current waiver 
     authority for territories.


                Section 3205--Determination of Allotment

       There are three elements to determine the allocation of 
     funding for SAMHSA block grants: (1) the population of 
     individuals needing services; (2) the cost of providing 
     services; and (3) the state income level. In August of 1997, 
     SAMHSA changed the data on determining the cost of providing 
     services from the use of manufacturing wages to 
     nonmanufacturing wages, which was determined

[[Page 19101]]

     to be the most appropriate method to reflect cost differences 
     among states. This action would have caused a decline of 
     funding in several states. To address this problem, this 
     section makes permanent provisions enacted in Public Law 105-
     277 on the formula for distribution of funds under the 
     Community Mental Health Services Block Grant (CMHS). The CMHS 
     Block Grant formula includes a ``hold harmless'' provision 
     which guarantees that no State will receive less funding than 
     it did in fiscal year 1998.


Section 3206--Protection and Advocacy for Mentally Ill Individuals Act 
                                of 1986

       This section makes technical changes to the formula for 
     distribution of funds under this program to correct a 
     provision that would have inappropriately reduced minimum 
     State allotments. It also provides for the renaming of the 
     Act to conform with changes made in previous laws, makes a 
     technical change to the provision on territories and 
     reauthorizes the program through fiscal year 2002.
       The bill would also permit an American Indian Consortia to 
     receive direct funding after the appropriation exceeds $25 
     million. It would also extend the responsibilities of the 
     Protection and Advocacy program to individuals living in the 
     communities when the appropriation exceeds $30 million.


   Section 3207--Requirement Relating to the Rights of Residents of 
                           Certain Facilities

       This measure would require facilities that are both within 
     the purview of the Protection and Advocacy program and which 
     receive appropriated funding from the Federal government to 
     protect and promote the rights of individuals with regard to 
     the appropriate use of seclusions and restraints. Such 
     covered facilities are required to inform the Secretary of 
     each death that occurs while a patient is restrained or in 
     seclusion, or each death that occurs within 24 hours after a 
     patient is restrained or in seclusion, or where it is 
     reasonable to assume that a patient's death is a result of 
     seclusion or restraint. The Secretary is required to issue 
     regulations within one year of enactment on appropriate staff 
     levels, appropriate training for staff on the use of 
     restraints and seclusions.
       Requires any such facility that is supported in whole or in 
     part with funds appropriated under the Public Health Service 
     Act to protect and promote the rights of each resident of the 
     facility, including the right to be free from physical or 
     mental abuse, corporal punishment, and any restraints or 
     involuntary seclusion imposed for purposes of discipline or 
     convenience; sets standards for when restraints or seclusion 
     may be imposed; requires each such facility to notify the 
     appropriate State licensing or regulatory agency of each 
     death that occurs in the facility and of the use of seclusion 
     or restraint in accordance with regulations promulgated by 
     the Secretary. Failure to comply with these requirements 
     including the failure to appropriately train staff makes such 
     facility ineligible for participation in any program 
     supported in whole or in part by funds appropriated under 
     this Act.


   Section 3208--Requirements relating to the rights of residents of 
 certain non-medical community-based facilities for children and youth

       Ensures that appropriately-trained supervisory personnel 
     are present whenever a physical restraint is required of a 
     resident of a non-medical community-based treatment facility. 
     The use of mechanical or chemical restraints in such 
     facilities is prohibited and physical restraint must be used 
     only in emergency situations. The section also authorizes the 
     Secretary to develop guidelines for licensing rules regarding 
     training use of restraints.


        Section 3209--Grants for Emergency Mental Health Centers

       This provision authorizes $25 million for the Secretary to 
     make grants to States, political subdivisions of States, 
     Indian tribes and tribal organizations to support the 
     designation of hospitals and health centers as Emergency 
     Mental Health Centers which will serve as a central receiving 
     point in the community for individuals who may be in need of 
     emergency mental health services.


            Section 3210--Grants for Jail Diversion Programs

       Authorizes $10 million for the Secretary to make grants to 
     States, political subdivisions of States, Indian tribes and 
     tribal organizations to develop and implement programs to 
     divert individuals with a mental illness from the criminal 
     justice system to community-based services.


     Section 3211--Grants for Improving Outcomes for Children and 
  Adolescents Through Services Integration Between Child Welfare and 
                         Mental Health Services

       The provision authorizes $10 million for the Secretary to 
     make grants to States, political subdivisions of States, 
     Indian tribes and tribal organizations to provide integrated 
     child welfare and mental health services for children and 
     adolescents under 19 years of age in the child welfare system 
     or at risk for becoming part of the system, and parents or 
     caregivers with a mental illness or a mental illness and a 
     co-occurring substance abuse disorder.


  Section 3212--Grants for the Integrated Treatment of Serious Mental 
                Illness and Co-occurring Substance Abuse

       Authorizes $40 million for the Secretary to make grants, 
     contracts or cooperative agreements with States, political 
     subdivisions of States, Indian tribes and tribal 
     organizations for the development or expansion of programs to 
     provide integrated treatment services for individuals with a 
     serious mental illness and a co-occurring substance abuse 
     disorder.


                     Section 3213--Training Grants

       The prevision authorizes $25 million for the Secretary to 
     award grants States, political subdivisions of States, Indian 
     tribes and tribal organizations or non-profit private 
     entities to train teachers and other relevant school 
     personnel to recognize symptoms of childhood and adolescent 
     mental disorders and to refer family members to the 
     appropriate mental health services if necessary; to train 
     emergency services personnel to identify and appropriately 
     respond to persons with a mental illness; and to provide 
     education to such teachers and emergency personnel regarding 
     resources that are available in the community for individuals 
     with a mental illness.

          Title XXXIII--Provisions Relating to Substance Abuse


Section 3301--Priority Substance Abuse Treatment Needs of Regional and 
                         National Significance

       As explained in section 3201, this section codifies what 
     the appropriations committees have done by repealing several 
     specific authorities related to substance abuse treatment 
     services that gives the Secretary more flexibility in 
     responding to the needs of people in need of substance abuse 
     treatment. It would authorize three types of grants: (1) 
     knowledge development and application grants, which are used 
     to develop more information on how best to serve those in 
     need; (2) training grants to disseminate the information that 
     the agency garners through its knowledge development; and (3) 
     targeted capacity response, which enables the agency to 
     respond to services needs in local communities. Repealed in 
     this section are sections 508, 509, 510, 511, 512, 571 and 
     1971 of the Public Health Service Act.
       This section also addresses the importance of the interface 
     between substance abuse treatment services and primary care.


Section 3302--Priority Substance Abuse Prevention Needs of Regional and 
                         National Significance

       This section implements in authorization for substance 
     abuse prevention what the appropriations committees did in 
     fiscal year 1996. It authorizes the same type of grants as 
     described in the previous section except that they pertain to 
     substance abuse prevention. Repeals sections 516 and 518 of 
     the Public Health Service Act.
       This section also addresses the importance of the interface 
     between substance abuse prevention services and primary care.


  Section 3303--Substance Abuse Prevention and Treatment Performance 
                        Partnership Block Grant

       This program provides funds to States for their use in 
     providing substance abuse prevention and treatment services. 
     While there is considerable flexibility in State use of 
     funds, there are a number of requirements which are directly 
     related to public health issues. This provision would begin 
     the process of giving States greater flexibility in their use 
     of funds and accountability based on performance instead of 
     expenditures.
       Greater flexibility is enhanced by the repeal of a 
     requirement that States spend 35 percent of their allotment 
     on drug related activities and 35 percent on alcohol related 
     activities. A provision requiring States to maintain a 
     $100,000 revolving fund to support homes for persons 
     recovering from substance abuse would be made optional thus 
     permitting States to continue such efforts or to use those 
     funds for other services as they deem necessary.
       This section also creates authority for the Secretary to 
     waive certain requirements for States who meet established 
     criteria. Those criteria would be established in regulation 
     after consultation with the States, providers and consumers.
       One provision within current law requires the State to 
     maintain its financial support for substance abuse prevention 
     and treatment services at the average of what it spent over 
     the past two years. While States support this requirement, it 
     discourages States from adding one time infusions of funds 
     into substance abuse services since it would increase the 
     calculation of the State's maintenance of effort requirement. 
     This section includes a provision that would exempt from 
     maintenance of effort requirements any one time infusion of 
     funds which are for a singular purpose.
       Current law allows the Secretary to set a date for the 
     submission of grant applications. Applications include a plan 
     on how funds will be used and a report on how funds were 
     spent the previous year. A provision in this section would 
     establish that State applications are due on October 1 of the 
     fiscal year prior to the fiscal year for which they are 
     seeking funds.

[[Page 19102]]

       This section also simplifies the waiver for territories and 
     reauthorizes the program through fiscal year 2002.


                Section 3304--Determination of Allotment

       There are three elements to determine the allocation of 
     funding for SAMHSA block grants: (1) the population of 
     individuals needing services; (2) the cost of providing 
     services; and (3) the state income level. In August of 1997, 
     SAMHSA changed the data on determining the cost of providing 
     services from the use of manufacturing wages to 
     nonmanufacturing wages, which was determined to be the most 
     appropriate method to reflect cost differences among states. 
     This action would have caused a decline of funding in several 
     states. To address this problem, this section makes permanent 
     provisions in Public Law 105-277 on the formula for 
     distribution of funds under the Substance Abuse Prevention 
     and Treatment Block Grant (SAPT).
       The SAPT Block Grant formula includes Minimum Growth and 
     Small State Minimum Rules needed to complete the phase-in of 
     the new formula. Also, the provision includes a Proportional 
     Scale Down Rule if appropriations decline in future years.


   Section 3305--Nondiscrimination and Institutional Safeguards for 
                          Religious Providers

       This section would permit religious organizations which 
     provide substance abuse services to receive Federal 
     assistance either through the Substance Abuse Prevention and 
     Treatment Block Grant or discretionary grants through the 
     Substance Abuse and Mental Health Services Administration 
     while maintaining their religious character and their ability 
     to hire individuals of the same faith. Such programs may not 
     discriminate against anyone interested in treatment at the 
     facility. If a person who is referred for services needs or 
     would prefer to be served in a different facility, the 
     program will refer that person to an appropriate treatment 
     program.
       The provision further stipulates that Federal funds 
     received under a block or discretionary grant for substance 
     abuse services by a religious organization will be maintained 
     in a separate account and only the Federal funds used by such 
     providers shall be subject to Federal audit requirements.
       A religious organization that believes that it has been 
     discriminated against based on the fact that it is a faith 
     based program may bring an action for injunctive relief 
     against the appropriate government agency or entity that has 
     allegedly committed the violation.
       Federal funds may not be used for sectarian worship, 
     instruction or proselytization.
       If a State or local government chooses to co-mingle their 
     funds with Federal funds, then the State and or local 
     government funds are subject to the provisions of this 
     section.


 Section 3306--Alcohol and Drug Prevention and Treatment Services for 
                      Indians and Native Alaskans

       Authorizes $15 million for the Secretary to make grants, 
     contracts or cooperative agreements with public and private 
     non-profit private entities including American Indian tribes 
     and tribal organizations and Native Alaskans for the purpose 
     of providing alcohol and drug prevention or treatment 
     services for Indians and Native Alaskans. Priority is given 
     to those entities that will provide such services on 
     reservations or tribal lands, employ culturally appropriate 
     approaches, and have provided prevention or treatment 
     services for at least one year prior to applying for a grant. 
     The Secretary is required to submit a report to the 
     Committees of jurisdiction after three years and annually 
     thereafter describing the services that have been provided 
     under this program.


               Section 3307--Establishment of Commission

       Authorizes $5 million to establish a Commission on Indian 
     and Native Alaskan Health Care that shall carry out a 
     comprehensive examination of the health concerns of Indians 
     and Native Alaskans living on reservations or tribal lands. 
     The Commission will consist of the Secretary as Chair and 15 
     appointed and voting members, 10 of whom must be American 
     Indians or Native Alaskans. The Director of the Indian Health 
     Service and the Commissioner of Indian Affairs are non-voting 
     members. The commission is to issue a report within three 
     years detailing the health condition of individuals living on 
     tribal lands, what services are currently available and if 
     there are insufficient services detail why this situation 
     exists, and make recommendations to the Congress on how to 
     address these issues.

   Title XXXIV--Provisions Relating to Flexibility and Accountability


           Section 3401--General Authorities and Peer Review

       This section removes the requirement that there be an 
     Associate Administrator for Alcohol Policy, and makes 
     necessary corrections to the peer review requirements to 
     reflect changes since 1992. The section also includes 
     language that provides additional confidentiality protection 
     for the information collected from individuals who 
     participate in national surveys conducted by the Substance 
     Abuse and Mental Health Services Administration.


                    Section 3402--Advisory Councils

       SAMHSA and each of its Centers are required under statute 
     to have an Advisory Council. Current law requires that they 
     meet three times a year. This section reduces the number of 
     times the councils are required to meet to two.


Section 3403--General Provisions for the Performance Partnership Block 
                                 Grants

       As part of the effort to change the current CMHS and SAPT 
     Block Grants into performance-based systems, the Secretary is 
     required to submit to Congress within two years a plan for 
     what these performance based programs would look like and how 
     they would operate. This plan would include how the States 
     would receive greater flexibility, what performance measures 
     would be used in holding States accountable, definitions for 
     the data elements that would be collected, the funds needed 
     to implement this system and where those funds would come 
     from, and needed legislative changes. This would give the 
     committees of jurisdiction one year to consider the plan and 
     implement any necessary changes in the next reauthorization 
     of SAMHSA in 2003.


