[Congressional Record (Bound Edition), Volume 146 (2000), Part 8]
[Senate]
[Pages 10675-10686]
[From the U.S. Government Publishing Office, www.gpo.gov]



          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. HELMS (for himself, Mr. Lott, Mr. Warner, Mr. Hatch, Mr. 
        Grams, and Mr. Shelby):
  S. 2726. A bill to protect United States military personnel and other 
elected and appointed officials of the United States Government against 
criminal prosecution by an international criminal court to which the 
United States is not a party; to the Committee on Foreign Relations.


            american servicemembers' protection act of 2000

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

                                S. 2726

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``American Servicemembers' 
     Protection Act of 2000''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) On July 17, 1998, the United Nations Diplomatic 
     Conference of Plenipotentiaries on the Establishment of an 
     International Criminal Court, meeting in Rome, Italy, adopted 
     the ``Rome Statute of the International Criminal Court.'' The 
     vote on adoption of the Statute was 120 in favor to 7 
     against, with 21 countries abstaining. The United States 
     voted against final adoption of the Rome Statute.
       (2) As of May 30, 2000, 96 countries had signed the Rome 
     Statute and 10 had ratified it. Pursuant to Article 126 of 
     the Rome Statute, the Statute will enter into force on the 
     first day of the month after the 60th day following the date 
     that the 60th country deposits an instrument ratifying the 
     Statute.
       (3) Since adoption of the Rome Statute, a Preparatory 
     Commission for the International Criminal Court has continued 
     to meet regularly to draft documents to implement the Rome 
     Statute, including Rules of Procedure and Evidence, 
     definitions of Elements of Crimes, and a definition of the 
     Crime of Aggression.
       (4) During testimony before the Congress, the lead United 
     States negotiator, Ambassador David Scheffer stated that the 
     United States could not sign the Rome Statute because certain 
     critical negotiating objectives of the United States had not 
     been achieved. As a result, he stated: ``We are left with 
     consequences that do not serve the cause of international 
     justice.''
       (5) Ambassador Scheffer went on to tell the Congress that: 
     ``Multinational peacekeeping forces operating in a country 
     that has joined the treaty can be exposed to the Court's 
     jurisdiction even if the country of the individual 
     peacekeeper has not joined the treaty.

[[Page 10676]]

     Thus, the treaty purports to establish an arrangement whereby 
     United States armed forces operating overseas could be 
     conceivably prosecuted by the international court even if the 
     United States has not agreed to be bound by the treaty. Not 
     only is this contrary to the most fundamental principles of 
     treaty law, it could inhibit the ability of the United States 
     to use its military to meet alliance obligations and 
     participate in multinational operations, including 
     humanitarian interventions to save civilian lives. Other 
     contributors to peacekeeping operations will be similarly 
     exposed.''.
       (6) Any Americans prosecuted by the International Criminal 
     Court will, under the Rome Statute, be denied many of the 
     procedural protections to which all Americans are entitled 
     under the Bill of Rights to the United States Constitution, 
     including, among others, the right to trial by jury, the 
     right not to be compelled to provide self-incriminating 
     testimony, and the right to confront and cross-examine all 
     witnesses for the prosecution.
       (7) American servicemen and women deserve the full 
     protection of the United States Constitution when they are 
     deployed around the world to protect the vital national 
     interests of the United States. The United States Government 
     has an obligation to protect American servicemen and women, 
     to the maximum extent possible, against criminal prosecutions 
     carried out by United Nations officials under procedures that 
     deny them their constitutional rights.
       (8) In addition to exposing American servicemen and women 
     to the risk of international criminal prosecution, the Rome 
     Statute creates a risk that the President and other senior 
     elected and appointed officials of the United States 
     Government may be prosecuted by the International Criminal 
     Court. Particularly if the Preparatory Commission agrees on a 
     definition of the Crime of Aggression, senior United States 
     officials may be at risk of criminal prosecution for national 
     security decisions involving such matters as responding to 
     acts of terrorism, preventing the proliferation of weapons of 
     mass destruction, and deterring aggression. No less than 
     American servicemen and women, senior officials of the United 
     States Government deserve the full protection of the United 
     States Constitution with respect to official actions taken by 
     them to protect the national interests of the United States.

     SEC. 3. TERMINATION OF PROHIBITIONS OF THIS ACT.

       The prohibitions and requirements of sections 4, 5, 6, and 
     7 shall cease to apply, and the authority of section 8 shall 
     terminate, if the United States becomes a party to the 
     International Criminal Court pursuant to a treaty made under 
     article II, section 2, clause 2 of the Constitution of the 
     United States.

     SEC. 4. PROHIBITION ON COOPERATION WITH THE INTERNATIONAL 
                   CRIMINAL COURT.

       (a) Construction.--The provisions of this section apply 
     only to cooperation with the International Criminal Court and 
     shall not be construed to apply to cooperation with an ad hoc 
     international criminal tribunal established by the United 
     Nations Security Council before or after the date of the 
     enactment of this Act to investigate and prosecute war crimes 
     committed in a specific country or during a specific 
     conflict.
       (b) Prohibition on Responding to Requests for 
     Cooperation.--No agency or entity of the United States 
     Government or of any State or local government, including any 
     court, may cooperate with the International Criminal Court in 
     response to a request for cooperation submitted by the 
     International Criminal Court pursuant to Part 9 of the Rome 
     Statute.
       (c) Prohibition on Specific Forms of Cooperation.--No 
     agency or entity of the United States Government or of any 
     State or local government, including any court, may undertake 
     any action described in the following articles of the Rome 
     Statute with the purpose or intent of cooperating with, or 
     otherwise providing support or assistance to, the 
     International Criminal Court:
       (1) Article 89 (relating to arrest, extradition, and 
     transit of suspects).
       (2) Article 92 (relating to provisional arrest of 
     suspects).
       (3) Article 93 (relating to seizure of property, asset 
     forfeiture, execution of searches and seizures, service of 
     warrants and other judicial process, taking of evidence, and 
     similar matters).
       (d) Restriction on Assistance Pursuant to Mutual Legal 
     Assistance Treaties.--The United States shall exercise its 
     rights to limit the use of assistance provided under all 
     treaties and executive agreements for mutual legal assistance 
     in criminal matters, multilateral conventions with legal 
     assistance provisions, and extradition treaties, to which the 
     United States is a party, and in connection with the 
     execution or issuance of any letter rogatory, to prevent the 
     transfer to, or other use by, the International Criminal 
     Court of any assistance provided by the United States under 
     such treaties and letters rogatory.
       (e) Prohibition on Investigative Activities of Agents.--No 
     agent of the International Criminal Court may conduct, in the 
     United States or any territory subject to the jurisdiction of 
     the United States, any investigative activity relating to a 
     preliminary inquiry, investigation, prosecution, or other 
     proceeding at the International Criminal Court.

     SEC. 5. RESTRICTION ON UNITED STATES PARTICIPATION IN CERTAIN 
                   UNITED NATIONS PEACEKEEPING OPERATIONS.

       (a) Policy.--Effective beginning on the date that the Rome 
     Statute enters into force pursuant to Article 126 of the Rome 
     Statute, the President should use the voice and vote of the 
     United States in the United Nations Security Council to 
     ensure that each resolution of the Security Council 
     authorizing a peacekeeping operation pursuant to chapter VI 
     or VII of the charter of the United Nations permanently 
     exempts United States military personnel participating in 
     such peacekeeping operation from criminal prosecution by the 
     International Criminal Court for actions undertaken by such 
     personnel in connection with the operation.
       (b) Restriction.--United States military personnel may not 
     participate in a peacekeeping operation authorized by the 
     United Nations Security Council pursuant to chapter VI or VII 
     of the charter of the United Nations on or after the date 
     that the Rome Statute enters into effect pursuant to Article 
     126 of the Rome Statute, unless the President has submitted 
     to the appropriate congressional committees a certification 
     described in subsection (c) with respect to such peacekeeping 
     operation.
       (c) Certification.--The certification referred to in 
     subsection (b) is a certification by the President that 
     United States military personnel are able to participate in a 
     peacekeeping operation without risk of criminal prosecution 
     by the International Criminal Court because--
       (1) in authorizing the peacekeeping operation, the United 
     Nations Security Council permanently exempted United States 
     military personnel participating in the operation from 
     criminal prosecution by the International Criminal Court for 
     actions undertaken by them in connection with the operation;
       (2) each country in which United States military personnel 
     participating in the peacekeeping operation will be present 
     is either not a party to the International Criminal Court or 
     has entered into an agreement in accordance with Article 98 
     of the Rome Statute preventing the International Criminal 
     Court from proceeding against United States personnel present 
     in that country; or
       (3) the President has taken other appropriate steps to 
     guarantee that United States military personnel participating 
     in the peacekeeping operation will not be prosecuted by the 
     International Criminal Court for actions undertaken by such 
     personnel in connection with the operation.

     SEC. 6. PROHIBITION ON DIRECT OR INDIRECT TRANSFER OF CERTAIN 
                   CLASSIFIED NATIONAL SECURITY INFORMATION TO THE 
                   INTERNATIONAL CRIMINAL COURT.

       (a) Direct Transfer.--Not later than the date on which the 
     Rome Statute enters into force, the President shall ensure 
     that appropriate procedures are in place to prevent the 
     transfer of classified national security information to the 
     International Criminal Court.
       (b) Indirect Transfer.--Not later than the date on which 
     the Rome Statute enters into force, the President shall 
     ensure that appropriate procedures are in place to prevent 
     the transfer of classified national security information 
     relevant to matters under consideration by the International 
     Criminal Court to the United Nations and to the government of 
     any country that is a party to the International Criminal 
     Court unless the United Nations or that government, as the 
     case may be, has provided written assurances that such 
     information will not be made available to the International 
     Criminal Court.

     SEC. 7. PROHIBITION OF UNITED STATES MILITARY ASSISTANCE TO 
                   PARTIES TO THE INTERNATIONAL CRIMINAL COURT.

       (a) Prohibition of Military Assistance.--Subject to 
     subsections (b), (c), and (d), no United States military 
     assistance may be provided to the government of a country 
     that is a party to the International Criminal Court.
       (b) Waiver.--The President may waive the prohibition of 
     subsection (a) with respect to a particular country if the 
     President determines and reports to the appropriate 
     congressional committees that such country has entered into 
     an agreement with the United States pursuant to Article 98 of 
     the Rome Statute preventing the International Criminal Court 
     from proceeding against United States personnel present in 
     such country.
       (c) Special Authorities.--The prohibition of subsection (a) 
     shall be subject to the special authorities of section 614 of 
     the Foreign Assistance Act of 1961 and the applicable 
     conditions and limitations under such section.
       (d) Exemption.--The prohibition of subsection (a) shall not 
     apply to the government of any country that is--
       (1) a NATO member country, or
       (2) a major non-NATO ally (including, inter alia, 
     Australia, Egypt, Israel, Japan, the Republic of Korea, and 
     New Zealand).

[[Page 10677]]



     SEC. 8. AUTHORITY TO FREE UNITED STATES MILITARY PERSONNEL 
                   AND CERTAIN OTHER PERSONS HELD CAPTIVE BY OR ON 
                   BEHALF OF THE INTERNATIONAL CRIMINAL COURT.

