[Congressional Record (Bound Edition), Volume 149 (2003), Part 10]
[Senate]
[Pages 13693-13714]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. ROCKEFELLER:
  S. 1179. A bill to amend title XVIII of the Social Security Act to 
expand Medicare benefits to prevent, delay, and minimize the 
progression of chronic conditions, and develop national policies on 
effective chronic condition care, and for other purposes; to the 
Committee on Finance.
  Mr. ROCKEFELLER. Mr. President, I come to the floor today to 
introduce the Medicare Chronic Care Improvement Act of 2003. For the 
last three decades, the Medicare program has fulfilled our promise to 
care for older Americans who have spent a lifetime working and 
contributing to our Nation's economy. Currently, 41 million seniors 
depend on Medicare for critical health care assistance. Those seniors 
have been asking Congress for many years to strengthen Medicare. This 
Congress, we must respond by taking action. We must enact legislation 
this year that fills the gaps in Medicare.
  When Congress and President Johnson designed the Medicare program in 
1965, they could not have foreseen the health care system that exists 
today. New technology, advances in research and an aging population 
have changed both what beneficiaries need and the system that is 
responding to those needs. One of the unforseen implications of these 
changes is a growing number of Americans living with chronic 
conditions.
  In 2000, over 45 percent of Americans had a chronic condition. That 
number continues to grow and, by 2020, more than 48 percent or 157 
million Americans, will have at least one chronic condition. Chronic 
conditions encompass an array of health conditions that are persistent, 
recurring, and cannot be cured. They include severely impairing 
conditions like Alzheimer's disease, congestive heart failure, chronic 
obstructive pulmonary disease, diabetes, depression, hypertension, and 
arthritis.
  Treating serious and disabling chronic conditions is the highest cost 
and fastest growing segment of health care. People with chronic 
conditions represent 78 percent of all health care spending. These 
people are the heaviest users of home health care visits, 
prescriptions, physician visits, and inpatient stays.
  As we grow older, the chances of developing a chronic condition 
increase. Thus, it should be no surprise that nearly 80 percent of 
Medicare beneficiaries have at least one chronic condition and two-
thirds have two or more chronic conditions. However, the Medicare fee-
for-service program does not currently cover many of the services 
needed to provide quality care to beneficiaries who are managing 
complex chronic conditions.
  To meet the needs of these individuals, our Medicare fee-for-service 
system must reflect a person-centered, system-oriented approach to 
care. Payers and providers who serve the same person must be empowered 
to work together to help people with chronic conditions prevent, delay, 
or minimize disease and disability progression and maximize their 
health and well being.
  That is why I am here to reintroduce a much needed solution--the 
Medicare Chronic Care Improvement Act of 2003. This bill establishes a 
comprehensive plan to improve and strengthen the Medicare fee-for-
service and Medicare+Choice systems by generating better health 
outcomes for beneficiaries with chronic conditions and increasing 
efficiency.
  This bill would achieve these results by, first, helping to prevent, 
delay, and minimize the progression of chronic conditions by 
authorizing the Secretary of Health and Human Services to expand 
coverage of preventive

[[Page 13694]]

health benefits. The bill permits providers to waive deductibles and 
co-payments for preventive and wellness services currently covered by 
Medicare and streamlines the process of approving new preventive 
benefits.
  Second, this bill provides a person-centered, system-oriented 
approach to care for this extremely vulnerable segment of our 
population by expanding Medicare coverage to include assessment, care-
coordination, self-management services, and patient and family 
caregiver education and counseling.
  For more detail, I am also entering a section-by-section bill summary 
into the Congressional Record following this statement.
  The Medicare Chronic Care Improvement Act provides a comprehensive 
solution to improving the quality of life and health for millions of 
Americans who are struggling with serious and disabling chronic 
conditions. Not only that, it has the potential to save the Medicare 
program money, by better managing and treating chronic conditions 
before costly complications result. That is good for seniors and good 
for Medicare--a win-win situation.
  It is time to step up to the plate and fulfill our obligation to our 
Nation's most vulnerable citizens. Improving Medicare is the right 
thing to do, but only if we do it the right way. I believe that this 
bill is a critical component of the right recipe for strengthening the 
Medicare program for today and tomorrow's beneficiaries. Unlike the 
administration's Medicare reform plan, the Medicare Chronic Care 
Improvement Act gives beneficiaries better care while maintaining 
consumer choice and improving the program's efficiency. Because these 
are the results that West Virginians want, I will fight to include the 
provisions of this bill in any Medicare reform package that moves 
through the Finance Committee or the Senate floor.
  I would like the record to reflect that the following groups publicly 
support this legislation: Alzheimer's Association; American Geriatrics 
Society; Center for Medicare Advocacy; Families USA; and Medicare 
Rights Center.
  National Chronic Care Consortium, representing such organizations as: 
Aging and Disability Services Administration, State of Washington 
(Olympia, WA); Aging in America, Inc (Bronx, NY); Albert Einstein 
Healthcare Network (Philadelphia, PA); Area Agency on Aging 10B Inc. 
(Akron, OH); Baylor Health Care System (Dallas, TX); Benjamin Rose 
(Cleveland, OH); Beth Abraham Family of Health Services (Bronx, NY); 
Blue Cross & Blue Shield of Minnesota (Eagan, MN); Carle Foundation 
Hospital-Health Systems Research Center (Mahomet, IL); Catholic Health 
Initiatives (Parker, CO); Centura Health (Denver, CO); Community Health 
Partnership, Inc. (Eau Claire, WI); Fairview Health Services/Enbenezer 
(Minneapolis, MN); Halleland Health Consulting (Minneapolis, MN); 
Hebrew Home and Hospital (Hartford, CT); Highmark Blue Cross Blue 
Shield (Pittsburgh, PA); Inglis Innovative Services (Philadelphia, PA); 
Lancaster General Hospital (Lancaster, PA); Masonicare (Wallingford, 
CT); Mercy Medical Center--North Iowa (Mason City, IA); MetroHealth 
System (Cleveland, OH); Metropolitan Jewish Health System (Brooklyn, 
NY); Minnesota Senior Health Options (MSHO) (St. Paul, MN); Motion 
Picture and Television Fund (Woodland Hills, CA); Northeast Health 
(Troy, NY); Presbyterian SeniorCare (Pittsburgh, PA); Saint Michael's 
Hospital (Stevens Point, WI); SCAN (Long Beach, CA); Sierra Health 
Services (Las Vegas, NV); Summa Health System (Akron, OH); Sutter 
Health (Sacramento, CA); Total Longterm Care, Inc. (Denver, CO); 
Upstate NY Network of the U.S. Dept. of Veterans Affairs, VISN 2 
(Albany, NY); ViaHealth (Rochester, NY); Visiting Nurse Service of New 
York (New York, NY); Volunteers of America National Services (Eden 
Prairie, MN); and Wisconsin Partnership Program at Community Living 
Alliance (Madison, WI).
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1179

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     Chronic Care Improvement Act of 2003''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

 TITLE I--BENEFITS TO PREVENT, DELAY, AND MINIMIZE THE PROGRESSION OF 
                          CHRONIC CONDITIONS.

          Subtitle A--Improving Access to Preventive Services

Sec. 101. Elimination of deductibles and coinsurance for existing 
              preventive health benefits.
Sec. 102. Institute of Medicine medicare prevention benefit study and 
              report.
Sec. 103. Authority to administratively provide for coverage of 
              additional preventive benefits.
Sec. 104. Coverage of an initial preventive physical examination.

  Subtitle B--Medicare Coverage for Care Coordination and Assessment 
                                Services

Sec. 111. Care coordination and assessment services.
Sec. 112. Care coordination and assessment services and quality 
              improvement program in Medicare+Choice plans.
Sec. 113. Improving chronic care coordination through information 
              technology.

                   Subtitle C--Additional Provisions

Sec. 121. Review of coverage standards.

 TITLE II--INSTITUTE OF MEDICINE STUDY ON EFFECTIVE CHRONIC CONDITION 
                                  CARE

Sec. 201. Institute of Medicine medicare chronic condition care 
              improvement study and report.

 TITLE I--BENEFITS TO PREVENT, DELAY, AND MINIMIZE THE PROGRESSION OF 
                          CHRONIC CONDITIONS.

          Subtitle A--Improving Access to Preventive Services

     SEC. 101. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR 
                   EXISTING PREVENTIVE HEALTH BENEFITS.