               Section 3404--Data Infrastructure Projects

       This section creates an authority for the Secretary to make 
     grants to States to assist them in developing the data 
     infrastructure necessary to implement a performance based 
     system. States are required to match the Federal 
     contribution.


      Section 3405--Repeal of Obsolete Addict Referral Provisions

       This section repeals certain obsolete provisions of the 
     Narcotic Addict Rehabilitation Act of 1966.


         Section 3406--Individuals with Co-Occurring Disorders

       The section requires the Secretary to report to the 
     committees of jurisdiction on how services are currently 
     being provided to those with a co-occurring mental health and 
     substance abuse disorder, what improvements are needed to 
     ensure that they receive the services they need, and a 
     summary of best practices on how to provide those services 
     including prevention of substance abuse among individuals who 
     have a mental illness and treatment for those with a co-
     occurring disorder.


   Section 3407--Services for Individuals with Co-Occurring Disorders

       The section clarifies that both Substance Abuse Prevention 
     and Treatment and Community Mental Health Service Block Grant 
     funds may be used to provide services to those with a co-
     occurring mental health and substance abuse disorder as long 
     as the funds are used for the purposes for which they were 
     authorized.

 Title XXXV--Waiver Authority for Physicians Who Dispense or Prescribe 
  Certain Narcotic Drugs for Maintenance Treatment or Detoxification 
                               Treatment


                       Section 3501--Short Title

                  Drug Addition Treatment Act of 2000


Section 3502--Waiver Authority for Physicians Who Dispense or Prescribe 
  Certain Narcotic Drugs for Maintenance Treatment or Detoxification 
                               Treatment

       The waiver from the requirements of the Narcotic Addict 
     Treatment Act would permit qualified physicians to dispense 
     (including prescribe) schedule III, IV, or V narcotic drugs 
     or combinations of such drugs approved by FDA for the 
     treatment of heroin addiction. The physician would be 
     required to refer the patient for appropriate counseling and 
     limit his or her practice to 30 patients.
       Physicians are qualified if they are licensed under State 
     law and hold a subspeciality board certification in addiction 
     psychiatry from the American Board of Medical Specialties, 
     certification in a subspeciality from the American 
     Osteopathic Association, certification from the American 
     Society of Addiction Medicine, the physician has participated 
     in a clinical trial on the narcotic drug, is approved by the 
     State licensing board or has such other training or 
     experience as the Secretary considers necessary. Permits the 
     Secretary to issue regulation on criteria for using other 
     credentialing bodies or on the limit of 30 patients. The 
     Secretary is also required under the provision to issue 
     practice guidelines within 120 days. States are given 3 years 
     in which to pass legislation that would prohibit a 
     practitioner from dispensing such drugs or combinations of 
     such drugs if they want.
       The Secretary or the Attorney General are authorized to 
     determine whether the program is working and to stop the 
     program with 60 days notice.

            Title XXXVI--Methamphetamine Anti-Proliferation


                       Section 3601--Short Title

             Methamphetamine Anti-Proliferation Act of 1999

                 Subtitle A--Methamphetamine Production

                       Part I--Criminal Penalties


 Section 3611--Enhanced Punishment of Amphetamine Laboratory Operators

       Section 3602 directs the Sentencing Commission to raise the 
     penalties for amphetamine related offenses to a level 
     comparable to those for methamphetamine.


  Section 3612--Enhance Punishment of Amphetamine and Methamphetamine 
                               Operators

       This section amends the Sentencing Guidelines by increasing 
     the base offense level for

[[Page 19103]]

     manufacturing amphetamine or methamphetamine to not less than 
     level 27 if the offense created a substantial risk of harm to 
     human life or to the environment and to not less than level 
     30 if the offense created a substantial risk of harm to the 
     life of a minor or incompetent.


       Section 3613--Mandatory Restitution for Meth Lab Clean-Up

       Section 103 makes reimbursement for the costs incurred by 
     the U.S. or State and local governments for the cleanup 
     associated with the manufacture of amphetamine or 
     methamphetamine mandatory. It also provides that the 
     restitution money will go to the Asset Forfeiture Fund 
     instead of the treasury.


              Section 3614--Methamphetamine Paraphernalia

       This section amends the anti-paraphernalia statute to 
     include paraphernalia used in connection with methamphetamine 
     use.

                   Part II--Enhanced Law Enforcement


Section 3621--Environmental Hazards Associated With Illegal Manufacture 
                   of Amphetamine and Methamphetamine

       This section authorizes the DEA to receive money from the 
     Asset Forfeiture Fund to pay for clean-up costs associated 
     with the illegal manufacture of amphetamine or 
     methamphetamine for the purposes of federal forfeiture and 
     disposition. It also allows for reimbursement to State and 
     local entities for clean-up costs when they assist in a 
     federal prosecution on amphetamine or methamphetamine related 
     charges to the extent such costs exceed equitable sharing 
     payments made to such State or local government in such case. 
     The section also expressly states that funds from the Violent 
     Crime Reduction Trust Fund can be used to pay for clean-up 
     costs.


  Section 3622--Reduction in Threshold for Non-Safe Harbor Productions

       This section reduces the threshold for retail sales of non-
     safe harbor products containing pseudoephedrine or 
     phenylpropanolamine from 24 grams to 9 grams. It also limits 
     the package size to not more than 3 grams of pseudoephedrine 
     or phenylpropanolamine base.


 Section 3623--Training for Drug Enforcement Administration and State 
      and Local Law Enforcement Personnel Relating to Clandestine 
                              Laboratories

       Section 3613 authorizes $5.5 million in funding for DEA 
     training programs designed to (1) train State and local law 
     enforcement in techniques used in meth investigations (2) 
     provide a certification program for State and local law 
     enforcement enabling them to meet requirements with respect 
     to the handling of wastes created by meth labs; (3) create a 
     certification program that enables certain State and local 
     law enforcement to recertify other law enforcement in their 
     regions; and (4) staff mobile training teams which provide 
     State and local law enforcement with advanced training in 
     conducting clan lab investigations and with training that 
     enables them to recertify other law enforcement personnel. 
     The training programs are authorized for 3 years after which 
     the States, either alone or in consultation/combination with 
     other States, will be responsible for training their own 
     personnel. The States will be required to submit a report 
     detailing what measures they are taking to ensure that they 
     have programs in place to take over the responsibility after 
     the three year federal program expires.


Sec. 3624--Combating Methamphetamine in High Intensity Drug Trafficking 
                                 Areas

       This section authorizes $15 million a year for fiscal years 
     2000-2004 to be appropriated to ONDCP to combat trafficking 
     of methamphetamine in designated HIDTA's by hiring new 
     federal, State, and local law enforcement personnel, 
     including agents, investigators, prosecutors, lab technicians 
     and chemists. It provides that the funds shall be apportioned 
     among the HIDTA's based on the following factors: (1) number 
     of Meth labs discovered in the previous year; (2) number of 
     Meth prosecutions in the previous year; (3) number of Meth 
     arrests in the previous year; (4) the amounts of Meth seized 
     in the previous year; and (5) intelligence and predictive 
     data from the DEA and HHS showing patterns and trends in 
     abuse, trafficking and transportation patterns in 
     methamphetamine, amphetamine and listed chemicals. Before 
     apportioning any funds, the Director must certify that the 
     law enforcement entities responsible for clan lab seizures 
     are providing lab seizure data to the national clandestine 
     laboratory database at the El Paso Intelligence Center. It 
     also provides that not more than five percent of the 
     appropriated amount may be used for administrative costs.


 Section 3625--Combating Amphetamine and Methamphetamine Manufacturing 
                            and Trafficking

       This section authorizes $6.5 million to be appropriated for 
     the hiring of new agents to (1) assist State and local law 
     enforcement in small and mid-sized communities in all phases 
     of drug investigations, including assistance with foreign-
     language interpretation; (2) staff additional regional 
     enforcement and mobile enforcement teams; (3) establish 
     additional resident offices and posts of duty to assist State 
     and local law enforcement in rural areas; and (4) provide the 
     Special Operations Division with additional agents for 
     intelligence and investigative operations.
       It also authorizes $3 million to enhance the investigative 
     and related functions of the Chemical Control Program to 
     implement further the provisions of the Comprehensive 
     Methamphetamine Control Act of 1996. The funds shall be used 
     to account accurately for the import and export of List I 
     chemicals and coordinate investigations surrounding the 
     diversion of these chemicals; to develop a computer 
     infrastructure sufficient to process and analyze time 
     sensitive enforcement information from suspicious orders 
     reported to DEA field offices and other law enforcement; and 
     to establish an education, training, and communications 
     process to alert industry of current trends and emerging 
     patterns of illicit manufacturing activities.

                Part III--Abuse Prevention and Treatment


          Section 3631--Expansion of Methamphetamine Research

       This section allows the Director of the National Institute 
     on Drug Abuse (NIDA) to make grants and enter into 
     cooperative agreements to expand the National Drug Abuse 
     Treatment Clinical Trials Network and current and on-going 
     research and clinical trials with treatment centers relating 
     to methamphetamine abuse and addiction and other biomedical, 
     behavioral and social issues related to methamphetamine abuse 
     and addiction. It authorizes to be appropriated such sums as 
     may be necessary and such sums are to supplement and not 
     supplant any other amounts appropriated for research on 
     methamphetamine abuse and addiction.


   Section 3632--Methamphetamine and Amphetamine Addiction Treatment

       This section authorizes $10 million in grants to States 
     that have a high rate, or have had a rapid increase, in 
     methamphetamine or amphetamine abuse or addiction, for 
     treatment of methamphetamine and amphetamine addiction.


            Section 3633--Study of Methamphetamine Treatment

       This section requires the Secretary of HHS, in consultation 
     with the Institute of Medicine of the National Academy of 
     Sciences, to conduct a study on the development of 
     medications for the treatment of addiction to amphetamine and 
     methamphetamine and to report the findings to the Judiciary 
     Committees of the Senate and House of Representatives.

                Part IV--Abuse Prevention and Treatment


   Section 3641--Report on Consumption of Methamphetamine and Other 
  Illicit Drugs in Rural Areas, Metropolitan Areas, and Consolidated 
                           Metropolitan Areas

       This section requires HHS to include in its annual National 
     Household Survey on Drug Abuse prevalence data on the 
     consumption of methamphetamine and other illicit drugs in 
     rural, metropolitan, and consolidated metropolitan areas.


    Section 3642--Report on Diversion of Ordinary, Over-the-Counter 
            Pseudoephedrine and Phenylpropanolamine Products

       This section requires the Attorney General to conduct a 
     study on the use of ordinary over-the-counter pseudoephedrine 
     and phenylpropanolamine products in the clandestine 
     production of illicit drugs. The report is to be submitted to 
     Congress and shall include the AG's findings and 
     recommendations on the need for additional measures, 
     including thresholds, to prevent diversion of blister pack 
     products.

               Subtitle B--Controlled Substance Generally


  Section 3651--Enhanced Punishment of Trafficking in List I Chemicals

       This section directs the Sentencing Commission to increase 
     the penalties for violations involving ephedrine, 
     pseudoephedrine, and phenylpropanolamine so that the 
     penalties correspond to the quantity of controlled substance 
     that could reasonably have been manufactured from these 
     chemicals. The Sentencing Commission is also directed to 
     establish a conversion table to determine the quantity of 
     controlled substances that can be manufactured from these 
     chemicals. The Sentencing Commission also shall review and 
     amend its guidelines concerning list I chemicals other than 
     those above, to provide for increased penalties to reflect 
     the dangerous nature of such offenses and the dangers 
     associated with manufacturing methamphetamine.


                 Section 3652--Mail Order Requirements

       This section represents changes to the reporting 
     requirements of 21 U.S.C. 830(b)(3) worked out between the 
     DEA and industry. Reporting will no longer be required for 
     valid prescriptions, limited distributions of sample 
     packages, distributions by retail distributors if consistent 
     with authorized activities, distributions to long term care 
     facilities, and any product which has been exempted by the 
     AG. It also allows the AG to revoke an exemption if he finds 
     the drug product being distributed is being used in violation 
     of the Controlled Substances Act.

[[Page 19104]]




    Section 3653--Theft and Transportation of Anhydrous Ammonia For 
        Purposes of Illicit Production of Controlled Substances

       This section makes it unlawful for a person to steal 
     anhydrous ammonia or to transport stolen anhydrous ammonia 
     across State lines knowing, intending, or having reasonable 
     cause to believe that such anhydrous ammonia will be used to 
     manufacture a controlled substance. Also provides funding to 
     Iowa State University to permit it to continue and expand its 
     current research into the development of inert agents that 
     will eliminate the usefulness of anhydrous ammonia as an 
     ingredient in the production of methamphetamine.

           Subtitle C--Ecstasy Anti-Proliferation Act of 2000


                           Section 3661--3665

       Directs the Sentencing Commission to review and amend the 
     Ecstasy guidelines to provide for increased penalties such 
     that those penalties reflect the seriousness of the offenses 
     of trafficking in and importing Ecstasy and related drugs. 
     Section 3665 authorizes $10 million in grants for prevention 
     efforts concerning Ecstasy and other ``club drugs.''