       (a) Authority.--The President is authorized to use all 
     means necessary and appropriate to bring about the release 
     from captivity of any person described in subsection (b) who 
     is being detained or imprisoned against that person's will by 
     or on behalf of the International Criminal Court.
       (b) Persons Authorized To Be Freed.--The authority of 
     subsection (a) shall extend to the following persons:
       (1) United States military personnel, elected or appointed 
     officials of the United States Government, and other persons 
     employed by or working on behalf of the United States 
     Government.
       (2) Military personnel, elected or appointed officials, and 
     other persons employed by or working on behalf of the 
     government of a NATO member country or major non-NATO ally 
     (including, inter alia, Australia, Egypt, Israel, Japan, the 
     Republic of Korea, and New Zealand) that is not a party to 
     the International Criminal Court, upon the request of such 
     government.
       (3) Individuals detained or imprisoned for official actions 
     taken while the individual was a person described in 
     paragraph (1) or (2), and in the case of such individuals 
     described in paragraph (2), upon the request of such 
     government.
       (c) Construction.--Subsection (a) shall not be construed to 
     authorize the payment of bribes or the provision of other 
     incentives to induce the release from captivity of a person 
     described in subsection (b).

     SEC. 9. STATUS OF FORCES AGREEMENTS.

       (a) Report on Status of Forces Agreements.--Not later than 
     6 months after the date of the enactment of this Act, the 
     President shall transmit to the appropriate congressional 
     committees a report evaluating the degree to which each 
     existing status of forces agreement with a foreign 
     government, or other similar international agreement, 
     protects United States military and other personnel from 
     extradition to the International Criminal Court under Article 
     98 of the Rome Statute.
       (b) Plan for Achieving Enhanced Protection of United States 
     Military Personnel.--Not later than 1 year after the date of 
     the enactment of this Act, the President shall transmit to 
     the appropriate congressional committees a plan for amending 
     existing status of forces agreements, or negotiating new 
     international agreements, in order to achieve the maximum 
     protection available under Article 98 of the Rome Statute for 
     United States military and other personnel in those countries 
     where maximum protection under Article 98 has not already 
     been achieved.
       (c) Submission in Classified Form.--The report under 
     subsection (a), and the plan under subsection (b), or 
     appropriate parts thereof, may be submitted in classified 
     form.

     SEC. 10. ALLIANCE COMMAND ARRANGEMENTS.

       (a) Report on Alliance Command Arrangements.--Not later 
     than 6 months after the date of the enactment of this Act, 
     the President shall transmit to the appropriate congressional 
     committees a report with respect to each military alliance to 
     which the United States is party--
       (1) describing the degree to which United States military 
     personnel may, in the context of military operations 
     undertaken by or pursuant to that alliance, be placed under 
     the command or operational control of foreign military 
     officers subject to the jurisdiction of the international 
     criminal court because they are nationals of a party to the 
     international criminal court, and
       (2) evaluating the degree to which United States military 
     personnel engaged in military operations undertaken by or 
     pursuant to that alliance may be exposed to greater risks as 
     a result of being placed under the command or operational 
     control of foreign military officers subject to the 
     jurisdiction of the international criminal court.
       (b) Plan for Achieving Enhanced Protection of United States 
     Military Personnel.--Not later than one year after the date 
     of the enactment of this Act, the President shall transmit to 
     the appropriate congressional committees a plan for modifying 
     command and operational control arrangements within military 
     alliances to which the United States is a party to reduce any 
     risks to United States military personnel identified pursuant 
     to subsection (a)(2).
       (c) Submission in Classified Form.--The report under 
     subsection (a), and the plan under subsection (b), or 
     appropriate parts thereof, may be submitted in classified 
     form.

     SEC. 11. WITHHOLDINGS.

       Funds withheld from the United States share of assessments 
     to the United Nations or any other international organization 
     pursuant to section 705 of the Admiral James W. Nance and Meg 
     Donovan Foreign Relations Authorization Act, Fiscal Years 
     2000 and 2001 (as enacted by section 1000(a)(7) of Public Law 
     106-113; 113 Stat. 1501A-460), are authorized to be 
     transferred to the Embassy Security, Construction and 
     Maintenance Account of the Department of State.

     SEC. 12. DEFINITIONS.

       As used in this Act and in sections 705 and 706 of the 
     Admiral James W. Nance and Meg Donovan Foreign Relations 
     Authorization Act, Fiscal Years 2000 and 2001, the following 
     terms have the following meanings:
       (1) Appropriate congressional committees.--The term 
     ``appropriate congressional committees'' means the Committee 
     on International Relations of the House of Representatives 
     and the Committee on Foreign Relations of the Senate.
       (2) Classified national security information.--The term 
     ``classified national security information'' means 
     information that is classified or classifiable under 
     Executive Order 12958 or a successor executive order.
       (3) Extradition.--The terms ``extradition'' and 
     ``extradite'' include both ``extradition'' and ``surrender'' 
     as those terms are defined in Article 102 of the Rome 
     Statute.
       (4) International criminal court.--The term ``International 
     Criminal Court'' means the court established by the Rome 
     Statute.
       (5) Major non-nato ally.--The term ``major non-NATO ally'' 
     means a country that has been so designated in accordance 
     with section 517 of the Foreign Assistance Act of 1961.
       (6) Party to the international criminal court.--The term 
     ``party to the International Criminal Court'' means a 
     government that has deposited an instrument of ratification, 
     acceptance, approval, or accession to the Rome Statute, and 
     has not withdrawn from the Rome Statute pursuant to Article 
     127 thereof.
       (7) Peacekeeping operation authorized by the united nations 
     security council pursuant to chapter vi of vii of the charter 
     of the united nations.--The term ``peacekeeping operation 
     authorized by the United Nations Security Council pursuant to 
     chapter VI of VII of the charter of the United Nations'' 
     means any military operation to maintain or restore 
     international peace and security that--
       (A) is authorized by the United Nations Security Council 
     pursuant to chapter VI or VII of the charter of the United 
     Nations, and
       (B) is paid for from assessed contributions of United 
     Nations members that are made available for peacekeeping 
     activities.
       (8) Rome statute.--The term ``Rome Statute'' means the Rome 
     Statute of the International Criminal Court, adopted by the 
     United Nations Diplomatic Conference of Plenipotentiaries on 
     the Establishment of an International Criminal Court on July 
     17, 1998.
       (9) Support.--The term ``support'' means assistance of any 
     kind, including material support, services, intelligence 
     sharing, law enforcement cooperation, the training or detail 
     of personnel, and the arrest or detention of individuals.
       (10) United states military assistance.--The term ``United 
     States military assistance'' means--
       (A) assistance provided under chapters 2 through 6 of part 
     II of the Foreign Assistance Act of 1961 (22 U.S.C. 2311 et 
     seq.);
       (B) defense articles or defense services furnished with the 
     financial assistance of the United States Government, 
     including through loans and guarantees; or
       (C) military training or education activities provided by 
     any agency or entity of the United States Government.
     Such term does not include activities reportable under title 
     V of the National Security Act of 1947 (50 U.S.C. 413 et 
     seq.).
                                 ______
                                 
      By Mr. KENNEDY (for himself, Mr. Bryan, Ms. Mikulski, and Mr. 
        Wellstone):
  S. 2727. A bill to improve the health of older Americans and persons 
with disabilities, and for other purposes; to the Committee on Finance.


                medicare health improvement act of 2000

  Mr. KENNEDY. Mr. President, today we are introducing legislation to 
improve the health of Medicare beneficiaries and the health of the 
Medicare program itself. Under Medicare, the health and quality of life 
for millions of older adults and people with disabilities have 
significantly improved. The rate of chronic disability among adults 
over 65 continues to decline, but we can do better. A recent report by 
the World Health Organization showed that the U.S. falls behind 23 
other nations in ``healthy life expectancy.'' On average, Americans can 
expect only 70 healthy years, compared to Japanese citizens who can 
anticipate 74\1/2\ years of life without disability. Chronic disability 
robs too many older Americans of active and productive years, and adds 
$26 billion annually in health care costs as people over 65 lose their 
ability to live independently.
  In the next 30 years, the viability of Medicare will be challenged as 
the baby boom generation ages. Nearly one fifth of the population will 
be 65 and older by 2025, which means that a larger number of 
beneficiaries will be supported by a smaller number of workers. The 
current debate over the future of Medicare often revolves around 
benefit cuts or tax increases. But an obvious

[[Page 10678]]

alternative that should be part of the debate is to reduce the demand 
for Medicare by improving the health of senior citizens. Unfortunately, 
Medicare today contains few incentives to encourage beneficiaries and 
providers to take health promotion and disease prevention seriously. 
This bill will help older adults and individuals with disabilities to 
improve their health. It will also educate health providers about the 
best practices for treatment of Medicare patients.
  Older adults are generally health conscious and are interested in 
taking steps to maintain their health and independence. Poor lifestyle 
factors--which include lack of exercise, poor diet, at-risk behaviors, 
smoking, and alcohol abuse--account for 70% of the physical decline and 
disease that occur with aging. Experts agree that the potential for 
better health through health promotion and disease prevention is great. 
Too often, however, older Americans lack the accurate information that 
would help them take advantage of these opportunities. This bill will 
ensure that Medicare beneficiaries are better informed about the 
lifestyle changes they can make to improve their health, and the 
preventive health services they can use to prevent disease.
  To encourage more beneficiaries to use the preventive services that 
Medicare currently offers, our legislation will eliminate cost-sharing 
for these services. Prevention saves lives and saves money. The 
incidence of cancer in adults over 65 is approximately eleven times 
higher than in persons under 65. Most cancers can be treated and many 
can be cured if detected early. But cancer screening tests are 
significantly underused by Medicare beneficiaries. Thirty-eight percent 
of women over 65 who have survived breast cancer (and remain at risk) 
do not receive an annual mammogram. Our bill will waive cost-sharing 
for mammography, screening pelvic exams, colorectal cancer screening, 
prostate cancer screening, bone mass measurement, hepatitis B vaccine 
and its administration, and diabetes self-management training.
  Despite the great potential of preventive services to improve the 
quality of life for older Americans, few clinical guidelines focus on 
preventive care for this population. Our bill calls for a task force to 
conduct studies to determine which preventive services in primary care 
are most valuable to senior citizens. A separate demonstration project 
will determine effective means to reduce smoking by Medicare 
beneficiaries. Cessation of smoking can reduce the risk of lung cancer, 
heart disease, and stroke. In 1997, smoking-related expenditures were 
estimated to cost the Medicare program a total of $20.5 billion.
  There are substantial defects in the quality of care provided to 
Medicare beneficiaries. Medical research has established that early use 
of a beta blocker after a heart attack reduces the risk of mortality 
and rehospitalization. Yet 51 percent of older adults fail to receive 
this treatment when it is indicated. In fact, patients at the highest 
risk of death in the hospital are least likely to receive a beta 
blocker.
  Every senior citizen deserves quality health care. The gaps between 
the best medical practice and actual practice must be narrowed. Our 
bill asks the Department of Health and Human Services to determine 
which areas in the treatment of Medicare beneficiaries do not meet the 
highest professional standards, and to determine the best practices in 
those areas. Steps will then be taken to inform health care 
professionals about these standards for treatment.
  The opportunities for better health care and budget savings are 
great, if care can be delivered to beneficiaries with high-cost chronic 
conditions in a more coordinated and effective way. Our legislation 
authorizes demonstration projects to develop innovative approaches to 
increase the quality of care and reduce costs for Medicare 
beneficiaries in skilled nursing facilities. Similar demonstration 
projects are authorized for beneficiaries with serious or chronic 
illness who do not reside in nursing facilities.
  In ways like this, we do more--much more--to preserve and strengthen 
Medicare, and achieve substantial long-term savings as well. I look 
forward to working closely with my colleagues on both sides of the 
aisle to achieve this important goal. I ask unanimous consent that the 
bill, the bill summary, and the relevant fact sheet be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2727

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     Health Improvement Act of 2000''.
       (b) Table of Contents.--The table of contents is as 
     follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.