       (a) In General.--Section 1833 of the Social Security Act 
     (42 U.S.C. 1395l) is amended by inserting after subsection 
     (o) the following new subsection:
       ``(p) Deductibles and Coinsurance Waived for Preventive 
     Health Items and Services.--The Secretary shall not require 
     the payment of any deductible or coinsurance under subsection 
     (a) or (b), respectively, of any individual enrolled for 
     coverage under this part for any of the following preventive 
     health items and services:
       ``(1) Blood-testing strips, lancets, and blood glucose 
     monitors for individuals with diabetes described in section 
     1861(n).
       ``(2) Diabetes outpatient self-management training services 
     (as defined in section 1861(qq)(1)).
       ``(3) Pneumococcal, influenza, and hepatitis B vaccines and 
     administration described in section 1861(s)(10).
       ``(4) Screening mammography (as defined in section 
     1861(jj)).
       ``(5) Screening pap smear and screening pelvic exam (as 
     defined in paragraphs (1) and (2) of section 1861(nn), 
     respectively).
       ``(6) Bone mass measurement (as defined in section 
     1861(rr)(1)).
       ``(7) Prostate cancer screening test (as defined in section 
     1861(oo)(1)).
       ``(8) Colorectal cancer screening test (as defined in 
     section 1861(pp)(1)).
       ``(9) Screening for glaucoma (as defined in section 
     1861(uu)).
       ``(10) Medical nutrition therapy services (as defined in 
     section 1861(vv)(1)).''.
       (b) Waiver of Coinsurance.--
       (1) In general.--Section 1833(a)(1)(B) of the Social 
     Security Act (42 U.S.C. 1395l(a)(1)(B)) is amended to read as 
     follows: ``(B) with respect to preventive health items and 
     services described in subsection (p), the amounts paid shall 
     be 100 percent of the fee schedule or other basis of payment 
     under this title for the particular item or service,''.
       (2) Elimination of coinsurance in outpatient hospital 
     settings.--The third sentence of section 1866(a)(2)(A) of the 
     Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by 
     inserting after ``1861(s)(10)(A)'' the following: ``, 
     preventive health items and services described in section 
     1833(p),''.
       (c) Waiver of Application of Deductible.--Section 
     1833(b)(1) of the Social Security Act (42 U.S.C. 1395l(b)(1)) 
     is amended to read as follows: ``(1) such deductible shall 
     not apply with respect to preventive health items and 
     services described in subsection (p),''.
       (d) Adding ``Lancet'' to Definition of DME.--Section 
     1861(n) of the Social Security Act (42 U.S.C. 1395x(n)) is 
     amended by striking ``blood-testing strips and blood glucose 
     monitors'' and inserting ``blood-testing strips, lancets, and 
     blood glucose monitors''.
       (e) Conforming Amendments.--
       (1) Elimination of coinsurance for clinical diagnostic 
     laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of 
     section 1833(a) of the Social Security Act (42 U.S.C. 
     1395l(a))

[[Page 13695]]

     are each amended by inserting ``or which are described in 
     subsection (p)'' after ``assignment-related basis''.
       (2) Elimination of coinsurance for certain dme.--Section 
     1834(a)(1)(A) of the Social Security Act (42 U.S.C. 
     1395m(a)(1)(A)) is amended by inserting ``(or 100 percent, in 
     the case of such an item described in section 1833(p))'' 
     after ``80 percent''.
       (3) Elimination of deductibles and coinsurance for 
     colorectal cancer screening tests.--Section 1834(d) of the 
     Social Security Act (42 U.S.C. 1395m(d)) is amended--
       (A) in paragraph (2)(C)--
       (i) by striking ``(C) Facility payment limit.--'' and all 
     that follows through ``Notwithstanding subsections'' and 
     inserting the following:
       ``(C) Facility payment limit.--Notwithstanding 
     subsections'';
       (ii) by striking ``(I) in accordance'' and inserting the 
     following:
       ``(i) in accordance'';
       (iii) by striking ``(II) are performed'' and all that 
     follows through ``payment under'' and inserting the 
     following:
       ``(ii) are performed in an ambulatory surgical center or 
     hospital outpatient department,

     payment under''; and
       (iv) by striking clause (ii); and
       (B) in paragraph (3)(C)--
       (i) by striking ``(C) Facility payment limit.--'' and all 
     that follows through ``Notwithstanding subsections'' and 
     inserting the following:
       ``(C) Facility payment limit.--Notwithstanding 
     subsections''; and
       (ii) by striking clause (ii).
       (f) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after January 1, 
     2004.

     SEC. 102. INSTITUTE OF MEDICINE MEDICARE PREVENTION BENEFIT 
                   STUDY AND REPORT.

       (a) Study.--
       (1) In general.--The Secretary of Health and Human Services 
     shall contract with the Institute of Medicine of the National 
     Academy of Sciences to--
       (A) conduct a comprehensive study of current literature and 
     best practices in the field of health promotion and disease 
     prevention among medicare beneficiaries, including the issues 
     described in paragraph (2); and
       (B) submit the report described in subsection (b).
       (2) Issues studied.--The study required under paragraph (1) 
     shall include an assessment of--
       (A) whether each health promotion and disease prevention 
     benefit covered under the medicare program is medically 
     effective (as defined in subsection (d)(3));
       (B) utilization by medicare beneficiaries of such benefits 
     (including any barriers to or incentives to increase 
     utilization);
       (C) quality of life issues associated with such benefits; 
     and
       (D) whether health promotion and disease prevention 
     benefits that are not covered under the medicare program that 
     would affect all medicare beneficiaries are likely to be 
     medically effective (as so defined).
       (b) Reports.--
       (1) Three-year report.--On the date that is 3 years after 
     the date of enactment of this Act, and each successive 3-year 
     anniversary thereafter, the Institute of Medicine of the 
     National Academy of Sciences shall submit to the President a 
     report that contains--
       (A) a detailed statement of the findings and conclusions of 
     the study conducted under subsection (a); and
       (B) the recommendations for legislation described in 
     paragraph (3).
       (2) Interim report based on new guidelines.--If the United 
     States Preventive Services Task Force or the Task Force on 
     Community Preventive Services establishes new guidelines 
     regarding preventive health benefits for medicare 
     beneficiaries more than 1 year prior to the date that a 
     report described in paragraph (1) is due to be submitted to 
     the President, then not later than 6 months after the date 
     such new guidelines are established, the Institute of 
     Medicine of the National Academy of Sciences shall submit to 
     the President a report that contains a detailed description 
     of such new guidelines. Such report may also contain 
     recommendations for legislation described in paragraph (3).
       (3) Recommendations for legislation.--The Institute of 
     Medicine of the National Academy of Sciences, in consultation 
     with the United States Preventive Services Task Force and the 
     Task Force on Community Preventive Services, shall develop 
     recommendations in legislative form that--
       (A) prioritize the preventive health benefits under the 
     medicare program; and
       (B) modify such benefits, including adding new benefits 
     under such program, based on the study conducted under 
     subsection (a).
       (c) Transmission to Congress.--
       (1) In general.--Subject to paragraph (2), on the day that 
     is 6 months after the date on which the report described in 
     paragraph (1) of subsection (b) (or paragraph (2) of such 
     subsection if the report contains recommendations in 
     legislative form described in subsection (b)(3)) is submitted 
     to the President, the President shall transmit the report and 
     recommendations to Congress.
       (2) Regulatory action by the secretary of health and human 
     services.--If the Secretary of Health and Human Services has 
     exercised the authority under section 103(a) to adopt by 
     regulation one or more of the recommendations under 
     subsection (b)(3), the President shall only submit to 
     Congress those recommendations under subsection (b)(3) that 
     have not been adopted by the Secretary.
       (3) Delivery.--Copies of the report and recommendations in 
     legislative form required to be transmitted to Congress under 
     paragraph (1) shall be delivered--
       (A) to both Houses of Congress on the same day;
       (B) to the Clerk of the House of Representatives if the 
     House is not in session; and
       (C) to the Secretary of the Senate if the Senate is not in 
     session.
       (d) Definition of medically effective.--In this section, 
     the term ``medically effective'' means, with respect to a 
     benefit or technique, that the benefit or technique has 
     been--
       (1) subject to peer review;
       (2) described in scientific journals; and
       (3) determined to achieve an intended goal under normal 
     programmatic conditions.

     SEC. 103. AUTHORITY TO ADMINISTRATIVELY PROVIDE FOR COVERAGE 
                   OF ADDITIONAL PREVENTIVE BENEFITS.

       (a) In General.--The Secretary of Health and Human Services 
     may by regulation adopt any or all of the legislative 
     recommendations developed by the Institute of Medicine of the 
     National Academy of Sciences, in consultation with the United 
     States Preventive Services Task Force and the Task Force on 
     Community Preventive Services in a report under section 
     102(b)(3) (relating to prioritizing and modifying preventive 
     health benefits under the medicare program and the addition 
     of new preventive benefits), consistent with subsection (b).
       (b) Elimination of Cost-Sharing.--With respect to items and 
     services furnished under the medicare program that the 
     Secretary has incorporated by regulation under subsection 
     (a), the provisions of section 1833(p) of the Social Security 
     Act (relating to elimination of cost-sharing for preventive 
     benefits), as added by section 101(a), shall apply to those 
     items and services in the same manner as such section applies 
     to the items and services described in paragraphs (1) through 
     (10) of such section.

     SEC. 104. COVERAGE OF AN INITIAL PREVENTIVE PHYSICAL 
                   EXAMINATION.

