[Congressional Record (Bound Edition), Volume 147 (2001), Part 8]
[Senate]
[Pages 11152-11163]
[From the U.S. Government Publishing Office, www.gpo.gov]



          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. HATCH (for himself and Mr. Kerry):
  S. 1066. A bill to amend title XVIII of the Social Security Act to 
establish procedures for determining payment amounts for new clinical 
diagnostic laboratory tests for which payment is made under the 
Medicare Program; to the Committee on Finance.
  Mr. HATCH. Mr. President, I rise to introduce the Medicare Patient 
Access to Preventive and Diagnostic Tests Act. This bipartisan 
legislation will establish new procedures under Medicare for 
determining the coding and payment amounts for clinical diagnostic 
laboratory tests. I am pleased to have my colleague, Senator John 
Kerry, as the lead Democratic sponsor of this bill. Similar legislation 
has been introduced in the House of Representatives by Congresswoman 
Jennifer Dunn and Congressman Jim McDermott. 
  Innovative clinical laboratory tests help save lives and reduce 
health care costs by detecting diseases, such as cancer, heart attacks, 
and kidney failure in their early stages, when they are more treatable. 
However, there are serious flaws in the way that the Center for 
Medicare and Medicaid Services, CMS, formally known as HCFA, currently 
sets reimbursement rates for diagnostic tests.
  This cumbersome bureaucratic system makes it difficult for physicians 
and laboratories to offer these diagnostic tests to their patients who 
need them. Due to institutionalized flaws in the current Medicare 
reimbursement system, revolutionary and innovative diagnostic tests may 
not benefit patients for years to come. In addition, it has been shown 
that lower laboratory payments correlate with lower utilization. The 
payment rates vary significantly from region to region and State to 
State.
  For example, in my home State of Utah, a patient is sent for blood 
work to test for kidney disease. Based upon the 2001 Medicare Lab 
Reimbursement schedule, the Utah lab would receive $2.12 for performing 
the test. However, labs in Arizona, Nevada, Montana, New Mexico and 
Wyoming, would receive $6.33 to perform the same test. This makes no 
economic or medical sense to me.
  A recent Institute of Medicine, IoM, report stated that Medicare 
payments for outpatient clinical laboratory services should be based on 
a single, rational fee schedule. Medicare should account for market-
based factors such as local labor costs and prices for goods and 
services in establishing the fee schedule. In addition, CMS should 
provide opportunities for stakeholder input and develop better 
communication with contractors while policies are being developed and 
after these policies are adopted.
  Our bill, based upon the principles of this IoM report, would require 
CMS to establish a national fee schedule for new and current tests, 
based upon an open, transparent, and rational public process for 
incorporating new tests, as well as to provide clear explanations of 
the reasoning behind its reimbursement decisions. This new process 
would be based upon science based methodologies for setting prices for 
new technologies that are designed to establish fair and appropriate 
payment levels for these items and services.
  CMS's procedures would provide that the payment amount for tests 
would be established under either the so-called gap-filling or cross-
walking methodologies, and they would specify the rules for deciding 
which methodology will be used and how it will be employed. In 
particular, the legislation would require that if a new test is 
clinically similar to a test for which a fee schedule amount has 
already been established, through cross-walking, CMS will pay the same 
fee schedule amount for the new test. In determining whether tests are 
clinically similar, CMS will not take into account economic factors.
  Finally, this new process would provide a mechanism for any 
laboratory or other stakeholder to challenge CMS fee schedule 
decisions. The cost of these changes is small in light of the 
significant impact on improving the quality of patient care.
  I hope my colleagues will join me in cosponsoring this bill. The 
laudable goal of this bipartisan legislation is to establish an open 
and transparent public process for incorporating new laboratory tests 
into the Medicare program. Many seniors currently do not have full 
access to the medical care they need due to the antiquated process for 
assigning billing codes and setting reimbursement rates. We need to 
bridge the gap between seniors and the life-saving lab tests they need 
to preserve their health and promote their well-being.
  I ask my colleagues to join with me in supporting this legislation 
and ask unanimous consent that the text of this bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1066

       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 ``Medicare Patient Access to 
     Preventive and Diagnostic Tests Act''.

     SEC. 2. CODING AND PAYMENT PROCEDURES FOR NEW CLINICAL 
                   DIAGNOSTIC LABORATORY TESTS UNDER MEDICARE.

       (a) Determining Payment Basis for New Lab Tests.--Section 
     1833(h) of the Social Security Act (42 U.S.C. 1395l(h)) is 
     amended by adding at the end the following new paragraph:
       ``(9)(A) The Secretary shall establish procedures for 
     determining the basis for, and amount of, payment under this 
     subsection for any clinical diagnostic laboratory test with 
     respect to which a new or substantially revised HCPCS code is 
     assigned on or after January 1, 2002 (in this subsection 
     referred to as `new tests'). Such procedures shall provide 
     that--
       ``(i) the payment amount for such a test will be 
     established only on--
       ``(I) the basis described in paragraph (10)(A); or

[[Page 11153]]

       ``(II) the basis described in paragraph (10)(B); and
       ``(ii) the Secretary shall determine whether the payment 
     amount for such a test is established on the basis described 
     in paragraph (10)(A) or the basis described in paragraph 
     (10)(B) only after the process described in subparagraph (B) 
     has been completed with respect to such test.
       ``(B) Determinations under subparagraph (A)(ii) shall be 
     made only after the Secretary--
       ``(i) makes available to the public (through an Internet 
     site and other appropriate mechanisms) a list that includes 
     any such test for which the establishment of a payment amount 
     under paragraph (10) is being considered for a year;
       ``(ii) on the same day such list is made available, causes 
     to have published in the Federal Register notice of a meeting 
     to receive comments and recommendations from the public on 
     the appropriate basis under paragraph (10) for establishing 
     payment amounts for the tests on such list;
       ``(iii) not less than 30 calendar days after publication of 
     such notice, convenes a meeting to receive such comments and 
     recommendations, with such meeting--
       ``(I) including representatives of each entity within the 
     Health Care Financing Administration (in this paragraph 
     referred to as `HCFA') that will be involved in determining 
     the basis on which payment amounts will be established for 
     such tests under paragraph (10) and implementing such 
     determinations;
       ``(II) encouraging the participation of interested parties, 
     including beneficiaries, device manufacturers, clinical 
     laboratories, laboratory professionals, pathologists, and 
     prescribing physicians, through outreach activities; and
       ``(III) affording opportunities for interactive dialogue 
     between representatives of HCFA and the public;
       ``(iv) makes minutes of such meeting available to the 
     public (through an Internet site and other appropriate 
     mechanisms) not later than 15 calendar days after such 
     meeting; -
       ``(v) taking into account the comments and recommendations 
     received at such meeting, develops and makes available to the 
     public (through an Internet site and other appropriate 
     mechanisms) a list of proposed determinations with respect to 
     the appropriate basis for establishing a payment amount under 
     paragraph (10) for each such code, together with an 
     explanation of the reasons for each such determination, and 
     the data on which the determination is based;
       ``(vi) on the same day such list is made available, causes 
     to have published in the Federal Register notice of a public 
     meeting to receive comments and recommendations from the 
     public on the proposed determinations;
       ``(vii) not later than August 1 of each year, but at least 
     30 calendar days after publication of such notice, convenes a 
     meeting to receive such comments and recommendations, with 
     such meeting being conducted in the same manner as the 
     meeting under clause (iii);
       ``(viii) makes a transcript of such meeting available to 
     the public (through an Internet site and other appropriate 
     mechanisms) as soon as is practicable after such meeting; and
       ``(ix) taking into account the comments and recommendations 
     received at such meeting, develops and makes available to the 
     public (through an Internet site and other appropriate 
     mechanisms) a list of final determinations of whether the 
     payment amount for such tests will be determined on the basis 
     described in paragraph (10)(A) or the basis described in 
     paragraph (10)(B), together with the rationale for each such 
     determination, the data on which the determination is based, 
     and responses to comments and suggestions received from the 
     public.
       ``(C) Under the procedures established pursuant to 
     subparagraph (A), the Secretary shall--
       ``(i) identify the rules and assumptions to be applied by 
     the Secretary in considering and making determinations of 
     whether the payment amount for a new test should be 
     established on the basis described in paragraph (10)(A) or 
     the basis described in paragraph (10)(B);
       ``(ii) make available to the public the data (other than 
     proprietary data) considered in making such determinations; 
     and
       ``(iii) provide for a mechanism under which--
       ``(I) an interested party may request an administrative 
     review of an adverse determination;
       ``(II) upon the request of an interested party, an 
     administrative review is conducted with respect to an adverse 
     determination; and
       ``(III) such determination is revised, as necessary, to 
     reflect the results of such review.
       ``(D) For purposes of this subsection--
       ``(i) the term `HCPCS' refers to the Health Care Financing 
     Administration Common Procedure Coding System; and
       ``(ii) a code shall be considered to be `substantially 
     revised' if there is a substantive change to the definition 
     of the test or procedure to which the code applies (such as a 
     new analyte or a new methodology for measuring an existing 
     analyte-specific test).
       ``(10)(A) Notwithstanding paragraphs (1), (2), and (4), if 
     a new test is clinically similar to a test for which a fee 
     schedule amount has been established under paragraph (5), the 
     Secretary shall pay the same fee schedule amount for the new 
     test.
       ``(B)(i) Notwithstanding paragraphs (1), (2), (4), and (5), 
     if a new test is not clinically similar to a test for which a 
     fee schedule has been established under paragraph (5), 
     payment under this subsection for such test shall be made on 
     the basis of the lesser of--
       ``(I) the actual charge for the test; or
       ``(II) an amount equal to 60 percent (or in the case of a 
     test performed by a qualified hospital (as defined in 
     paragraph (1)(D)) for outpatients of such hospital, 62 
     percent) of the prevailing charge level determined pursuant 
     to the third and fourth sentences of section 1842(b)(3) for 
     the test for a locality or area for the year (determined 
     without regard to the year referred to in paragraph 
     (2)(A)(i), or any national limitation amount under paragraph 
     (4)(B), and adjusted annually by the percentage increase or 
     decrease under paragraph (2)(A)(i));