                    TITLE I--HCFA MISSION STATEMENT

Sec. 101. Establishment of HCFA mission statement with regard to the 
              medicare program.

  TITLE II--ENABLING OLDER AMERICANS AND PERSONS WITH DISABILITIES TO 
                      IMPROVE THEIR HEALTH STATUS

Sec. 201. Waiver of all preventive services cost sharing under the 
              medicare program.
Sec. 202. Information campaign on preventive health care for older 
              Americans and individuals with disabilities.
Sec. 203. Development of health status self-assessment tool for 
              medicare beneficiaries.

 TITLE III--IMPROVING THE QUALITY OF CARE PROVIDED TO OLDER AMERICANS 
                     AND PERSONS WITH DISABILITIES

Sec. 301. Information campaign for the best practices for the treatment 
              of conditions of medicare beneficiaries.
Sec. 302. Program to promote the use of best practices for the 
              treatment of conditions of medicare beneficiaries and to 
              reduce hospital and physician visits that result from 
              improper drug use.
Sec. 303. Studies on preventive interventions in primary care for older 
              Americans.
Sec. 304. Smoking cessation demonstration project.

 TITLE IV--DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF RESIDENTS OF 
     SKILLED NURSING FACILITIES AND PERSONS WITH SERIOUS ILLNESSES

Sec. 401. Demonstration projects to provide effective care for skilled 
              nursing facility residents.
Sec. 402. Demonstration projects to improve the care of persons with 
              serious illnesses.

   TITLE V--WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER 
                               AMERICANS

Sec. 501. White House Conference on Improving the Health of Older 
              Americans.

     SEC. 2. DEFINITIONS.

       In this Act:
       (1) Commissioner.--The term ``Commissioner'' means the 
     Commissioner of Social Security.
       (2) Medicare beneficiaries.--The term ``medicare 
     beneficiaries'' means individuals who are entitled to 
     benefits under part A or enrolled under part B of the 
     medicare program, including individuals enrolled in a 
     Medicare+Choice plan offered by a Medicare+Choice 
     organization under part C of such program.
       (3) Medicare program.--The term ``medicare program'' means 
     the health insurance program under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.).
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

                    TITLE I--HCFA MISSION STATEMENT

     SEC. 101. ESTABLISHMENT OF HCFA MISSION STATEMENT WITH REGARD 
                   TO THE MEDICARE PROGRAM.

       Part A of title XVIII of the Social Security Act (42 U.S.C. 
     1395 et seq.) is amended by inserting before section 1801 the 
     following:


                        ``HCFA MISSION STATEMENT

       ``Sec. 1800. In administering the health insurance program 
     established under this title, it is the mission of the Health 
     Care Financing Administration to--
       ``(1) effectively and efficiently administer a program of 
     health insurance coverage for individuals who are entitled to 
     benefits under part A or enrolled under part B of this title, 
     including individuals enrolled in a Medicare+Choice plan 
     offered by a Medicare+Choice organization under part C of 
     this title, in accordance with the requirements of this 
     title;
       ``(2) assure that health care provided to such individuals 
     is of the highest quality; and

[[Page 10679]]

       ``(3) carry out programs in cooperation with other 
     Government agencies and the private sector to promote health, 
     prevent disease, and assure the highest possible functional 
     level for such individuals.''.

  TITLE II--ENABLING OLDER AMERICANS AND PERSONS WITH DISABILITIES TO 
                      IMPROVE THEIR HEALTH STATUS

     SEC. 201. WAIVER OF ALL PREVENTIVE SERVICES COST SHARING 
                   UNDER THE MEDICARE PROGRAM.

       (a) Waiver of Coinsurance and Deductibles.--
       (1) In general.--Section 1834 of the Social Security Act 
     (42 U.S.C. 1395m) is amended by adding at the end the 
     following:
       ``(m) Waiver of Coinsurance and Deductible for Preventive 
     Services.--
       ``(1) Coinsurance.--
       ``(A) In general.--Notwithstanding any other provision of 
     this part--
       ``(i) the Secretary shall waive any coinsurance applicable 
     to services described in subparagraph (B); and
       ``(ii) with respect to payment for such services, any 
     reference to a percent that is less than 100 percent shall be 
     deemed to be a reference to 100 percent.
       ``(B) Services described.--The services described in this 
     subparagraph are the following services:
       ``(i) Screening mammography (as defined in section 
     1861(jj)).
       ``(ii) Screening pelvic exam (as defined in section 
     1861(nn)(2)).
       ``(iii) Hepatitis B vaccine and its administration (under 
     section 1861(s)(10)(B)).
       ``(iv) Colorectal cancer screening test (as defined in 
     section 1861(pp)).
       ``(v) Bone mass measurement (as defined in section 
     1861(rr)).
       ``(vi) Prostate cancer screening test (as defined in 
     section 1861(oo)).
       ``(vii) Diabetes outpatient self-management training 
     services (as defined in section 1861(qq)).
       ``(2) Deductible.--
       ``(A) In general.--Notwithstanding any other provision of 
     this part, the deductible described in section 1833(b) shall 
     not apply with respect to services described in subparagraph 
     (B).
       ``(B) Services described.--The services described in this 
     subparagraph are the following services:
       ``(i) Hepatitis B vaccine and its administration (under 
     section 1861(s)(10)(B)).
       ``(ii) Colorectal cancer screening test (as defined in 
     section 1861(pp)).
       ``(iii) Bone mass measurement (as defined in section 
     1861(rr)).
       ``(iv) Prostate cancer screening test (as defined in 
     section 1861(oo)).
       ``(v) Diabetes outpatient self-management training services 
     (as defined in section 1861(qq)).''.
       (2) Conforming amendment.--Section 1833(a) of the Social 
     Security Act (42 U.S.C. 1395l(a)) is amended by striking 
     ``section 1876'' and inserting ``sections 1834 and 1876'' in 
     the matter preceding paragraph (1).
       (b) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after December 31, 
     2001.

     SEC. 202. INFORMATION CAMPAIGN ON PREVENTIVE HEALTH CARE FOR 
                   OLDER AMERICANS AND INDIVIDUALS WITH 
                   DISABILITIES.

       (a) In General.--The Secretary and the Commissioner shall 
     jointly conduct an information campaign, in consultation with 
     the heads of other Government agencies and States and the 
     private sector, for individuals who have attained age 50 and 
     individuals with disabilities to promote--
       (1) the use of preventive health services among such 
     individuals, including services that are available to 
     medicare beneficiaries and are covered by the medicare 
     program;
       (2) the proper use of prescription and over-the-counter 
     drugs in order to reduce the number of hospital stays and 
     physician visits among such individuals that are a result of 
     the improper use of such drugs; and
       (3) the steps (including exercise, maintenance of a proper 
     diet, and utilization of accident prevention techniques) that 
     such individuals may take in order to promote and safeguard 
     their health.
       (b) Use of Services.--The information campaign described in 
     subsection (a) shall stress the benefits of--
       (1) using the services described in subsection (a)(1);
       (2) following the proper directions for using prescription 
     and over-the-counter drugs as described in subsection (a)(2); 
     and
       (3) utilizing the steps described in subsection (a)(3).
       (c) Elements of Campaign.--In conducting the information 
     campaign described in subsection (a), the Secretary and the 
     Commissioner (as applicable) shall--
       (1) expand the section in the Medicare and You handbook on 
     preventive benefits to include a more detailed description of 
     the importance of using preventive health services and the 
     benefits offered under the medicare program;
       (2) instruct fiscal intermediaries and carriers under the 
     medicare program to include preventive benefits messages on 
     the Medicare Summary Notice statement and the Explanation of 
     Medicare Benefits;
       (3) regularly include preventive benefits messages on the 
     medicare part B benefits statement;
       (4) combine public service announcements and a print media 
     campaign to raise awareness of the value of using preventive 
     health services;
       (5) distribute brochures and other information on health 
     promotion and disease prevention activities through--
       (A) State health insurance assistance programs;
       (B) area agencies on aging;
       (C) Social Security Administration field offices; and
       (D) any other appropriate entities, as determined by the 
     Secretary and the Commissioner; and
       (6) include information on the importance of using 
     preventive health services--
       (A) on the cost of living adjustment (COLA) notice, which 
     is sent to individuals who receive disability benefits under 
     titles II and XVI of the Social Security Act (42 U.S.C. 401 
     et seq.; 1381 et seq.);
       (B) on the social security account statements distributed 
     pursuant to section 1143 of the Social Security Act (42 
     U.S.C. 1320b-13); and
       (C) in brochures on retirement and survivors' benefits that 
     are produced by the Commissioner.
       (d) Targeted Populations.--To the extent appropriate, 
     aspects of the information campaign described in subsection 
     (a) may be targeted to specific subpopulations of medicare 
     beneficiaries.
       (e) Grants and Contracts.--
       (1) In general.--The Secretary and the Commissioner shall 
     provide grants to, and enter into contracts with, eligible 
     entities to assist with carrying out the purposes of this 
     section.
       (2) Eligible entity defined.--In this subsection, the term 
     ``eligible entity'' means--
       (A) any community organization working with medicare 
     beneficiaries;
       (B) any organization representing medicare beneficiaries;
       (C) area agencies on aging; and
       (D) any other appropriate entities, as determined by the 
     Secretary and the Commissioner.

     SEC. 203. DEVELOPMENT OF HEALTH STATUS SELF-ASSESSMENT TOOL 
                   FOR MEDICARE BENEFICIARIES.

       (a) Development.--The Secretary, in conjunction with the 
     Director of the National Institutes of Health, the Director 
     of the Centers for Disease Control and Prevention (CDC), the 
     Administrator of the Substance Abuse and Mental Health 
     Services Administration (SAMHSA), and the Administrator of 
     the Agency for Healthcare Research and Quality (AHRQ), shall 
     develop a health status self-assessment tool that includes 
     assessment of mental health status, alcohol use, and 
     substance use, and assists medicare beneficiaries in 
     identifying important health information, risk factors, or 
     significant symptoms that should be acted upon or discussed 
     with the beneficiary's health care provider.
       (b) Distribution.--The Secretary shall establish procedures 
     for the distribution of the self-assessment form developed 
     under subsection (a) and may contract with the eligible 
     entities described in section 202(e)(2) to distribute and 
     promote the use of such forms.
       (c) Training.--The Secretary shall establish a training 
     program for the staff of State health insurance assistance 
     programs that will enable such staff to assist medicare 
     beneficiaries in completing the self-assessment form 
     developed under subsection (a).

 TITLE III--IMPROVING THE QUALITY OF CARE PROVIDED TO OLDER AMERICANS 
                     AND PERSONS WITH DISABILITIES

     SEC. 301. INFORMATION CAMPAIGN FOR THE BEST PRACTICES FOR THE 
                   TREATMENT OF CONDITIONS OF MEDICARE 
                   BENEFICIARIES.