       (a) Coverage.--Section 1861(s)(2) of the Social Security 
     Act (42 U.S.C. 1395x(s)(2)) is amended--
       (1) in subparagraph (U), by striking ``and'' at the end;
       (2) in subparagraph (V), by inserting ``and'' at the end; 
     and
       (3) by adding at the end the following new subparagraph:
       ``(W) an initial preventive physical examination (as 
     defined in subsection (ww));''.
       (b) Services Described.--Section 1861 of such Act (42 
     U.S.C. 1395x) is amended by adding at the end the following 
     new subsection:

               ``Initial Preventive Physical Examination

       ``(ww) The term `initial preventive physical examination' 
     means physicians' services consisting of a physical 
     examination with the goal of health promotion and disease 
     detection and includes a history and physical exam, a health 
     risk appraisal, and health risk counseling, and laboratory 
     tests or other items and services as determined by the 
     Secretary in consultation with the United States Preventive 
     Services Task Force.''.
       (c) Waiver of Deductible and Coinsurance.--
       (1) Deductible.--The first sentence of section 1833(b) of 
     such Act (42 U.S.C. 1395l(b)) is amended--
       (A) by striking ``and'' before ``(6)'', and
       (B) by inserting before the period at the end the 
     following: ``, and (7) such deductible shall not apply with 
     respect to an initial preventive physical examination (as 
     defined in section 1861(ww))''.
       (2) Coinsurance.--Section 1833(a)(1) of such Act (42 U.S.C. 
     1395l(a)(1)) is amended--
       (A) in clause (N), by inserting ``(or 100 percent in the 
     case of an initial preventive physical examination, as 
     defined in section 1861(ww))'' after ``80 percent''; and
       (B) in clause (O), by inserting ``(or 100 percent in the 
     case of an initial preventive physical examination, as 
     defined in section 1861(ww))'' after ``80 percent''.
       (d) Payment as Physicians' Services.--Section 1848(j)(3) of 
     such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting 
     ``(2)(W),'' after ``(2)(S),''.
       (e) Other Conforming Amendments.--Section 1862(a) of such 
     Act (42 U.S.C. 1395y(a)) is amended--
       (1) in paragraph (1)--
       (A) by striking ``and'' at the end of subparagraph (H);
       (B) by striking the semicolon at the end of subparagraph 
     (I) and inserting ``, and''; and
       (C) by adding at the end the following new subparagraph:
       ``(J) in the case of an initial preventive physical 
     examination (as defined in section 1861(ww)), which is 
     performed not later than 6 months after the date the 
     individual's first coverage period begins under part B;''; 
     and
       (2) in paragraph (7), by striking ``or (H)'' and inserting 
     ``(H), or (J)''.
       (f) Effective Date.--The amendments made by this section 
     shall apply to services

[[Page 13696]]

     furnished on or after January 1, 2004, but only for 
     individuals whose coverage period begins on or after such 
     date.

  Subtitle B--Medicare Coverage for Care Coordination and Assessment 
                                Services

     SEC. 111. CARE COORDINATION AND ASSESSMENT SERVICES.

       (a) Services Authorized.--Title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.) is amended by adding at 
     the end the following new section:


              ``care coordination and assessment services

       ``Sec. 1897. (a) Purpose.--
       ``(1) In general.--The purpose of this section is to 
     provide the appropriate level and mix of follow-up care to an 
     individual with a chronic condition who qualifies as an 
     eligible beneficiary (as defined in paragraph (2)).
       ``(2) Eligible beneficiary defined.--In this section, the 
     term `eligible beneficiary' means a beneficiary who--
       ``(A) has a serious and disabling chronic condition (as 
     defined in subsection (f)(1)); or
       ``(B) has four or more chronic conditions (as defined in 
     subsection (f)(4)).
       ``(b) Election of Care Coordination and Assessment 
     Services.--
       ``(1) In general.--On or after January 1, 2005, an eligible 
     beneficiary may elect to receive care coordination services 
     in accordance with the provisions of this section under 
     which, in appropriate circumstances, the eligible beneficiary 
     has health care services covered under this title managed and 
     coordinated by a care coordinator who is qualified under 
     subsection (e) to furnish care coordination services under 
     this section.
       ``(2) Revocation of election.--An eligible beneficiary who 
     has made an election under paragraph (1) may revoke that 
     election at any time.
       ``(c) Outreach.--The Secretary shall provide for the wide 
     dissemination of information to beneficiaries and providers 
     of services, physicians, practitioners, and suppliers with 
     respect to the availability of and requirements for care 
     coordination services under this section.
       ``(d) Care Coordination and Assessment Services 
     Described.--Care coordination services under this section 
     shall include the following:
       ``(1) Basic care coordination and assessment services.--
     Except as otherwise provided in this section, eligible 
     beneficiaries who have made an election under this section 
     shall receive the following services:
       ``(A)(i) An initial assessment of an individual's medical 
     condition, functional and cognitive capacity, and 
     environmental and psychosocial needs.
       ``(ii) Annual assessments after the initial assessment 
     performed under clause (i), unless the physician or care 
     coordinator of the individual determines that additional 
     assessments are required due to sentinel health events or 
     changes in the health status of the individual that may 
     require changes in the plan of care developed for the 
     individual.
       ``(B) The development of an initial plan of care, and 
     subsequent appropriate revisions to that plan of care.
       ``(C) The management of, and referral for, medical and 
     other health services, including multidisciplinary care 
     conferences and coordination with other providers.
       ``(D) The monitoring and management of medications.
       ``(E) Patient education and counseling services.
       ``(F) Family caregiver education and counseling services.
       ``(G) Self-management services, including health education 
     and risk appraisal to identify behavioral risk factors 
     through self-assessment.
       ``(H) Consultations by telephone with physicians and other 
     appropriate health care professionals, including 24-hour 
     access to a care coordinator.
       ``(I) Coordination with the principal caregiver in the 
     home.
       ``(J) The managing and facilitating of transitions among 
     health care professionals and across settings of care, 
     including the following:
       ``(i) The pursuit the treatment option elected by the 
     individual.
       ``(ii) The inclusion of any advance directive executed by 
     the individual in the medical file of the individual.
       ``(K) Activities that facilitate continuity of care and 
     patient adherence to plans of care.
       ``(L) Information about, and referral to, community-based 
     services, including patient and family caregiver education 
     and counseling about such services, and facilitating access 
     to such services when elected.
       ``(M) Information about, and referral to, hospice services 
     and palliative care, including patient and family caregiver 
     education and counseling about hospice services and 
     palliative care, and facilitating transition to hospice when 
     elected.
       ``(N) Such other medical and health care services for which 
     payment would not otherwise be made under this title as the 
     Secretary determines to be appropriate for effective care 
     coordination, including the additional items and services as 
     described in paragraph (2).
       ``(2) Additional benefits.--The Secretary may specify 
     additional benefits for which payment would not otherwise be 
     made under this title that may be available to eligible 
     beneficiaries who have made an election under this section 
     (subject to an assessment by the care coordinator of an 
     individual beneficiary's circumstances and need for such 
     benefits) in order to encourage the receipt of, or to improve 
     the effectiveness of, care coordination services.
       ``(e) Care Coordinators.--
       ``(1) Requirement for Certification.--
       ``(A) In general.--In order to be qualified to furnish care 
     coordination and assessment services under this section, an 
     individual or entity shall be a health care professional or 
     entity (which may include physicians, physician group 
     practices, or other health care professionals or entities the 
     Secretary may find appropriate) who has been certified for a 
     period (as provided in subparagraph (B)) by the Secretary, or 
     by an organization recognized by the Secretary, as having met 
     such criteria as the Secretary may establish for the 
     furnishing of care coordination under this section (which may 
     include experience in the provision of care coordination or 
     primary care physician's services).
       ``(B) Period of certification.--The period of certification 
     for an individual referred to in subparagraph (A) is as 
     follows:
       ``(i) A one-year period for each of the first three years 
     of participation under this section.
       ``(ii) A three-year period thereafter.
       ``(2) Additional requirements.--
       ``(A) Submission of data.--A care coordinator shall comply 
     with such data collection and reporting requirements as the 
     Secretary determines necessary to assess the effect of care 
     coordination on health outcomes.
       ``(B) Participation in quality improvement program.--A care 
     coordinator shall participate in the quality improvement 
     program under paragraph (3).
       ``(C) Additional terms.--A care coordinator shall comply 
     with such other terms and conditions as the Secretary may 
     specify.
       ``(3) Quality improvement program.--
       ``(A) In general.--The Secretary shall establish a chronic 
     care quality assurance program to monitor and improve 
     clinical outcomes for beneficiaries with chronic conditions.
       ``(B) Elements of Program.--Under the program, the 
     Secretary shall--
       ``(i) establish standards to measure--

       ``(I) quality and performance of the care of chronic 
     conditions;
       ``(II) the continuity and coordination of care that 
     eligible beneficiaries under this section receive; and
       ``(III) both underutilization and overutilization of 
     services;