     until the beginning of the third full calendar year that 
     begins on or after the date on which an HCPCS code is first 
     assigned with respect to such test, or, if later, the 
     beginning of the first calendar year that begins on or after 
     the date on which the Secretary determines that there are 
     sufficient claims data to establish a fee schedule amount 
     pursuant to clause (ii).
       ``(ii) Notwithstanding paragraphs (2), (4), and (5), the 
     fee schedule amount for a clinical diagnostic laboratory test 
     described in clause (i) that is performed--
       ``(I) during the first calendar year after clause (i) 
     ceases to apply to such test, shall be an amount equal to the 
     national limitation amount that the Secretary determines 
     (consistent with clause (iii)) would have applied to such 
     test under paragraph (4)(B)(viii) during the preceding 
     calendar year, adjusted by the percentage increase or 
     decrease determined under paragraph (2)(A)(i) for such first 
     calendar year; and
       ``(II) during a subsequent year, is the fee schedule amount 
     determined under this clause for the preceding year, adjusted 
     by the percentage increase or decrease that applies under 
     paragraph (5)(A) for such year.
       ``(iii) For purposes of clause (ii)(I), the national 
     limitation amount for a test shall be set at 100 percent of 
     the median of the payment amounts determined under clause 
     (ii)(I) for all payment localities or areas for the last 
     calendar year for which payment for such test was determined 
     under clause (i).
       ``(iv) Nothing in clause (ii) shall be construed as 
     prohibiting the Secretary from applying (or authorizing the 
     application of) the comparability provisions of the first 
     sentence of such section 1842(b)(3) with respect to amounts 
     determined under such clause.''.
       (b) Establishment of National Fee Schedule Amounts.--
       (1) In general.--Section 1833(h) of the Social Security 
     Act, as amended by subsection (a), is amended--
       (A) in paragraph (2), by striking ``paragraph (4)'' and 
     inserting ``paragraphs (4), (5), and (10)'';----
       (B) in paragraph (4)(B)(viii), by inserting ``and before 
     January 1, 2002,'' after ``December 31, 1997,'';
       (C) by redesignating paragraphs (5), (6), and (7), as 
     paragraphs (6), (7), and (8), respectively; and
       (D) by inserting after paragraph (4) the following new 
     paragraph:
       ``(5) Notwithstanding paragraphs (2) and (4), the Secretary 
     shall set the fee schedule amount for a test (other than a 
     test to which paragraph (10)(B) applies) at--
       ``(A) for tests performed during 2002, an amount equal to 
     the national limitation amount for that test for 2001, and 
     adjusted by the percentage increase or decrease determined 
     under paragraph (2)(A)(i) for such year; and
       ``(B) for tests performed during a year after 2002, the 
     amount determined under this subparagraph for the preceding 
     year, adjusted by the percentage increase or decrease 
     determined under paragraph (2)(A)(i) for such year.''.
       (2) Conforming amendments.--Paragraphs (1)(D)(i) and 
     (2)(D)(i) of section 1833(a) of the Social Security Act (42 
     U.S.C. 1395l(a)) are each amended by striking ``the 
     limitation amount for that test determined under subsection 
     (h)(4)(B),''.
       (c) Mechanism for Review of Adequacy of Payment Amounts.--
     Section 1833(h) of the Social Security Act (42 U.S.C. 
     1395l(h)), as amended by subsection (b), is amended by adding 
     at the end the following:
       ``(11) The Secretary shall establish a mechanism under 
     which--
       ``(A) an interested party may request a timely review of 
     the adequacy of the existing payment amount under this 
     subsection for a particular test; and
       ``(B) upon the receipt of such a request, a timely review 
     is carried out.''.
       (d) Use of Inherent Reasonableness Authority.--Section 
     1842(b)(8) of the Social Security Act (42 U.S.C. 1395u(b)(8)) 
     is amended by adding at the end the following:
       ``(E)(i) The Secretary may not delegate the authority to 
     make determinations with respect to clinical diagnostic 
     laboratory tests

[[Page 11154]]

     under this paragraph to a regional office of the Health Care 
     Financing Administration or to an entity with a contract 
     under subsection (a).
       ``(ii) In making determinations with respect to clinical 
     diagnostic laboratory tests under this paragraph, the 
     Secretary--
       ``(I) shall base such determinations on data from affected 
     payment localities and all sites of care; and
       ``(II) may not use a methodology that assigns undue weight 
     to the prevailing charge levels for any 1 type of entity with 
     a contract under subsection (a).''.
       (e) Prohibition.--Section 1833(h) of the Social Security 
     Act (42 U.S.C. 1395l(h)), as amended by subsection (c), is 
     amended by adding at the end the following new paragraph:
       ``(12)(1) Notwithstanding the preceding provisions of this 
     subsection, the Secretary may not establish a payment level 
     for a new test that is lower than the level for an existing, 
     clinically similar test solely on the basis that the new test 
     may be performed by a laboratory with a certificate of waiver 
     under section 353(d)(2) of the Public Health Service Act (42 
     U.S.C. 263a(d)(2)).
       ``(2) Nothing in paragraph (1) shall be construed to limit 
     the authority of the Secretary to establish a payment level 
     for a new test that is lower than the level for an existing, 
     clinically similar test if such payment level is determined 
     on a basis other than the basis described in such paragraph 
     or on more than 1 basis.''.
       (f) Effective Dates.--
       (1) Establishment of procedures.--The Secretary of Health 
     and Human Services shall establish the procedures required to 
     implement paragraphs (9), (10), (11), and (12) of section 
     1833(h) of the Social Security Act (42 U.S.C. 1395l(h)), as 
     added by this section, by not later than January 1, 2002.
       (2) Inherent reasonableness.--The amendments made by 
     subsection (d) shall apply to determinations made on or after 
     the date of enactment of this Act.
                                 ______
                                 
      By Mr. GRASSLEY (for himself, Mr. Torricelli, and Mr. Craig):
  S. 1067. A bill to amend the Internal Revenue Code of 1986 to expand 
the availability of Archer medical savings accounts; to the Committee 
on Finance.
  Mr. GRASSLEY. Mr. President, today, on behalf of myself and my 
colleague, Senator Torricelli, I am introducing legislation, the 
Medical Savings Availability Act of 2001, which would make the 
availability of medical savings accounts permanent and would make it 
possible for any individual to purchase a medical savings account. Our 
bill would liberalize existing law authorizing medical savings accounts 
in a number of other respects.
  Medical savings accounts are a good idea. They are basically IRAs, an 
idea everybody understands, which must be used for payment of medical 
expenses.
  The widespread use of medical savings accounts should have several 
beneficial consequences.
  They should reduce health care costs. Administrative costs should be 
lower. Consumers with MSAs should use health care services in a more 
discriminating manner. Consumers with MSAs should be more selective in 
choosing providers. This should cause those providers to lower their 
prices to attract medical savings account holders as patients.
  Medical savings accounts can also help to put the patient back into 
the health care equation. Patients should make more cost-conscious 
choices about routine health care. Patients with MSAs would have 
complete choice of provider.
  Medical savings accounts should make health care coverage more 
dependable. MSAs are completely portable. MSAs are still the property 
of the individual even if they change jobs. Hence, for those with MSAs, 
job changes do not threaten them with the loss of health insurance.
  Medical savings accounts should increase health care coverage. 
Perhaps as many as half of the more than 40 million Americans who are 
uninsured at any point in time are without health insurance only for 
four months or less. A substantial number of these people are uninsured 
because they are between jobs. Use of medical savings accounts should 
reduce the number of the uninsured by equipping people to pay their own 
health expenses while unemployed.
  Medical savings accounts should promote personal savings. Since pre-
tax monies are deposited in them, there should be a strong tax 
incentive to use them.
  As I understand it, there are approximately 100,000 MSA accounts 
covering a total of approximately 250,000. I understand also that 
approximately one-third of those who have set up medical savings 
accounts were previously uninsured.
  But medical savings accounts have fallen short of their promise 
because of various restrictions in the authorizing law.
  The present law has a sunset of December, 2001, which has discouraged 
insurers from offering such plans. Current MSA law prohibits around 70 
percent of the working population from purchasing them because purchase 
is limited to the self-employed or to employees of small businesses of 
less than 50 employees.
  The bill we are introducing today would eliminate the restrictions 
that have limited the availability of MSAs: First, it would remove the 
December, 2001, sunset provision and make the availability of MSAs 
permanent; second, it would repeal the limitations on the number of 
MSAs that can be established; third, it stipulates that the 
availability of these accounts is not limited to employees of small 
employers and self-employed individuals; fourth, it increases the 
amount of the deduction allowed for contributions to medical savings 
accounts to 100 percent of the deductible; fifth, it permits both 
employees and employers to contribute to medical savings accounts; 
sixth, it reduces the permitted deductibles under high deductible plans 
from $1,500 in the case of individuals to $1,000 and from $3,000 in the 
case of couples to $2,000; seventh, the bill would permit medical 
savings accounts to be offered under cafeteria plans; and finally, the 
bill would encourage preferred provider organizations to offer MSAs.
  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. 1067

       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 ``Medical Savings Account 
     Availability Act of 2001''.

     SEC. 2. EXPANSION OF AVAILABILITY OF ARCHER MEDICAL SAVINGS 
                   ACCOUNTS.

       (a) Repeal of Limitations on Number of Medical Savings 
     Accounts.--
       (1) In general.--Subsections (i) and (j) of section 220 of 
     the Internal Revenue Code of 1986 are hereby repealed.
       (2) Conforming amendments.--
       (A) Paragraph (1) of section 220(c) of such Code is amended 
     by striking subparagraph (D).
       (B) Section 138 of such Code is amended by striking 
     subsection (f).
       (b) Availability Not Limited to Accounts for Employees of 
     Small Employers and Self-Employed Individuals.--
       (1) In general.--Subparagraph (A) of section 220(c)(1) of 
     such Code (relating to eligible individual) is amended to 
     read as follows:
       ``(A) In general.--The term `eligible individual' means, 
     with respect to any month, any individual if--
       ``(i) such individual is covered under a high deductible 
     health plan as of the 1st day of such month, and
       ``(ii) such individual is not, while covered under a high 
     deductible health plan, covered under any health plan--

       ``(I) which is not a high deductible health plan, and
       ``(II) which provides coverage for any benefit which is 
     covered under the high deductible health plan.''.

       (2) Conforming amendments.--
       (A) Section 220(c)(1) of such Code is amended by striking 
     subparagraph (C).
       (B) Section 220(c) of such Code is amended by striking 
     paragraph (4) (defining small employer) and by redesignating 
     paragraph (5) as paragraph (4).
       (C) Section 220(b) of such Code is amended by striking 
     paragraph (4) (relating to deduction limited by compensation) 
     and by redesignating paragraphs (5), (6), and (7) as 
     paragraphs (4), (5), and (6), respectively.
       (c) Increase in Amount of Deduction Allowed for 
     Contributions to Medical Savings Accounts.--
       (1) In general.--Paragraph (2) of section 220(b) of such 
     Code is amended to read as follows:
       ``(2) Monthly limitation.--The monthly limitation for any 
     month is the amount equal to \1/12\ of the annual deductible 
     (as of the first day of such month) of the individual's 
     coverage under the high deductible health plan.''.
       (2) Conforming amendment.--Clause (ii) of section 
     220(d)(1)(A) of such Code is amended by striking ``75 percent 
     of''.