                       Subtitle D--Miscellaneous


    Section 3671--Anti-drug Messages on Federal Government Internet 
                                Websites

       This section requires all federal departments and agencies, 
     in consultation with ONDCP, to place anti-drug messages on 
     their Internet websites and an electronic hyperlink to 
     ONDCP's website. Numerous government agencies have children's 
     websites, including the Social Security Administration.


   Section 3672--Reimbursement By Drug Enforcement Administration of 
      Expenses Incurred To Remediate Methamphetamine Laboratories

       Authorizes $20 million to be appropriated in FY 2001 for 
     the DEA to reimburse States, units of local government, 
     Indian tribal governments, and other public entities for 
     expenses incurred to clean-up and safely dispose of 
     substances associated with clandestine methamphetamine 
     laboratories which may present a danger to public health or 
     the environment.


                   Section 3673--Severability Section

       Any provision held to be invalid or unenforceable by its 
     terms, or as applied to any person or circumstance, is to be 
     given the maximum effect permitted by law, or if it is held 
     to be invalid or unenforceable, such provision shall be 
     severed from this Act.

  Ms. COLLINS. Mr. President, I commend my colleagues, the chair and 
ranking member of the Public Health Subcommittee of the Health, 
Education, Labor, and Pensions Committee, for all of their efforts in 
bringing the Children's Health Act of 2000 to the Senate floor. This 
omnibus bill is the result of months of bipartisan collaboration and 
discussion between Members of both the House and the Senate in an 
effort to address important children's health issues in this Congress.
  As the co-chair of the Senate Diabetes Caucus, I am particularly 
pleased that the Pediatric Diabetes Research and Prevention Act, which 
I introduced earlier this year with Senators Breaux, Abraham, Craig, 
and Bunning, has been included in this bill. Our legislation--which was 
also cosponsored by Senators Grassley, Bingaman, Chafee, Roth, 
Hollings, and Schumer--will help us to reduce the tremendous toll that 
diabetes takes on our nation's children and young people, and I want to 
thank my colleagues for including it in the omnibus bill.
  As noted in the recent cover story in Newsweek, diabetes is a 
devastating, lifelong condition that affects people of every age, race, 
and nationality. Sixteen million Americans suffer from diabetes and 
about 800,000 new cases are diagnosed each year. It is one of our 
nation's most costly diseases in both human and economic terms. 
Diabetes is the leading cause of kidney failure, blindness in adults, 
and amputations not related to injury. It is a major risk factor for 
heart disease and stroke and shortens life expectancy up to 15 years. 
Moreover, diabetes costs our nation more than $105 billion a year in 
health-related expenditures. More than one out of every ten health care 
dollars and about one out of four Medicare dollars are spent on people 
with diabetes.
  Unfortunately, there currently is no method to prevent or cure 
diabetes and available treatments have only limited success in 
controlling its devastating consequences. The burden of diabetes is 
particularly heavy for children and young adults with type I, also 
known as juvenile diabetes. Juvenile diabetes is the second most common 
chronic disease affecting children. Moreover, it is one that they never 
outgrow.
  As the founder of the Senate Diabetes Caucus, I have met many 
children with diabetes who face a daily struggle to keep their blood 
glucose levels under control: kids like nine-year-old Nathan Reynolds, 
an active young boy from North Yarmouth, who was Maine's delegate to 
the Juvenile Diabetes Foundation's Children's Congress last year. 
Nathan was diagnosed with diabetes in December of 1997, which forced 
him to change both his life and his family's life. He has learned how 
to take his blood--something his four-year-old brother reminds him to 
do before every meal--check his blood sugar level, and give himself an 
insulin shot on his own, sometimes with the help of his parents or his 
school nurse. Nathan told me that his greatest wish was that, just 
once, he could take a ``day off'' from his diabetes.
  The sad fact is that children like Nathan with diabetes can never 
take a day off from their disease. There is no holiday from dealing 
with their diabetes. They face a lifetime of multiple daily finger 
pricks to check their blood sugar levels and daily insulin shots. 
Moreover, insulin is not a cure for diabetes, and it does not prevent 
the onset of serious complications. As a consequence, children like 
Nathan also face the possibility of lifelong disabling complications, 
such as kidney failure and blindness.
  Reducing the health and human burden of diabetes and its enormous 
economic impact depends upon identifying the factors responsible for 
the disease and developing new methods for prevention, better 
treatment, and ultimately a cure. The provisions of the Pediatric 
Diabetes Research and Prevention Act that have been included in the 
Children's Health Act of 2000 will do just that.
  One of the most important actions we can take is to establish a type 
I diabetes monitoring system. Currently there is no way to track the 
incidence of type I diabetes across the country. As a consequence, the 
estimates for the number of people with type I diabetes from the 
American Diabetes Association, the Juvenile Diabetes Foundation, the 
Centers for Disease Control and Prevention, and the National Institutes 
of Health vary enormously from 123,000 to over 1.5 million, a 13-fold 
variation. One of the best ways to define the prevalence and incidence 
of a disease, as well as to characterize and study populations, is to 
establish a national database specific to that disease, which our 
legislation would do.
  Obesity and inadequate physical activity--both major problems in the 
United States today--are important risk factors for type 2, or non-
insulin dependent diabetes. Unfortunately, obesity is a significant and 
growing problem among children in the United States, which has led to a 
disturbing increase in the incidence of type 2 diabetes among young 
people. This is particularly alarming since type 2 diabetes has long 
been considered an ``adult'' disease. Nearly all of the documented 
cases of type 2 diabetes in young people have occurred in obese 
children, who are also at increased risk for the complications 
associated with the disease. Moreover, these complications will likely 
develop at an earlier age than if these children had developed type 2 
diabetes as adults. Our legislation therefore calls for the 
implemention of a national public health effort to address the 
increasing incidence of type 2 diabetes in children and young people.
  In addition, the legislation calls for long-term studies of persons 
with type 1 diabetes at the National Institutes of Health where these 
individuals will be followed for 10 years or more. This long-term 
analysis of type 1 diabetes will provide an invaluable basis for the 
investigation and identification of the causes and characteristics of 
diabetes and its complications and it will also help to identify a 
potential study population for clinical trials. The legislation also 
directs the Secretary of Health and Human Services to support regional 
clinical research centers for the prevention, detection, treatment

[[Page 19105]]

and cure of type 1 diabetes. And finally, the legislation directs the 
Secretary of HHS to provide for a national program to prevent type 1 
diabetes, including efforts to develop a vaccine.
  Mr. President, these provisions will help us to better understand and 
ultimately conquer diabetes, which has had such a devastating impact on 
millions of American children and their families. It is therefore most 
appropriate that they be included in the Children's Health Act of 2000, 
and I urge all of my colleagues to join me in supporting it.
  Mr. REED. Mr. President, I rise to add my voice to the chorus of 
support for this legislation, which will have a strong positive impact 
on the youth of this nation.
  The first element of this initiative that I would like to highlight 
are the provisions regarding children's public health. This effort will 
greatly enhance health promotion and disease prevention directed 
towards youth, improve access to certain health care services for needy 
children and bolster resources for pediatric-specific medical research. 
Children are our most precious resource, and we should do all we can to 
enable our children to reach their full potential both physically and 
intellectually. The Children's Public Health Act takes an important 
step toward achieving this goal by creating an environment where 
children are able to grow and develop unhindered by the burden of 
disease.
  Medical science has made incredible strides in reducing and 
preventing devastating childhood diseases that were prevalent only a 
generation ago. Yet, despite these advances in our ability to stem the 
spread of deadly infectious diseases, there has been an increase in the 
incidence of chronic and debilitating disorders that afflict children. 
Specifically, over the past decade, we have seen a rise in the number 
of children suffering from asthma, autism, and other diseases 
attributed to poor diet and lack of physical activity, such as 
diabetes, high cholesterol and hypertension in young children. This 
legislation sets forth a balanced, creative approach to these troubling 
pediatric conditions by augmenting pediatric clinical research, while 
also expanding and intensifying screening, education, outreach, 
monitoring and training efforts led by State and local public health 
agencies and other health care providers.
  There are two specific initiatives that I am especially proud of in 
this legislation. The first seeks to address an entirely preventable 
problem that continues to plague far too many children in this nation--
lead poisoning. While tremendous strides have been made over the last 
20 years in reducing lead exposure among our citizens, it is estimated 
that nearly one million preschoolers nationwide still have excessive 
levels of lead in their blood--making lead poisoning the leading 
childhood environmental disease.
  Lead is most harmful to children under age six because lead is easily 
absorbed into their growing bodies, and interferes with the developing 
brain and nervous system. The effect of lead poisoning on a child 
ranges from mild to severe. Most often in the U.S., children are 
poisoned through chronic, low-level exposure to lead-based paint, which 
can cause reduced IQ and attention span, hyperactivity, impaired 
growth, reading and learning disabilities. Children with high blood 
lead levels can suffer from brain damage, behavior and learning 
problems, slowed growth, and hearing loss, among other maladies.
  Timely childhood lead screening and appropriate follow-up care for 
children most at-risk of lead exposure is critical to mitigating the 
long-term health and developmental effects of lead. Regrettably, our 
current system is not adequately protecting children, particularly low-
income children, from this hazard. It is estimated that two-thirds of 
at-risk children have never been screened and, consequently, remain 
untreated.
  This legislation takes some of the critical steps necessary to begin 
to address this problem. Specifically, the bill strengthens the lead 
program at the Centers for Disease Control and Prevention by providing 
new resources to conduct extensive outreach and education in 
coordination with other state programs that serve families with 
children at-risk of lead poisoning, such as WIC and Head Start. The 
bill also authorizes the implementation of community-based 
interventions to mitigate lead hazards and establishes guidelines for 
the reporting and tracking of blood lead screening tests so that we may 
have more accurate data on the number of lead-exposed children 
nationwide. The legislation also designates resources for health care 
provider education and training on current lead screening practices.
  The second element of this bill that I believe will have a major 
impact on improving the overall health of children relates to the 
problem of childhood obesity. Over the past fifteen years, the number 
of overweight children in this country has doubled. It is estimated 
that an alarming five million youth 6-19 years of age are overweight, 
while another six million children are overweight to the point that 
their health is endangered.
  Contributing to this alarming trend has been the rise in fast food 
consumption, coupled with an increasingly sedentary lifestyle where 
time engaged in physical activity has been replaced by hours playing 
computer games and watching television. The New York Times recently 
noted that the average child between the ages of 6 and 11 watches 25 
hours of television a week--and this does not include time spent 
playing video games or on a computer.
  Another reason for the lack of physical activity in children is the 
reduction in daily participation in physical education classes. Fewer 
and fewer States require school districts to offer physical education, 
despite the fact that children who engage in regular physical activity 
often perform better in school. We are raising a generation of inactive 
children that will likely become inactive, chronically ill adults. By 
not ensuring kids take time to participate in regular physical 
activity, we, as a society, are doing them a great disservice in the 
long run.
  Already, we are seeing younger and younger Americans with the signs 
of heart disease and diabetes, among other obesity-linked illnesses. 
The Centers for Disease Control and Prevention reports that 60 percent 
of overweight 5-10 year old children already have at least one risk 
factor for heart disease, such as hypertension, while the number of 
children diagnosed with Type II diabetes has skyrocketed. If we 
continue on this trajectory, obesity-related illnesses will soon rival 
smoking as a leading cause of preventable death, costing hundreds of 
thousands of American lives and billions of dollars in health care 
costs and lost productivity. Clearly, action needs to be taken.
  This legislation acknowledges this trend and attempts to reverse it 
through a multi-faceted approach. First, the bill authorizes a new 
competitive grant program through the Centers for Disease Control and 
Prevention to assist states and localities to develop and implement 
comprehensive school- and community-based approaches to promoting good 
nutrition and physical activity among children. The bill also calls for 
greater applied research to improve our understanding of the multiple 
factors that contribute to obesity and eating disorders and emphasizes 
the need for a nationwide public education campaign to educate families 
about the importance of good eating habits and regular physical 
activity. Lastly, the bill provides for health professional education 
and training to aid in the identification and treatment of overweight 
children, children suffering from an eating disorder or children at 
risk of these conditions.
  The other major component of this bill is based on S. 976, the Youth 
Drug and Mental Health Services Act, which originated in the Senate 
Health, Education, Labor, and Pensions Committee, and passed the full 
Senate last year. This legislation reauthorizes programs administered 
by the Substance Abuse and Mental Health Services Administration 
(SAMHSA), and also provides many enhancements that will specifically 
benefit children and adolescents suffering from substance abuse or 
mental health problems, children