       ``(ii) provide to care coordinators periodic reports on 
     their performance on such measures; and
       ``(iii) make available information on quality and outcomes 
     measures to facilitate beneficiary comparison and choice of 
     care coordination options (in such form and on such quality 
     and outcomes measures as the Secretary determines to be 
     appropriate).
       ``(C) Review of claims.--
       ``(i) In general.--Subject to clause (ii), under the 
     program the Secretary shall make available to care 
     coordinators claims data relating to a beneficiary for whom 
     the coordinator coordinates care under this section for the 
     coordinator's review and subsequent appropriate follow-up 
     action.
       ``(ii) Authorization.--Data may only be provided to a care 
     coordinator under clause (i) if the eligible beneficiary 
     involved has given written authorization for such information 
     to be so provided.
       ``(4) Limitation on number of care coordinators.--Payment 
     may only be made under this section for care coordination 
     services furnished during a period to one care coordinator 
     with respect to an eligible beneficiary.
       ``(5) Payment for services.--
       ``(A) In general.--The Secretary shall establish payment 
     terms and conditions and payment rates for basic care 
     coordination and assessment services described in subsection 
     (d).
       ``(B) Payment methodology.--Payment under this section 
     shall be made in a manner that bundles payment for all care 
     coordination and assessment services furnished during a 
     period, as specified by the Secretary.
       ``(C) Codes.--The Secretary may establish new billing codes 
     to carry out the provisions of this paragraph.
       ``(f) Definitions.--In this section:
       ``(1) Serious and disabling chronic condition.--The term 
     `serious and disabling chronic condition' means, with respect 
     to an individual, that the individual has at least one 
     chronic condition and a licensed health care practitioner has 
     certified within the preceding 12-month period that--
       ``(A) the individual has a level of disability such that 
     the individual is unable to perform (without substantial 
     assistance from another individual) for a period of at least 
     90 days due to a loss of functional capacity--
       ``(i) at least 2 activities of daily living; or
       ``(ii) such number of instrumental activities of daily 
     living that is equivalent (as determined by the Secretary) to 
     the level of disability described in clause (i);
       ``(B) the individual has a level of disability equivalent 
     (as determined by the Secretary) to the level of disability 
     described in subparagraph (A); or

[[Page 13697]]

       ``(C) the individual requires substantial supervision to 
     protect the individual from threats to health and safety due 
     to severe cognitive impairment.
       ``(2) Activities of daily living.--The term `activities of 
     daily living' means each of the following:
       ``(A) Eating.
       ``(B) Toileting.
       ``(C) Transferring.
       ``(D) Bathing.
       ``(E) Dressing.
       ``(F) Continence.
       ``(3) Instrumental activities of daily living.--The term 
     `instrumental activities of daily living' means each of the 
     following:
       ``(A) Medication management.
       ``(B) Meal preparation.
       ``(C) Shopping.
       ``(D) Housekeeping.
       ``(E) Laundry.
       ``(F) Money management.
       ``(G) Telephone use.
       ``(H) Transportation use.
       ``(4) Chronic condition.--The term `chronic condition' 
     means an illness, functional limitation, or cognitive 
     impairment that--
       ``(A) lasts, or is expected to last, at least one year;
       ``(B) limits what a person can do; and
       ``(C) requires on-going medical care.
       ``(5) Beneficiary.--The term `beneficiary' means an 
     individual entitled to benefits under part A and enrolled 
     under part B, including an individual enrolled under the 
     Medicare+Choice program under part C.''.
       (b) Coverage of Care Coordination and Assessment Services 
     as a Part B Medical Service.--
       (1) In general.--Section 1861(s) of the Social Security Act 
     (42 U.S.C. 1395x(s)) is amended--
       (A) in the second sentence, by redesignating paragraphs 
     (16) and (17) as clauses (i) and (ii); and
       (B) in the first sentence--
       (i) by striking ``and'' at the end of paragraph (14);
       (ii) by striking the period at the end of paragraph (15) 
     and inserting ``; and''; and
       (iii) by adding after paragraph (15) the following new 
     paragraph:
       ``(16) care coordination and assessment services furnished 
     by a care coordinator in accordance with section 1897.''.
       (2) Conforming amendments.--Sections 1864(a) 1902(a)(9)(C), 
     and 1915(a)(1)(B)(ii)(I) of such Act (42 U.S.C. 1395aa(a), 
     1396a(a)(9)(C), and 1396n(a)(1)(B)(ii)(I)) are each amended 
     by striking ``paragraphs (16) and (17)'' each place it 
     appears and inserting ``clauses (i) and (ii) of the second 
     sentence''.
       (3) Part b coinsurance and deductible not applicable to 
     care coordination and assessment services.--
       (A) Coinsurance.--Section 1833(a)(1) of the Social Security 
     Act (42 U.S.C. 1395l(a)(1)) is amended--
       (i) by striking ``and'' at the end of subparagraph (T); and
       (ii) by inserting before the final semicolon ``, and (V) 
     with respect to care coordination and assessment services 
     described in section 1861(s)(16) that are furnished by, or 
     coordinated through, a care coordinator, the amounts paid 
     shall be 100 percent of the payment amount established under 
     section 1897''.
       (B) Deductible.--Section 1833(b) of such Act (42 U.S.C. 
     1395l(b)) is amended--
       (i) by striking ``and'' at the end of paragraph (5); and
       (ii) by inserting before the final period ``, and (7) such 
     deductible shall not apply with respect to care coordination 
     and assessment services (as described in section 
     1861(s)(16))''.
       (C) Elimination of coinsurance in outpatient hospital 
     settings.--The third sentence of section 1866(a)(2)(A) of 
     such Act (42 U.S.C. 1395cc(a)(2)(A)), as amended by section 
     101(b)(2), is further amended by inserting after ``section 
     1833(p),'' the following: ``with respect to care coordination 
     and assessment services (as described in section 
     1861(s)(16)),''.

     SEC. 112. CARE COORDINATION AND ASSESSMENT SERVICES AND 
                   QUALITY IMPROVEMENT PROGRAM IN MEDICARE+CHOICE 
                   PLANS.

       Section 1852(e)(1) of the Social Security Act (42 U.S.C. 
     1395w-22(e)(1)) is amended by inserting before the period at 
     the end the following: ``, including a quality improvement 
     program for coordinated care services referred to in section 
     1897(e)(3)''.

     SEC. 113. IMPROVING CHRONIC CARE COORDINATION THROUGH 
                   INFORMATION TECHNOLOGY.

       (a) Technology Improvement Grants.--
       (1) In general.--The Secretary of Health and Human Services 
     (hereinafter in this section referred to as the 
     ``Secretary'') shall make grants to eligible entities to 
     enable such entities to develop, implement, or train 
     personnel in the use of standardized clinical information 
     technology systems designed to--
       (A) improve the coordination and quality of care furnished 
     to medicare beneficiaries with chronic conditions; and
       (B) increase administrative efficiencies of such entities.
       (2) Care coordinators as eligible entities.--In this 
     section, an eligible entity is a care coordinator who 
     furnishes care coordination services to medicare 
     beneficiaries under section 1897 of the Social Security Act.
       (b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), a care coordinator shall--
       (1) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require, including a description of the 
     clinical information technology system that the care 
     coordinator intends to implement using amounts received under 
     the grant;
       (2) provide assurances that are satisfactory to the 
     Secretary that such system, for which amounts are to be 
     expended under the grant, conforms to the standards 
     established by the Secretary under part C of title XI of the 
     Social Security Act, and such other standards as the 
     Secretary may specify; and
       (3) furnish the Secretary with such information as the 
     Secretary may require to--
       (A) evaluate the project for which the grant is made; and
       (B) ensure that funding provided under the grant is 
     expended for the purposes for which it is made.
       (c) Matching Requirement.--The Secretary may not make a 
     grant to a care coordinator under subsection (a) unless that 
     care coordinator agrees that, with respect to the costs to be 
     incurred by the care coordinator in carrying out the 
     activities for which the grant is being awarded, the care 
     coordinator will make available (directly or through 
     donations from public or private entities) non-Federal 
     contributions toward such costs in an amount equal to $1 for 
     each $1 of Federal funds provided under the grant.
       (d) Reports to Congress.--
       (1) Initial Report.--Not later than 18 months after the 
     first grant has been made under this section, the Secretary 
     shall submit an initial report to Congress containing the 
     information referred to in paragraph (3) as well as any 
     recommendations with respect to grants under this section.
       (2) Final Report.--Not later than 6 months after the last 
     grant has been awarded (as determined by the Secretary) under 
     this section, the Secretary shall submit a final report to 
     Congress containing the information referred to in paragraph 
     (2) as well as any recommendations with respect to grants 
     under this section.
       (3) Contents of report.--The reports under this subsection 
     shall include the following:
       (A) A description of the number and nature of grants made 
     under this section.
       (B) An evaluation of--
       (i) improvements in the coordination and quality of care 
     furnished to beneficiaries with chronic conditions; and
       (ii) increases in administrative efficiencies of care 
     coordinators.
       (e) Authorization of Appropriations.--For each of fiscal 
     years 2005, 2006, and 2007, there are authorized to be 
     appropriated to the Secretary $10,000,000 to carry out the 
     program under this section.