[[Page 11155]]

       (d) Both Employers and Employees May Contribute to Medical 
     Savings Accounts.--Paragraph (4) of section 220(b) of such 
     Code (as redesignated by subsection (b)(2)(C)) is amended to 
     read as follows:
       ``(4) Coordination with exclusion for employer 
     contributions.--The limitation which would (but for this 
     paragraph) apply under this subsection to the taxpayer for 
     any taxable year shall be reduced (but not below zero) by the 
     amount which would (but for section 106(b)) be includible in 
     the taxpayer's gross income for such taxable year.''.
       (e) Reduction of Permitted Deductibles Under High 
     Deductible Health Plans.--
       (1) In general.--Subparagraph (A) of section 220(c)(2) of 
     such Code (defining high deductible health plan) is amended--
       (A) by striking ``$1,500'' in clause (i) and inserting 
     ``$1,000''; and
       (B) by striking ``$3,000'' in clause (ii) and inserting 
     ``$2,000''.
       (2) Conforming amendment.--Subsection (g) of section 220 of 
     such Code is amended to read as follows:
       ``(g) Cost-of-Living Adjustment.--
       ``(1) In general.--In the case of any taxable year 
     beginning in a calendar year after 1998, each dollar amount 
     in subsection (c)(2) shall be increased by an amount equal 
     to--
       ``(A) such dollar amount, multiplied by
       ``(B) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which such taxable 
     year begins by substituting `calendar year 1997' for 
     `calendar year 1992' in subparagraph (B) thereof.
       ``(2) Special rules.--In the case of the $1,000 amount in 
     subsection (c)(2)(A)(i) and the $2,000 amount in subsection 
     (c)(2)(A)(ii), paragraph (1)(B) shall be applied by 
     substituting `calendar year 2000' for `calendar year 1997'.
       ``(3) Rounding.--If any increase under paragraph (1) or (2) 
     is not a multiple of $50, such increase shall be rounded to 
     the nearest multiple of $50.''.
       (f) Providing Incentives for Preferred Provider 
     Organizations To Offer Medical Savings Accounts.--Clause (ii) 
     of section 220(c)(2)(B) of such Code is amended by striking 
     ``preventive care if'' and all that follows and inserting 
     ``preventive care.''
       (g) Medical Savings Accounts May Be Offered Under Cafeteria 
     Plans.--Subsection (f) of section 125 of such Code is amended 
     by striking ``106(b),''.
       (h) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2001.
                                 ______
                                 
      By Mrs. BOXER:
  S. 1068. A bill to provide refunds for unjust and unreasonable 
charges on electric energy; to the Committee on Energy and Natural 
Resources.
  Mrs. BOXER. Mr. President, earlier this week the Federal Energy 
Regulatory Commission issued an order to provide price mitigation to 
California's electricity market. This order is a stunning turnaround 
for an agency that refused to recognize that this energy crisis is a 
regional problem and that cost-based pricing is in order. However, 
FERC's order does not adequately address past grievances regarding 
refunds for overcharges by the generators.
  Therefore, today I am introducing the Electricity Gouging Relief Act 
in an effort to bring much needed relief to consumers, businesses and 
the State of California from price gouging by electricity generators. 
This legislation helps to right past wrongs by providing rebates in 
cases where companies were engaged in gouging.
  Generators' profits increased on average by 508 percent between 1999 
and 2000. One company, Reliant Energy, experienced a 1,685 percent 
increase in profits in the same time period. This compares to a 16 
percent increase in profits across the electric and gas industry and an 
increase in demand of only four percent.
  My bill would require the Federal Energy Regulatory Commission, FERC, 
to order refunds for past electricity purchases in cases where FERC 
determined that the prices charged by the generators were ``unjust and 
unreasonable.'' The bill would affect electricity sales that took place 
between June 1, 2000--when price spikes first occurred in San Diego and 
June 19, 2001--the day before FERC's order became effective.
  I encourage my colleagues to support this bill. FERC's actions on 
Monday are a step in the right direction. Now, we need to refund 
overcharges by the generators to consumers.
  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. 1068

       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 ``Electricity Gouging Relief 
     Act of 2001''.

     SEC. 2. REFUNDS FOR EXCESSIVE CHARGES.

       Section 206 of the Federal Power Act (16 U.S.C. 824e) is 
     amended by adding at the end the following:
       ``(e) Refunds for Excessive Charges.--
       ``(1) Notwithstanding any other provision of this section, 
     the Commission shall, within 60 days after enactment of this 
     subsection, order a refund for the portion of charges on the 
     transmission or sale or electric energy that are or have been 
     deemed by the Commission to be unjust or unreasonable. Such 
     refunds shall include interest from the date on which the 
     charges were paid.
       ``(2) The refunds ordered under paragraph (1) shall apply 
     to charges paid between June 1, 2000 and June 19, 2001.''.
                                 ______
                                 
      By Mr. LEVIN (for himself, Mr. Kohl, Mr. Feingold, Mr. Schumer, 
        Mr. Johnson, and Ms. Stabenow):
  S. 1069. A bill to amend the Natural Trails System Act to clarify 
Federal authority relating to land acquisition from willing sellers 
from the majority of the trails in the System, and for other purposes; 
to the Committee on Energy and Natural Resources.
  Mr. LEVIN. Mr. President, today I am introducing the Willing Seller 
Amendments of 2001 which would amend the National Trails System Act, 
NTSA, to provide Federal authority to acquire land from willing sellers 
to complete nine national scenic and historic trails authorized under 
the Act. The legislation gives the Federal agencies administering the 
trails the ability to acquire land from willing sellers only. The 
legislation would not commit the Federal Government to purchase any 
land or to spend any money but would allow managers to purchase land to 
protect the national trails as opportunities arise and as funds are 
appropriated.
  For most of the national scenic and historic trails, barely one-half 
of their congressionally authorized length and resources are protected. 
Without willing seller authority, Federal trail managers' hands are 
tied when development threatens important links in the wild landscapes 
of the national scenic trails or in the sites that authenticate the 
stories of the historic trails. With willing seller authority, sections 
of trail can be moved from roads where hikers and other trail users are 
unsafe, and critical historic sites can be preserved for future 
generations to experience. Moreover, this authority protects private 
property rights, as landowners along the nine affected trails are 
currently denied the right to sell land to the Federal Government if 
they desire to do so.
  Willing seller authority is crucial for the North Country National 
Scenic Trail, which runs through my home State of Michigan, because 
completion of the Trail faces significant challenges. These challenges 
which relate to development pressure and the need to cross long 
stretches of private and corporate held lands are common themes 
throughout the seven states linked by the 4,600-mile long North Country 
Trail.
  This legislation is also vital on a national level and accomplishes 
several important goals. First, it restores basic property rights--
Section 10 (c) of the National Trails System Act as currently written 
diminishes the right of thousands of people who own land along four 
national scenic trails and five national historic trails to sell their 
property or easements on their property, by prohibiting federal 
agencies from buying their land. Many of these landowners have offered 
to sell their land to the Federal Government to permanently protect 
important historical resources that their families have protected for 
generations or to maintain the continuity of a national scenic trail. 
Providing this authority to Federal agencies to purchase land from 
willing sellers along these nine trails will restore this basic 
property right to thousands of landowners.
  Second, it restores the ability of Federal agencies to carry out 
their responsibility to protect nationally significant components of 
our nation's cultural, natural and recreational heritage. The National 
Trails System Act

[[Page 11156]]

authorizes establishment of national scenic and historic trails to 
protect important components of our historic and natural heritage. One 
of the fundamental responsibilities given to the Federal agencies 
administering these trails is to protect their important cultural and 
natural resources. Without willing-seller authority, the agencies are 
prevented from directly protecting these resources along nine trails--
nearly one-half of the National Trails System.
  Third, it restores consistency to the National Trails System Act, 
NTSA. Congress enacted the National Trails System Act in 1968 ``. . .to 
provide for the ever-increasing outdoor recreation needs of an 
expanding population and . . . to promote the preservation of, public 
access to, travel within, and enjoyment and appreciation of the open-
air, outdoor areas and historic resources of the Nation . . . by 
instituting a national system of recreation, scenic and historic trails 
. . .'' The agencies are authorized to collaborate with other Federal 
agencies, State and local governments and private organizations in 
planning, developing and managing the trails; to develop uniform 
standards for marking, interpreting and constructing the trails; to 
regulate their use; and to provide grants and technical assistance to 
cooperating agencies and organizations. The NTSA is supposed to provide 
these and other authorities to be applied consistently throughout the 
National Trails System. However, land acquisition authority, an 
essential means for protecting the special resources and continuity 
that are the basis for these trails, has been inconsistently applied. 
The Federal agencies have been given land acquisition authority for 
thirteen of the twenty-two national scenic and historic trails but have 
been denied authority to acquire land for the other nine trails. This 
bill restores consistency to the National Trails System Act by enabling 
the Federal agencies to acquire necessary land for all twenty-two 
national scenic and historic trails.
  Finally, this legislation enables Federal agencies to respond to 
opportunities to protect important resources provided by willing 
sellers. The willing seller land acquisition authority provided for 
these nine trails and subsequent appropriations from the Land and Water 
Conservation Fund will enable the Federal agencies administering them 
to respond to conservation opportunities afforded by willing 
landowners.
  I am pleased today to introduce this important legislation to restore 
parity to the National Trails System and provide authority to protect 
critical resources along the nation's treasured national scenic and 
historic trails.
                                 ______
                                 
      By Mr. REED:
  S. 1070. A bill to amend the XXVII of the Public Health Service Act 
and part 7 of subtitle B of title 1 of the Employee Retirement Income 
Security Act of 1974 to establish standards for the health quality 
improvement of children in managed care plans and other health plans; 
to the Committee on Health, Education, Labor, and Pensions.
  Mr. REED. Mr. President, today I am introducing legislation that I 
believe is very pertinent to the current debate over managed care 
protections. My longstanding concern has been to ensure that the needs 
of children in managed care are not left out of the debate. That is why 
I am reintroducing the Children's Health Insurance Accountability Act.
  This legislation sets the standard for what kinds of protections 
ought to be in place for children who receive care through health 
maintenance organizations. Specifically, this bill provides common 
sense protections for children in managed care plans such as: access to 
necessary pediatric primary care and specialty services; appeal rights 
that address the special needs of children, including an expedited 
review if a child's life or development is in jeopardy; quality 
measurements of health outcomes unique to children; utilization review 
rules that are specific to children with evaluation from those with 
pediatric expertise; and child-specific information requirements that 
will help parents and employers choose health plans on the basis of 
care provided to children.
  I am pleased that the major provisions of this legislation are 
incorporated into the McCain-Edwards-Kennedy Patient Protection bill, 
S. 1052. It is difficult enough to have a sick child, but to face 
barrier after barrier to necessary care for your child is 
unconscionable. Our current system is often failing our kids when they 
most need us. It is this simple: if we do not have health plan 
standards, there is no guarantee that we are providing adequate care 
for our children. And when it comes to our children, we should not take 
risks.
  Not one of us can deny that managed care plays a valid role in our 
health care system. Managed care's emphasis on preventive care has 
benefits for young and old alike. And HMOs have resulted in lower co-
payments for consumers and higher immunization rates for our children. 
However, many questions have arisen about patient access to medical 
services and the consequences of cost-cutting measures and other 
incentives under managed care.
  The Children's Health Insurance Accountability Act seeks to address 
these concerns as they relate to children. Children are not small 
adults and often have very different health and developmental needs. We 
should be sure that we are always vigilant when it comes to their 
health and well-being, not only in the context of patient protection 
legislation, but in other policy measures we consider this year.
  I am pleased that this legislation is supported by a number of 
children's health and advocacy organizations, including the American 
Academy of Pediatrics, the Children's Defense Fund and the National 
Association of Children's Hospitals.
  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. 1070

       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 ``Children's Health Insurance 
     Accountability Act of 2001''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Children have health and development needs that are 
     markedly different than those for the adult population.
       (2) Children experience complex and continuing changes 
     during the continuum from birth to adulthood in which 
     appropriate health care is essential for optimal development.
       (3) The vast majority of work done on development methods 
     to assess the effectiveness of health care services and the 
     impact of medical care on patient outcomes and patient 
     satisfaction has been focused on adults.
       (4) Health outcome measures need to be age, gender, and 
     developmentally appropriate to be useful to families and 
     children.
       (5) Costly disorders of adulthood often have their origins 
     in childhood, making early access to effective health 
     services in childhood essential.
       (6) More than 200 chronic conditions, disabilities and 
     diseases affect children, including asthma, diabetes, sickle 
     cell anemia, spina bifida, epilepsy, autism, cerebral palsy, 
     congenital heart disease, mental retardation, and cystic 
     fibrosis. These children need the services of specialists who 
     have in depth knowledge about their particular condition.
       (7) Children's patterns of illness, disability and injury 
     differ dramatically from adults.

     SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

       (a) Patient Protection Standards.--Title XXVII of the 
     Public Health Service Act is amended--
       (1) by redesignating part C as part D; and
       (2) by inserting after part B the following:

            ``Part C--Children's Health Protection Standards

     ``SEC. 2770. ACCESS TO CARE.

       ``(a) Access to Appropriate Primary Care Providers.--
       ``(1) In general.--If a group health plan, or a health 
     insurance issuer in connection with the provision of health 
     insurance coverage, requires or provides for an enrollee to 
     designate a participating primary care provider for a child 
     of such enrollee--
       ``(A) the plan or issuer shall permit the enrollee to 
     designate a physician who specializes in pediatrics as the 
     child's primary care provider; and
       ``(B) if such an enrollee has not designated such a 
     provider for the child, the plan or issuer shall consider 
     appropriate pediatric expertise in mandatorily assigning such 
     an enrollee to a primary care provider.

[[Page 11157]]

       ``(2) Construction.--Nothing in paragraph (1) shall waive 
     any requirements of coverage relating to medical necessity or 
     appropriateness with respect to coverage of services.
       ``(b) Access to Pediatric Specialty Services.--
       ``(1) Referral to specialty care for children requiring 
     treatment by specialists.--
       ``(A) In general.--In the case of a child who is covered 
     under a group health plan, or health insurance coverage 
     offered by a health insurance issuer and who has a mental or 
     physical condition, disability, or disease of sufficient 
     seriousness and complexity to require diagnosis, evaluation 
     or treatment by a specialist, the plan or issuer shall make 
     or provide for a referral to a specialist who has extensive 
     experience or training, and is available and accessible to 
     provide the treatment for such condition or disease, 
     including the choice of a nonprimary care physician 
     specialist participating in the plan or a referral to a 
     nonparticipating provider as provided for under subparagraph 
     (D) if such a provider is not available within the plan.
       ``(B) Specialist defined.--For purposes of this subsection, 
     the term `specialist' means, with respect to a condition, 
     disability, or disease, a health care practitioner, facility, 
     or center (such as a center of excellence) that has extensive 
     pediatric expertise through appropriate training or 
     experience to provide high quality care in treating the 
     condition, disability or disease.
       ``(C) Referrals to participating providers.--A plan or 
     issuer is not required under subparagraph (A) to provide for 
     a referral to a specialist that is not a participating 
     provider, unless the plan or issuer does not have an 
     appropriate specialist that is available and accessible to 
     treat the enrollee's condition and that is a participating 
     provider with respect to such treatment.
       ``(D) Treatment of nonparticipating providers.--If a plan 
     or issuer refers a child enrollee to a nonparticipating 
     specialist, services provided pursuant to the referral shall 
     be provided at no additional cost to the enrollee beyond what 
     the enrollee would otherwise pay for services received by 
     such a specialist that is a participating provider.
       ``(E) Specialists as primary care providers.--A plan or 
     issuer shall have in place a procedure under which a child 
     who is covered under health insurance coverage provided by 
     the plan or issuer who has a condition or disease that 
     requires specialized medical care over a prolonged period of 
     time shall receive a referral to a pediatric specialist 
     affiliated with the plan, or if not available within the 
     plan, to a nonparticipating provider for such condition and 
     such specialist may be responsible for and capable of 
     providing and coordinating the child's primary and specialty 
     care.
       ``(2) Standing referrals.--
       ``(A) In general.--A group health plan, or health insurance 
     issuer in connection with the provision of health insurance 
     coverage of a child, shall have a procedure by which a child 
     who has a condition, disability, or disease that requires 
     ongoing care from a specialist may request and obtain a 
     standing referral to such specialist for treatment of such 
     condition. If the primary care provider in consultation with 
     the medical director of the plan or issuer and the specialist 
     (if any), determines that such a standing referral is 
     appropriate, the plan or issuer shall authorize such a 
     referral to such a specialist. Such standing referral shall 
     be consistent with a treatment plan.
       ``(B) Treatment plans.--A group health plan, or health 
     insurance issuer, with the participation of the family and 
     the health care providers of the child, shall develop a 
     treatment plan for a child who requires ongoing care that 
     covers a specified period of time (but in no event less than 
     a 6-month period). Services provided for under the treatment 
     plan shall not require additional approvals or referrals 
     through a gatekeeper.
       ``(C) Terms of referral.--The provisions of subparagraph 
     (C) and (D) of paragraph (1) shall apply with respect to 
     referrals under subparagraph (A) in the same manner as they 
     apply to referrals under paragraph (1)(A).
       ``(c) Adequacy of Access.--For purposes of subsections (a) 
     and (b), a group health plan or health insurance issuer in 
     connection with health insurance coverage shall ensure that a 
     sufficient number, distribution, and variety of qualified 
     participating health care providers are available so as to 
     ensure that all covered health care services, including 
     specialty services, are available and accessible to all 
     enrollees in a timely manner.
       ``(d) Coverage of Emergency Services.--
       ``(1) In general.--If a group health plan, or health 
     insurance coverage offered by a health insurance issuer, 
     provides any benefits for children with respect to emergency 
     services (as defined in paragraph (2)(A)), the plan or issuer 
     shall cover emergency services furnished under the plan or 
     coverage--
       ``(A) without the need for any prior authorization 
     determination;
       ``(B) whether or not the physician or provider furnishing 
     such services is a participating physician or provider with 
     respect to such services; and
       ``(C) without regard to any other term or condition of such 
     coverage (other than exclusion of benefits, or an affiliation 
     or waiting period, permitted under section 2701).
       ``(2) Definitions.--In this subsection:
       ``(A) Emergency medical condition based on prudent 
     layperson standard.--The term `emergency medical condition' 
     means a medical condition manifesting itself by acute 
     symptoms of sufficient severity (including severe pain) such 
     that a prudent layperson, who possesses an average knowledge 
     of health and medicine, could reasonably expect the absence 
     of immediate medical attention to result in a condition 
     described in clause (i), (ii), or (iii) of section 
     1867(e)(1)(A) of the Social Security Act.
       ``(B) Emergency services.--The term `emergency services' 
     means--
       ``(i) a medical screening examination (as required under 
     section 1867 of the Social Security Act) that is within the 
     capability of the emergency department of a hospital, 
     including ancillary services routinely available to the 
     emergency department to evaluate an emergency medical 
     condition (as defined in subparagraph (A)); and
       ``(ii) within the capabilities of the staff and facilities 
     available at the hospital, such further medical examination 
     and treatment as are required under section 1867 of such Act 
     to stabilize the patient.
       ``(3) Reimbursement for maintenance care and post-
     stabilization care.--A group health plan, and health 
     insurance issuer offering health insurance coverage, shall 
     provide, in covering services other than emergency services, 
     for reimbursement with respect to services which are 
     otherwise covered and which are provided to an enrollee other 
     than through the plan or issuer if the services are 
     maintenance care or post-stabilization care covered under the 
     guidelines established under section 1852(d) of the Social 
     Security Act (relating to promoting efficient and timely 
     coordination of appropriate maintenance and post-
     stabilization care of an enrollee after an enrollee has been 
     determined to be stable).
       ``(e) Prohibition on Financial Barriers.--A health 
     insurance issuer in connection with the provision of health 
     insurance coverage may not impose any cost sharing for 
     pediatric specialty services provided under such coverage to 
     enrollee children in amounts that exceed the cost-sharing 
     required for other specialty care under such coverage.
       ``(f) Children With Special Health Care Needs.--A health 
     insurance issuer in connection with the provision of health 
     insurance coverage shall ensure that such coverage provides 
     special consideration for the provision of services to 
     enrollee children with special health care needs. Appropriate 
     procedures shall be implemented to provide care for children 
     with special health care needs. The development of such 
     procedures shall include participation by the families of 
     such children.
       ``(g) Definitions.--In this part:
       ``(1) Child.--The term `child' means an individual who is 
     under 19 years of age.
       ``(2) Children with special health care needs.--The term 
     `children with special health care needs' means those 
     children who have or are at elevated risk for chronic 
     physical, developmental, behavioral or emotional conditions 
     and who also require health and related services of a type 
     and amount not usually required by children.

     ``SEC. 2771. CONTINUITY OF CARE.

       ``(a) In General.--If a contract between a health insurance 
     issuer, in connection with the provision of health insurance 
     coverage, and a health care provider is terminated (other 
     than by the issuer for failure to meet applicable quality 
     standards or for fraud) and an enrollee is undergoing a 
     course of treatment from the provider at the time of such 
     termination, the issuer shall--
       ``(1) notify the enrollee of such termination, and
       ``(2) subject to subsection (c), permit the enrollee to 
     continue the course of treatment with the provider during a 
     transitional period (provided under subsection (b)).
       ``(b) Transitional Period.--
       ``(1) In general.--Except as provided in paragraphs (2) 
     through (4), the transitional period under this subsection 
     shall extend for at least--
       ``(A) 60 days from the date of the notice to the enrollee 
     of the provider's termination in the case of a primary care 
     provider, or
       ``(B) 120 days from such date in the case of another 
     provider.
       ``(2) Institutional care.--The transitional period under 
     this subsection for institutional or inpatient care from a 
     provider shall extend until the discharge or termination of 
     the period of institutionalization and shall include 
     reasonable follow-up care related to the institutionalization 
     and shall also include institutional care scheduled prior to 
     the date of termination of the provider status.
       ``(3) Pregnancy.--If--
       ``(A) an enrollee has entered the second trimester of 
     pregnancy at the time of a provider's termination of 
     participation, and
       ``(B) the provider was treating the pregnancy before date 
     of the termination,
     the transitional period under this subsection with respect to 
     provider's treatment of the pregnancy shall extend through 
     the provision of post-partum care directly related to the 
     delivery.
       ``(4) Terminal illness.--
       ``(A) In general.--If--
       ``(i) an enrollee was determined to be terminally ill (as 
     defined in subparagraph (B))

[[Page 11158]]

     at the time of a provider's termination of participation, and
       ``(ii) the provider was treating the terminal illness 
     before the date of termination,
     the transitional period under this subsection shall extend 
     for the remainder of the enrollee's life for care directly 
     related to the treatment of the terminal illness.
       ``(B) Definition.--In subparagraph (A), an enrollee is 
     considered to be `terminally ill' if the enrollee has a 
     medical prognosis that the enrollee's life expectancy is 6 
     months or less.
       ``(c) Permissible Terms and Conditions.--An issuer may 
     condition coverage of continued treatment by a provider under 
     subsection (a)(2) upon the provider agreeing to the following 
     terms and conditions:
       ``(1) The provider agrees to continue to accept 
     reimbursement from the issuer at the rates applicable prior 
     to the start of the transitional period as payment in full.
       ``(2) The provider agrees to adhere to the issuer's quality 
     assurance standards and to provide to the issuer necessary 
     medical information related to the care provided.
       ``(3) The provider agrees otherwise to adhere to the 
     issuer's policies and procedures, including procedures 
     regarding referrals and obtaining prior authorization and 
     providing services pursuant to a treatment plan approved by 
     the issuer.

     ``SEC. 2772. CONTINUOUS QUALITY IMPROVEMENT.