[[Page 19106]]

who have witnessed violence, and children from families needing 
substance abuse or mental health treatment and other support services.
  I am pleased that this legislation includes a provision that I worked 
on to address the severe shortage of transitional services for youth 
who are leaving the juvenile justice system. Specifically, the bill 
addresses this shortage by authorizing grants to local juvenile justice 
agencies to provide comprehensive community-based services such as 
mental health and substance abuse treatment, job training, vocational 
services, and mentoring programs to juvenile offenders.
  Studies have found that the juvenile population has a special need 
for these types of services, mental health and substance abuse 
treatment, in particular. It is estimated that the rate of mental 
disorder is two to three times higher among the juvenile offender 
population than among youth in the general population. According to a 
1994 Department of Justice study, 73 percent of the juveniles surveyed 
reported mental health problems, and 57 percent reported past 
treatment. Also, it is estimated that 60 percent of youth in the 
juvenile justice system have substance abuse disorders, compared to 22 
percent in the general population.
  Unfortunately, there currently exists little, if any, support for 
youth who are leaving the juvenile justice system. Many services, such 
as mental health and substance abuse treatment, provided while the 
youngster was detained or incarcerated, are discontinued upon their 
release. Given this breakdown in the continuity of services, it is 
hardly surprising that of the 4 million youngsters arrested each year, 
30 percent are likely to recidivate within the year of arrest.
  In the handful of places where transitional services have been 
provided, the results have been outstanding. For instance, in Rhode 
Island we have a successful program called ``Project Reach.'' Yale 
University, in its evaluation of Project Reach, found that children 
receiving transitional services improved dramatically: 80 percent had 
significant increases in their grades in school; school attendance 
increased from 50 to 75 percent; and there was a 60 percent reduction 
in youth encounters with police after enrolling in the program. In 
addition, there was a 50 percent decrease in out-of-home placement for 
these children. In other words, children who once had problems so 
severe that they had to be removed from their homes are now able to 
remain with their families in their communities.
  Adequate transitional and aftercare services to prevent recidivism 
are essential to reducing the societal costs associated with juvenile 
delinquency, promoting teen health, and fostering safe communities. 
These provisions recognize the serious gap in services for youth 
offenders and takes important steps to address this serious deficiency. 
I am grateful for the inclusion of this critical language in the bill.
  As I have noted, there are many positive aspects to this legislation. 
However, I have deep reservations about a particular provision that was 
retained in the SAMHSA bill that allows all religious institutions, 
including pervasively religious organizations, such as churches and 
other houses of worship, to use taxpayer dollars to advance their 
religious mission. I oppose this ``charitable choice'' language and 
offered an amendment to modify it when the original legislation was 
considered in Committee last year.
  Although charitable choice has already become law as a part of 
welfare reform and the Community Services Block Grant, CSBG, section of 
the Human Services Reauthorization Act, the inclusion of charitable 
choice in this legislation is particularly disturbing since, unlike its 
application to the intermittent services provided under Welfare Reform 
and CSBG, SAMHSA funds are used to provide substance abuse treatment 
which is ongoing, involves direct counseling of beneficiaries and is 
often clinical in nature. In the context of these programs it would be 
difficult if not impossible to segregate religious indoctrination from 
the social service.
  Faith-based organizations do have an important and necessary role to 
play in combating many of our nation's social ills, including youth 
violence, homelessness, and substance abuse. In fact, I have seen 
first-hand the impact that faith-based organizations such as Catholic 
Charities have on delivering certain services to people in need in my 
own state. By enabling faith-based organizations to join in the battle 
against substance abuse, we add another powerful tool in our ongoing 
efforts to help people move from dependence to independence.
  While there are many benefits that come with allowing religious 
organizations to provide social services with federal funds, I am 
concerned that without proper safeguards, well-intentioned proposals to 
help religious organizations aid needy populations, might actually harm 
the First Amendment's principle of separation of church and state. The 
charitable choice provision creates a disturbing new avenue for 
employment discrimination and proselytization in programs funded by 
SAMHSA. Under current law, many religiously-affiliated nonprofit 
organizations already provide government-funded social services without 
employment discrimination and proselytization. However, the legislation 
extends Title VII's religious exemption to cover the hiring practices 
of organizations participating in SAMHSA programs.
  As I already mentioned, during markup, I offered an amendment that 
would have addressed this issue by including important safeguards and 
protections for beneficiaries and employees of SAMHSA funded programs. 
Specifically, the amendment would have removed the provision that 
allows religious organizations to require employees hired for SAMHSA 
funded programs to subscribe to the organization's religious tenets and 
teachings. Since the bill prohibits religious organizations from 
proselytizing in conjunction with the dissemination of social services 
under SAMHSA programs, it seems contradictory to permit religious 
organizations to require their employees to subscribe to the 
organization's tenets and teachings when it has no bearing on the 
provision of services. Second, the amendment would have eliminated the 
extension of Title VII's religious exemption to cover the hiring 
practices of organizations participating in SAMHSA funded programs.
  Ultimately, my proposal would not have reduced the ability of 
religious groups to hire co-religionists or more actively participate 
in SAMHSA funded programs. It merely would have eliminated the explicit 
ability to discriminate in taxpayer-funded employment and left to the 
courts the decision of whether employees who work on, or are paid 
through, government grants or contracts are exempt from the prohibition 
on religious employment discrimination.
  For the last 30 years, federal civil rights laws have expanded 
employment opportunities and sought to counter discrimination in the 
workplace. I recognize that we need the assistance of religious 
organizations in the battle against substance abuse. However, 
partnerships with faith-based organizations should augment--not 
replace--government programs. These partnerships should respect First 
Amendment protections and not allow taxpayer dollars to be used to 
proselytize or to support discrimination. I believe we need a far more 
robust and informed debate before we allow any expansion of current 
exemptions to Title VII.
  Nevertheless, this combined legislation has many meaningful 
provisions that will go a long way towards improving the health and 
well-being of our children. This legislation not only strengthens 
pediatric medical research, it also includes important enhancements in 
maternal and prenatal health as well as several other health promotion 
and disease prevention initiatives that will greatly enhance the 
quality of life for children. Similarly, the bill contains elements 
that will greatly improve mental health and substance abuse services 
for children and adolescents.
  I am pleased to have worked on this legislation and look forward to 
its expeditious passage this year.

[[Page 19107]]


  Mr. DOMENICI. Mr. President, I rise today to briefly speak about the 
passage of the children's health bill and the Substance Abuse and 
Mental Health Services Administration reauthorization bill.
  I would like to begin by congratulating Senators Frist and Kennedy 
for their work on this important piece of legislation and to tell them 
how pleased I am the package contains a number of provisions from the 
Mental Health Early Intervention, Treatment, and Prevention Act of 
2000, S. 2639.
  Today we do not even question whether mental illness is treatable. 
But, today we recoil in shock and disbelief at the consequences of 
individuals not being diagnosed or following their treatment plans. The 
results are tragedies we would have prevented.
  Just look at the tragic incidents at the Baptist Church in Dallas/
Fort Worth, the Jewish Day Care Center in Los Angeles, and the United 
States Capitol to see the common link: a severe mental illness. Or the 
fact that there are 30,000 suicides every year, including 2,000 
children and adolescents.
  It was not too long ago that our Nation decided we did not want to 
keep people with a mental illness institutionalized. Simply put, it was 
inhumane to simply lock these individuals up without even using science 
to consider other alternatives.
  Make no mistake, our Nation still has these same individuals with 
mental illness, we just do not have a very good way to deal with these 
individuals. Many of these individuals formerly locked up are now our 
neighbors taking the proper medication to manage their illness.
  However, our Nation simply does not have an understanding of what 
happens when individuals stop taking their medications because sadly 
many of these highly publicized incidents of mass violence all too 
often involve an individual with a mental illness.
  When these incidents occur, my wife and I watch with horror on 
television and we often turn to each other and say that person was a 
schizophrenic or that individual was a manic depressive.
  Some of you may have seen the recent 4 part series of articles in the 
New York Times reviewing the cases of 100 rampage killers. Most notably 
the review found that 48 killers had some kind of formal diagnosis for 
a mental illness, often schizophrenia.
  Twenty-five of the killers had received a diagnosis of mental illness 
before committing their crimes. Fourteen of 24 individuals prescribed 
psychiatric drugs had stopped taking their medication prior to 
committing their crimes.
  With this in mind I am especially pleased that with the passage of 
this package we are taking a very positive step forward to address the 
problem I have mentioned. The provisions adopted from the Mental Health 
Early Intervention, Treatment, and Prevention Act of 2000 will serve to 
give more people the ability to identify when someone might be 
suffering from mental illness and pose a threat to themselves or 
others.
  I think it's important that we begin to find ways to get these people 
help before we find them involved in a violent tragedy and I would like 
to briefly touch upon several of those provisions I believe will take 
us a long way towards that goal:
  A grant program will provide training to teachers and emergency 
services personnel to identify and respond to individuals with mental 
illness, and to raise awareness about available mental health 
resources. Another grant program creates Emergency Mental Health 
Centers that will serve as a specific site in communities for 
individuals in need of emergency mental health services, and will also 
provide mobile crisis intervention teams.
  The Jail Diversion Demonstration will create 125 programs to divert 
individuals with mental illness from the criminal justice system to 
community-based services. And finally, the Mental Illness Treatment 
Grant will provide integrated treatment for individuals with a serious 
mental illness and a co- occurring substance abuse disorder with an 
emphasis placed on individuals with a history of involvement with law 
enforcement or a history of unsuccessful treatment.
  In closing, I really believe we have a historic opportunity to become 
preventers of serious, serious acts of violence before they happen and 
I look forward to working with my colleagues in the future to continue 
addressing this important issue.
  Mr. WELLSTONE. Mr. President, I rise today in support of the passage 
of the Children's Health Act of 2000, an extraordinary bipartisan bill 
that includes so many outstanding provisions to improve the health and 
mental health of the children of our country. The bill includes the 
reauthorization of the Substance Abuse and Mental Health Services 
Administration, a long-overdue reauthorization and revitalization of an 
agency that provides most of the public funding of mental health and 
addiction services to our communities. SAMHSA has many dedicated staff 
who have worked so hard to develop and manage remarkable programs over 
the last several years. I am proud to have played a role in the 
development of this comprehensive bill, and to join my colleagues in 
encouraging its quick passage into law.
  The Children's Health Act of 2000 takes a major step forward in 
supporting research, services, treatment, and professional training to 
begin to address some of the most significant health problems affecting 
children of all ages. This legislation clearly states that children's 
health, including their mental health and addiction treatment needs, 
must be a priority for our country. It is not enough to deal with our 
children's health needs only after they have become crises. Many of the 
programs outlined in this bill recognize this problem by focusing on 
prevention and education programs, and by supporting programs to train 
researchers and health care providers who specialize in children's 
health.
  Many of the health areas included in this comprehensive bill were 
identified by the Department of Health and Human Services as among the 
top 10 leading health indicators for children in its major public 
health initiative ``Healthy People 2010,'' launched in January 2000. 
Several were of particular importance to me as I worked on this bill, 
especially programs supporting treatment of mental illness and 
addiction; increased access to health care, especially for our mentally 
ill youth in correctional facilities; and overall improvements in 
fitness and oral health for all our children, including low-income 
children and children living in rural areas.
  Dr. David Satcher, the United States Surgeon General, has released 
several groundbreaking reports in recent years which highlight the 
scope and the specific health needs of our children. These reports 
included ``Mental Health: A Report of the Surgeon General''; ``The 
Surgeon General's Call to Action to Prevent Suicide''; and the first 
ever ``Oral Health In America: A Report of the Surgeon General,'' which 
each begins to address these severe health crises in these areas for so 
many of our children. The problems identified by Dr. Satcher touch on 
both the national problems across our country, and also highlight the 
significant health care disparities for different groups. I am pleased 
to have contributed to many new legislative and funding efforts to 
support improvements in these areas of health care.
  In the Surgeon General's 2000 report on oral health, the strong link 
between oral health and overall health was highlighted, and this bill 
helps to address the problems identified in the report. Dr. Satcher 
emphasized the devastating consequences of untreated oral disease and 
how it can affect children's health and well-being, leading to serious 
pain and suffering, time lost from school, loss of permanent teeth, 
damage to self-esteem, and co-existing medical conditions. So much of 
what we need to do is already known. We need to identify the unmet need 
and improve access to care for those who need it most. This bill 
includes funding for school-based and other innovative oral health care 
programs to improve the overall health of our children. The oral health 
programs included in this bill are an important step forward.
  Healthy People 2010 goals also identified obesity as a major problem 
for