                   Subtitle C--Additional Provisions

     SEC. 121. REVIEW OF COVERAGE STANDARDS.

       (a) Review.--With respect to determinations under section 
     1862(a)(1) of such Act (42 U.S.C. 1395y(a)(1)) (relating to 
     whether an item or service is reasonable and necessary for 
     the diagnosis or treatment of illness or injury for purposes 
     of payment under title XVIII of such Act), the Secretary of 
     Health and Human Services shall conduct a review of--
       (1) regulations, policies, procedures, and instructions of 
     the Centers for Medicare & Medicaid Services for making those 
     determinations; and
       (2) policies, procedures, local medical review policies, 
     manual instructions, interpretative rules, statements of 
     policy, and guidelines of general applicability of fiscal 
     intermediaries (under section 1816 of the Social Security Act 
     (42 U.S.C. 1395h)) and carriers under section 1842 of such 
     Act (42 U.S.C. 1395u) for making those determinations.
       (b) Modification.--Insofar as the Secretary determines that 
     the Centers for Medicare & Medicaid Services, a fiscal 
     intermediary, or a carrier has misapplied such standard by 
     requiring that the item or service improve the condition of 
     the patient with respect to such illness or injury, the 
     Secretary shall take such corrective measures as are 
     appropriate to ensure the Centers, intermediary, or carrier 
     (as the case may be) applies the proper standard for making 
     such determinations.
       (c) Report.--On the date that is 18 months after the date 
     of enactment of this Act, the Secretary shall submit to 
     Congress a report that contains--
       (1) a detailed statement of the findings and conclusions of 
     the review conducted under subsection (a);
       (2) a detailed statement of the modifications made under 
     subsection (b); and
       (3) recommendations to avoid misapplication of the standard 
     in the future.

 TITLE II--INSTITUTE OF MEDICINE STUDY ON EFFECTIVE CHRONIC CONDITION 
                                  CARE

     SEC. 201. INSTITUTE OF MEDICINE MEDICARE CHRONIC CONDITION 
                   CARE IMPROVEMENT STUDY AND REPORT.

       (a) Study.--
       (1) In general.--The Secretary of Health and Human Services 
     shall contract with the Institute of Medicine of the National 
     Academy of Sciences to--
       (A) conduct a comprehensive study of the medicare program 
     to identify--

[[Page 13698]]

       (i) factors that facilitate provision of effective care 
     (including, where appropriate, hospice care) for medicare 
     beneficiaries with chronic conditions; and
       (ii) factors that impede provision of such care for such 
     beneficiaries,
     including the issues studied under paragraph (2); and
       (B) submit the report described in subsection (b).
       (2) Issues studied.--The study required under paragraph (1) 
     shall--
       (A) identify inconsistent clinical, financial, or 
     administrative requirements across provider and supplier 
     settings or professional services with respect to medicare 
     beneficiaries;
       (B) identify requirements under the program imposed by law 
     or regulation that--
       (i) promote costshifting across providers and suppliers;
       (ii) impede provision of effective, seamless transitions 
     across health care settings, such as between hospitals, 
     skilled nursing facilities, home health services, hospice 
     care, and care in the home;
       (iii) impose unnecessary burdens on such beneficiaries and 
     their family caregivers;
       (iv) impede the establishment of administrative information 
     systems to track health status, utilization, cost, and 
     quality data across providers and suppliers and provider 
     settings;
       (v) impede the establishment of clinical information 
     systems that support continuity of care across settings and 
     over time; or
       (vi) impede the alignment of financial incentives among the 
     medicare program, the medicaid program, and group health 
     plans and providers and suppliers that furnish services to 
     the same beneficiary.
       (b) Report.--On the date that is 18 months after the date 
     of enactment of this Act, the Institute of Medicine of the 
     National Academy of Sciences shall submit to Congress and the 
     Secretary of Health and Human Services a report that 
     contains--
       (1) a detailed statement of the findings and conclusions of 
     the study conducted under subsection (a); and
       (2) recommendations to improve provision of effective care 
     for medicare beneficiaries with chronic conditions.
                                 ______
                                 
      By Mr. SANTORUM (for himself and Mr. Baucus):
  S. 1180. A bill to amend the Internal Revenue Code of 1986 to modify 
to work opportunity credit and the welfare-to-work credit; to the 
Committee on Finance.
  Mr. SANTORUM. Mr. President, I am pleased to join Senator Baucus in 
the introduction of the Encouraging Work Act of 2003. The Work 
Opportunity Tax Credit, WOTC, and Welfare-to-Work Tax Credit, W-t-W, 
are tax incentives that encouraging employers to hire public assistance 
recipients and other individuals with barriers to employment. The 
combination of Welfare Reform passed by Congress in 1996 and the 
assistance to employers found in the WOTC and W-t-W has enabled 
expanded opportunity for many Americans. Yet more can be done.
  Under present law, WOTC provides a 40 percent tax credit on the first 
$6,000 of wages for those working at least 400 hours, or a partial 
credit of 25 percent for those working 120-399 hours. W-t-W provides a 
35 percent tax credit on the first $10,000 of wages for those working 
400 hours in the first year. In the second year, the W-t-W credit is 50 
percent of the first $10,000 of wages earned. WOTC and W-t-W are key 
elements of welfare reform. A growing number of employers use these 
programs in the retail, health care, hotel, financial services, food, 
and other industries. These programs have helped over 2,200,000 
previously dependent persons to find jobs.
  Eligibility is limited to: 1. recipients of Temporary, Assistance to 
Needy Families, TANF, in 9 of the 18 months ending on the hiring date; 
2. individuals receiving Supplemental Security Income, SSI, benefits; 
3. disabled individuals with vocational rehabilitation referrals; 4. 
veterans on food stamps; 5. individuals aged 18-24 in households 
receiving food stamp benefits; 6. qualified summer youth employees: 7. 
low-income ex-felons; and 8. individuals ages 18-24 living in 
empowerment zones or renewal communities. Eligibility for W-t-W is 
limited to individuals receiving welfare benefits for 18 consecutive 
months ending on the hiring date. More than 80 percent of WOTC and W-t-
W hires were previously dependent on public assistance programs. These 
credits are both a hiring incentive, offsetting some of the higher 
costs of recruiting, hiring, and retaining public assistance recipients 
and other low-skilled individuals, and a retention incentive, providing 
a higher reward for those who stay longer on the job.
  Without action by Congress WOTC and W-t-W will expire on December 31, 
2003. After seven years of experience with these programs, their value 
has been well demonstrated. In 2001, the GAO issued a report that 
indicated that employers have significantly changed their hiring 
practices because of WOTC. With the resources provided by WOTC, 
employers have provided job mentors, lengthened training periods, 
engaged in recruiting outreach, and listed jobs or requested referrals 
from public agencies or partnerships. WOTC and W-t-W have become a true 
public-private partnership in which the Department of Labor, the 
Internal Revenue Service, the states, and employers have forged 
excellent working relationships.
  But the challenges for employers and those looking for better 
opportunities are real. The job skills of eligible persons leaving 
welfare are sometimes limited, and the costs of recruiting, training, 
and supervising low-skilled individuals cause many employers to look 
elsewhere for employees. The weak economy and rising unemployment give 
employers more hiring options. WOTC and W-t-W are proven incentives for 
encouraging employers to seek employees from the targeted groups.
  Despite the considerable success of WOTC and W-t-W, many vulnerable 
individuals still need a boost in finding employment. This is 
particularly true during periods of high unemployment. There are 
several legislative changes that would strengthen these programs, 
expand employment opportunities for needy individuals, and make the 
programs more attractive to employers.
  The Administration's FY 2004 budget proposes to simplify these 
important employment incentives by combining them into one credit and 
making the rules for computing the combined credits simpler. The 
credits would be combined by creating a new welfare-to-work target 
group under WOTC. The minimum employment periods and credit rates for 
the first year of employment under the present work opportunity tax 
credit would apply to W-t-W employees. The maximum amount of eligible 
wages would continue to be $10,000 for W-t-W employees and $6,000 for 
other target groups ($3,000 for summer youth). In addition, the second 
year 50-percent credit under W-t-W would continue to be available for 
W-t-W employees under the modified WOTC.
  Under current law, only those ex-felons whose annual family income is 
70 percent or less than the Bureau of Labor Statistics lower living 
standard during the six months preceding the hiring date are eligible 
for WOTC. The Administration's FY 2004 budget proposes to eliminate the 
family income attribution rule.
  Permanent extension would provide these programs with greater 
stability, thereby encouraging more employers to participate, make 
investments in expanding outreach to identify potential workers from 
the targeted groups, and avoid the wasteful disruption of termination 
and renewal. A permanent extension would also encourage the state job 
services to invest the resources needed to make the certification 
process more efficient and employer-friendly.
  Current WOTC eligibility rules heavily favor the hiring of women 
because single mothers are much more likely to be on welfare or food 
stamps. Women constitute about 80 percent of those hired under the WOTC 
program, but men from welfare households face the same or even greater 
barriers to finding work. Increasing the age ceiling in the ``food 
stamp category'' would greatly improve the job prospects for many 
absentee fathers and other ``at risk'' males. This change would be 
completely consistent with program objectives because many food stamp 
households include adults who are not working, and more than 90 percent 
of those on food stamps live below the poverty line.
  The Work Opportunity Credit and Welfare-to-Work Credit have been 
successful in moving traditionally hard-to-employ persons off welfare 
and into the workforce, where they contribute