       ``(a) In General.--A health insurance issuer that offers 
     health insurance coverage for children shall establish and 
     maintain an ongoing, internal quality assurance program that 
     at a minimum meets the requirements of subsection (b).
       ``(b) Requirements.--The internal quality assurance program 
     of an issuer under subsection (a) shall--
       ``(1) establish and measure a set of health care, 
     functional assessments, structure, processes and outcomes, 
     and quality indicators that are unique to children and based 
     on nationally accepted standards or guidelines of care;
       ``(2) maintain written protocols consistent with recognized 
     clinical guidelines or current consensus on the pediatric 
     field, to be used for purposes of internal utilization 
     review, with periodic updating and evaluation by pediatric 
     specialists to determine effectiveness in controlling 
     utilization;
       ``(3) provide for peer review by health care professionals 
     of the structure, processes, and outcomes related to the 
     provision of health services, including pediatric review of 
     pediatric cases;
       ``(4) include in member satisfaction surveys, questions on 
     child and family satisfaction and experience of care, 
     including care to children with special needs;
       ``(5) monitor and evaluate the continuity of care with 
     respect to children;
       ``(6) include pediatric measures that are directed at 
     meeting the needs of at-risk children and children with 
     chronic conditions, disabilities and severe illnesses;
       ``(7) maintain written guidelines to ensure the 
     availability of medications appropriate to children;
       ``(8) use focused studies of care received by children with 
     certain types of chronic conditions and disabilities and 
     focused studies of specialized services used by children with 
     chronic conditions and disabilities;
       ``(9) monitor access to pediatric specialty services; and
       ``(10) monitor child health care professional satisfaction.
       ``(c) Utilization Review Activities.--
       ``(1) Compliance with requirements.--
       ``(A) In general.--A health insurance issuer that offers 
     health insurance coverage for children shall conduct 
     utilization review activities in connection with the 
     provision of such coverage only in accordance with a 
     utilization review program that meets at a minimum the 
     requirements of this subsection.
       ``(B) Definitions.--In this subsection:
       ``(i) Clinical peers.--The term `clinical peer' means, with 
     respect to a review, a physician or other health care 
     professional who holds a non-restricted license in a State 
     and in the same or similar specialty as typically manages the 
     pediatric medical condition, procedure, or treatment under 
     review.
       ``(ii) Health care professional.--The term `health care 
     professional' means a physician or other health care 
     practitioner licensed or certified under State law to provide 
     health care services and who is operating within the scope of 
     such licensure or certification.
       ``(iii) Utilization review.--The terms `utilization review' 
     and `utilization review activities' mean procedures used to 
     monitor or evaluate the clinical necessity, appropriateness, 
     efficacy, or efficiency of health care services, procedures 
     or settings for children, and includes prospective review, 
     concurrent review, second opinions, case management, 
     discharge planning, or retrospective review specific to 
     children.
       ``(2) Written policies and criteria.--
       ``(A) Written policies.--A utilization review program shall 
     be conducted consistent with written policies and procedures 
     that govern all aspects of the program.
       ``(B) Use of written criteria.--A utilization review 
     program shall utilize written clinical review criteria 
     specific to children and developed pursuant to the program 
     with the input of appropriate physicians, including 
     pediatricians, nonprimary care pediatric specialists, and 
     other child health professionals.
       ``(C) Administration by health care professionals.--A 
     utilization review program shall be administered by qualified 
     health care professionals, including health care 
     professionals with pediatric expertise who shall oversee 
     review decisions.
       ``(3) Use of qualified, independent personnel.--
       ``(A) In general.--A utilization review program shall 
     provide for the conduct of utilization review activities only 
     through personnel who are qualified and, to the extent 
     required, who have received appropriate pediatric or child 
     health training in the conduct of such activities under the 
     program.
       ``(B) Peer review of adverse clinical determinations.--A 
     utilization review program shall provide that clinical peers 
     shall evaluate the clinical appropriateness of adverse 
     clinical determinations and divergent clinical options.

     ``SEC. 2773. APPEALS AND GRIEVANCE MECHANISMS FOR CHILDREN.

       ``(a) Internal Appeals Process.--A health insurance issuer 
     in connection with the provision of health insurance coverage 
     for children shall establish and maintain a system to provide 
     for the resolution of complaints and appeals regarding all 
     aspects of such coverage. Such a system shall include an 
     expedited procedure for appeals on behalf of a child enrollee 
     in situations in which the time frame of a standard appeal 
     would jeopardize the life, health, or development of the 
     child.
       ``(b) External Appeals Process.--A health insurance issuer 
     in connection with the provision of health insurance coverage 
     for children shall provide for an independent external review 
     process that meets the following requirements:
       ``(1) External appeal activities shall be conducted through 
     clinical peers, a physician or other health care professional 
     who is appropriately credentialed in pediatrics with the same 
     or similar specialty and typically manages the condition, 
     procedure, or treatment under review or appeal.
       ``(2) External appeal activities shall be conducted through 
     an entity that has sufficient pediatric expertise, including 
     subspeciality expertise, and staffing to conduct external 
     appeal activities on a timely basis.
       ``(3) Such a review process shall include an expedited 
     procedure for appeals on behalf of a child enrollee in which 
     the time frame of a standard appeal would jeopardize the 
     life, health, or development of the child.

     ``SEC. 2774. ACCOUNTABILITY THROUGH DISTRIBUTION OF 
                   INFORMATION.

       ``(a) In General.--A health insurance issuer in connection 
     with the provision of health insurance coverage for children 
     shall submit to enrollees (and prospective enrollees), and 
     make available to the public, in writing the health-related 
     information described in subsection (b).
       ``(b) Information.--The information to be provided under 
     subsection (a) shall include a report of measures of 
     structures, processes, and outcomes regarding each health 
     insurance product offered to participants and dependents in a 
     manner that is separate for both the adult and child 
     enrollees, using measures that are specific to each group.''.
       (b) Application to Group Health Insurance Coverage.--
       (1) In general.--Subpart 2 of part A of title XXVII of the 
     Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is 
     amended by adding at the end the following:

     ``SEC. 2707. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS.

       ``(a) In General.--Each health insurance issuer shall 
     comply with children's health accountability requirement 
     under part C with respect to group health insurance coverage 
     it offers.
       ``(b) Assuring Coordination.--The Secretary of Health and 
     Human Services and the Secretary of Labor shall ensure, 
     through the execution of an interagency memorandum of 
     understanding between such Secretaries, that--
       ``(1) regulations, rulings, and interpretations issued by 
     such Secretaries relating to the same matter over which such 
     Secretaries have responsibility under part C (and this 
     section) and section 714 of the Employee Retirement Income 
     Security Act of 1974 are administered so as to have the same 
     effect at all times; and
       ``(2) coordination of policies relating to enforcing the 
     same requirements through such Secretaries in order to have a 
     coordinated enforcement strategy that avoids duplication of 
     enforcement efforts and assigns priorities in enforcement.''.
       (2) Conforming amendment.--Section 2792 of the Public 
     Health Service Act (42 U.S.C. 300gg-92) is amended by 
     inserting ``and section 2707(b)'' after ``of 1996''.
       (c) Application to Individual Health Insurance Coverage.--
     Part B of title XXVII of the Public Health Service Act (42 
     U.S.C. 300gg-41 et seq.) is amended by inserting after 
     section 2752 the following:

     ``SEC. 2753. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS.

       ``Each health insurance issuer shall comply with children's 
     health accountability requirements under part C with respect 
     to individual health insurance coverage it offers.''.
       (d) Modification of Preemption Standards.--

[[Page 11159]]

       (1) Group health insurance coverage.--Section 2723 of the 
     Public Health Service Act (42 U.S.C. 300gg-23) is amended--
       (A) in subsection (a)(1), by striking ``subsection (b)'' 
     and inserting ``subsection (b) and (c)'';
       (B) by redesignating subsections (c) and (d) as subsections 
     (d) and (e), respectively; and
       (C) by inserting after subsection (b) the following new 
     subsection:
       ``(c) Special Rules in Case of Children's Health 
     Accountability Requirements.--Subject to subsection (a)(2), 
     the provisions of section 2707 and part C, and part D insofar 
     as it applies to section 2707 or part C, shall not prevent a 
     State from establishing requirements relating to the subject 
     matter of such provisions so long as such requirements are at 
     least as stringent on health insurance issuers as the 
     requirements imposed under such provisions.''.
       (2) Individual health insurance coverage.--Section 2762 of 
     the Public Health Service Act (42 U.S.C. 300gg-62) is 
     amended--
       (A) in subsection (a), by striking ``subsection (b), 
     nothing in this part'' and inserting ``subsections (b) and 
     (c)''; and
       (B) by adding at the end the following new subsection:
       ``(c) Special Rules in Case of Children's Health 
     Accountability Requirements.--Subject to subsection (b), the 
     provisions of section 2753 and part C, and part D insofar as 
     it applies to section 2753 or part C, shall not prevent a 
     State from establishing requirements relating to the subject 
     matter of such provisions so long as such requirements are at 
     least as stringent on health insurance issuers as the 
     requirements imposed under such section.''.

     SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY 
                   ACT OF 1974.

       (a) In General.--Subpart B of part 7 of subtitle B of title 
     I of (29 U.S.C. 1185 et seq.) is amended by adding at the end 
     the following:

     ``SEC. 714. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS.

       ``(a) In General.--Subject to subsection (b), the 
     provisions of part C of title XXVII of the Public Health 
     Service Act shall apply under this subpart and part to a 
     group health plan (and group health insurance coverage 
     offered in connection with a group health plan) as if such 
     part were incorporated in this section.
       ``(b) Application.--In applying subsection (a) under this 
     subpart and part, any reference in such part C--
       ``(1) to health insurance coverage is deemed to be a 
     reference only to group health insurance coverage offered in 
     connection with a group health plan and to also be a 
     reference to coverage under a group health plan;
       ``(2) to a health insurance issuer is deemed to be a 
     reference only to such an issuer in relation to group health 
     insurance coverage or, with respect to a group health plan, 
     to the plan;
       ``(3) to the Secretary is deemed to be a reference to the 
     Secretary of Labor;
       ``(4) to an applicable State authority is deemed to be a 
     reference to the Secretary of Labor; and
       ``(5) to an enrollee with respect to health insurance 
     coverage is deemed to include a reference to a participant or 
     beneficiary with respect to a group health plan.''.
       (b) Modification of Preemption Standards.--Section 731 of 
     the Employee Retirement Income Security Act of 1974 (42 
     U.S.C. 1191) is amended--
       (1) in subsection (a)(1), by striking ``subsection (b)'' 
     and inserting ``subsections (b) and (c)'';
       (2) by redesignating subsections (c) and (d) as subsections 
     (d) and (e), respectively; and
       (3) by inserting after subsection (b) the following new 
     subsection:
       ``(c) Special Rules in Case of Patient Accountability 
     Requirements.--Subject to subsection (a)(2), the provisions 
     of section 714, shall not prevent a State from establishing 
     requirements relating to the subject matter of such 
     provisions so long as such requirements are at least as 
     stringent on group health plans and health insurance issuers 
     in connection with group health insurance coverage as the 
     requirements imposed under such provisions.''.
       (c) Conforming Amendments.--
       (1) Section 732(a) of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1185(a)) is amended by 
     striking ``section 711'' and inserting ``sections 711 and 
     714''.
       (2) The table of contents in section 1 of the Employee 
     Retirement Income Security Act of 1974 is amended by 
     inserting after the item relating to section 713 the 
     following new item:

``Sec. 714. Children's health accountability standards.''.

     SEC. 4. STUDIES.