[[Page 19108]]

children, particularly because of the decline in physical activity 
among our children. One-fourth of our children aged 6-17 are 
overweight, and the percentage of children who are seriously overweight 
has doubled in the last thirty years. This is not a minor issue for the 
health of our children: obesity as a chronic illness is related to 
other serious chronic conditions in children, including type II 
diabetes, hypertension, and asthma. Research has also shown that 60% of 
overweight children 5-10 years old already have at least one risk 
factor for heart disease. Adult obesity is associated with many of the 
leading causes of death and disability, including heart disease, 
diabetes, arthritis, and cancer. The public health efforts in this bill 
that focus on this serious national problem, including improvements in 
physical education funding, public health education, and nutrition 
education, are ones I enthusiastically support. In the future we must 
do even more to again make physical education a high priority for our 
country and establish a national foundation to promote physical 
activity for all ages.
  I am particularly proud of the section of this bill that supports 
local suicide prevention programs focusing on our young people. Youth 
suicide must be recognized for the national crisis that it is. In my 
own state of Minnesota, suicide is the second leading cause of death 
among our youth, as it is in half of the states in our country. 
Overall, in the United States, it is the third leading cause of death 
among our children, taking more lives than homicide. We know from the 
outstanding research supported by the National Institute of Mental 
Health that 90% of all completed suicides are linked to untreated or 
inadequately treated mental illness or addiction. More than 500,000 
Americans attempt to take their own lives every year. In this bill, $75 
million will be authorized to support local prevention programs 
focusing on our children who are at risk of taking their own lives. 
More than 50 groups supported our efforts to improve funding for 
suicide prevention programs this year, including local programs, like 
the Minnesota group, Suicide Awareness/Voices of Education (SA/VE), as 
well as national groups, such as Suicide Prevention and Advocation 
Network (SPAN), the National Hope Line Network, and the National Mental 
Health Association.
  We can no longer afford to turn our eyes away from the horrible 
reality that many of our citizens, even our children, may want to die. 
We continue to treat mental illness and severe drug addiction as 
somehow less important than other illnesses. We blame the sick for 
their disease, and the result can be death and tragedy. Today, we begin 
to acknowledge that this kind of discrimination is against many of our 
own children.
  I am also pleased to have worked to include an additional $4 million 
to support resource centers for those who work with our mentally ill 
youth in correctional facilities. Our children need help in many areas: 
education, child care, juvenile justice, and health care. Many are 
experiencing severe drug addiction, mental illness, and lack of access 
to health care coverage. The Director of the Office of National Drug 
Control Policy (ONDCP) has recognized that the number one priority for 
the nation's National Drug Control Strategy is to educate and enable 
America's youth to reject illegal drugs as well as alcohol and tobacco. 
And yet 80 percent of adolescents needing treatment are unable to 
access services because of the severe lack of coverage for addiction 
treatment or the unavailability of treatment programs or trained health 
care providers in their community. Many of these children end up in the 
juvenile justice system as a result.
  The reauthorization of SAMHSA within this bill, with its state block 
grant funding for mental health and addiction treatment, is a good 
beginning. But so much more must be done to stop treating our children 
as second class citizens, and to stop treating mental illness and 
addiction as second class illnesses. We must continue to fight for 
fairness and parity in health care coverage for our children, indeed 
for all of our citizens, who suffer from mental illness and addiction. 
It is their future, and ours, as a country, that is at stake.
  Mr. ASHCROFT. Mr. President, I am pleased to support the Children's 
Health Act of 2000 that will pass the Senate today. This legislation is 
the result of months of dedicated work by a number of Senators and 
House members. I believe the final language represents a comprehensive 
approach to promote physical and mental health for children, and 
protect them from dangerous, illegal drugs. I am a co-sponsor of the 
Senate version of this bill, a previous Senate version of the 
Children's Health Act (S. 2868), as well as the author of two key 
provisions contained in the package we are considering today.
  I rise today to speak in favor of this legislation and to thank the 
bill's sponsor, Senator Frist, for working with me to include two 
provisions that I believe are essential tools for advancing health and 
safety of America's children. The bill that will pass today, H.R. 4365, 
contains three main sections: (1) the text of S. 486, the 
Methamphetamine Anti-Proliferation Act, a bill I introduced last year 
that previously passed the Senate and has been approved by the House 
Judiciary Committee for consideration by the House of Representatives; 
(2) the Youth Drug and Mental Health Services Act, which reauthorizes 
programs within the jurisdiction of the Substance Abuse and Mental 
Health Services Administration (SAMHSA) to improve mental health and 
substance abuse services for children and adolescents and allows the 
Charitable Choice concept, which I first authored in the 104th 
Congress, to be applied to the programs covered by this Act and (3) the 
Children's Health Act, which amends the Public Health Services Act to 
revise, extend, and establish programs with respect to children's 
health research, health promotion and disease prevention activities 
conducted through Federal public health agencies.
  Mr. President, let me touch briefly on each of these three main 
sections.
  First, this bill includes the text of S. 486, the Methamphetamine 
Anti-Proliferation Act, a bill I introduced in February 25, 1999 in 
response to the growing problem of methamphetamine production and use 
in my home state of Missouri, throughout the Midwest and in many other 
states as well. Unfortunately, the problem of methamphetamine has only 
gotten worse in the past year and a half. This anti-meth measure I 
authored will help fight meth in Missouri and the U.S. with $55 million 
in new resources for enforcement, cleanup, school- and community-based 
prevention efforts, and rehabilitation services.
  The Methamphetamine Anti-Proliferation Act will bolster the fight 
against meth through stiffer penalties for drug criminals; more money 
for law enforcement, education, and prevention; and a wider ban on meth 
paraphernalia. The bill directs the U.S. Sentencing Commission to raise 
its guidelines for sentencing meth offenders. It requires mandatory 
reimbursement for the costs incurred by federal, state and local 
governments for the cleanup associated with meth labs. It authorizes 
$5.5 million in funding for DEA programs to train State and local law 
enforcement in techniques used in meth investigations and staff mobile 
training teams which provide State and local law enforcement with 
advanced training in conducting lab investigations. It also provides 
$15 million in funding to combat the trafficking of meth in counties 
designated High Intensity Drug Trafficking Areas.
  This legislation also provides for further research into the use of 
meth; authorizes $15 million in funds for community- and school-based 
anti-meth education programs; and includes an additional $10 million in 
resources for treatment of meth addiction. It directs HHS to include 
its annual National Household Survey on Drug Abuse prevalence data on 
the consumption of methamphetamine and other illicit drugs in rural, 
metropolitan, and consolidated metropolitan areas and

[[Page 19109]]

requires the Secretary of HHS, in consultation with the Institute of 
Medicine, to conduct a study on the development of medications for the 
treatment of addiction to methamphetamine.
  The nation's lead anti-drug agency, the Drug Enforcement 
Administration (DEA), has thrown its support behind the Methamphetamine 
Anti-Proliferation Act. In endorsing this bill, DEA Administrator 
Donnie Marshall said this bill is ``landmark methamphetamine 
legislation.'' Marshall stated: ``I believe this bill (the 
Methamphetamine Anti-Proliferation Act) will prove instrumental in the 
Drug Enforcement Administration's efforts to bring to a halt the 
continued spread of methamphetamine across our country.''
  Mr. President, I am sad that Missouri is notorious as a national 
center of meth production and distribution. Methamphetamine, for those 
who are lucky enough not to have a meth problem in their areas, is a 
highly addictive synthetic drug that is typically made in illegal 
clandestine ``labs.'' Missouri and California lead the nation in 
seizures of such labs. In Missouri, the federal Drug Enforcement 
Administration and state and local law enforcement officers seized only 
two such labs in 1992, 14 in 1994, and a record 679 in 1998. This 
number jumped to 920 in 1999, setting a new record.
  The second section of this bill is the Youth Drug and Mental Health 
Services Act, which reauthorizes the Substance Abuse and Mental Health 
Services Administration (SAMHSA). This section addresses the issue of 
drug abuse in our nation's youth which has dramatically increased this 
decade. It creates new programs to provide additional funding for 
youth-targeted treatment and early intervention services. Under this 
bill, states will receive more flexibility in the use of block grant 
funds and the Secretary of Health and Human Services will have more 
flexibility to respond to the needs of young people who need mental 
health and substance abuse services.
  I am especially pleased that included in the Youth Drug and Mental 
Health Services Act is an expansion of the Charitable Choice provision, 
which will allow federally-funded substance abuse services to be open 
to faith-based providers. Under Charitable Choice, which was first 
enacted into law in 1996 as part of the welfare reform law, churches 
and other faith-based providers are able to compete on an equal footing 
with other non-governmental organizations in providing services to 
disadvantaged Americans.
  Since its enactment, Charitable Choice has been expanded from job 
training and related services for welfare clients to include the 
Community Services Block Grant program, which is used for a variety of 
anti-poverty activities, such as improving job and educational 
opportunities and providing financial management and emergency 
assistance. This latest expansion will apply Charitable Choice to 
federal drug treatment programs that will total $1.6 billion for Fiscal 
Year 2000. My home state of Missouri is slated to receive $24.46 
million in substance abuse block grant funding for the coming fiscal 
year.
  Charitable Choice calls our nation to its highest and best in our 
effort to help those in need. It meets the tests of compassion and 
common sense that count for so much in Missouri. When people of faith 
extend compassionate help to those in need, the results can be 
stunningly successful. Where too many traditional substance abuse 
treatment programs have failed to help those in need, faith-based 
programs have succeeded. For example, Teen Challenge has show that 86% 
of its graduates remain drug-free. San Antonio's Victory Fellowship 
boasts of a success rate of over 80%. This is the test of common sense: 
America needs to create a vibrant partnership that succeeds where other 
approaches have failed.
  Mr. President, the bipartisan support for Charitable Choice is 
overwhelming in Congress. In additional, both Presidential candidates--
Governor Bush and Vice President Gore--strongly support the program. It 
is my hope that this broad national consensus will continue to grow and 
that soon will be able to enact a comprehensive expansion of Charitable 
Choice to all federally-funded social services programs.
  Third, the Children's Public Health Act has four overriding themes 
represented in its four titles: Injury Prevention, Maternal and Infant 
Health, Pediatric Health Promotion, and Pediatric Research. This 
legislation focuses federal research efforts in these areas and 
provides a comprehensive approach to children's health. For example, 
the bill includes authorization for research to prevent traumatic brain 
injuries, provides federal grants for comprehensive asthma services to 
children, and establishes a National Center for Birth Defects and 
Development Disabilities within the CDC. The bill also includes 
childhood obesity prevention programs, childhood lead prevention 
programs, and a groundbreaking pediatric research initiative within NIH 
to ensure the realization of expanding opportunities for advancement in 
scientific investigations and care for children. This legislation also 
includes support for pediatric graduate medical education in children's 
hospitals, an issue that has been a high priority of mine for years.
  I am hopeful, that with passage of this landmark legislation, we can 
improve the lives of America's children. By funding research for many 
childhood diseases and disabilities, expanding programs to assist youth 
with addiction and mental health problems through faith-based 
providers, and drastically increasing the war against meth, this bill 
is an important step in the right direction. I thank all those who 
worked on this legislation, and urge the President to sign this bill to 
help secure a safer and healthier future for the next generation.
  Mr. LOTT. Mr. President, I ask consent that the amendment that is 
offered in the nature of a substitute be agreed to, the bill be read 
the third time and passed, as amended, the motion to reconsider be laid 
on the table, and that any statements related to the bill be printed in 
the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 4181) was agreed to.
  The bill (H.R. 4365), as amended, was read the third time and passed.
  Mr. BOND. Mr. President, I rise to speak on an issue of great 
importance to America's families--the health of our nation's children--
and to talk about crucial legislation which the Senate has passed today 
called the Children's Health Act of 2000.
  Whenever we talk about children's health, we should not ignore the 
fact that there is a lot of good news. The fact is that most children 
are persistently healthy. A majority of children can actually go 
through a year with no more serious health problems than scrapes and 
bruises, a stuffy nose, or an easily-treatable earache. I'm not sure 
how many of us can say that--I know I can't. And on a variety of 
indicators that measure children's health, the good news is only 
getting better. In the last decade, we have seen improvements in 
immunization rates, infant mortality, child mortality, and reduced teen 
birth rates.
  There are of course exceptions to these healthy kids. Thousands of 
children are born every year with a birth defect. Too many children 
suffer moderate to serious accidents of all types. And an unfortunate 
minority face other serious or long-term health problems. Worse, 
children who are sick are often very sick. These exceptions to the rule 
are all the more tragic because our expectation is that our children 
will be healthy.
  That is why the Children's Health Act, which the Senate has passed 
today, is so important. As sound as our children's overall health is, 
it can be better. As well as our nation is doing to protect our 
children's health, we can do more.
  Mr. President, the Children's Health Act covers many specific health 
problems that afflict children--autism, arthritis, asthma, brain 
injuries, lead poisoning, and so on. Each of the legislative provisions 
that addresses these problems deserves attention, and I hope that the 
merits of each of these sections can be presented. Right now, I would 
like to focus on the sections of