       (a) Study.--The Secretary, in consultation with the 
     Administrator for Health Care Policy and Research, the 
     Director of the National Institutes of Health, and such other 
     professional societies and experts as the Secretary considers 
     appropriate, shall--
       (1) conduct a study to determine areas where treatment of 
     medicare beneficiaries falls short of the highest 
     professional standards; and
       (2) determine the best practices in the areas described in 
     paragraph (1).
       (b) Information Campaign.--The Secretary shall provide for 
     an information campaign to inform medicare beneficiaries 
     about the results of the study conducted under subsection 
     (a).

     SEC. 302. PROGRAM TO PROMOTE THE USE OF BEST PRACTICES FOR 
                   THE TREATMENT OF CONDITIONS OF MEDICARE 
                   BENEFICIARIES AND TO REDUCE HOSPITAL AND 
                   PHYSICIAN VISITS THAT RESULT FROM IMPROPER DRUG 
                   USE.

       (a) In General.--The Secretary, in conjunction with the 
     Administrator of the Health Resources and Service 
     Administration and such other agencies and professional 
     societies as the Secretary deems appropriate, shall establish 
     a program to--
       (1) improve treatment of medicare beneficiaries based on 
     the results of the study conducted under section 301(a) and 
     other relevant information; and
       (2) reduce the number of hospital stays and physician 
     visits among medicare beneficiaries that are a result of the 
     improper use of prescription and over-the-counter drugs.

[[Page 10680]]

       (b) Elements of Program.--The program described in 
     subsection (a) shall include--
       (1) an information campaign for health professionals;
       (2) coordination of the part of the program established 
     under subsection (a) that is designed to achieve the purpose 
     described in paragraph (2) of that subsection with the 
     information campaign conducted under section 202; and
       (3) any other activity the Secretary considers appropriate 
     to carry out the purposes described in subsection (a).
       (c) Demonstrations and Grants.--In establishing the program 
     under subsection (a), the Secretary may conduct demonstration 
     projects and award grants to eligible entities (as defined in 
     subsection (d)).
       (d) Eligible Entity Defined.--In this section, the term 
     ``eligible entity'' means an entity that is an academic 
     health center, a professional medical society, or such other 
     entity as the Secretary considers appropriate to carry out 
     the purposes of this section.
       (e) Report to Congress.--Not later than 1 year after the 
     date of enactment of this Act, and annually thereafter, the 
     Secretary shall annually report to Congress on the program 
     conducted under this section.

     SEC. 303. STUDIES ON PREVENTIVE INTERVENTIONS IN PRIMARY CARE 
                   FOR OLDER AMERICANS.

       (a) Studies.--The Secretary, acting through the United 
     States Preventive Services Task Force, shall conduct a series 
     of studies designed to identify preventive interventions that 
     can be delivered in the primary care setting that are most 
     valuable to older Americans.
       (b) Mission Statement.--The mission statement of the United 
     States Preventive Services Task Force is amended to include 
     the evaluation of services that are of particular relevance 
     to older Americans.
       (c) Report.--Not later than 1 year after the date of 
     enactment of this Act, and annually thereafter, the Secretary 
     shall submit a report to Congress on the conclusions of the 
     studies conducted under subsection (a), together with 
     recommendations for such legislation and administrative 
     actions as the Secretary considers appropriate.

     SEC. 304. SMOKING CESSATION DEMONSTRATION PROJECT.

       (a) In General.--The Secretary, acting through the 
     Administrator of the Health Care Financing Administration, 
     shall conduct a demonstration project to--
       (1) evaluate the most successful and cost-effective means 
     of providing smoking cessation services to medicare 
     beneficiaries; and
       (2) test incentive systems for physicians, other health 
     care professionals, and medicare beneficiaries to optimize 
     rates of successful smoking cessation among medicare 
     beneficiaries.
       (b) Latest Scientific Evidence.--The Secretary shall use 
     the latest scientific evidence regarding smoking cessation 
     strategies and guidelines in conducting the demonstration 
     project under this section.
       (c) Payment.--Payment to an individual or an entity for a 
     service provided under the demonstration project shall be 
     equal to the lesser of--
       (1) the actual charge for providing the service to a 
     medicare beneficiary; or
       (2) the amount determined by a fee schedule established by 
     the Secretary for the purposes of this section for such 
     service.
       (d) Waiver Authority.--
       (1) In general.--The Secretary may waive such requirements 
     of the medicare program as may be necessary for the purposes 
     of carrying out the demonstration project conducted under 
     this section.
       (2) Non-medicare providers.--Individuals and entities that 
     do not provide items and services under the medicare program 
     shall be permitted to participate in the demonstration 
     project conducted under this section.
       (e)  Report to Congress.--Not later than 1 year after the 
     date of enactment of this Act, and annually thereafter, the 
     Secretary shall report to Congress on the demonstration 
     project conducted under this section.

 TITLE IV--DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF RESIDENTS OF 
     SKILLED NURSING FACILITIES AND PERSONS WITH SERIOUS ILLNESSES

     SEC. 401. DEMONSTRATION PROJECTS TO PROVIDE EFFECTIVE CARE 
                   FOR SKILLED NURSING FACILITY RESIDENTS.

       (a) In General.--The Secretary shall conduct demonstration 
     projects that are designed to provide medicare beneficiaries 
     who are residents of skilled nursing facilities (as defined 
     in section 1819(a) of the Social Security Act (42 U.S.C. 
     1395i-3(a)) with higher quality and more cost-effective 
     services in order to avoid unnecessary hospitalizations of 
     such residents.
       (b) Requirements.--
       (1) In general.--The demonstration projects conducted under 
     this section shall include the following:
       (A) Programs of case management.
       (B) Programs of disease management.
       (C) Such other programs as the Secretary determines are 
     likely to increase the quality of, and reduce the cost of, 
     the care provided to such residents.
       (2) Authorized techniques.--The demonstration projects 
     conducted under this section may utilize--
       (A) contracts with centers of excellence or other entities 
     or individuals with special expertise in providing quality 
     services to residents of skilled nursing facilities;
       (B) innovative payment techniques, including capitation 
     payments, for all or selected services provided under such 
     projects and incentive payments to reward favorable cost and 
     quality outcomes;
       (C) provision of services not normally covered under the 
     medicare program, if the provision of such services would 
     result in the more cost-effective provision of, or higher 
     quality of, services covered under such program; or
       (D) reduced cost-sharing requirements for medicare 
     beneficiaries participating in such projects.
       (c) Waiver Authority.--The Secretary may waive such 
     requirements of the medicare program as may be necessary for 
     the purposes of carrying out the demonstration projects 
     conducted under this section other than requirements relating 
     to providing medicare beneficiaries with freedom of choice of 
     provider under section 1802 of the Social Security Act (42 
     U.S.C.1395a) or any other provision of law.
       (d)  Report to Congress.--Not later than 1 year after the 
     date of enactment of this Act, and annually thereafter, the 
     Secretary shall report to Congress on the demonstration 
     projects conducted under this section.

     SEC. 402. DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF 
                   PERSONS WITH SERIOUS ILLNESSES.

       (a) Expansion of Medicare Coordinated Care Demonstration 
     Project.--Section 4016 of the Balanced Budget Act (Public Law 
     105-33; 111 Stat. 343) is amended--
       (1) by striking subsection (a)(2) and inserting the 
     following:
       ``(2) Target individual defined.--In this section, the term 
     ``target individual'' means an individual that is enrolled 
     under the fee-for-service program under parts A and B of 
     title XVIII of the Social Security Act (42 U.S.C. 1395c et 
     seq.; 1395j et seq.) and--
       ``(A) has a chronic illness, as defined and identified by 
     the Secretary; or
       ``(B) has a serious illness, as so defined and 
     identified.'';
       (2) in subsection (b)(2), by striking ``Not'' and inserting 
     ``With respect to demonstration projects for items and 
     services provided to target individuals described in 
     subsection (a)(2)(A), not''; and
       (3) by adding at the end the following:
       ``(f) Requirements.--
       ``(1) In general.--The demonstration projects conducted 
     under this section shall include--
       ``(A) programs of case management;
       ``(B) programs of disease management; and
       ``(C) such other programs as the Secretary determines are 
     likely to increase the quality of, and reduce the cost of, 
     the care provided to target individuals.
       ``(2) Authorized techniques.--The demonstration projects 
     conducted under this section may include--
       ``(A) contracts with centers of excellence or other 
     entities or individuals with special expertise in providing 
     quality services to target individuals;
       ``(B) innovative payment techniques, including capitation 
     payments, for all or selected services provided under such 
     projects and incentive payments to reward favorable cost and 
     quality outcomes;
       ``(C) provision of services not normally covered under 
     title XVIII of the Social Security Act (42 U.S.C 1395 et 
     seq.), if the provision of such services would result in the 
     more cost-effective provision of, or higher quality of, 
     services covered under that title; or
       ``(D) reduced cost-sharing requirements for target 
     individuals participating in such projects.''.
       (b) Effective Date.--The amendments made by this section 
     shall take effect on the date of enactment of this Act.

   TITLE V--WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER 
                               AMERICANS

     SEC. 501. WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF 
                   OLDER AMERICANS.

       (a) In General.--Not later than December 31, 2002, the 
     President shall convene a White House Conference on Improving 
     the Health of Older Americans.
       (b) Goal of Conference.--The goal of the Conference shall 
     be to--
       (1) develop a consensus on a program to enable older 
     Americans to protect and improve their own health;
       (2) develop procedures to ensure that--
       (A) older Americans are provided with the highest standard 
     of health care available, with an emphasis on assuring that 
     standard practice is also the best practice; and
       (B) the needs of older Americans are more effectively met 
     through the benefits provided under the medicare program; and
       (3) outline a research and demonstration agenda to further 
     the goals described in paragraphs (1) and (2).
       (c) Conference Participants.--
       (1) Participants.--In order to carry out the purposes of 
     this section, the Conference shall bring together--
       (A) representatives of older Americans and those who care 
     for older Americans;

[[Page 10681]]

       (B) researchers and research institutions with an expertise 
     in issues related to older Americans;
       (C) health professionals and members of professional 
     societies with expertise in caring for older Americans; and
       (D) other appropriate parties.
       (2) Selection of delegates.--The participants shall be 
     selected without regard to political affiliation or past 
     partisan activity and shall, to the best of the President's 
     ability, be representative of the spectrum of thought in the 
     field of geriatric health care.
                                  ____


            Medicare Health Improvement Act of 2000--Summary

       The viability of Medicare is increasingly threatened as the 
     nation's population ages and as large numbers of 
     beneficiaries are supported by fewer workers. The current 
     debate over the future of Medicare often revolves around 
     benefit cuts or tax increases. But an alternative that should 
     be part of the debate is to improve the health of 
     beneficiaries and reduce the demand for Medicare. 
     Unfortunately, Medicare contains few incentives to encourage 
     beneficiaries and providers to take health promotion and 
     disease prevention seriously. This bill will help older 
     Americans and individuals with disabilities to improve their 
     health and will educate health care providers in the best 
     practices to achieve these goals.


                    title i: hcfa mission statement

       The purpose of this title is to establish a mission 
     statement for the Health Care Financing Administration, the 
     agency in the Department of Health and Human Services that 
     administers Medicare. The mission of HCFA would be to: (1) 
     effectively and efficiently administer health insurance 
     coverage; (2) assure that the health care provided to 
     Medicare beneficiaries is of the highest quality; (3) carry 
     out health promotion and disease prevention activities; (4) 
     and assure the highest possible level of functioning for 
     beneficiaries.