       (a) By Secretary.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall conduct a study, and prepare and submit to 
     Congress a report, concerning--
       (1) the unique characteristics of patterns of illness, 
     disability, and injury in children;
       (2) the development of measures of quality of care and 
     outcomes related to the health care of children; and
       (3) the access of children to primary mental health 
     services and the coordination of managed behavioral health 
     services.
       (b) By GAO.--
       (1) Managed care.--Not later than 1 year after the date of 
     enactment of this Act, the General Accounting Office shall 
     conduct a study, and prepare and submit to the Committee on 
     Labor and Human Resources of the Senate and the Committee on 
     Commerce of the House of Representatives a report, 
     concerning--
       (A) an assessment of the structure and performance of non-
     governmental health plans, medicaid managed care 
     organizations, plans under title XIX of the Social Security 
     Act (42 U.S.C. 1396 et seq.), and the program under title XXI 
     of the Social Security Act (42 U.S.C. 1397aa et seq.) serving 
     the needs of children with special health care needs;
       (B) an assessment of the structure and performance of non-
     governmental plans in serving the needs of children as 
     compared to medicaid managed care organizations under title 
     XIX of the Social Security Act (42 U.S.C. 1396 et seq.); and
       (C) the emphasis that private managed care health plans 
     place on primary care and the control of services as it 
     relates to care and services provided to children with 
     special health care needs.
       (2) Plan survey.--Not later than 1 year after the date of 
     enactment of this Act, the General Accounting Office shall 
     prepare and submit to the Committee on Labor and Human 
     Resources of the Senate and the Committee on Commerce of the 
     House of Representatives a report that contains a survey of 
     health plan activities that address the unique health needs 
     of adolescents, including quality measures for adolescents 
     and innovative practice arrangement.
                                 ______
                                 
      By Mr. INHOFE:
  S. 1073. A bill to establish a National Commission to Eliminate Waste 
in Government; to the Committee on Government Affairs.
  Mr. INHOFE. Mr. President, today I rise to bring attention to an 
issue that affects all Americans, government waste. As we all know, the 
Federal Government is infamous for its profligate programs and 
approaches to problem solving. In the last decade, we have seen 
inefficiency of mammoth proportions within the government.
  As a result, I have introduced legislation that would establish a 
national commission to eliminate government waste. This act would 
resurrect President Reagan's work to find an equitable way to enact 
fiscal responsibility and accountability within the government. During 
the Reagan Administration, a private sector study of government was 
commissioned to dispose of Federal waste, mismanagement, and abuse. Led 
by industrialist J. Peter Grace, the Grace Commission produced 47 
reports with 2,478 recommendations. As a result of this study, 
President Reagan issued executive orders that saved the Federal 
Government more than $110 billion.
  Today, many Federal agencies still use cumbersome bureaucratic 
procedures. The National Commission to Eliminate Waste in Government 
Act would establish a commission to conduct a private sector survey on 
management and cost control within the government. It would also 
provide an opportunity for the commission to review existing reports on 
government waste. Because the commission would be funded, staffed, and 
equipped by the private sector, it would not cost the government one 
dime.
  I urge my colleagues to support this end to government waste and the 
beginning of discipline and efficiency within our government.
                                 ______
                                 
      By Mr. GRASSLEY (for himself, Mr. Biden, Mr. Smith of Oregon, and 
        Mr. Daschle):
  S. 1075. A bill to extend and modify the Drug-Free Communities 
Support Program, to authorize a National Community Antidrug Coalition 
Institute, and for other purposes; to the Committee on the Judiciary.
  Mr. GRASSLEY. Mr. President, I rise today to introduce legislation to 
re-authorize the Drug Free Communities Act. I am pleased to be joined 
by my colleagues, Senator Biden, Senator Smith, and Senator Daschle in 
introducing this legislation which will continue for another 5 years 
the successes that we have found with Drug Free Communities Program. In 
addition, it builds upon the successes that coalitions have had by 
encouraging them to establish a coalition mentoring program for nearby 
communities. Finally, this act will authorize funding for the National 
Anti-Drug Coalition Institute, which will provide education,

[[Page 11160]]

training, and technical assistance to leaders of community coalitions.
  Substance abuse remains a problem in communities across the country. 
Substance abuse is the cause of or associated with many of today's 
problems, but is a preventable behavior. Community anti-drug coalitions 
are implementing long-term strategies to address the problem of 
substance abuse in their communities. By bringing together a cross-
section of the community to address a common problem, community 
coalitions are discovering and implementing unique community solutions 
to reduce and prevent the incidence of substance abuse in their 
communities. And that idea, that communities are best suited to address 
their own problems, is the underlying premise that has been proven with 
the success of the Drug Free Communities program.
  There are three key features to the Drug Free Communities Act. First, 
communities must take the initiative. In order to receive support, a 
community coalition must demonstrate that there is a long-term 
commitment to address teen-drug use. It must have a sustainable 
coalition that includes the involvement of representatives from a wide 
variety of community activists.
  In addition, every coalition must show that it can sustain itself. 
Community coalitions must be in existence for at least 6 months before 
applying. They are only eligible to receive support if they can match 
these donations dollar for dollar with non-Federal funding, up to 
$100,000 per coalition.
  An Advisory Commission, consisting of local community leaders, and 
State and national experts in the field of substance abuse, has worked 
closely with the Office of National Drug Control Policy to oversee the 
successful management and growth of this grant program. Because of this 
partnership, grants have gone to communities and programs that can make 
a difference in the lives of our children.
  Today, we have better evidence that coalitions are working, that they 
are making a difference. A recent study sponsored by the Annie E. Casey 
Foundation documented the difference that eight community coalitions, 
all of which have received funding through the Drug Free Communities 
program, from around the country have made in their communities.
  In addition to continuing this successful program, this re-
authorization legislation adds the possibility for a supplemental grant 
to the Drug-Free Communities Grant Program. The supplemental grant is 
available to any coalition that has been in existence for at least 5 
years, achieved measurable results in youth substance abuse prevention 
and treatment, have staff or Coalition members willing to serve as 
mentors for persons interested in starting or expanding a Coalition in 
their community, identified demonstrable support from members of the 
identified community, and have created a detailed plan for mentoring 
either newly formed or developing Coalitions.
  Coalitions receiving the supplemental grant must use these funds to 
support and encourage the development of new, self-supporting community 
coalitions focused on the prevention and treatment of substance abuse 
in the new coalition's community. This supplemental grant can be 
renewed provided the recipient coalition continues to meet the 
underlying criteria and has made progress in the development of new 
coalitions.
  Starting a new anti-drug coalition is a difficult exercise, which 
makes the success of these coalitions I mentioned earlier all the more 
remarkable. But I also know this from personal experience. For the past 
4 years, I have worked with leaders from across my State of Iowa to 
start and grow the Face It Together Coalition, a State-wide, anti-drug 
coalition designed to bring together people from all walks of life, 
business leaders, doctors and nurses, law enforcement, school 
professionals, members of the media, and so on, to work together toward 
a common goal: keeping kids drug free.
  In working with FIT, it has become clear that by working together, 
everyone can accomplish more. This is a solid, grass-roots initiative 
that can work. But it hasn't been an easy process, and it will continue 
to require the dedication and commitment of all of our board members. 
One of the biggest challenges that we face has not been finding ideas 
of what to do, or even finding effective ongoing projects in the State, 
but identifying and securing funding to support the expansion of our 
activities. Much can and has been done by volunteers, and through the 
networking connections that the Board members are able to bring to the 
table.
  In addition, this legislation will authorize $2 million in federal 
funding for two years for the National Community Anti-Drug Coalition 
Institute. Modeled after the success we have seen from the National 
Drug Court Institute, this national non-profit organization will 
represent, provide technical assistance and training, and have special 
expertise and broad, national-level experience in community anti-drug 
coalitions.
  The funding for the Institute will be to 1. provide education, 
training, and technical assistance to key members of community anti-
drug coalitions, 2. develop and disseminate evaluation tools, 
mechanisms, and measures to assess and document coalition performance, 
and 3. bridge the gap between research and practice by providing 
community coalitions with practical information based on the most 
current research on coalition-related issues. The Institute is expected 
to last for more than 2 years, and to pursue and obtain additional 
funding from sources other than the Federal Government.
  In conclusion, I encourage all of my colleagues to join me in 
supporting this legislation. It is supported by the Administration. It 
has the support of communities all across the Nation. The Drug Free 
Communities Program works. I look forward to working with my colleagues 
here and in the House to ensure quick passage.
  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. 1075

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

     SECTION 1. EXTENSION OF DRUG-FREE COMMUNITIES SUPPORT 
                   PROGRAM.

       (a) Findings.--Congress makes the following findings:
       (1) In the next 15 years, the youth population in the 
     United States will grow by 21 percent, adding 6,500,000 youth 
     to the population of the United States. Even if drug use 
     rates remain constant, there will be a huge surge in drug-
     related problems, such as academic failure, drug-related 
     violence, and HIV incidence, simply due to this population 
     increase.
       (2) According to the 1994-1996 National Household Survey, 
     60 percent of students age 12 to 17 who frequently cut 
     classes and who reported delinquent behavior in the past 6 
     months used marijuana 52 days or more in the previous year.
       (3) The 2000 Washington Kids Count survey conducted by the 
     University of Washington reported that students whose peers 
     have little or no involvement with drinking and drugs have 
     higher math and reading scores than students whose peers had 
     low level drinking or drug use.
       (4) Substance abuse prevention works. In 1999, only 10 
     percent of teens saw marijuana users as popular, compared to 
     17 percent in 1998 and 19 percent in 1997. The rate of past-
     month use of any drug among 12 to 17 year olds declined 26 
     percent between 1997 and 1999. Marijuana use for sixth 
     through eighth graders is at the lowest point in 5 years, as 
     is use of cocaine, inhalants, and hallucinogens.
       (5) Community Anti-Drug Coalitions throughout the United 
     States are successfully developing and implementing 
     comprehensive, long-term strategies to reduce substance abuse 
     among youth on a sustained basis. For example:
       (A) The Boston Coalition brought college and university 
     presidents together to create the Cooperative Agreement on 
     Underage Drinking. This agreement represents the first 
     coordinated effort of Boston's many institutions of higher 
     education to address issues such as binge drinking, underage 
     drinking, and changing the norms surrounding alcohol abuse 
     that exist on college and university campuses.
       (B) The Miami Coalition used a three-part strategy to 
     decrease the percentage of high school seniors who reported 
     using marijuana at least once during the most recent 30-day 
     period. The development of a media strategy, the creation of 
     a network of prevention agencies, and discussions with high 
     school students about the dangers of marijuana all