[[Page 19110]]

the Children's Health Act that I have strongly supported. Most of these 
provisions were included in legislation--called Healthy Kids 2000--
which I introduced last year.
  As both a Governor and a Senator, one of my main priorities in health 
care has been to try to find new ways to prevent birth defects. Because 
we expect our children and our babies to be healthy, birth defects can 
be truly devastating to a family. Yet they happen far too frequently--
150,000 children are born every year with some type of birth defect.
  Today alone, about 6 or 7 families in this country will have a child 
with one very serious type of birth defect, called a neural tube 
defect. Spina bifida is the most well known of these defects of the 
brain and spine. The complications that result from this type of birth 
defect range from serious, long-term health problems to death, but the 
real tragedy is that many of these birth defects could have been 
prevented.
  One simple step--women of childbearing age taking 400 micrograms of 
folic acid every day--can help women and families significantly reduce 
the chance of this type of birth defect by up to 70 percent. Yet most 
women just don't know about folic acid. Simply making them aware of the 
importance of folic acid is such an easy and inexpensive way to prevent 
birth defects, it is simply silly not to do everything we can to make 
sure every woman in this country knows about the benefits of folic 
acid.
  One provision of the Children's Health Act was taken from the Folic 
Acid Promotion Act, which I have introduced with Senator Abraham. This 
section authorizes expanded effort by the Centers for Disease Control 
to get more women of childbearing age to use folic acid. The CDC has 
begun activity in this area, but the continued depth of the problem 
demonstrates that much more can be done.
  Another easy thing we can do to bring greater focus and attention to 
the problem of birth defects is to simply reorganize how and where the 
work on birth defects is done within the Centers for Disease Control. 
Right now, the CDC's work on birth defects is done within one of its 
main branches, the National Center for Environmental Health, whose 
responsibilities expand significantly beyond birth defects.
  I believe the seriousness of this problem--over 400 infants are born 
every day with some type of birth defect--and the significant amount of 
CDC funding spent on birth defects justify a Center within the Centers 
for Disease Control focused exclusively on this issue. The Children's 
Health Act calls for a fourth Center within the CDC--the National 
Center for Birth Defects and Developmental Disabilities--which will 
allow for consolidation, greater visibility and expansion of CDC's 
efforts to prevent birth defects. This builds on the comprehensive 
prevention program outlined in the Birth Defects Prevention Act, which 
I sponsored and Congress passed in 1998.
  One area of children's health that has been getting worse over the 
last decade is the percentage of babies born with a low birth weight. 
Low birth-weight babies have a much higher chance of developmental and 
other problems as they grow up. One reason for this declining trend is 
the persistent levels of cigarette, alcohol, and drug use during 
pregnancy. Somewhere between 19 and 27 percent of pregnant women in the 
U.S. smoke during pregnancy, despite the fact that these smokers are at 
a significantly higher risk for stillbirth, premature births, low 
birth-weight, and birth defects.
  The Children's Health Act contains another provision from my Healthy 
Kids 2000 legislation which establishes a grant program run by CDC to 
establish community-based programs designed to reduce and prevent 
prenatal smoking, alcohol, and drug use. We can work with women to help 
them understand the consequences of using these types of substances on 
their babies and to help them change their behavior so they can have 
healthier infants.
  The health of a mother during her pregnancy obviously has a 
tremendous health impact on her child. Yet we as a nation still have a 
surprisingly large amount of serious complications that occur during 
pregnancy even before labor. 1,000 women actually die every year during 
pregnancy, and this figure has been increasing in the 1990s. A full 20 
percent of women have serious health problems even before they go into 
labor.
  But despite these problems, our public health system does not have a 
comprehensive system in place to monitor, research, and try to prevent 
these maternal deaths and complications. Only 15 states have a program 
of their own that does this. Well, if we can't look at a problem and 
study it, we certainly can't hope to understand the problem, much less 
to solve it. I believe the CDC needs to do further work with states to 
understand exactly why so many women are having pregnancy-related 
problems and to figure out what we can do about it. The Children's 
Health Act authorizes CDC to expand their efforts so we can prevent 
these problems and help women have healthy pregnancies so they can have 
healthy kids.
  Finally, I have been a strong supporter of Senator DeWine's Pediatric 
Research Initiative within the National Institutes of Health. I am 
pleased to be a cosponsor of his bill, and I included the Pediatric 
Research Initiative in my Healthy Kids 2000 legislation. I am happy to 
report that the Pediatric Research Initiative has been included in the 
Children's Health Act.
  I believe we need to encourage the NIH to focus more on children's 
health care research. In recent years, NIH has seen significant 
increases in the funding needed to support the critical research they 
do. This crucial work helps us better understand how various diseases 
work, what we can do to prevent them, and how to cure those who are 
afflicted. I am concerned, however, that pediatric research at NIH has 
not shared fully in this research expansion.
  The Pediatric Research Initiative provides the NIH with additional 
funds that are specifically dedicated to pediatric research. This 
funding can be used by the NIH Director for research that shows the 
most promise to address successfully childhood health concerns. The 
Pediatric Research Initiative would not earmark funds to any specific 
institute or to any specific disease. This commonsense legislation 
simply provides extra funding to the Office of the Director with 
maximum flexibility to invest that money in any area of pediatric 
research in any of the NIH Institutes. I believe this is a reasonable, 
and not a very restrictive, response to concerns that the NIH 
shortchanges pediatric research.
  Mr. President, I would like to commend and thank Senators Frist, 
Kennedy, and all of the other distinguished Senators who have worked to 
put this crucial bill together. I have been pleased to work with them 
to ensure that this bill addresses some of the most pressing health 
care concerns our nation's children face. I hope and expect that the 
House of Representatives will follow-up quickly on Senate action so we 
can send this bill to the President.
  Last year, I introduced the Healthy Kids 2000 Act based on a simple 
idea--we want children to be healthy, and we want pregnant women to be 
healthy. Passage today of the Children's Health Act promises to bring 
us closer to this simple but critically important goal.
  Mr. LEVIN. Mr. President, according to the experts, the number of 
heroin users is on the rise while the average age of first heroin use 
is dropping. Heroin addiction is a public health crisis of significant 
proportion. This legislation, the Hatch-Levin Drug Addiction Act, S. 
324, will allow us to effectively utilize a new medical discovery of a 
substance called Buprenorphine, which has proven to be an 
extraordinarily effective means for combating heroin addiction by 
blocking the craving for heroin.
  But this anti-addiction medication can help us win the war against 
heroin and heroin addiction only if we change our laws so that the 
medication can be dispensed in physician's offices instead of a 
centralized clinic. That is what this legislation accomplishes.
  It is estimated that there are approximately one million heroin 
addicts in the U.S. According to the U.S. Department of Health and 
Human Services, many of these heroin addicts want

[[Page 19111]]

to kick their habit, but do not wish to receive treatment in methadone 
clinics ``. . . because of the stigma of being in methadone treatment 
or their concerns about the medical effects of methadone.''
  The Drug Addiction Treatment Act has now passed the House of 
Representatives in slightly different form than we passed in the Senate 
on November 19. Its adoption again by the Senate as Title XXXV, Section 
3501 and Section 3502 of the substitute amendment to H.R. 4365, the 
Children Health Act of 2000, paves the way for physician office-based 
dispensing of a medication which has been the subject of extensive 
successful research and clinical trials in the U.S. and France. This 
medication, Buprenorphine, was developed under a Cooperative Research 
and Development Agreement between the National Institute on Drug Abuse 
and a private pharmaceutical manufacturer, and is expected to receive 
FDA approval in the weeks ahead. Buprenorphine has already been in use, 
in physician offices, for a number of years in France, where 
significant success has been achieved in getting individuals off of 
heroin, reducing crime and heroin-related deaths. For example, since 
the introduction of Buprenorphine in France, there has been an 80 
percent decline in deaths by heroin overdose--from 505 in 1994 to 92 in 
1998; user crime and arrests are down by 57 percent--from 17,356 in 
1995 to 7,649 in 1998; and trafficking arrests have declined by 40 
percent--from 3,329 in 1995 to 1,979 in 1997.
  Over a year ago, I introduced the Drug Addiction Treatment Act, S. 
324, along with Senator Hatch, Senator Moynihan and Senator Biden, in 
order to put in place the necessary mechanisms to accommodate this 
revolutionary new treatment that can block the craving for heroin and 
dramatically restore the quality of the lives of individuals and 
families who have struggled to get out from under heroin addiction.
  There are a number of reasons why our legislation is necessary. Under 
current law, the Narcotic Addict Treatment Act of 1974, the process by 
which individual physicians must be approved in order to prescribe 
narcotics in drug treatment is a cumbersome and complex regulatory 
process. Federal regulations and State regulations, which could, under 
existing law, be written to allow Buprenorphine to be utilized in 
physician offices will take an extensive period of time to be written 
and take many years to be implemented. Indeed, there is no assurance 
that such regulations will ever be written by both federal and state 
governments. In the meantime, a very effective medication is 
unavailable to those who are addicted to Heroin.
  The Hatch-Levin legislation would allow for the utilization of 
Buprenorphine by qualified physicians in a physician's office. It will 
also assure that Buprenorphine will be made available in every state 
unless a state expressly opts out of the program through legislation.
  The current federal regulatory process needed to be utilized before 
treatment of addiction in an office-based setting is allowed include: 
(1) Writing the regulations, which could take up to a year or more; (2) 
Issuance of the proposed rule which would be published in the Federal 
Register, including the announcement of a period of time for public 
comment on the proposed rule; (3) A review of the public comments, 
which could take a year or more; (4) The issuance of the final rule, 
(5) Then each State is required to affirmatively approve and implement 
the physician office approach which typically takes 2-4 years, in those 
states that do act.
  Based on the experience with the introduction of LAAM for the 
treatment of heroin addiction--a medication similar to methadone which 
is effective for up to three days, as opposed to the daily dosage 
required by methadone--most states may never approve the physician 
office approach and for those that do the process could go on for as 
many as 4-5 years. That was the case with California and New York. 
According to findings reported by the U.S. Department of Health and 
Human Services on July 14, 1999: ``Current federal and state 
regulations prevent ease of entry into methadone or LAMM maintenance 
treatment. . . .''
  So, while it is possible under current law for regulations to be 
written by HHS allowing for the use of Buprenorphine in the treatment 
of heroin addiction and to allow for it to be prescribed in physician 
offices,
  (1) there is no certainty that they will be written;
  (2) if such regulations are written, it would take years for them to 
take effect; and
  (3) each state must explicitly opt into the program by writing 
regulations or adopting a law.
  In each state not opting in, the treatment in a physician office 
would not be available as described
  The result of the above cumbersome and complex process has been a 
treatment system consisting primarily of large methadone clinics, 
preventing physicians from treating patients in convenient office-based 
settings, thereby making treatment unavailable as a practical matter to 
many in need of it. Also, experts say that many heroin addicts who want 
treatment are often deterred because, in addition to the stigma that is 
associated with large centralized methadone clinics, they must travel 
long distances daily to receive such treatment and cannot maintain a 
job while doing so. Even though Buprenorphine does not possess the 
addictive qualities of methadone, because of the constraints in current 
law, it would nonetheless have to be dispensed in this same manner--in 
centralized clinics--rather than in the private office of a qualified 
physician.
  The Drug Addiction Treatment Act, S. 324 (H.R. 2634), will make it 
possible for medications like Buprenorphine, which have little or no 
likelihood of diversion or abuse, to be made available in the offices 
of physicians who have the training and certification and license to 
treat persons addicted to opiates. It is anticipated that the initial 
group of eligible physicians to dispense Buprenorphine will come from 
the 10,000 practitioners with addiction treatment certification from 
the American Society of Addiction Medicine, or board certification in 
addiction psychiatry or medical toxicology from the American Board of 
Medical Specialties or certification in addiction medicine from the 
American Osteopathic Association. The protections in the legislation 
against abuse are as follows: Physicians may not treat more than 30 
patients in an office setting; appropriate counseling and other 
ancillary services are a requirement under this legislation; the 
Attorney General may terminate a physician's DEA registration if these 
conditions are violated; and the program may be discontinued altogether 
if the Secretary of HHS and Attorney General determine that this new 
type of decentralized treatment has not proven to be an effective form 
of treatment. Finally, states may opt out of the provision.
  Recent findings of the Monitoring the Future Program, headed by Dr. 
Lloyd Johnson of the University of Michigan, indicates that heroin use 
among American teens doubled between 1991 and 1998, and represents a 
clear danger for a significant number of American young people. Dr. 
Johnson attributes this sharp increase to non-injectable use--smoking 
and snorting, and notes that the very high purity and low cost of 
heroin on the street has made these new developments possible; and 
that, unfortunately, a number of those users will switch over to 
injection.
  The Drug Enforcement Administration reports that the price of heroin 
has steadily declined since 1980, though it is more potent. In 1980, 
heroin cost $3.90 per milligram and was 3.6 percent pure heroin. Today, 
heroin costs about $1 per milligram, yet it is 10 times more pure. This 
purer, cheaper heroin is available everywhere--in our inner cities, in 
our suburbs and in our small towns. For instance, according to the 
National Center on Addiction and Substance Abuse, over 32 percent of 
persons living in small towns, age of 12 and over, have easy access to 
heroin.
  The need for this change in our law to make available more broadly an 
effective heroin blocker was expressed by experts at a May 9, 1997 Drug 
Forum on Anti-addiction Research, which I convened along with Senator 
Moynihan