  title ii: enabling older americans and persons with disabilities to 
                          improve their health

       Cost-sharing is waived for the following preventive 
     services currently covered by Medicare--screening 
     mammography, screening pelvic exam, hepatitis B vaccine and 
     its administration, colorectal cancer screening, bone mass 
     measurement, prostate cancer screening, and diabetes 
     outpatient self-management training services.
       An information campaign for individuals over age 50 and 
     individuals with disability will be conducted jointly by the 
     Secretary of Health and Human Services and the Commissioner 
     of Social Security to promote the use of preventive health 
     services, including services not covered by Medicare. The 
     campaign will also encourage the proper use of prescription 
     and over-the-counter medications, and the use of measures 
     such as exercise, proper diet, and accident prevention to 
     safeguard health.
       A health status self-assessment program will be developed 
     to help Medicare beneficiaries identify health information, 
     risk factors, and symptoms that they should act on or discuss 
     with their health provider.


   title iii: improving the quality of care for older americans and 
                       persons with disabilities

       HHS, in consultation with other agencies, will conduct a 
     study to determine areas in the treatment of Medicare 
     beneficiaries that do not meet the highest professional 
     standards. The study will also determine the best practices 
     for treatment in these areas and inform Medicare 
     beneficiaries about the study results.
       A program will be established to inform health 
     professionals of the best practices for treatment, and to 
     reduce hospital stays and outpatient visits attributable to 
     improper use of medications.
       A task force will conduct studies to determine which 
     preventive services in primary care are most valuable to 
     older Americans.
       A smoking cessation demonstration project will determine 
     how to reduce smoking most effectively among Medicare 
     beneficiaries.


title iv: demonstration projects to improve the care of skilled nursing 
              residents and persons with serious illnesses

       HHS will conduct demonstration projects on case management 
     and disease management to increase the quality and reduce the 
     cost of care for Medicare beneficiaries in nursing 
     facilities. The projects will encourage contracts with 
     Centers of Excellence, and will be authorized to use 
     innovative payment techniques, explore services not normally 
     covered by Medicare, and experiment with reduced cost-sharing 
     requirements for beneficiaries. Similar demonstration 
     projects will be conducted to improve the care of 
     beneficiaries with serious or chronic illness who are not in 
     nursing facilities.


   title iv: white house conference on improving the health of older 
                               americans

       This title requests the President to convene a White House 
     Conference on Improving the Health of Older Americans. The 
     goals of the Conference will be to develop ways to enable 
     older Americans to improve their health, and to develop 
     procedures to ensure that they receive the highest quality of 
     care, including the development of a research and 
     demonstration agenda to advance these goals.


                                  cost

       The Congressional Budget Office estimates that the cost of 
     this program will be $1.6 billion over 5 years and $5 billion 
     over 10 years.
                                  ____


          Medicare Health Improvement Act of 2000--Fact Sheet

       The health and quality of life for millions of adults age 
     65 or older and people with disabilities have significantly 
     improved under Medicare. From 1982 to 1994, chronic 
     disability among Americans over 65 declined by 1.3% annually, 
     and has continued to decline through 1999. Nevertheless, a 
     recent report by the World Health Organization revealed that 
     the U.S. lags behind Europe, Australia, Canada, Israel and 
     Japan in ``healthy life expectancy.'' Americans have a life 
     expectancy of 76.7 years of which 70 will be without 
     disability, in comparison to Japanese citizens who can 
     anticipate 74.5 healthy years. Chronic disability robs older 
     Americans of active and productive years. It adds $26 billion 
     annually in health care costs for those over 65 who lose 
     their ability to live independently over the course of a 
     year.
       In the next 30 years, the viability of Medicare will be 
     challenged as the baby boom generation ages. The percentage 
     of the population 65 and older is expected to increase from 
     13% to 19% in 2025, resulting in larger numbers of 
     beneficiaries who will be supported by fewer workers. If the 
     prevalence of chronic disability can be further reduced and 
     healthy life expectancy increased, the aging population will 
     enjoy a longer period of independence and general well-being 
     while using fewer medical services.
       Medicare was enacted in 1965 to ensure acute medical care 
     for older adults and persons with disabilities. As the field 
     of medicine and the demographics of the American population 
     have changed, the purpose of Medicare has evolved to include 
     health promotion and disease prevention activities.
       Older Americans and persons with disabilities can 
     contribute significantly to improving their health.
       Medicare offers multiple preventive services, but current 
     cost-sharing requirements often deter people from using these 
     services. Additional measures such as exercise, proper diet, 
     accident prevention and appropriate use of medications, can 
     enable beneficiaries to prevent or delay the onset of 
     disability. According to Healthy People 2010, ``More than any 
     other age group, older adults are seeking health information 
     and are willing to make changes to maintain their health and 
     independence.'' Medicare can do more to inform people about 
     health promotion and disease prevention to help them improve 
     their health.
       Lifestyle problems account for approximately 70% of the 
     physical decline and disease that occur with aging. The over-
     65 population is increasingly knowledgeable about medical 
     issues and can be motivated to make behavioral changes to 
     improve their health.
       Deaths from heart disease and stroke rise significantly 
     over age 65, accounting for more than 40% of all deaths among 
     persons aged 65 to 74, and almost 60% of deaths in persons 
     age 85 and older. Medication and dietary changes have been 
     shown to reduce risk factors for heart disease and stroke, 
     such as high blood pressure and high cholesterol. Other 
     lifestyle changes--including increased physical activity, 
     maintaining healthy weight and cessation of smoking--can also 
     be effective.
       Osteoporosis leads to 300,000 hip fractures each year and 
     50,000 deaths from complications. 50% of fracture victims 
     lost their ability to walk independently. The direct and 
     indirect costs of osteoporosis are estimated to be $13.8 
     billion annually.
       Only 13% of people ages 65 to 74 engage in vigorous 
     physical activity that promotes cardiorespiratory fitness and 
     prevents osteoporosis. Only 11% engage in strengthening 
     exercises and only 22% engage in stretching exercises. For 
     those ages 75 older, the rates are 6%, 8%, and 21% 
     respectively. Yet these activities help older adults maintain 
     their functional independence and quality of life.
       The incidence of cancer in adults ages 65 and older is 
     approximately 11 times higher than that for persons under 65. 
     Most cancers can be treated and many can be cured if detected 
     early, but cancer screening tests are underutilized by 
     Medicare beneficiaries. In 1998, only 42.7% of older women 
     obtained a Pap smear. One study showed that only 62% of 
     breast cancer survivors over 65 and at risk for recurrence, 
     obtained an annual mammogram.
       Good health largely depends on taking responsibility for 
     one's own health. Studies support a role for educational 
     programs that provide relevant information and guidelines to 
     enable medical consumers to determine when professional care 
     is required.
       Medicare beneficiaries are entitled to treatment that meets 
     the highest professional standards.
       Medicare effectively pays the bills for covered health 
     services, but it is less successful in assuring that older 
     adults and persons with disabilities actually receive the 
     quality health care they need and deserve. Less than

[[Page 10682]]

     optimal health care is extremely costly to Medicare.
       Approximately 17,000 individuals aged 65 or older die of 
     influenza or influenza-related pneumonia each year. But in 
     1997, only 63% of non-institutionalized older adults received 
     the influenza vaccine, and only 43% received the pneumococcal 
     vaccine. For every 10,000 persons over 65 who receive the 
     pneumococcal vaccine, approximately $1.4 million in health 
     care costs are saved.
       On average, older adults use 4.5 prescription medication at 
     the same time and are at higher risk of misuse or drug-drug 
     interactions. Hospitalization from drug reactions or 
     interactions is six times higher for older adults than for 
     the general population.
       Aspirin is an effective therapy that can reduce the risk of 
     death and disability from coronary artery disease, including 
     heart attacks and strokes. Yet this inexpensive medication is 
     inadequately used, especially in community settings. General 
     practitioners (11%), family doctors (18%), and internists 
     (20%) are less likely to recommend the use of aspirin than 
     are cardiologists (37%). Aspirin is especially underused in 
     patients over 80 years old, even though this population is 
     likely to receive the greatest benefit.
       Early use of a beta-blocker reduces the rates of mortality 
     and rehospitalization after acute myocardial infarction. Yet 
     51% of older adults who are eligible for such therapy do not 
     receive a beta blocker after a heart attack. In fact, 
     patients at highest risk for death in the hospital were the 
     least likely to receive beta blockers.
       Mental illness is not a part of normal aging. Depression 
     affects up to 20% of older adults in the community and up to 
     37% of older primary care patients, but often goes 
     unrecognized and untreated. Both major and minor depression 
     are associated with high use of health care services and poor 
     quality of life. Untreated, depression can worsen symptoms of 
     other illness, produce disability, and result in suicide. The 
     incidence of suicide is highest in the elderly population. Up 
     to 75% of older suicide victims are seen by their primary 
     care provider in the month prior to suicide, but are not 
     treated or referred for treatment of their depression.
       Physicians diagnose only 30% of older adults who have an 
     alcohol problem. The effects of alcohol can be greater in 
     older patients, due to changes in body mass and metabolism. 
     Drinking is linked with falls, motor vehicle accidents, and 
     is often a factor in suicide and martial violence. Alcohol 
     interacts with may medications and impairs judgment and 
     cognition. The long-term abuse of alcohol increases the risk 
     for high blood pressure, arrhythmias, cardiomyopathy and 
     stroke, as well as certain cancers.
       Smoking-related expenditures were 9.4% of Medicare 
     expenditures in 1993 and were estimated to cost Medicare 
     $20.5 billion in 1997. Cessation of smoking slows the rate of 
     decline of lung function, in addition to reducing the risk of 
     heart disease and stroke.
       Improving the health of older adults and persons with 
     disabilities will also improve the health of Medicare.
       Improving the health of older adults and persons with 
     disabilities is essential for its own sake, and is also one 
     of the most important ways to improve the health of Medicare, 
     even as enrollment increases.
       Chronically disabled adults over 65 have health costs that 
     are seven times those of healthy individuals. Reduction in 
     the rate of chronic disability could maintain the current 
     disabled retiree to worker ratio through 2030, despite a 
     dramatic change in the overall retiree to worker ratio, with 
     potentially immense savings to Medicare.
       Savings achieved by improving the health of Medicare 
     beneficiaries outweigh any costs associated with increased 
     longevity.