[[Page 11161]]

     contributed to a decrease in the percentage of seniors who 
     reported using marijuana from more than 22 percent in 1995 to 
     9 percent in 1997. The Miami Coalition was able to achieve 
     these results while national rates of marijuana use were 
     increasing.
       (C) The Nashville Prevention Partnership worked with 
     elementary and middle school children in an attempt to 
     influence them toward positive life goals and discourage them 
     from using substances. The Partnership targeted an area in 
     East Nashville and created after school programs, mentoring 
     opportunities, attendance initiatives, and safe passages to 
     and from school. Attendance and test scores increased as a 
     result of the program.
       (D) At a youth-led town meeting sponsored by the Bering 
     Strait Community Partnership in Nome, Alaska, youth 
     identified a need for a safe, substance-free space. With help 
     from a variety of community partners, the Partnership staff 
     and youth members created the Java Hut, a substance-free 
     coffeehouse designed for youth. The Java Hut is helping to 
     change norms in the community by providing a fun, youth-
     friendly atmosphere and activities that are not centered 
     around alcohol or marijuana.
       (E) Portland's Regional Drug Initiative (RDI) has promoted 
     the establishment of drug-free workplaces among the city's 
     large and small employers. More than 3,000 employers have 
     attended an RDI training session, and of those, 92 percent 
     have instituted drug-free workplace policies. As a result, 
     there has been a 5.5 percent decrease in positive workplace 
     drug tests.
       (F) San Antonio Fighting Back worked to increase the age at 
     which youth first used illegal substances. Research suggests 
     that the later the age of first use, the lower the risk that 
     a young person will become a regular substance abuser. As a 
     result, the age of first illegal drug use increased from 9.4 
     years in 1992 to 13.5 years in 1997.
       (G) In 1990, multiple data sources confirmed a trend of 
     increased alcohol use by teenagers in the Troy community. 
     Using its ``multiple strategies over multiple sectors'' 
     approach, the Troy Coalition worked with parents, physicians, 
     students, coaches, and others to address this problem from 
     several angles. As a result, the rate of twelfth grade 
     students who had consumed alcohol in the past month decreased 
     from 62.1 percent to 53.3 percent between 1991 and 1998, and 
     the rate of eighth grade students decreased from 26.3 percent 
     to 17.4 percent. The Troy Coalition believes that this 
     decline represents not only a change in behavior on the part 
     of students, but also a change in the norms of the community.
       (H) In 2000, the Coalition for a Drug-Free Greater 
     Cincinnati surveyed more than 47,000 local seventh through 
     twelfth graders. The results provided evidence that the 
     Coalition's initiatives are working. For the first time in a 
     decade, teen drug use in Greater Cincinnati appears to be 
     leveling off. The data collected from the survey has served 
     as a tool to strengthen relationships between schools and 
     communities, as well as facilitate the growth of anti-drug 
     coalitions in communities where they had not existed.
       (6) Despite these successes, drug use continues to be a 
     serious problem facing communities across the United States. 
     For example:
       (A) According to the Pulse Check: Trends in Drug Abuse Mid-
     Year 2000 report--
       (i) crack and powder cocaine remains the most serious drug 
     problem;
       (ii) marijuana remains the most widely available illicit 
     drug, and its potency is on the rise;
       (iii) treatment sources report an increase in admissions 
     with marijuana as the primary drug of abuse--and adolescents 
     outnumber other age groups entering treatment for marijuana;
       (iv) 80 percent of Pulse Check sources reported increased 
     availability of club drugs, with ecstasy (MDMA) and ketamine 
     the most widely cited club drugs and seven sources reporting 
     that powder cocaine is being used as a club drug by young 
     adults;
       (v) ecstasy abuse and trafficking is expanding, no longer 
     confined to the ``rave'' scene;
       (vi) the sale and use of club drugs has grown from 
     nightclubs and raves to high schools, the streets, 
     neighborhoods, open venues, and younger ages;
       (vii) ecstasy users often are unknowingly purchasing 
     adulterated tablets or some other substance sold as MDMA; and
       (viii) along with reports of increased heroin snorting as a 
     route of administration for initiates, there is also an 
     increase in injecting initiates and the negative health 
     consequences associated with injection (for example, 
     increases in HIV/AIDS and Hepatitis C) suggesting that there 
     is a generational forgetting of the dangers of injection of 
     the drug.
       (B) The 2000 Parent's Resource Institute for Drug Education 
     study reported that 23.6 percent of children in the sixth 
     through twelfth grades used illicit drugs in the past year. 
     The same study found that monthly usage among this group was 
     15.3 percent.
       (C) According to the 2000 Monitoring the Future study, the 
     use of ecstasy among eighth graders increased from 1.7 
     percent in 1999 to 3.1 percent in 2000, among tenth graders 
     from 4.4 percent to 5.4 percent, and from 5.6 percent to 8.2 
     percent among twelfth graders.
       (D) A 1999 Mellman Group study found that--
       (i) 56 percent of the population in the United States 
     believed that drug use was increasing in 1999;
       (ii) 92 percent of the population viewed illegal drug use 
     as a serious problem in the United States; and
       (iii) 73 percent of the population viewed illegal drug use 
     as a serious problem in their communities.
       (7) According to the 2001 report of the National Center on 
     Addiction and Substance Abuse at Columbia University entitled 
     ``Shoveling Up: The Impact of Substance Abuse on State 
     Budgets'', using the most conservative assumption, in 1998 
     States spent $77,900,000,000 to shovel up the wreckage of 
     substance abuse, only $3,000,000,000 to prevent and treat the 
     problem and $433,000,000 for alcohol and tobacco regulation 
     and compliance. This $77,900,000,000 burden was distributed 
     as follows:
       (A) $30,700,000,000 in the justice system (77 percent of 
     justice spending).
       (B) $16,500,000,000 in education costs (10 percent of 
     education spending).
       (C) $15,200,000,000 in health costs (25 percent of health 
     spending).
       (D) $7,700,000,000 in child and family assistance (32 
     percent of child and family assistance spending).
       (E) $5,900,000,000 in mental health and developmental 
     disabilities (31 percent of mental health spending).
       (F) $1,500,000,000 in public safety (26 percent of public 
     safety spending) and $400,000,000 for the state workforce.
       (8) Intergovernmental cooperation and coordination through 
     national, State, and local or tribal leadership and 
     partnerships are critical to facilitate the reduction of 
     substance abuse among youth in communities across the United 
     States.
       (9) Substance abuse is perceived as a much greater problem 
     nationally than at the community level. According to a 2001 
     study sponsored by The Pew Charitable Trusts, between 1994 
     and 2000--
       (A) there was a 43 percent increase in the percentage of 
     Americans who felt progress was being made in the war on 
     drugs at the community level;
       (B) only 9 percent of Americans say drug abuse is a 
     ``crisis'' in their neighborhood, compared to 27 percent who 
     say this about the nation; and
       (C) the percentage of those who felt we lost ground in the 
     war on drugs on a community level fell by more than a 
     quarter, from 51 percent in 1994 to 37 percent in 2000.
       (b) Extension and Increase of Program.--Section 1024(a) of 
     the National Narcotics Leadership Act of 1988 (21 U.S.C. 
     1524(a)) is amended--
       (1) by striking ``and'' at the end of paragraph (4); and
       (2) by striking paragraph (5) and inserting the following 
     new paragraphs:
       ``(5) $50,600,000 for fiscal year 2002;
       ``(6) $60,000,000 for fiscal year 2003;
       ``(7) $70,000,000 for fiscal year 2004;
       ``(8) $70,000,000 for fiscal year 2005;
       ``(9) $75,000,000 for fiscal year 2006; and
       ``(10) $75,000,000 for fiscal year 2007.''.
       (c) Extension of Limitation on Administrative Costs.--
     Section 1024(b) of that Act (21 U.S.C. 1524(b)) is amended by 
     striking paragraph (5) and inserting the following new 
     paragraph (5):
       ``(5) 8 percent for each of fiscal years 2002 through 
     2007.''.
       (d) Additional Grants.--Section 1032(b) of that Act (21 
     U.S.C. 1533(b)) is amended by adding at the end the following 
     new paragraph (3):
       ``(3) Additional grants.--
       ``(A) In general.--Subject to subparagraph (F), the 
     Administrator may award an additional grant under this 
     paragraph to an eligible coalition awarded a grant under 
     paragraph (1) or (2) for any first fiscal year after the end 
     of the 4-year period following the period of the initial 
     grant under paragraph (1) or (2), as the case may be.
       ``(B) Scope of grants.--A coalition awarded a grant under 
     paragraph (1) or (2), including a renewal grant under such 
     paragraph, may not be awarded another grant under such 
     paragraph, and is eligible for an additional grant under this 
     section only under this paragraph.
       ``(C) No priority for applications.--The Administrator may 
     not afford a higher priority in the award of an additional 
     grant under this paragraph than the Administrator would 
     afford the applicant for the grant if the applicant were 
     submitting an application for an initial grant under 
     paragraph (1) or (2) rather than an application for a grant 
     under this paragraph.
       ``(D) Renewal grants.--Subject to subparagraph (F), the 
     Administrator may award a renewal grant to a grant recipient 
     under this paragraph for each of the fiscal years of the 4-
     fiscal year period following the fiscal year for which the 
     initial additional grant under subparagraph (A) is awarded in 
     an amount not to exceed amounts as follows:
       ``(i) For the first and second fiscal years of that 4-
     fiscal year period, the amount equal to 80 percent of the 
     non-Federal funds, including in-kind contributions, raised by 
     the coalition for the applicable fiscal year.

[[Page 11162]]

       ``(ii) For the second, third, and fourth fiscal years of 
     that 4-fiscal year period, the amount equal to 67 percent of 
     the non-Federal funds, including in-kind contributions, 
     raised by the coalition for the applicable fiscal year.
       ``(E) Suspension.--If a grant recipient under this 
     paragraph fails to continue to meet the criteria specified in 
     subsection (a), the Administrator may suspend the grant, 
     after providing written notice to the grant recipient and an 
     opportunity to appeal.
       ``(F) Limitation.--The amount of a grant award under this 
     paragraph may not exceed $100,000 for a fiscal year.''.
       (e) Data Collection and Dissemination.--Section 1033(b) of 
     that Act (21 U.S.C. 1533(b)) is amended by adding at the end 
     the following new paragraph:
       ``(3) Consultation.--The Administrator shall carry out 
     activities under this subsection in consultation with the 
     Advisory Commission and the National Community Antidrug 
     Coalition Institute.''.
       (f) Limitation on Use of Certain Funds for Evaluation of 
     Program.--Section 1033(b) of that Act, as amended by 
     subsection (e) of this section, is further is amended by 
     adding at the end the following new paragraph:
       ``(4) Limitation on use of certain funds for evaluation of 
     program.--Amounts for activities under paragraph (2)(B) may 
     not be derived from amounts under section 1024(a), except for 
     amounts that are available under section 1024(b) for 
     administrative costs.''.

     SEC. 2. SUPPLEMENTAL GRANTS FOR COALITION MENTORING 
                   ACTIVITIES UNDER DRUG-FREE COMMUNITIES SUPPORT 
                   PROGRAM.

       Subchapter I of chapter 2 of the National Narcotics 
     Leadership Act of 1988 (21 U.S.C. 1531 et seq.) is amended by 
     adding at the end the following new section:

     ``SEC. 1035. SUPPLEMENTAL GRANTS FOR COALITION MENTORING 
                   ACTIVITIES.