[[Page 19112]]

and Senator Bob Kerrey. Forum participants, including distinguished 
experts such as Dr. Herbert Kleber and Dr. Donald Landry of Columbia 
University, Dr. Charles Schuster of Wayne State University and Dr. 
James H.Wood of the University of Michigan told us that this dramatic 
new anti-addiction medication is coming in the nick of time. The 
untreated population of opiate addicts, and other injection drug users, 
is the primary means for the spread of HIV, hepatitis B and C, and 
tuberculosis into the general population, not to mention the families 
of such addicted persons. Failure to block the craving for illicit 
drugs along with failure to provide traditional treatment will most 
certainly contribute to the crime related to addiction and continue the 
spiral of huge health care costs--costs that will largely be borne not 
by the addicts, not by insurance companies--but by the American 
taxpayer.
  The President of the Michigan Public Health Association, Dr. 
Stephanie Meyers Schim, has spoken out eloquently about the ``great 
problems'' of substance abuse. In her letter to me in support of our 
bill she says: ``Substance abuse affects health care costs, mortality, 
workers' compensation claims, reduced productivity, crime, suicide, 
domestic violence, child abuse, and increased costs associated with 
extra law enforcement, motor vehicle crashes, crime, and lost 
productivity.'' Dr. Schim goes on to say, ``Buprenorphine will allow 
drug addicted individuals to maximize everyday life activities, and 
participate more fully in work day and family activities while seeking 
the needed treatment and counseling to become drug free''.
  Dr. James H. Wood, Professor of Pharmacology at the University of 
Michigan Medical School recently wrote: ``One of the most important 
aspects of your bill is the use of Buprenorphine by well-trained 
physicians to treat narcotic addiction from their offices, which has 
the potential to attract and treat effectively sizable populations of 
currently untreated addicts. A major byproduct of this increased 
treatment, of course, will be reduction in the demand for illicit 
narcotics in the U.S.''
  Dr. Thomas Kosten, President of the American Academy of Addiction 
Psychiatry echoed these sentiments in recent testimony on The Drug 
Addiction Treatment Act before the House Commerce Committee on Health 
and Environment, and I quote: ``. . . I would like to support the 
availability of Buprenorphine for office based practice. Addiction is a 
brain disease and office-based practice is primarily needed for 
effective treatment of Buprenorphine.''
  The American Society of Addiction Medicine (ASAM), and the College on 
Problems of Drug Dependence which is the nation's longest standing 
organization of scientists addressing drug dependence and drug abuse, 
have stated that the availability of Buprenorphine in physicians' 
offices adds a needed expansion of current treatment for heroin 
addiction. ASAM also cautioned that Buprenorphine will lose much of its 
utility if it is tied to the very heavily regulated structure for 
current treatments of heroin addiction.
  There are other compelling reasons why we must expedite the delivery 
of anti-addiction medications. Of the juveniles who land behind bars in 
state institutions, more than 60 percent of them reported using drugs 
once a week or more, and over 40 percent reported being under the 
influence of drugs while committing crimes, according to a report from 
the Bureau of Justice Statistics. Drug-related incarcerations are up 
and we are building more jails and prisons to accommodate them--more 
than 1000 have been built over the past 20 years. According to the July 
14, 1999 Office of National Drug Control Policy Update, ``Drug-related 
arrests are up from 1.1 million arrests in 1988 to 1.6 million arrests 
in 1997--steady increases every year since 1991''.
  In crafting the provisions of this legislation, we consulted with the 
U.S. Department of Health and Human Services, including the Federal 
Drug Administration, and the Drug Enforcement Administration. Of 
critical importance is the fact that Buprenorphine is not addictive 
like methadone so the likelihood of diversion is small. Nothing in our 
bill is intended to change the rules pertaining to methadone clinics or 
other facilities or practitioners that conduct drug treatment services 
with addictive substances. I received a very supportive letter from HHS 
Secretary Donna Shalala in which she reports on the safety and utility 
of Buprenorphine, as follows:

       I am especially encouraged by the results of published 
     clinical studies of Buprenorphine. Buprenorphine is a partial 
     mu opiate receptor agonist, in Schedule V of the Controlled 
     Substances Act, with unique properties which differentiate it 
     from full agonists such as methadone or LAAM. The 
     pharmacology of the combination tablet consisting of 
     Buprenorphine and naloxone results in. . . .low value and low 
     desirability for diversion on the street.
       Published clinical studies suggest that it has very limited 
     euphorigenic affects, and has the ability to percipitate 
     withdrawal in individuals who are highly dependent upon other 
     opioids. Thus, Buprenorphine and Buprenorphine/naloxone 
     products are expected to have low diversion potential. 
     Buprenorphine and Buprenorphine/naloxone products are 
     expected to reach new groups of opiate addicts--for example, 
     those who do not have access to methadone programs, those who 
     are reluctant to enter methadone treatment programs, and 
     those who are unsuited to them {this would include for 
     example, those in their first year of opiates addiction or 
     those addicted to lower doses of opiates}.
       Buprenorphine and Buprenorphine/naloxone products should 
     increase the amount of treatment capacity available and 
     expand the range of treatment options that can be used by 
     physicians. Buprenorphine and Buprenorphine/Naloxone would 
     not replace methadone. Methadone and LAAM clinics would 
     remain an important part of the treatment continuum.

  In closing, I would like to include excerpts from the statement which 
was presented by Dr. Charles O'Brien before the Senate Caucus on 
International Narcotics Control, May 9, 2000. Dr. O'Brien is Professor 
and Vice Chair of Psychiatry at the University of Pennsylvania, 
Director of the Behavioral Health, Philadelphia VA Medical Center, 
Center for Studies of Addiction, Upenn/VAMC, and Research Director, 
Philadelphia VA. Mental Illness Research, Education and Clinical 
Center. Dr. O'Brien's remarks are as follows:

       While our first goal in the treatment of heroin addiction 
     is complete abstinence, we know that this is not realistic 
     for a great majority of patients. Even those who do well 
     initially in a drug free residential program have a high 
     frequency of relapse when they return to the neighborhood 
     where drugs are available.
       Another new medication that is being successfully used in 
     France and is currently being reviewed by the FDA for use in 
     the U.S. is buprenorphine. Its chemical category is somewhat 
     different from methadone in that it is a partial agonist at 
     opiate receptors. This medication has been found to be as 
     effective as methadone and in some cases even better. It 
     seems to be particularly effective for adolescents with a 
     heroin problem. Buprenorphine is very unlikely to produce 
     overdose and in France, the death rate due to opiate overdose 
     has dropped by about 75 percent. Not only does it not produce 
     overdose itself, but it may even provide a measure of 
     protection against overdose by heroin.
       The safety and efficacy of buprenorphine is such that it 
     should be made available to all physicians to treat patients 
     with opiate problems in their offices. This would be a major 
     benefit to patients who are unable and unwilling to come to 
     specialized methadone programs. It would be available not 
     just to heroin addicts, but to anyone with an opiate problem, 
     including many citizens who would not ordinarily be 
     associated with the term addiction. The availability of 
     buprenorphine would enable physicians to control the opiate 
     abuse problems of many Americans who are now being 
     inadequately treated or not treated at all.
       One important development is the combination of 
     buprenorphine with naloxone, a full antagonist. If the 
     combination is taken by mouth, this new medication is 
     effective in reducing drug craving and stabilizing the person 
     to lead a normal life. If someone tries to abuse it by 
     injecting it, the naloxone component would then be effective 
     in blocking the effects and preventing a ``high'' or 
     euphoria. Thus, the diversion potential of this new 
     medication should be minimized.
       Several treatment programs have already studied 
     buprenorphine in the treatment of adolescent heroin abusers. 
     It has been found to detoxify, that is treat withdrawal 
     symptoms, while the body cleanses itself of heroin, more 
     effectively than other medications. Thus a greater proportion 
     of young people are able to get off of heroin and receive 
     counseling and other forms of rehabilitation. Buprenorphine 
     is also very effective

[[Page 19113]]

     as a longer term medication that a young person can take 
     daily, return to school or job training and after six months 
     or more maintain a stable drug free state. Once this 
     medication is approved by the FDA and is allowed to be used 
     in physicians' offices, it could dramatically improve the 
     treatment of heroin addiction in the U.S.
       In summary Mr. Chairman, we are in the midst of the highest 
     availability of relatively pure heroin in our recorded 
     history. Fortunately we have effective treatments including 
     new medications that are coming on line. One of them, 
     buprenorphine, is well advanced in the FDA approval process 
     and is being considered for use in a new approach to opiate 
     addiction. This new approach [embodied in S. 324] in keeping 
     with the scientific data, would allow physicians to treat 
     heroin addiction in their offices just as we treat any other 
     medical problem.

  The success of this vital legislation would not have been possible 
without the leadership and support of Senator Hatch, Chairman of the 
Judiciary Committee. Nor would it have been possible without the strong 
support of Senator Moynihan, Ranking Member of the Finance Committee, 
and Senator Biden, Ranking Member of the Judiciary Subcommittee on 
Youth Violence, both of whom possess a clear grasp of the issues 
surrounding illicit drug addiction and have long sought to address 
them.
  Mr. MOYNIHAN. Mr. President, I rise to commend the Senate for again 
unanimously passing the Drug Addiction Treatment Act of 2000. Today it 
passed as an amended version of S. 324, of which I am an original 
cosponsor, in Title XXXV, sections 3501 and 3502, of the Senate 
substitute to the Children's Health Act of 2000, H.R. 4365. The 
Senate's action today marks a milestone in the treatment of opiate 
dependence. The Drug Addiction Treatment Act increases access to new 
medications, such as buprenorphine, to treat opiate addiction. I thank 
my colleagues Senator Levin (whose long-term vision inspired this 
legislation), Senator Hatch, and Senator Biden for their leadership and 
dedication in developing this Act, and I look forward to seeing the 
Drug Addiction Treatment Act of 2000 become law.
  Determining how to deal with the problem of addiction is not a new 
topic. Just over a decade ago when we passed the Anti-Drug Abuse Act of 
1988, I was assigned by our then-Leader, Senator Robert Byrd, with 
Senator Sam Nunn, to co-chair a working group to develop a proposal for 
drug control legislation. We worked together with a similar Republican 
task force. We agreed, at least for a while, to divide funding under 
our bill between demand reduction activities (60 percent) and supply 
reduction activities (40 percent). And we created the Director of 
National Drug Control Policy (section 1002); next, ``There shall be in 
the Office of National Drug Control Policy a Deputy Director for Demand 
Reduction and a Deputy Director for Supply Reduction.''
  We put demand first. To think that you can ever end the problem by 
interdicting the supply of drugs, well, it's an illusion. There's no 
possibility.
  I have been intimately involved with trying to eradicate the supply 
of drugs into this country. It fell upon me, as a member of the Nixon 
Cabinet, to negotiate shutting down the heroin traffic that went from 
central Turkey to Marseilles to New York --``the French Connection''--
but we knew the minute that happened, another route would spring up. 
That was a given. The success was short-lived. What we needed was 
demand reduction, a focus on the user. And we still do.
  Demand reduction requires science and it requires doctors. I see the 
science continues to develop, and The Drug Addiction Treatment Act of 
2000 will allow doctors and patients to make use of it.
  Congress and the public continue to fixate on supply interdiction and 
harsher sentences (without treatment) as the ``solution'' to our drug 
problems, and adamantly refuse to acknowledge what various experts now 
know and are telling us: that addiction is a chronic, relapsing 
disease; that is, the brain undergoes molecular, cellular, and 
physiological changes which may not be reversible.
  What we are talking about is not simply a law enforcement problem, to 
cut the supply; it is a public health problem, and we need to treat it 
as such. We need to stop filling our jails under the misguided notion 
that such actions will stop the problem of drug addiction. The Drug 
Addiction Treatment Act of 2000 is a step in the right direction.
  Mr. BIDEN. Mr. President, today the United States Senate has passed 
the Children's Health Act of 2000, an Act which will have a far-ranging 
impact on the health of America's youth. This legislation not only 
addresses juvenile arthritis, diabetes, asthma and other childhood 
diseases, but it also takes important steps to address what I would 
argue is a public health epidemic for both children and adults--
substance abuse and addiction.
  The Children's Health Act reauthorizes the Substance Abuse and Mental 
Health Services Administration (SAMHSA), the federal agency devoted to 
substance abuse prevention and treatment services as well as a wide 
range of mental health programs. The bill also includes three important 
drug bills which I have cosponsored: the Methamphetamine Anti-
Proliferation Act, the Ecstasy Anti-Proliferation Act and the Drug 
Addiction Treatment Act. The result is a comprehensive piece of 
legislation which includes the law enforcement, treatment and 
prevention services necessary to address substance abuse in the United 
States today.
  Mr. President, in 1996 I joined with my distinguished friend and 
colleague, Senator Hatch, to introduce the ``Hatch-Biden 
Methamphetamine Control Act'' to address the growing threat of 
methamphetamine use in our country before it was too late.
  Our failure to foresee and prevent the crack cocaine epidemic is one 
of the most significant public policy mistakes in recent history. We 
were determined not to repeat that mistake with methamphetamine.
  That 1996 Act provided crucial tools that we needed to stay ahead of 
the methamphetamine epidemic--increased penalties for possessing and 
trafficking in methamphetamine and the precursor chemicals and 
equipment used to manufacture the drug; tighter reporting requirements 
and restrictions on the legitimate sales of products containing 
precursor chemicals to prevent their diversion; increased reporting 
requirements for firms that sell those products by mail; and enhanced 
prison sentences for meth manufacturers who endanger the life of any 
individual or endanger the environment while making this drug. We also 
created a national working group of law enforcement and public health 
officials to monitor any growth in the methamphetamine epidemic.
  I have no doubt that our 1996 legislation slowed this epidemic 
significantly. But we are up against a powerful and highly addictive 
drug.
  The Methamphetamine Anti-Proliferation Act--which I have 
cosponsored--builds on the 1996 Act. First and foremost, it closes the 
``amphetamine loophole'' in current law by making the penalties for 
manufacturing, distributing, importing and exporting amphetamine the 
same as those for meth. After all, the two drugs differ by only one 
chemical and are sold interchangeably on the street. If users can't 
tell the difference between the two substances, there is no reason why 
the penalties should be different.
  The bill also addresses the growing problem of meth labs by 
establishing penalties for manufacturing the drug with an enhanced 
penalty for those who would put a child's life at risk in the process. 
We provide $20 million for the Drug Enforcement Administration (DEA) to 
reimburse states for cleaning up toxic meth labs and $5.5 million for 
the DEA to certify state and local officials to handle the hazardous 
byproducts at the lab sites. We also provide $15 million for additional 
law enforcement personnel--including agents, investigators, 
prosecutors, lab technicians, chemists, investigative assistants and 
drug prevention specialists--in High Intensity Drug Trafficking Areas 
where meth is a problem.
  Also included in the bill is $6.5 million for new agents to assist 
State and local law enforcement in small and mid-sized communities in 
all phases of drug investigations and assist state and local law 
enforcement in rural