[[Page 13699]]

to our economy. However, employer participation in these important 
programs can be increased, particularly among small and medium-sized 
employers. This is due to the complexity of the credits and the fact 
that they are both only temporary provisions of the tax code subject to 
renewal every year or two. Small, medium, and even some large employers 
find it difficult to justify developing the necessary infrastructure to 
administer and participate in these programs when their continued 
existence beyond one or two years is constantly in question.
  This legislation will remedy this problem by combining WOTC and W-t-W 
into one, more easily administered tax credit, and by making it a 
permanent part of the tax code. Many organizations including the 
National Council of Chain Restaurants, National Retail Federation, Food 
Marketing Institute, National Association of Convenience Stores, 
National Restaurant Association, American Hotel & Lodging Association, 
National Roofing Contractors Association, National Association of Chain 
Drug Stores, American Nursery and Landscape Association, and the 
American Health Care Association support this legislation. 
Representatives Amo Houghton, R-NY, and Charles Rangel, D-NY, have 
introduced identical legislation in the House of Representatives. I 
urge my colleagues to join us in supporting this legislation.
  Mr. BAUCUS. Mr. President, I am pleased to join my colleague, Senator 
Santorum, and my other Senate colleagues in introducing legislation to 
permanently extend and improve upon the Work Opportunity and the 
Welfare-to-Work tax credits. During this year's debate on the Jobs and 
Growth Tax Reconciliation Act, I voted to extend these tax credits were 
not included in the final conference agreement, but I continue to 
strongly support the passage of legislation this year to make these 
credits permanent and make several reforms in the programs to improve 
their effectiveness.
  Over the past seven years, the Work Opportunity Tax Credit, WOTC, and 
the Welfare-to-Work, W-t-W, tax credit have helped over 2.2 million 
public assistance dependent individuals enter the workforce. Both of 
these important programs are scheduled to expire on December 31, 2003. 
These hiring tax incentives have clearly demonstrated their 
effectiveness in helping to level the job selection playing field for 
low-skilled individuals by providing employers with additional 
resources to help recruit, select, train and retain individuals with 
significant barriers to work. Many vulnerable individuals still need a 
boost in finding employment, and this is particularly critical during 
periods of high unemployment. The weak economy and rising unemployment 
give employers many more hiring options because of the larger pool of 
experienced laid-off workers. Without an extension of these programs, 
the task of transitioning from welfare-to-work will become even harder 
for individuals reaching their welfare eligibility ceiling this year.
  Because of the costs involved in setting up and administering a WOTC/
W-t-W program, employers have established massive outreach programs to 
maximize the number of eligible persons in their hiring pool. The 
States, in turn, have steadily improved the programs through improved 
administration. WOTC has become an example of a true public-private 
partnership design to assist the most needy. Without the additional 
resources provided by these hiring tax incentives, few employers would 
actively seek out this hard-to-employ population.
  WOTC provides employers with a graduated tax credit equal to 25-
percent of the first $6,000 in wages for eligible individuals working 
between 120 hours and 399 hours and a 40-percent tax credit on the 
first $6,000 in wages for those working over 400 hours. The W-t-W tax 
credit is geared toward long term welfare recipients and provides a 35-
percent tax credit on the first $10,000 in wages during the first year 
of employment and a 50-percent credit on the first $10,000 for those 
who stay on the job a second year.
  In my own State of Montana many businesses take advantage of this 
program, including large multinational firms and smaller family-owned 
businesses. Those who truly benefit from the WOTC/W-t-W program, 
however, are low-income families, under the Food Stamp Program and the 
Aid to Families with Dependent Children, AFDC, and Temporary Assistance 
for Needy Families, TANF, program, and also low income U.S. Veterans. 
In Montana, more than 1,000 people were certified as eligible under the 
WOTC program during the past 18 months, October 2001 through March 
2003, including 476 Food Stamp recipients, 475 AFDC/TANF recipients, 
and 52 U.S. veterans.
  The bill we are introducing provides for a permanent program 
extension of the two credits. After seven years of experience with WOTC 
and W-t-W, we know that employers do respond to these important hiring 
tax incentives. Permanent extension would provide these programs with 
greater stability, thereby encouraging more employers to participate, 
make investments in expanding outreach to identify potential workers 
from the targeted groups, and avoid the wasteful disruption of 
termination and renewal. A permanent extension would also encourage the 
state job services to invest the resources needed to make the 
certification process more efficient and employer-friendly.
  The bill also includes a proposal to simplify the programs by 
combining them into one credit and making the rules for computing the 
combined credits simpler. This would be accomplished by creating a new 
welfare-to-work target group under WOTC. The minimum employment periods 
and credit rates for the first year of employment under present work 
opportunity tax credit would apply to W-t-W employees. THe maximum 
amount of eligible wages would continue to be $10,000 for W-t-W 
employees. In addition, the second year 50-percent credit under W-t-W 
would continue to be available for W-t-W employees under the modified 
WOTC.
  Finally, there are other changes in the bill that would extend these 
benefits to more people and help them find work. Because of the 
program's eligibility criteria, over 80 percent of those hired are 
women leaving welfare. Since men generally are not eligible for TANF 
benefits, the fathers of children on welfare receive little help in 
finding work, even though they often face even greater barriers to work 
than women on welfare. We propose to help absentee fathers find work 
and provide the resources to assume their family responsibilities by 
opening up WOTC eligibility to anyone 39 years old or younger in 
families receiving food stamps or residing in enterprise zones or 
empowerment communities. Raising the eligibility limits in these two 
categories will extend eligibility to hundreds of thousands of at-risk 
men.
  I urge my colleagues to support this important piece of legislation.
                                 ______
                                 
      By Mr. CORZINE (for himself, Mr. Lautenberg, and Mr. Akaka):
  S. 1181. A bill to promote youth financial education; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. CORZINE. Mr. President, I rise today to introduce along with 
Senators Lautenberg and Akaka the Youth Financial Literacy Act to call 
attention to an important issue in education: teaching students the 
basic principles of financial literacy to prepare them to be 
responsible consumers. This legislation will give young Americans the 
tools they need to succeed in this ever-changing economy.
  Today, it is as important for young people to learn about staying out 
of debt, maintaining good credit and building up their savings as it is 
for them to learn about geography, science and history.
  Far too many of our youth enter adulthood lacking basic financial 
literacy skills, not knowing how to budget their wages or salaries or 
build personal savings. A recent survey by the non-profit JumpStart 
Coalition reveals that the only 21 percent of students between the ages 
of 16 and 22 say they have taken a personal finance course at school. 
The study also found that when high school seniors were tested on

[[Page 13700]]

basic financial literacy, they answered a mere 50.2 percent of the 
questions correctly. That, is simply not acceptable.
  Providing financial education to our nation's young people must be a 
priority. Indeed it is time for our schools to make a more concerted 
effort to prepare our children for success in new ways including their 
future financial decision-making.
  I am not alone in advocating the importance of financial literacy. 
Federal Reserve Chairman Alan Greenspan has said, ``Improving basic 
financial education at the elementary and secondary school levels is 
essential to providing a foundation for financial literacy that can 
help prevent younger people from making poor financial decisions.''
  Today, I hope to elevate the discussion of this issue by introducing 
the Youth Financial Education Act, which would provide $100 million in 
grants to states to help them develop and implement financial education 
programs in elementary and secondary schools, including helping to 
prepare teachers to provide financial education. It would also 
establish a national clearinghouse for instructional materials and 
information regarding model financial education programs.
  I am happy to report that in my state of New Jersey many have already 
started the ball rolling on financial literacy education. My State 
allows local schools the option of offering financial education in high 
school, and the New Jersey Coalition for Financial Education is working 
with the New Jersey Department of Education to develop and implement 
core curriculum standards. I believe it is time for our Nation to 
follow suit and begin to focus on the financial literacy education of 
all young Americans.
  We must not sit idly by while so many of our children lack financial 
literacy. So I ask for my colleagues to join me in support of the Youth 
Financial Literacy Act, which will ensure that our next generation is 
prepared to meet the challenges of the new economy.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1181

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

     SECTION 1. PROMOTING YOUTH FINANCIAL LITERACY.