       ``(a) Authority To Make Grants.--As part of the program 
     established under section 1031, the Director may award an 
     initial grant under this subsection, and renewal grants under 
     subsection (f), to any coalition awarded a grant under 
     section 1032 that meets the criteria specified in subsection 
     (d) in order to fund coalition mentoring activities by such 
     coalition in support of the program.
       ``(b) Treatment with Other Grants.--
       ``(1) Supplement.--A grant awarded to a coalition under 
     this section is in addition to any grant awarded to the 
     coalition under section 1032.
       ``(2) Requirement for basic grant.--A coalition may not be 
     awarded a grant under this section for a fiscal year unless 
     the coalition was awarded a grant or renewal grant under 
     section 1032(b) for that fiscal year.
       ``(c) Application.--A coalition seeking a grant under this 
     section shall submit to the Administrator an application for 
     the grant in such form and manner as the Administrator may 
     require.
       ``(d) Criteria.--A coalition meets the criteria specified 
     in this subsection if the coalition--
       ``(1) has been in existence for at least 5 years;
       ``(2) has achieved, by or through its own efforts, 
     measurable results in the prevention and treatment of 
     substance abuse among youth;
       ``(3) has staff or members willing to serve as mentors for 
     persons seeking to start or expand the activities of other 
     coalitions in the prevention and treatment of substance 
     abuse;
       ``(4) has demonstrable support from some members of the 
     community in which the coalition mentoring activities to be 
     supported by the grant under this section are to be carried 
     out; and
       ``(5) submits to the Administrator a detailed plan for the 
     coalition mentoring activities to be supported by the grant 
     under this section.
       ``(e) Use of Grant Funds.--A coalition awarded a grant 
     under this section shall use the grant amount for mentoring 
     activities to support and encourage the development of new, 
     self-supporting community coalitions that are focused on the 
     prevention and treatment of substance abuse in such new 
     coalitions' communities. The mentoring coalition shall 
     encourage such development in accordance with the plan 
     submitted by the mentoring coalition under subsection (d)(5).
       ``(f) Renewal Grants.--The Administrator may make a renewal 
     grant to any coalition awarded a grant under subsection (a), 
     or a previous renewal grant under this subsection, if the 
     coalition, at the time of application for such renewal 
     grant--
       ``(1) continues to meet the criteria specified in 
     subsection (d); and
       ``(2) has made demonstrable progress in the development of 
     one or more new, self-supporting community coalitions that 
     are focused on the prevention and treatment of substance 
     abuse.
       ``(g) Grant Amounts.--
       ``(1) In general.--Subject to paragraphs (2) and (3), the 
     total amount of grants awarded to a coalition under this 
     section for a fiscal year may not exceed the amount of non-
     Federal funds raised by the coalition, including in-kind 
     contributions, for that fiscal year.
       ``(2) Initial grants.--The amount of the initial grant 
     awarded to a coalition under subsection (a) may not exceed 
     $75,000.
       ``(3) Renewal grants.--The total amount of renewal grants 
     awarded to a coalition under subsection (f) for any fiscal 
     year may not exceed $75,000.
       ``(h) Fiscal Year Limitation on Amount Available For 
     Grants.--The total amount available for grants under this 
     section, including renewal grants under subsection (f), in 
     any fiscal year may not exceed the amount equal to five 
     percent of the amount authorized to be appropriated by 
     section 1024(a) for that fiscal year.''.

     SEC. 3. FIVE-YEAR EXTENSION OF ADVISORY COMMISSION ON DRUG-
                   FREE COMMUNITIES.

       Section 1048 of the National Narcotics Leadership Act of 
     1988 (21 U.S.C. 1548) is amended by striking ``2002'' and 
     inserting ``2007''.

     SEC. 4. AUTHORIZATION FOR NATIONAL COMMUNITY ANTIDRUG 
                   COALITION INSTITUTE.

       (a) In General.--The Director of the Office of National 
     Drug Control Policy may, using amounts authorized to be 
     appropriated by subsection (d), make a grant to an eligible 
     organization to provide for the establishment of a National 
     Community Antidrug Coalition Institute.
       (b) Eligible Organizations.--An organization eligible for 
     the grant under subsection (a) is any national nonprofit 
     organization that represents, provides technical assistance 
     and training to, and has special expertise and broad, 
     national-level experience in community antidrug coalitions 
     under section 1032 of the National Narcotics Leadership Act 
     of 1988 (21 U.S.C. 1532).
       (c) Use of Grant Amount.--The organization receiving the 
     grant under subsection (a) shall establish a National 
     Community Antidrug Coalition Institute to--
       (1) provide education, training, and technical assistance 
     for coalition leaders and community teams;
       (2) develop and disseminate evaluation tools, mechanisms, 
     and measures to better assess and document coalition 
     performance measures and outcomes; and
       (3) bridge the gap between research and practice by 
     translating knowledge from research into practical 
     information.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated for purposes of activities under this 
     section, including the grant under subsection (a), amounts as 
     follows:
       (1) For each of fiscal years 2002 and 2003, $2,000,000.
       (2) For each of fiscal years 2004, 2005, 2006, and 2007, 
     such sums as may be necessary for such activities.

  Mr. BIDEN. Mr. President, today I introduce legislation to 
reauthorize the Drug Free Communities Act, a program which currently 
funds more than 300 community coalitions across the country that work 
to reduce drug, alcohol, and tobacco use.
  Four years ago, I worked with Senator Grassley, Representatives Sandy 
Levin and Rob Portman, and others to create this important program to 
fund coalitions of citizens--parents, youth, businesses, media, law 
enforcement, religious organizations, civic groups, doctors, nurses, 
and others--working to reduce youth substance abuse.
  Community coalitions across the country--including two in my home 
State of Delaware--are galvanizing tremendous support for prevention 
efforts. They are helping fellow citizens make a difference in their 
communities. And they are helping all sectors of the community send a 
consistent message about alcohol, drugs, and tobacco.
  I have been fighting for this type of anti-drug program for local 
communities for over a decade because I believe that prevention is a 
critical--but too often overlooked--part of an effective drug strategy.
  Substance abuse is one of our Nation's most pervasive problems. 
Addiction is a disease that does not discriminate on the basis of age, 
gender, socioeconomic status, race or creed. And while we tend to 
stereotype drug abuse as an urban problem, the steadily growing number 
of heroin and methamphetamine addicts in rural villages and suburban 
towns shows that is simply not the case.
  We have nearly 15 million drug users in this country, 4 million of 
whom are hard-core addicts. We all know someone--a family member, 
neighbor, colleague or friend--who has become addicted to drugs or 
alcohol. And we are all affected by the undeniable correlation between 
substance abuse and crime--an overwhelming 80 percent of the 2 million 
men and women behind bars today have a history of drug and alcohol 
abuse or addiction or were arrested for a drug-related crime.
  All of this comes at a hefty price. Drug abuse and addiction cost 
this Nation $110 billion in law enforcement

[[Page 11163]]

and other criminal justice expenses, medical bills, lost earnings and 
other costs each year. Illegal drugs are responsible for thousands of 
deaths each year and for the spread of a number of communicable 
diseases, including AIDS and Hepatitis C. And a study by the National 
Center on Addiction and Substance Abuse at Columbia University (CASA) 
shows that 7 out of 10 cases of child abuse and neglect are caused or 
exacerbated by substance abuse and addiction.
  Another CASA study recently revealed that for each dollar that States 
spend on substance-abuse related programs, 96 cents goes to dealing 
with the consequences of substance abuse and only 4 cents to preventing 
and treating it. Investing more in prevention and treatment is cost-
effective because it will decrease much of the street crime, child 
abuse, domestic violence, and other social ills that can result from 
substance abuse.
  If we can get kids through age 21 without smoking, abusing alcohol, 
or using drugs, they are unlikely to have a substance abuse problem in 
the future. But there are still those who shrug their shoulders and say 
``kids are kids--they are going to experiment.'' Others find the 
thought of keeping kids drug-free too daunting a task, and they give up 
too soon.
  But the truth is that we are learning more and more about drug 
prevention as researchers isolate the so-called ``risk'' and 
``protective'' factors for drug use. In other words, we now know that 
if a child has low self-esteem or emotional problems; has a substance 
abuser for a parent; is a victim of child abuse; or is exposed to pro-
drug media messages, that child is at a higher risk of smoking, 
drinking and using illegal drugs. But the good news is that we are also 
learning what decreases a child's risk of substance abuse.
  The Drug Free Communities program allows coalitions to put prevention 
research into action in cities and towns nationwide by funding 
initiatives tailored to a community's individual needs.
  In my home State of Delaware, both the New Castle County Community 
Partnership and the Delaware Prevention Coalition's Southern 
Partnership are working to prevent youth substance abuse by helping 
kids do better in school, addressing their behavioral problems, and 
teaching them the dangers associated with drug, alcohol, and tobacco 
use. The Delaware coalitions know that teachers who have high 
expectations of their students and help them develop good social skills 
also help to prevent substance use. And they know that if kids think 
that drugs, alcohol, and tobacco are bad for them, they will be less 
likely to use them.
  Other coalitions are working to engage the religious community. In 
Florida, the Miami Coalition for a Safe and Drug Free Community has 
developed a substance abuse manual for religious leaders so that they 
will know how to identify substance abuse and help people who need 
treatment find it. They are also teaching religious leaders how to 
incorporate messages about substance abuse into their sermons.
  Still other groups are working with the business community. A 
coalition in Troy, MI, is working with the Chamber of Commerce to form 
an Employee Assistance Program for a consortium of small businesses who 
could not otherwise afford to have one.
  These are just a few examples of the efforts that are making a 
difference and just a few of the reasons why I am proud to support 
community coalitions.
  Drug abuse plagues the entire community. We all feel the 
consequences--crime, homelessness, domestic violence, child abuse, 
despair--and we all need to do something about it. Prevention messages 
must come from all sectors of the community, from a number of different 
voices. Coalitions bring those groups together, give them information 
they need, help develop programs that work, and nurture them to 
success.
  I believe that the Drug Free Communities program is a powerful 
prevention initiative and I urge my colleagues to support its 
reauthorization.
  I ask unanimous consent that the full text of the bill be printed in 
the Record.
  Mr. SMITH of Oregon. Mr. President, I rise today to join my 
distinguished colleagues to support the reauthorization of the Drug-
Free Communities Support Program. Drug-Free Community grants have had 
an extremely positive impact on my home State of Oregon, and I know 
that the program has benefitted a great number of communities all 
across this country. I am proud to be an original cosponsor of this 
important bill.
  Federal Drug-Free Community grants serve programs in 14 Oregon 
communities in urban, suburban, and rural areas alike. All Drug-Free 
Community grants go directly to communities to support a wide variety 
of innovative drug-abuse prevention programs, ranging from community 
education programs and after-school programs to parenting classes and 
youth camps. Communities are invested in the process through a dollar-
for-dollar match requirement, ensuring their interest in getting 
results, and they are getting results. With help from Federal Drug-Free 
Community dollars, Oregon drug abuse prevention groups are increasing 
citizen participation and they have produced a measurable decrease in 
both adult and youth substance abuse.
  Portland's Regional Drug Initiative, RDI, for example, has promoted 
the establishment of drug-free workplaces among the city's large and 
small employers. Over 3,000 employers have attended an RDI training 
session, and of those, 92 percent have instituted drug-free workplace 
policies, resulting in a 5.5 percent decrease in positive workplace 
drug tests. At the Southern Oregon Drug Awareness program in Medford, 
OR, 320 young people have participated in its violence prevention 
course, and upon completion, two-thirds of those students report having 
no additional discipline referrals in school. These are two fine 
examples of how the Drug-Free Communities Support Program is directly 
responsible for positively impacting lives in Oregon and all across our 
Nation.
  This bill will reauthorize the Drug-Free Communities Support Program 
to provide grants for an additional five years. The bill will also 
authorize the creation of a National Community Anti-Drug Coalition 
Institute, which will serve as a valuable information clearing house 
for programs seeking to improve themselves by using the best practices 
of other successful community programs. The bill also establishes a new 
coalition mentoring program which will enable established coalitions 
like the Oregon Partnership to help communities develop their own local 
drug prevention coalitions.
  Substance prevention works, and drug abuse is becoming less common 
through community prevention efforts, but this is no time to rest on 
our laurels. Over the next fifteen years, the youth population in the 
United States will grow by 21 percent, and we must ensure that the 
programs are in place to prevent these youths from succumbing to drug-
related problems, such as academic failure, drug-related violence, and 
HIV infection. The Drug-Free Communities Support Program is an 
important partner in local efforts to prevent these problems, and I 
urge my colleagues to join me in supporting its reauthorization.

                          ____________________