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areas. The bill also provides $3 million to monitor List I chemicals, 
including those used in manufacturing methamphetamine, and prevent 
their diversion to illicit use.
  Further, the legislation provides $10 million in prevention funds and 
$10 million for treating methamphetamine addiction, as well as much 
needed money for researching new treatment modalities, including 
clinical trials. It asks the Institute of Medicine to issue a report on 
the status of the development of pharmacotherapies for treatment of 
amphetamine and methamphetamine addiction, such as the good work that 
the scientists at the National Institute on Drug Abuse have done to 
isolate amino acids and develop medications to deal with meth overdose 
and addiction.
  The Children's Health Act also includes the ``Ecstasy Anti-
Proliferation Act,'' a bill which Senators Graham, Grassley and Thomas 
and I introduced in May to address the new drug on the scene--Ecstasy, 
a synthetic stimulant and hallucinogen. The legislation takes the 
steps--both in terms of law enforcement and prevention--to address this 
problem in a serious way before it gets any worse.
  Ecstasy belongs to a group of drugs referred to as ``club drugs'' 
because they are associated with all-night dance parties known as 
``raves.'' There is a widespread misconception that it is not a 
dangerous drug--that it is ``no big deal.'' I believe that Ecstasy is a 
very big deal. The drug depletes the brain of serotonin, the chemical 
responsible for mood, thought, and memory.
  If that isn't a big deal, I don't know what is.
  A few months ago we got a significant warning sign that Ecstasy use 
is becoming a real problem. The University of Michigan's Monitoring the 
Future survey, a national survey measuring drug use among students, 
reported that while overall levels of drug use had not increased, past 
month use of Ecstasy among high school seniors increased more than 66 
percent.
  The survey showed that nearly six percent of high school seniors have 
used Ecstasy in the past year. This may sound like a small number, but 
put in perspective it is deeply alarming--it is five times the number 
of seniors who used heroin and it is just slightly less than the 
percentage of seniors who used cocaine.
  And with the supply of Ecstasy increasing as rapidly as it is, the 
number of kids using this drug is only likely to increase. So far this 
year, the Customs Service has already seized 9 million Ecstasy pills--
three times the total amount seized in all of 1999 and twelve times the 
amount seized in all of 1998.
  Though New York is the East Coast hub for this drug, it is spreading 
quickly throughout the country. In my home state of Delaware, law 
enforcement officials have seized Ecstasy pills in Rehoboth Beach and 
are noticing the emergence of an Ecstasy problem in Newark among 
students at the University of Delaware.
  The legislation directs the United States Sentencing Commission to 
increase the recommended penalties for manufacturing, importing, 
exporting or trafficking Ecstasy.
  The legislation also authorizes a $10 million prevention campaign in 
schools and communities to make sure that everyone--kids, adults, 
parents, teachers, cops, coaches, clergy, etc.--know just how dangerous 
this drug really is. We need to dispel the myth that Ecstasy is not a 
dangerous drug because, as I stated earlier, this is a substance that 
can cause brain damage and can even result in death. We need to spread 
the message so that kids know the risk involved with taking Ecstasy, 
what it can do to their bodies, their brains, their futures. Adults 
also need to be taught about this drug--what it looks like, what 
someone high on Ecstasy looks like, and what to do if they discover 
that someone they know is using it.
  Mr. President, I have come to the floor of the United States Senate 
on numerous occasions to state what I view as the most effective way to 
prevent a drug epidemic. My philosophy is simple: the best time to 
crack down on a drug with uncompromising enforcement pressure is before 
the abuse of the drug has become rampant. The advantages of doing so 
are clear--there are fewer pushers trafficking in the drug and, most 
important, fewer lives and fewer families will have suffered from the 
abuse of the drug.
  It is clear that Ecstasy use is on the rise and I am pleased that the 
Senate has acted today to address the escalating problem of this drug 
before it gets any worse.
  In addition to stopping the proliferation of new drugs, we also need 
to invest in treating those who are already addicted. More than ten 
years ago, in December 1989, I released a Senate Judiciary Committee 
Report entitled ``Pharmacotherapy: A Strategy for the 1990s.'' In this 
report I argued that there was scientific promise for medicines that 
might lessen an addict's craving for cocaine and heroin, as well as to 
reduce their enjoyment of those drugs.
  This report asked the question: ``If drug abuse is an epidemic, are 
we doing enough to find a medical `cure'?''
  At the time, despite the efforts of myself and other members of 
Congress, the answer to that question was as clear as it was 
distressing: the nation was doing far too little to find medicines that 
treat the disease of drug addiction.
  To address this shortfall, I authored, along with Senator Kennedy, 
the Pharmacotherapy Development Act--which passed into law in 1992. The 
cornerstone of this Act was its call for a ten year, $1 billion effort 
to research and develop anti-addiction medications.
  I cannot think of a more worthwhile investment. There is no other 
disease that effects so many, directly and indirectly. We have 14 
million drug users in this country, four million of whom are hard-core 
addicts. We all have a family member, neighbor, colleague or friend who 
has become addicted. We are all impacted by the undeniable correlation 
between drugs and crime--an overwhelming 80 percent of the men and 
women behind bars today have a history of drug and alcohol abuse or 
addiction or were arrested for a drug-related crime. It only makes 
sense to unleash the full powers of medical science to find a ``cure'' 
for this social and human ill.
  Ten years ago, the question was: ``Are we doing enough to find a 
`cure'?'' Unfortunately that question is still with us. But today we 
also have another question: ``Are we doing enough to get the `cures' we 
have to those who need them?'' We have an enormous ``treatment gap'' in 
this country. Only two million of the estimated 4.4 to 5.3 million 
people who need drug treatment are receiving it.
  That is why I have worked with Senators Hatch, Levin and Moynihan and 
Representative Biley to craft the ``Drug Addiction Treatment Act,'' a 
bill which creates a new system for delivering anti-addiction 
medications to patients who need them. Under the bill qualified doctors 
can be granted a waiver to prescribe certain Schedule III, IV and V 
medications from their offices. This is a significant step toward 
bridging the treatment gap.
  Right now we have some highly effective pharmacotherapies to treat 
heroin addiction and we are still working on developing similar 
medications for cocaine addiction. Access to currently available 
medications such as methadone and LAAM (Levo-Alpha Acetylmethadol) has 
been strangled by layers of bureaucracy and regulation. As a result, 
only 22 percent of opiate addicts are now receiving pharmacotherapy 
treatment. General McCaffrey and Secretary Shalala are leading the 
charge to fix that problem and I applaud their efforts.
  Under the legislation passed today, patients will be able to get new 
medications such a buprenorphine and a buprenorphine-naloxone 
combination product--which are now under review by the Food and Drug 
Administration--much like they can get other medications: a doctor 
prescribes them and the patient can get the medication from the local 
pharmacy. This new system helps to move drug treatment into the 
mainstream of medicine.
  The difficulties of distributing treatment medications to addicts not 
only

[[Page 19115]]

hurts those who are not getting the treatment they need, but it also 
stifles private research. I have often bemoaned the fact that private 
industry has not aggressively developed pharmacotherapies. As we 
increase access to these drugs, we increase incentives for private 
investment in this valuable research.
  I am proud that the Senate has acted today to pass ``The Drug 
Addiction Treatment Act'' because it helps get new, promising anti-
addiction medications get to those who need them. By allowing certain 
doctors to dispense Schedule III, IV and V drugs from their offices, 
the bill expands treatment flexibility and access and encourages others 
to develop similar medications.
  Mr. President, in passing the Children's Health Act today, the Senate 
has taken an important step to addressing the problem of substance 
abuse and all of the social ills that go along with it. I congratulate 
all of my colleagues who have worked on this legislation which will 
make an important contribution to public health and public safety in 
this country.
  Mr. DeWINE. Mr. President, I rise today as a co-author of the 
``Children's Health Act of 2000.'' This bill is essential in enabling 
us to build a health care system that is responsive to the unique needs 
of children. The ``Children's Health Act of 2000'' is a big step in the 
right direction, and I commend my colleagues, Senators Frist, Jeffords, 
and Kennedy for their efforts to construct a bill that can really make 
a positive difference in the health and the lives of children.
  Mr. President, I am especially pleased that the ``Children's Health 
Act'' contains several important initiatives that my colleagues and I 
had introduced already as separate bills. One such initiative--the 
Pediatric Research Initiative--would help ensure that more of the 
increased research funding at the National Institutes of Health (NIH) 
is invested specifically in children's health research.
  While children represent close to 30 percent of the population of 
this country, NIH devotes only about 12 percent of its budget to 
children, and, in recent years, that proportion has been declining even 
further. We must reverse this disturbing trend. It simply makes no 
sense to conduct health research for adults and hope that those 
findings also will apply to children. A ``one size fits all'' research 
approach just doesn't work. The fact is that children have medical 
conditions and health care needs that differ significantly from adults. 
Children's health deserves more attention from the research community. 
That's why the Pediatric Research Initiative is such an important part 
of the ``Children's Health Act.'' It would provide the federal support 
for pediatric research that is so vital to ensuring that children 
receive the appropriate and best health care possible.
  The Pediatric Research Initiative would authorize at least $50 
million for each of the next five years for the Office of the Director 
of the National Institute of Health (NIH) to conduct, coordinate, 
support, develop, and recognize pediatric research. In doing so, we 
will be able to ensure researchers target and study child-specific 
diseases. With more than 20 Institutes and Centers and Offices within 
NIH that conduct, support, or develop pediatric research in some way, 
this investment would promote greater coordination and focus in 
children's health research, and hopefully encourage new initiatives and 
areas of research.
  The ``Children's Health Act'' also would authorize the Secretary of 
HHS to establish a pediatric research loan repayment program for 
qualified health professionals who conduct pediatric research. Trained 
researchers are essential if we are to make significant advances in the 
study of pediatric health care, especially in light of the new and 
improved Food and Drug Administration (FDA) policies that encourage the 
testing of medications for use by children.
  Additionally, the ``Children's Health Act'' includes the ``Children's 
Asthma Relief Act,'' which Senator Durbin and I introduced last year. 
The sad reality for children is that asthma is becoming a far too 
common and chronic childhood illness. From 1979 to 1992, the 
hospitalization rates among children due to asthma increased 74 
percent. Today, estimates show that more than seven percent of children 
now suffer from asthma. Nationwide, the most substantial prevalence 
rate increase for asthma occurred among children aged four and younger. 
Those four and younger also were hospitalized at the highest rate among 
all individuals with asthma.
  According to 1998 data from the Centers for Disease Control (CDC), my 
home state of Ohio ranks about 17th in the estimated prevalence rates 
for asthma. Based on a 1994 CDC National Health Interview Survey, an 
estimated 197,226 children under 18 years of age in Ohio suffer from 
asthma. We need to address this problem adequately. The ``Children's 
Health Act'' would help do that by ensuring that children with asthma 
receive the care they need to lead healthy lives. The bill would 
authorize funding for fiscal years 2001 through 2005 for the Secretary 
of Health and Human Services (HHS) to establish state and local 
community grants to be used for asthma detection, treatment, and 
education services; require coordination with current children's health 
programs to identify children who are asthmatic and may otherwise 
remain undetected and untreated; require NIH to direct more resources 
to its National Asthma Education Prevention Program to develop a 
federal plan for responding to asthma; and require the Center for 
Disease Control to conduct local asthma surveillance activities to 
collect data on the prevalence and severity of asthma. This 
surveillance data will help us better detect asthmatic conditions, so 
that we can treat more children and ensure that we are targeting our 
resources in an effective and efficient way to reverse the disturbing 
trend in the hospitalization and death rates of asthmatic children.
  Since research shows that children living in urban areas suffer from 
asthma at such alarming rates and that allergens, such as cockroach 
waste, contribute to the onset of asthma, this bill also adds urban 
cockroach management to the current preventive health services block 
grant, which currently can be used for rodent control.
  The ``Children's Health Act'' also includes a bill I introduced 
separately with Senator Dodd. This section would require that the 
Secretary of HHS ensure that all research that is conducted, supported, 
or regulated by HHS complies with regulations governing the protection 
of children involved in research. Children who participate in clinical 
trials are medical pioneers. It is just common sense that we update and 
apply the strongest federal guidelines to ensure the safety of these 
young people as they participate in clinical trials that will ensure 
that medicines will be safe and appropriate for use in all children.
  Finally, Mr. President, the ``Children's Health Act'' includes 
language that I strongly support to re-authorize funding for children's 
hospitals' Graduate Medical Education (GME) programs for four 
additional years. Last year, as part of the ``Health Care Research and 
Quality Act,'' which was signed into law, we authorized funding for two 
years for children's hospitals' GME programs. The teaching mission of 
these hospitals is essential. Children's hospitals comprise less than 
one percent of all hospitals, yet they train five percent of all 
physicians, nearly 30 percent of all pediatricians, and almost 50 
percent of all pediatric specialists. By providing our nation with 
highly qualified pediatricians, children's hospitals can offer children 
the best possible care and offer parents peace of mind. They serve as 
the health care safety net for low-income children in their respective 
communities and are often the sole regional providers of many critical 
pediatric services. These institutions also serve as centers of 
excellence for very sick children across the nation. Federal funding 
for GME in children's hospitals is a sound investment in children's 
health and provides stability for the future of the pediatric 
workforce.
  Mr. President, as the father of eight children and the grandfather of 
five, I firmly believe that we must move forward to protect the 
interests--and especially the health--of all children.


The ``Children's Health Act of 2000'' makes crucial investments in our 
country's future--investments that will yield great returns. If we 
focus on improving health care for all children today, we will have a 
generation of healthy adults tomorrow.

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