                                summary

       Establishes a mission statement for the Health Care 
     Financing Administration, with new emphasis on health 
     promotion and diseases prevention.
       Waives cost-sharing for preventive services currently 
     offered by Medicare, such as screening mammography, screening 
     pelvic exam, colorectal screening, bone mass measurement and 
     diabetes self-management training.
       Provides an information campaign to promote the use of 
     preventive health services.
       Authorizes the development of a health self-assessment tool 
     that includes assessment of mental health.
       Promotes the use of best practices for treatment of 
     Medicare beneficiaries.
       Establishes a demonstration project for smoking cessation.
       Provides demonstration projects to improve the care of 
     residents in skilled nursing facilities and persons with 
     serious illnesses who are not in nursing facilities.
       Requests a White House conference on improving the health 
     of older Americans.
       The cost of these specific measures is estimated to be $1.6 
     billion over 5 years and $5 billion over 10 years, but these 
     costs are likely to be offset by reductions in Medicare costs 
     as the measures become effective in improving the health of 
     senior citizens.
                                 ______
                                 
      By Mr. CONRAD (for himself and Mr. Smith of Oregon):
  S. 2729. A bill to amend the Internal Revenue Code of 1986 and the 
Surface Mining Control and Reclamation Act of 1977 to restore stability 
and equity to the financing of the United Mine Workers of America 
Combines Benefit Fund by eliminating the liability of reachback 
operations, to provide additional sources of revenue to the Fund, and 
for other purposes; to the Committee on Finance.


                combined fund stability and fairness act

  Mr. CONRAD. Mr. President, I rise to introduce, along with my 
colleague, Senator Gordon Smith of Oregon, legislation that we call the 
Combined Fund Stability and Fairness Act.
  The Coal Act of 1992 represents an unbreakable commitment to retired 
miners, their spouses, and their dependents. But it is clear today that 
if we do not address the shortcomings of the 1992 Act, we will fall 
short of keeping that promise.
  Simply put, the Combined Benefit Fund needs to be put on a firm 
financial footing so that the miners and their family members--who 
depend on the health benefits the Fund provides--can stop worrying 
about when their benefits might be cut.
  The Coal Act of 1992 cast a wide net in identifying companies that 
would be obligated to pay into the fund. Not only were companies then 
in the coal mining business included, but the Act also brought in 
companies that were no longer in the bituminous coal mining business as 
well as successor companies. Nearly eight years later, we know that 
Congress overreached.
  Two years ago, the Supreme Court in Eastern Enterprises versus Apfel, 
held that the so-called ``super reachback'' companies should not have 
been included among Combined Benefit Fund contributors in the first 
place.
  The logic of the Court's decision in Eastern appears just as 
applicable to the reachback companies. They should not have been 
included either.
  The bill the Senator from Oregon and I are introducing today is not a 
bailout for the reachback companies. In fact, the reachbacks will not 
receive one penny under this legislation. It provides relief to the 
reachbacks on a prospective basis only.
  There are a limited number of companies that will receive payments 
under this bill. One group--what we refer to as the ``final judgment'' 
companies--are companies in the same situation as Eastern Enterprises. 
However, they had been unsuccessful in litigation decided before the 
Eastern decision, and were barred from recovery by the doctrine of res 
judicata. The other group--the ``stranded interim'' companies--are 
companies that were assessed following the enactment of the 1992 Act 
but were never assigned any beneficiaries.
  The total of the refunds to be paid to these two groups of companies 
amounts to about $28 million. That is the only money under this bill 
that would not go retired miners and their dependents.
  I think this is a fundamental question of fairness and equity. Those 
companies ought to be treated the same way as those companies that were 
relieved of the obligation because of the Eastern decision. That is 
just basic fairness.
  To help ensure the solvency of the Combined Benefit Fund into the 
future, the legislation would extend the Abandoned Mine Reclamation Fee 
program beyond its current expiration date of 2004 through 2010. The 
interest earned on the Abandoned Mine Lands Fund would be made 
available to the Combined Benefit Fund. This is similar to the approach 
Congress took with respect to the AML fund in the 1992 Act.
  It is important to stress that the AML fees would be lowered 
substantially from current levels. The rate on surface-mined coal would 
drop from 35 cents per ton to 20 cents per ton; the rate on 
underground-mined coal would drop from 15 cents per ton to 5 cents per 
ton; and the rate on lignite coal would drop from 10 cents per ton to 5 
cents per ton.
  The legislation also authorizes the transfer of $38 million in 
general fund revenues every year to cover any shortfall in the fund.

[[Page 10683]]

  The combination of the AML Fund interest money, the premium 
adjustment mechanism, and the annual general fund transfers will ensure 
that all Combined Benefit Fund obligations will be fully met.
  The fundamental purpose of the Combined Fund Stability and Fairness 
Act is to provide a secure, sound and fair financial foundation for the 
benefits miners have been promised. It is my hope that Congress will 
not delay in addressing this issue. Too many people are depending on 
us.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2729

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

     SECTION 1. SHORT TITLE; AMENDMENTS OF 1986 CODE.

       (a) Short Title.--This Act may be cited as the ``Combined 
     Fund Stability and Fairness Act''.
       (b) Amendment of 1986 Code.--Except as otherwise expressly 
     provided, whenever in this Act an amendment or repeal is 
     expressed in terms of an amendment to, or repeal of, a 
     section or other provision, the reference shall be considered 
     to be made to a section or other provision of the Internal 
     Revenue Code of 1986.

                     TITLE I--REACHBACK PROVISIONS

     SEC. 101. REFORM OF REACHBACK PROVISIONS OF COAL INDUSTRY 
                   HEALTH BENEFIT SYSTEM.

       (a) Agreements Covered by Health Benefit System.--
       (1) In general.--Section 9701(b)(1) (defining coal wage 
     agreement) is amended to read as follows:
       ``(1) Coal agreements.--
       ``(A) 1988 agreement.--The term `1988 agreement' means the 
     collective bargaining agreement between the settlors which 
     became effective on February 1, 1988.
       ``(B) Coal wage agreement.--The term `coal wage agreement' 
     means the 1988 agreement and any predecessor to the 1988 
     agreement.''
       (2) Conforming amendment.--Section 9701(b) (relating to 
     agreements) is amended by striking paragraph (3).
       (b) Definitions Applicable to Operators.--
       (1) Signatory operator.--Section 9701(c)(1) (defining 
     signatory operator) is amended to read as follows:
       ``(1) Signatory operator.--The term `signatory operator' 
     means a 1988 agreement operator.''
       (2) 1988 agreement operator.--Section 9701(c)(3) (defining 
     1988 agreement operator) is amended to read as follows:
       ``(3) 1988 agreement operator.--The term `1988 agreement 
     operator' means--
       ``(A) an operator which was a signatory to the 1988 
     agreement, or
       ``(B) a person in business which, during the term of the 
     1988 agreement, was a signatory to an agreement (other than 
     the National Coal Mine Construction Agreement or the Coal 
     Haulers' Agreement) containing pension and health care 
     contribution and benefit provisions which are the same as 
     those contained in the 1988 agreement.
     Such term shall not include any operator who was assessed, 
     and paid the full amount of, contractual withdrawal liability 
     to the 1950 UMWA Benefit Plan, the 1974 UMWA Benefit Plan, or 
     the Combined Fund.''
       (3) Conforming amendments.--
       (A) Section 9711(a) is amended by striking ``maintained 
     pursuant to a 1978 or subsequent coal wage agreement''.
       (B) Section 9711(b)(1) is amended by striking ``pursuant to 
     a 1978 or subsequent coal wage agreement''.
       (c) Modifications To Reflect Reachback Reforms.--
       (1) Board of trustees of combined fund.--
       (A) In general.--Section 9702(b)(1) is amended--
       (i) by striking ``one individual who represents'' in 
     subparagraph (A) and inserting ``two individuals who 
     represent'',
       (ii) by striking subparagraph (B) and redesignating 
     subparagraphs (C) and (D) as subparagraphs (B) and (C), 
     respectively, and
       (iii) by striking ``(A), (B), and (C)'' in subparagraph (C) 
     (as so redesignated) and inserting ``(A) and (B)''.
       (B) Conforming amendment.--Section 9702(b)(3) is amended to 
     read as follows:
       ``(3) Special rule.--If the BCOA ceases to exist, any 
     trustee or successor under paragraph (1)(A) shall be 
     designated by the 3 employers who were members of the BCOA on 
     the enactment date and who have been assigned the greatest 
     number of eligible beneficiaries under section 9706.''
       (C) Transition rule.--Any trustee serving on the date of 
     the enactment of this Act who was appointed to serve under 
     section 9702(b)(1)(B) of the Internal Revenue Code of 1986 
     (as in effect before the amendments made by this paragraph) 
     shall continue to serve until a successor is appointed under 
     section 9702(b)(1)(A) of such Code (as in effect after such 
     amendments).
       (2) Assignment of beneficiaries.--Section 9706 (relating to 
     assignment of eligible beneficiaries) is amended by adding at 
     the end the following:
       ``(h) Assignment as of October 1, 2000.--
       ``(1) In general.--Effective October 1, 2000, the 
     Commissioner of Social Security shall--
       ``(A) revoke all assignments to persons other than 1988 
     agreement operators for purposes of assessing premiums for 
     periods after September 30, 2000,
       ``(B) make no further assignments to persons other than 
     1988 agreement operators, and
       ``(C) terminate all unpaid liabilities of persons other 
     than 1988 agreement operators with respect to eligible 
     beneficiaries whose assignment to such persons is pending on 
     October 1, 2000.
       ``(2) Reassignment upon purchase.--This subsection shall 
     not be construed to prohibit the reassignment under 
     subsection (b)(2) of an eligible beneficiary.''
       (3) Liability for 1992 plan.--
       (A) In general.--Section 9712(d) (relating to guarantee of 
     benefits) is amended by striking paragraph (3) and by 
     redesignating paragraphs (4), (5), and (6) as paragraphs (3), 
     (4), and (5), respectively.
       (B) Conforming amendment.--Section 9712(d)(3) (as 
     redesignated under subparagraph (A)) is amended by striking 
     ``or last signatory operator described in paragraph (3)''.
       (C) Effective date.--The amendments made by this paragraph 
     shall apply to premiums assessed for periods after September 
     30, 2000, except that a person other than a 1988 agreement 
     operator shall not be liable for any unpaid premium under 
     section 9712(d) of the Internal Revenue Code of 1986 as of 
     such date if liability for such premium had not been assessed 
     or was being contested on such date.

                     TITLE II--FINANCING PROVISIONS

                          Subtitle A--Premiums

     SEC. 201. REDUCTION IN ANNUAL PREMIUMS TO COAL MINERS 
                   COMBINED FUND IF SURPLUS EXISTS.

       (a) In General.--Part II of subchapter B of chapter 99 
     (relating to financing of Combined Benefit Fund) is amended 
     by inserting after section 9704 the following new section:

     ``SEC. 9704A. REDUCTIONS IN HEALTH BENEFIT PREMIUM IF SURPLUS 
                   EXISTS.