       Title IV of the Elementary and Secondary Education Act of 
     1965 (20 U.S.C. 7101 et seq.) is amended by adding at the end 
     the following:

              ``PART D--PROMOTING YOUTH FINANCIAL LITERACY

     ``SEC. 4401. SHORT TITLE AND FINDINGS.

       ``(a) Short Title.--This part may be cited as the `Youth 
     Financial Education Act'.
       ``(b) Findings.--Congress finds the following:
       ``(1) In order to succeed in our dynamic American economy, 
     young people must obtain the skills, knowledge, and 
     experience necessary to manage their personal finances and 
     obtain general financial literacy. All young adults should 
     have the educational tools necessary to make informed 
     financial decisions.
       ``(2) Despite the critical importance of financial literacy 
     to young people, the average student who graduates from high 
     school lacks basic skills in the management of personal 
     financial affairs. A nationwide survey conducted in 2002 by 
     the Jump$tart Coalition for Personal Financial Literacy 
     examined the financial knowledge of 4,024 12th graders. On 
     average, survey respondents answered only 50 percent of the 
     questions correctly. This figure is down from the 52 percent 
     average score in 2000 and the 57 percent average score in 
     1997.
       ``(3) An evaluation by the National Endowment for Financial 
     Education High School Financial Planning Program undertaken 
     jointly with the United States Department of Agriculture 
     Cooperative State Research, Education, and Extension Service 
     demonstrates that as little as 10 hours of classroom 
     instruction can impart substantial knowledge and affect 
     significant change in how teens handle their money.
       ``(4) State educational leaders have recognized the 
     importance of providing a basic financial education to 
     students in kindergarten through grade 12 by integrating 
     financial education into State educational standards, but by 
     2002 only 4 States required students to complete a course 
     that covered personal finance before graduating from high 
     school.
       ``(5) Teacher training and professional development are 
     critical to achieving youth financial literacy. Teachers 
     confirm the need for professional development in personal 
     finance education. In a survey by the National Institute for 
     Consumer Education, 77 percent of a State's economics 
     teachers revealed that they had never had a college course in 
     personal finance.
       ``(6) Personal financial education helps prepare students 
     for the workforce and for financial independence by 
     developing their sense of individual responsibility, 
     improving their life skills, and providing them with a 
     thorough understanding of consumer economics that will 
     benefit them for their entire lives.
       ``(7) Financial education integrates instruction in 
     valuable life skills with instruction in economics, including 
     income and taxes, money management, investment and spending, 
     and the importance of personal savings.
       ``(8) The consumers and investors of tomorrow are in our 
     schools today. The teaching of personal finance should be 
     encouraged at all levels of our Nation's educational system, 
     from kindergarten through grade 12.

     ``SEC. 4402. STATE GRANT PROGRAM.

       ``(a) Program Authorized.--The Secretary is authorized to 
     provide grants to State educational agencies to develop and 
     integrate youth financial education programs for students in 
     elementary schools and secondary schools.
       ``(b) State Plan.--
       ``(1) Approved state plan required.--To be eligible to 
     receive a grant under this section, a State educational 
     agency shall submit an application that includes a State 
     plan, described in paragraph (2), that is approved by the 
     Secretary.
       ``(2) State plan contents.--The State plan referred to in 
     paragraph (1) shall include--
       ``(A) a description of how the State educational agency 
     will use grant funds;
       ``(B) a description of how the programs supported by a 
     grant will be coordinated with other relevant Federal, State, 
     regional, and local programs; and
       ``(C) a description of how the State educational agency 
     will evaluate program performance.
       ``(c) Allocation of Funds.--
       ``(1) Allocation factors.--Except as otherwise provided in 
     paragraph (2), the Secretary shall allocate the amounts made 
     available to carry out this section pursuant to subsection 
     (a) to each State according to the relative populations in 
     all the States of students in kindergarten through grade 12, 
     as determined by the Secretary based on the most recent 
     satisfactory data.
       ``(2) Minimum allocation.--Subject to the availability of 
     appropriations and notwithstanding paragraph (1), a State 
     that has submitted a plan under subsection (b) that is 
     approved by the Secretary shall be allocated an amount that 
     is not less than $500,000 for a fiscal year.
       ``(3) Reallocation.--In any fiscal year an allocation under 
     this subsection--
       ``(A) for a State that has not submitted a plan under 
     subsection (b); or
       ``(B) for a State whose plan submitted under subsection (b) 
     has been disapproved by the Secretary;

     shall be reallocated to States with approved plans under this 
     section in accordance with paragraph (1).
       ``(d) Use of Grant Funds.--
       ``(1) Required uses.--A grant made to a State educational 
     agency under this part shall be used--
       ``(A) to provide funds to local educational agencies and 
     public schools to carry out financial education programs for 
     students in kindergarten through grade 12 based on the 
     concept of achieving financial literacy through the teaching 
     of personal financial management skills and the basic 
     principles involved with earning, spending, saving, and 
     investing;
       ``(B) to carry out professional development programs to 
     prepare teachers and administrators for financial education; 
     and
       ``(C) to monitor and evaluate programs supported under 
     subparagraphs (A) and (B).
       ``(2) Limitation on administrative costs.--A State 
     educational agency receiving a grant under subsection (a) may 
     use not more than 4 percent of the total amount of the grant 
     in each fiscal year for the administrative costs of carrying 
     out this section.
       ``(e) Report to the Secretary.--Each State educational 
     agency receiving a grant under this section shall transmit a 
     report to the Secretary with respect to each fiscal year for 
     which a grant is received. The report shall describe the 
     programs supported by the grant and the results of the State 
     educational agency's monitoring and evaluation of such 
     programs.

     ``SEC. 4403. CLEARINGHOUSE.

       ``(a) Authority.--Subject to the availability of 
     appropriations, the Secretary shall make a grant to, or 
     execute a contract with, an eligible entity with substantial 
     experience in the field of financial education, such as the 
     Jump$tart Coalition for Personal Financial Literacy, to 
     establish, operate, and maintain a national clearinghouse (in 
     this part referred to as the `Clearinghouse') for 
     instructional materials and information regarding model 
     financial education programs and best practices.

[[Page 13701]]

       ``(b) Eligible Entity.--In this section, the term `eligible 
     entity' means a national nonprofit organization with a proven 
     record of--
       ``(1) cataloging youth financial literacy materials; and
       ``(2) providing support services and materials to schools 
     and other organizations that work to promote youth financial 
     literacy.
       ``(c) Application.--An eligible entity desiring to 
     establish, operate, and maintain the Clearinghouse shall 
     submit an application to the Secretary at such time, in such 
     manner, and accompanied by such information, as the Secretary 
     may reasonably require.
       ``(d) Basis and Term.--The Secretary shall make the grant 
     or contract authorized under subsection (a) on a competitive, 
     merit basis for a term of 5 years.
       ``(e) Use of Funds.--The Clearinghouse shall use the funds 
     provided under a grant or contract made under subsection 
     (a)--
       ``(1) to maintain a repository of instructional materials 
     and related information regarding financial education 
     programs for elementary schools and secondary schools, 
     including kindergartens, for use by States, localities, and 
     the general public;
       ``(2) to disseminate to States, localities, and the general 
     public, through electronic and other means, instructional 
     materials and related information regarding financial 
     education programs for elementary schools and secondary 
     schools, including kindergartens; and
       ``(3) to the extent that resources allow, to provide 
     technical assistance to States, localities, and the general 
     public on the design, establishment, and implementation of 
     financial education programs for elementary schools and 
     secondary schools, including kindergartens.
       ``(f) Consultation.--The chief executive officer of the 
     eligible entity selected to establish and operate the 
     Clearinghouse shall consult with the Department of the 
     Treasury and the Securities Exchange Commission with respect 
     to its activities under subsection (e).
       ``(g) Submission to Clearinghouse.--Each Federal agency or 
     department that develops financial education programs and 
     instructional materials for such programs shall submit to the 
     Clearinghouse information on the programs and copies of the 
     materials.
       ``(h) Application of Copyright Laws.--In carrying out this 
     section the Clearinghouse shall comply with the provisions of 
     title 17 of the United States Code.

     ``SEC. 4404. EVALUATION AND REPORT.

       ``(a) Performance Measures.--The Secretary shall develop 
     measures to evaluate the performance of programs assisted 
     under sections 4402 and 4403.
       ``(b) Evaluation According to Performance Measures.--
     Applying the performance measures developed under subsection 
     (a), the Secretary shall evaluate programs assisted under 
     sections 4402 and 4403--
       ``(1) to judge their performance and effectiveness;
       ``(2) to identify which of the programs represent the best 
     practices of entities developing financial education programs 
     for students in kindergarten through grade 12; and
       ``(3) to identify which of the programs may be replicated 
     and used to provide technical assistance to States, 
     localities, and the general public.
       ``(c) Report.--For each fiscal year for which there are 
     appropriations under section 4407(a), the Secretary shall 
     transmit a report to Congress describing the status of the 
     implementation of this part. The report shall include the 
     results of the evaluation required under subsection (b) and a 
     description of the programs supported under section 4402.