       ``(a) General Rule.--If this section applies to any plan 
     year, the per beneficiary premium used for purposes of 
     computing the health benefit premium under section 9704(b) 
     for the plan year shall be the reduced per beneficiary 
     premium determined under subsection (c).
       ``(b) Years to Which Section Applies.--
       ``(1) In general.--This section applies to any plan year 
     beginning after September 30, 2000, if the trustees determine 
     that the Combined Fund has an excess reserve for the plan 
     year.
       ``(2) Excess reserve.--For purposes of this section--
       ``(A) In general.--The term `excess reserve' means, with 
     respect to any plan year, the excess (if any) of--
       ``(i) the projected net assets as of the close of the test 
     period for the plan year, over
       ``(ii) the projected 3-month asset reserve as of such time.
       ``(B) Projected net assets.--For purposes of subparagraph 
     (A)(i), the projected net assets shall be the amount of the 
     net assets which the trustees determine will be available at 
     the end of the test period for projected fund benefits. Such 
     determination shall be made in the same manner used by the 
     Combined Fund to calculate net assets available for projected 
     fund benefits in the Statement of Net Assets (Deficits) 
     Available for Fund Benefits for purposes of the monthly 
     financial statements of the Combined Fund for the plan year 
     beginning October 1, 1999.
       ``(C) Projected 3-month asset reserve.--For purposes of 
     subparagraph (A)(ii), the projected 3-month asset reserve is 
     an amount equal to 25 percent of the projected expenses 
     (including administrative expenses) from the health benefit 
     premium account and unassigned beneficiaries premium account 
     for the plan year immediately following the test period. The 
     determination of such amount shall be based on the 10-year 
     forecast of the projected net assets and cash balance of the 
     Combined Fund prepared annually by an actuary retained by the 
     Combined Fund.
       ``(D) Test period.--For purposes of this section, the term 
     `test period' means, with respect to any plan year, the plan 
     year and the following plan year.
       ``(c) Reduced Per Beneficiary Premium.--For purposes of 
     this section, the reduced per beneficiary premium for any 
     plan year to which this section applies is the per 
     beneficiary premium determined under section 9704(b)(2) 
     without regard to this section, reduced (but not below zero) 
     by--
       ``(1) the excess reserve for the plan year, divided by
       ``(2) the total number of eligible beneficiaries which are 
     assigned to assigned operators under section 9706 as of the 
     close of the preceding plan year.
       ``(d) Termination of Premium Reduction.--If, on any day 
     during a plan year to

[[Page 10684]]

     which this section applies, the Combined Fund has net assets 
     available for projected fund benefits (determined in the same 
     manner as projected net assets under subsection (b)(2)(B)) in 
     an amount less than the projected 3-month asset reserve 
     determined under subsection (b)(2)(C) for the plan year--
       ``(1) this section shall not apply to months in the plan 
     year beginning after such day, and
       ``(2) the monthly installment under section 9704(g)(1) for 
     such months shall be equal to the amount which would have 
     been determined if the health benefits premium under section 
     9704(b) had not been reduced under this section for the plan 
     year.''
       (b) Conforming Amendments.--
       (1) Section 9704(a) (relating to annual premiums) is 
     amended by striking ``Each'' and inserting ``Subject to 
     section 9704A, each''.
       (2) The table of sections for part II of subchapter B of 
     chapter 99 is amended by inserting after the item relating to 
     section 9704 the following new item:

``Sec. 9704A. Reductions in health benefit premium if surplus exists.''

       (c) Effective Date.--The amendments made by this subsection 
     shall apply to plan years of the Combined Fund beginning 
     after September 30, 2000.

     SEC. 202. ELECTION TO PREFUND REQUIRED CONTRIBUTIONS.

       (a) Combined Fund.--Section 9704(g) (relating to payment of 
     premiums) is amended by redesignating paragraph (2) as 
     paragraph (3) and by inserting after paragraph (1) the 
     following:
       ``(2) Election to prefund.--
       ``(A) In general.--An assigned operator shall be entitled 
     to prefund its obligations to the Combined Fund by depositing 
     into an irrevocable trust dedicated solely to the payment of 
     such obligations an amount which the board of trustees 
     determines, on the basis of reasonable actuarial assumptions, 
     to be equal to the present value of the operator's present 
     and future obligations to the Combined Fund.
       ``(B) Effects on liability.--If an assigned operator 
     prefunds its obligations under this paragraph--
       ``(i) the assigned operator (and any successor) shall 
     continue to remain liable for such obligations if the amount 
     deposited is insufficient, but
       ``(ii) any related person to such operator (or successor) 
     shall be relieved of any liability for such obligations.''
       (b) 1992 Fund.--Section 9712(d) (relating to guarantee of 
     benefits), as amended by section 101, is amended by adding at 
     the end the following:
       ``(6) Election to prefund.--
       ``(A) In general.--A 1988 last signatory operator shall be 
     entitled to prefund its obligations to the 1992 UMWA Benefit 
     Plan by depositing into an irrevocable trust dedicated solely 
     to the payment of such obligations an amount which the board 
     of trustees determines, on the basis of reasonable actuarial 
     assumptions, to be equal to the present value of the 
     operator's present and future obligations to such plan.
       ``(B) Effects on liability.--If a 1988 last signatory 
     operator prefunds its obligations under this paragraph--
       ``(i) the operator (and any successor) shall continue to 
     remain liable for such obligations if the amount deposited is 
     insufficient, but
       ``(ii) any related person to such operator (or successor) 
     shall be relieved of any liability for such obligations.''

     SEC. 203. FIRST YEAR PAYMENTS OF 1988 OPERATORS.

       So much of section 9704(i)(1)(D) as precedes clause (ii) is 
     amended to read as follows:
       ``(D) Premium reductions and refunds.--
       ``(i) 1st year payments.--In the case of a 1988 agreement 
     operator making payments under subparagraph (A)--

       ``(I) the premium of such operator under subsection (a) 
     shall be reduced by the amount paid under subparagraph (A) by 
     such operator for the plan year beginning February 1, 1993, 
     or
       ``(II) if the amount so paid exceeds the operator's 
     liability under subsection (a), the excess shall be refunded 
     to the operator.''

       Subtitle B--Transfers From Abandoned Mine Reclamation Fund

     SEC. 211. TRANSFER OF INTEREST FROM ABANDONED MINE 
                   RECLAMATION FUND TO COMBINED FUND.

       (a) In General.--Section 402(h)(2) of the Surface Mining 
     Control and Reclamation Act of 1977 (30 U.S.C. 1232(h)(2)) is 
     amended to read as follows:
       ``(2)(A) Except as provided in subparagraph (B), the 
     Secretary shall transfer from the fund to the United Mine 
     Workers of America Combined Benefit Fund established under 
     section 9702 of the Internal Revenue Code of 1986 for any 
     fiscal year the amount of interest which the Secretary 
     estimates will be earned and paid to the fund during the 
     fiscal year.
       ``(B) The Secretary shall increase the amount transferred 
     under subparagraph (A) for fiscal year 2001 by the excess 
     of--
       ``(i) the total amount of interest earned and paid to the 
     fund after September 30, 1992, and before October 1, 2000, 
     over
       ``(ii) the total amount transferred to the Combined Fund 
     under this subsection for fiscal years beginning before 
     October 1, 2000.''
       (b) Conforming Amendments.--Section 204(h) of such Act (30 
     U.S.C. 1232(h)) is amended by striking paragraph (3) and by 
     redesignating paragraph (4) as paragraph (3).
       (c) Effective Date.--The amendments made by this section 
     shall apply to fiscal years beginning after September 30, 
     2000.

     SEC. 212. MODIFICATIONS OF ABANDONED MINE RECLAMATION FEE 
                   PROGRAM.

       (a) Reductions in Reclamation Fees.--Section 402(a) of the 
     Surface Mining Control and Reclamation Act of 1977 (30 U.S.C. 
     1232(a)) is amended--
       (1) by striking ``35 cents'' and inserting ``20 cents'',
       (2) by striking ``15 cents'' and inserting ``5 cents'', and
       (3) by striking ``10 cents'' and inserting ``5 cents''.
       (b) Extension of Fee Program.--Section 402(b) of such Act 
     (30 U.S.C. 1232(b)) is amended by striking ``2004'' and 
     inserting ``2010''.
       (c) Effective Date.--The amendments made by subsection (a) 
     shall apply to fiscal years beginning after September 30, 
     2000.

     SEC. 213. USE OF FUNDS TRANSFERRED FROM ABANDONED MINE 
                   RECLAMATION FUND.

       (a) In General.--Section 9705(b)(2) of the Internal Revenue 
     Code of 1986 (relating to use of funds) is amended to read as 
     follows:
       ``(2) Use of funds.--The amount transferred under paragraph 
     (1) for any fiscal year shall be used--
       ``(A) first, to refund to an assigned operator (and any 
     related person to such operator) an amount equal to the sum 
     of--
       ``(i) any amount paid by such operator or person to the 
     Combined Fund (and not previously refunded) solely by reason 
     of the operator having been a signatory to a pre-1974 coal 
     wage agreement, plus
       ``(ii) interest on the amount under clause (i) at the 
     overpayment rate established under section 6621 for the 
     period from the payment of such amount to the refund under 
     this subparagraph,
       ``(B) second, to make any refund required under section 
     9704(i)(1)(D)(i)(II),
       ``(C) third, to proportionately reduce the unassigned 
     beneficiary premium under section 9704(a)(3) of each assigned 
     operator for the plan year in which transferred, and
       ``(D) last, to pay the amount of any other obligation 
     occurring in the Combined Fund.''
       (b) Effective Date.--The amendment made by this subsection 
     shall apply to fiscal years beginning after September 30, 
     2000.

                       Subtitle C--Authorization

     SEC. 221. AUTHORIZATION OF TRANSFER OF FUNDS TO COMBINED 
                   BENEFIT FUND.

       Section 9705 (relating to transfers to the Combined Benefit 
     Fund) is amended by adding at the end the following:
       ``(c) Authorization of Appropriations.--
       ``(1) In general.--There is authorized to be appropriated 
     $38,000,000 for each fiscal year beginning after September 
     30, 2000.
       ``(2) Use of funds.--Any amounts transferred to the 
     Combined Fund under paragraph (1) shall be available, without 
     fiscal year limitation, to cover any shortfall in any premium 
     account established under section 9704(e).
       ``(3) Transfers.--
       ``(A) In general.--The Secretary shall transfer amounts 
     appropriated under paragraph (1) on October 1 of each fiscal 
     year.
       ``(B) Excess amounts.--If the Secretary, after examining 
     the audit of the Combined Fund by the Comptroller General of 
     the United States, determines that the amount transferred for 
     any fiscal year exceeds the amount required to cover 
     shortfalls for that year, the Secretary shall notify the 
     Committees on Appropriations of the House of Representatives 
     and the Senate and the authorization of appropriations for 
     the first fiscal year after the determination shall be 
     reduced by the amount of the excess.''

     SEC. 222. ANNUAL AUDIT.

       Section 9702 (relating to establishment of the Combined 
     Fund) is amended by adding at the end the following:
       ``(d) Annual Audit.--
       ``(1) Audit.--The Comptroller General of the United States 
     shall conduct an annual audit of the Combined Fund. Such 
     audit shall include--
       ``(A) a review of the progress the Combined Fund is making 
     toward a managed care system as required under this 
     subchapter, and
       ``(B) a review of the use of, and necessity for, amounts 
     transferred to the Combined Fund under section 9705(c).
       ``(2) Report.--The Comptroller General shall report the 
     results of any audit under paragraph (1) to the Secretary of 
     the Treasury and to the appropriate committees of Congress, 
     including its recommendations (if any) as to any 
     administrative savings which may be achieved without reducing 
     the effective level of benefits under section 9703.''
                                 ______
                                 
      By Mr. FRIST for himself and Mr. Kennedy):
  S. 2731. A bill to amend title III of the Public Health Service Act 
to enhance the Nation's capacity to address public health threats and 
emergencies; to the Committee on Health, Education and Pensions.

[[Page 10685]]




           Public Health Threats and Emergencies Act of 2000

  Mr. FRIST. Mr. President. I am pleased today to introduce the 
``Public Health Threats and Emergencies Act of 2000'' with my 
colleague, Senator, Kennedy, to improve our public health 
infrastructure and to address the growing threats of antimicrobial 
resistance and bioterrorism.
  Over the last two years, we have held three hearings and forums on 
these topics, and I also commissioned a GAO report on antimicrobial 
resistance. The outcome of all this research is clear; we need to 
improve our public health infrastructure to be able to respond in a 
timely and effective manner to these and other threats.
  For too long, we have not provided adequate funding to maintain and 
improve the core capacities of our nation's public health 
infrastructure. As the GAO report found, many State and local public 
health agencies lack even the most basic equipment such as FAX machines 
or answering machines to assist their workload and improve 
communications.
  We face a myriad of public health threats everyday, and besides 
improving our core public health capacity, this act aim addresses two 
problems in particular: antimicrobial resistance and bioterrorism.
  Antimicrobial resistance is a pressing pubic health problem. As a 
heart and lung transplant surgeon, I know all too well that the most 
common cause of death after transplantation of a heart or lung is not 
rejection, but infection. One hundred percent of transplantation 
patients contract infections following surgery. Infection is the most 
common complication following surgery, the leading cause for 
rehospitalization, and the most expensive aspect of treatment post-
transplantation. Antibiotics are a mainstay of treatment, yet we are 
increasingly seeing resistant bacteria which are not killed by most 
first-line antimicrobials.
  In fact, the New England Journal of Medicine has reported that 
certain Staphylocci, which are a common cause of post-surgical and 
hospital acquired infections, are showing intermediate resistance to 
vancomycin, an antibiotic of the last resort. Just recently in mid-
April, the FDA approved the first entirely new type antibiotic in 35 
years.
  How did we reach this point? For most of human history, infections 
were the scourge of man's existence causing debilitating disease and 
often death. Antibiotics, when initially discovered more than 50 years 
ago, were heralded as miracle drugs and quickly became our most lethal 
weapon in the crusade against disease-causing bacteria. Antibiotics 
were widely dispensed and, in the 1970's premature optimism lead us to 
declare the war on infections won.
  Unfortunately, we discovered that bacteria are cagey, tenacious 
organisms that swiftly developed resistance to antibiotics and adapted 
to drug-rich environments. In addition, the art of medicine evolved, 
creating new opportunities for bacteria to cause infection from 
invasive procedures using catheters to organ transplant recipients who 
are treated with immunosuppressive agents to prevent rejection. As a 
result, we are both seeing more invasive, life-threatening infections 
that require concurrent treatment with several antibiotics to control 
and infections that were on the decline, such as Tuberculosis, re-
emerging in an antimicrobial resistant form.
  While infections have plagued man's existence for most of human 
history, throughout civilization, bioweapons have been strategically 
deployed during critical military battles. For example, in 1344, the 
Mongols hurled corpses infected with bubonic plague over the city walls 
of Caffa (now Feodossia, Ukraine). During World War I, the Germans 
hoped to gain an advantage by infecting their enemies horses and 
livestock with anthrax.
  Bioterrorism is a significant threat to our country. As a nation we 
are presently more vulnerable to bioweapons than other more traditional 
means of warfare. Bioweapons pose considerable challenges that are 
different from those of standard terrorist devices, including chemical 
weapons.
  The mere term ``bioweapon'' invokes visions of immense human pain and 
suffering and mass casualties. Pound for pound, ounce for ounce, 
bioagents represent one of the most lethal weapons of mass destruction 
known. Moreover, victims of a covert bioterrorist attack do not 
necessarily develop symptoms upon exposure to the bioagent. Development 
of symptoms may be delayed days long after the bioweapon is dispersed.
  As a result, exposed individuals will most likely show up in 
emergency rooms, physician offices, or clinics, with nondescript 
symptoms or ones that mimic the common cold or flu. In all likelihood, 
physicians and other health care providers will not attribute these 
symptoms to a bioweapon. If the bioagent is communicable, such as small 
pox, many more people may be infected in the interim, including our 
health care workers. As Stephanie Bailey, the Director of Health for 
Metropolitan Nashville and Davidson County pointed out in our hearing 
on bioterrorism, ``many localities are on their own for the first 24 to 
48 hours after an attack before Federal assistance can arrive and be 
operational. This is the critical time for preventing mass 
casualties.''
  If experts are correct in their belief that a major bioterrorist 
attack is a virtual certainty, that it is no longer a question of 
``if'' but rather ``when.'' In fact, my home town of Nashville last 
year joined an ever-increasing number of cities to receive and respond 
to a package that was suspected of containing anthrax. Thankfully, this 
was a hoax.
  To address these concerns about our public health infrastructure and 
improve our preparedness for the threats of antimicrobial resistance 
and bioterrorism, I have joined with Senator Kennedy to provide greater 
resources and coordination to address these issues.
  The Public Health Threats and Emergencies Act, which we introduce 
today, will provide needed guidance, resources, and coordination to 
increase the core capacities of the nation's public health 
infrastructure. This Act will also improve the coordination and 
increase the resources available to address the threats of bioterrorism 
and antimicrobial resistance.
  Strengthening capacities to ensure that the public health 
infrastructure is adequate to respond to carry out core functions and 
respond to emerging threats and emergencies, the Public Health Threats 
and Emergencies Act authorizes: the establishment of voluntary 
performance goals for public health systems; grants to public health 
agencies to conduct assessments and build core capacities to achieve 
these goals; and funding to rebuild and remodel the facilities of the 
Center for Disease Control and Prevention.
  To strengthen public health capacities to combat antimicrobial 
resistance, the Act authorizes: a task force to coordinate Federal 
programs related to antimicrobial resistance and to improve public 
education on antimicrobial resistance; the National Institutes of 
Health (NIH) to support research into the development of new 
therapeutics against and improved diagnostics for resistant pathogens; 
and grants for activities to improve specific capacities to detect, 
monitor, and combat antimicrobial resistance.
  To strengthen public health capacities to prevent and respond to 
bioterrorism, the Act authorizes: two interdepartmental task forces to 
address joint issues of research needs and the public health and 
medical consequences of bioterrorism; NIH and CDC research on the 
epidemiology of bioweapons and the development of new vaccines or 
therapeutics for bioweapons; and grants to public health agencies and 
hospitals and care facilities to detect, diagnose, and respond to 
bioterrorism.
  Mr. President, this Act is necessary. We must take steps now to 
improve our basic capacities to address all public health threats, 
including antimicrobial resistance and bioterrorism. I am hopeful this 
legislation provides State and local public health agencies the 
resources to improve their abilities so that we better protect the 
health and well-being of our Nation's citizens.

[[Page 10686]]

  I want to thank Senator Kennedy for joining me in this effort and for 
the work of his staff. I would also like to thank Dr. Stephanie Bailey, 
the Director of Health for Metropolitan Nashville and Davidson County 
for her assistance and input on this important piece of legislation.
  Mr. KENNEDY. Mr. President, several months ago, my distinguished 
colleague, Senator Bill Frist, and I began to develop legislation 
needed to enhance the nation's protections against the triple threat to 
health posed by new and resurgent infectious diseases, by ``superbugs'' 
resistant to antibiotics, and by terrorist attacks with biological 
weapons. Today, Senator Frist and I are introducing the Public Health 
Threats and Emergencies Act of 2000. I commend Senator Frist for his 
leadership and commitment on this important legislation.
  The bill that we are introducing today will provide the nation with 
additional weapons to win the battle against the deadly perils of 
infectious disease, antimicrobial resistance and bioterrorism. The 
Public Health Threats and Emergencies Act of 2000 will revitalize the 
nation's ability to monitor and fight outbreaks of infectious disease, 
control the spread of germs resistant to antibiotics, and protect the 
nation more effectively against bioterrorism.
  Today we face a world where deadly contagious diseases that erupt in 
one part of the world can be transported across the globe with the 
speed of a jet aircraft. The recent outbreak of West Nile Fever in the 
New York area is an ominous warning of future dangers. Diseases such as 
cholera, typhoid and pneumonia that we have fought for generations 
still claim millions of lives across the world and will pose increasing 
dangers to this country in years to come. New plagues like Ebola virus, 
Lassa Fever and others now unknown to science may one day invade our 
shores.
  Less exotic, but also deadly, are the simpler infections that for 
almost a century we have been able to treat with antibiotics, but that 
are now becoming resistant even to our most advanced medicines. Drugs 
that once had the power to cure dangerous infections are now often 
useless--because ``superbugs`' have now become resistant to all but the 
most powerful and expensive medications. Strains of tuberculosis that 
are resistant to antimicrobial drugs are prevalent around the world, 
and are a growing danger in our inner cities and among the homeless. If 
action is not urgently taken, we may soon return to the days when a 
simple case of food poisoning could prove deadly and a mere cut could 
become severely infected and cost a limb.
  The growing financial burden of antimicrobial resistance on the 
health care system is staggering. Treating a patient with TB usually 
costs $12,000. But when a patient has drug-resistant TB, that figure 
soars to $180,000. The National Foundation for Infectious Diseases 
estimates that the total cost of antimicrobial resistance to the U.S. 
health care system is as high as $4 billion every year--and this figure 
will only rise as resistant infections become more common.
  But the most potentially deadly of these threats is bioterrorism. We 
are a nation at risk. Biological weapons are the massive new threats of 
the twenty-first century. The Office of Emergency Preparedness 
estimates that 40 million Americans could die if a terrorist released 
smallpox into the American population. Anthrax could kill 10 million. 
Other deadly pathogens known to have been developed in biological 
warfare labs around the world could kill millions.
  Our proposal will strengthen the nation's public health agencies, 
which provide the first line of defense against bioterrorism and many 
other threats to the public health. Our legislation authorizes the 
Secretary of Health and Human Services to respond swiftly and 
effectively to a public health emergency, and provides the Secretary 
with needed resources to mount a strong defense against whatever danger 
imperils the nation's health.
  The bill calls upon the Secretary of Health and Human Services to 
establish a national monitoring plan for dangerous infections resistant 
to antibiotics, and to work closely with state and local public health 
agencies to ensure that this peril is contained.
  It is also essential to educate patients and medical providers in the 
appropriate use of antibiotics. Too often, patients demand antibiotics 
and doctors provide them for illnesses which do not require and do not 
respond to these drugs. Our legislation calls upon the federal 
government to lead a national campaign to educate patients and health 
providers in the appropriate use of antibiotics.
  The threat of bioterrorism demands particular attention, because of 
its potential for massive death and destruction. Currently, dozens of 
federal agencies share responsibility for domestic preparedness against 
bioterrorist attacks. This bill will enhance the nation's preparedness 
by improving coordination among federal agencies responsible for all 
aspects of a bioterrorist attack. Better coordination will allow us to 
develop the public health countermeasures needed to defend against 
bioterrorism, such as stockpiles of essential supplies and effective 
disaster planning.
  Since the infectious organisms likely to be used in a bioterrorist 
attack are rarely encountered in normal medical practice, many doctors 
or laboratory specialists are likely to be unable to diagnose persons 
with these diseases rapidly and accurately. Recognizing a bioterrorist 
attack quickly is a major part of containing it. This bill will improve 
the preparedness of public health institutions, health providers, and 
emergency personnel to detect, diagnose, and respond to bioterrorist 
attacks through improved training and public education.
  One of the highest duties of Congress is to protect the nation 
against all threats, foreign and domestic. Deadly infectious diseases, 
new ``superbugs'' resistant to antibiotics, and bioterrorism clearly 
menace the nation. We must resist these threats as vigorously as we 
would fight an invading army. the Frist-Kennedy bill is intended to 
provide the weapons we need to win this battle.

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