     ``SEC. 4405. DEFINITIONS.

       ``In this part:
       ``(1) Financial education.--The term `financial education' 
     means educational activities and experiences, planned and 
     supervised by qualified teachers, that enable students to 
     understand basic economic and consumer principals, acquire 
     the skills and knowledge necessary to manage personal and 
     household finances, and develop a range of competencies that 
     will enable them to become responsible consumers in today's 
     complex economy.
       ``(2) Qualified teacher.--The term `qualified teacher' 
     means a teacher who holds a valid teaching certification or 
     is considered to be qualified by the State educational agency 
     in the State in which the teacher works.

     ``SEC. 4406. PROHIBITION.

       ``Nothing in this part shall be construed to authorize an 
     officer or employee of the Federal Government to mandate, 
     direct, or control a State, local educational agency, or 
     school's specific instructional content, curriculum, or 
     program of instruction, as a condition of eligibility to 
     receive funds under this part.

     ``SEC. 4407. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) Authorization.--For the purposes of carrying out this 
     part, there are authorized to be appropriated $100,000,000 
     for each of the fiscal years 2004 through 2008.
       ``(b) Limitation on Funds for Clearinghouse.--The Secretary 
     may use not less than 2 percent and not more than 5 percent 
     of amounts appropriated under subsection (a) for each fiscal 
     year to carry out section 4403.
       ``(c) Limitation on Funds for Secretary Evaluation.--The 
     Secretary may use not more than $200,000 from the amounts 
     appropriated under subsection (a) for each fiscal year to 
     carry out subsections (a) and (b) of section 4404.
       ``(d) Limitation on Administrative Costs.--Except as 
     necessary to carry out subsections (a) and (b) of section 
     4404 using amounts described in subsection (c) of this 
     section, the Secretary shall not use any portion of the 
     amounts appropriated under subsection (a) for the costs of 
     administering this part.''.
                                 ______
                                 
      By Mr. McCONNELL (for himself, Mrs. Feinstein, Mr. McCain, Mr. 
        Leahy, Mr. Specter, Mr. Kennedy, Ms. Mikulski, Mr. Kyl, Mr. 
        Daschle, Mr. Santorum, and Mr. Brownback):
  S. 1182. A bill to sanction the ruling Burmese military junta, to 
strengthen Burma's democratic forces and support and recognize the 
National League of Democracy as the legitimate representative of the 
Burmese people, and for other purposes; to the Committee on Foreign 
Relations.
  Mr. McCONNELL. Mr. President, while democracy activists in Burma have 
been murdered, intimidated and harassed for well over a decade, the 
blitzkrieg on freedom launched last weekend by the illegitimate State 
Peace and Development Council--SPDC--killed and injured scores of 
supporters from the National League for Democracy--NLD.
  Democracy leader Aung San Suu Kyi and numerous other activists were 
brutalized, arrested and today remain held incommunicado. Reports 
indicate that Suu Kyi is being held in the Yemon military camp, 40 
kilometers outside of Rangoon. It is believed she suffers from 
lacerations to her face and a broken shoulder. The administration 
should waste no time in gaining access to Suu Kyi to ensure her safety 
and security.
  I have come to the floor every day this week to draw attention to the 
untenable situation in that country. On Monday, I urged the 
administration to act promptly and decisively in support of democracy 
in Burma. The State Department can take specific action without the 
need for legislation--such as broadening visa restrictions, freezing 
assets, and downgrading Burma's diplomatic status in Washington.
  Mr. McCAIN. Will the Senator yield for a question?
  Mr. McCONNELL. Yes.
  Mr. McCAIN. I thank the Senator from Kentucky for his advocacy for, 
not only one of the world's great, courageous figures, but also on 
behalf of democracy and freedom in a small country far away.
  Is the Senator from Kentucky aware of any action, or even any 
statements being made by our friends in Asia, including ASEAN, and how 
does he feel about that?
  Mr. McCONNELL. I would say to my friend from Arizona, there will be a 
regional ASEAN meeting in Phnom Penh on June 18 and 19. Secretary 
Powell is scheduled to be there. I hope that will be an opportunity to 
hear from the other Asian, ASEAN countries, that maybe, for once, they 
will understand what a pariah regime that is and work with us in a 
coordinated fashion to impose sanctions that will actually mean 
something in bringing down the regime.
  Mr. McCAIN. If the Senator will yield for one further question, has 
the Senator heard about a statement of the Japanese Foreign Minister 
that basically is saying that everything was pretty well--the status 
quo was pretty well satisfactory in Burma? And before I ask the Senator 
to answer the question, I want to say again, I thank him for his 
advocacy of many years, for the democratic movement in Burma, sometimes 
known as Myanmar. I thank him and look forward to working with him.
  I think the Congress can act, and I hope we can work in concert with 
the administration.
  Mr. McCONNELL. I thank my friend from Arizona. I understand the 
Japanese may be reconsidering their statement of yesterday. There could 
well be a subsequent statement today that might be more pleasing to the 
Senator from Arizona and myself.
  I thank him for being an extraordinary leader on this issue, as well, 
and for agreeing to cosponsor the bill I am about to introduce.

[[Page 13702]]

  I also might mention, I had an opportunity to talk with the Deputy 
Secretary of State and Deputy Secretary of Defense today to encourage 
them to take a very great interest and recommend the President take a 
very great interest in this issue. The only way, obviously, we are 
going to have an impact in Burma is for the United States to use the 
kind of leadership only it can provide to rally the world around a 
sanctions regime and tighten the noose around this regime and hopefully 
this will be the beginning of that effort.
  Mr. McCAIN. I thank my friend.
  Mr. McCONNELL. The White House should utilize all authority at its 
disposal to immediately sanction the junta, including banning imports 
from Burma and raising the brutal crackdown on democracy before the 
U.N. Security Council.
  On Tuesday, I appealed to the international community to stand by the 
people of Burma during their dark hour of need, and called upon the 
world's democracies to act in support of Suu Kyi and her courageous 
supporters. Elected representatives cannot stand by idly while 
democracy in Burma is strangled by the SPDC.
  Today, along with my colleagues Senators Feinstein, McCain, Leahy, 
Specter, Kennedy, Mikulski, Kyl, Daschle, and Santorum, I am 
introducing the ``Burmese Freedom and Democracy Act of 2003''. This act 
recognizes that what is needed in Burma is fewer carrots and more 
sticks.
  Among other restrictions that I will describe shortly, the act 
imposes an import ban on articles produced, mined, manufactured, grown, 
or assembled in Burma. It prohibits the import of goods to the United 
States produced by the SPDC, companies in which the junta has a 
financial interest, and the SPDC's political arm, the Union Solidarity 
Development Association--USDA.
  Lest my colleagues forget, the USDA, under the direction of the 
junta, orchestrated the recent terror in the townships that left scores 
dead and Suu Kyi injured. They are Burma's fedayeen.
  There are some who discount economic sanctions as a tool to coerce 
and modify the behavior of repressive nations. According to their 
argument, sanctions hurt the very people they are intended to help.
  Sanctions in Burma will not rape ethnic girls and women, burn down 
their villages and murder their brothers, husbands, and sons.
  Sanctions in Burma will not impress children into the military, drug 
them, and send them off to dangerous battlefields.
  Sanctions in Burma will not use slave labor, nor will they profit 
from an illicit narcotics trade that wreaks havoc among the region's 
youth and contributes to an exploding HIV/AIDS rate along Burma's 
borders.
  Finally, sanctions in Burma will not attack peaceful supporters of 
the NLD or democracy leader Aung San Suu Kyi, nor will they ever take a 
single life by an act of violence.
  The SPDC is guilty of committing the laundry list of heinous crimes 
that I just described. Every single one of them is an assault on the 
human rights and dignity of the Burmese people. Burma's junta is as 
chronic an abuser of human rights as Kim Jong-Il in North Korea--and as 
was the Taliban in Afghanistan and Saddam Hussein in Iraq.
  The fact of the matter is that the import ban will impact a 
negligible percentage of Burma's population. It will deny Burma the 
ability to import some $350 million to $470 million worth of goods to 
the United States--most of which are garments and textiles--thus 
denying the SPDC legitimate revenue.
  Unfortunately, the people of Burma reap almost no benefits from this 
income. The SPDC is more interested in spending revenue on itself than 
in investing in the welfare of the people of Burma.
  With over one-quarter of Burma's imports currently destined for the 
United States, the ban will hit the SPDC where it hurts most--in the 
pocketbook and its public image.
  South African Bishop Desmond Tutu, who knows a thing or two about 
sanctions and repression, said of Burma earlier this week:

       We urge freedom loving governments everywhere to impose 
     sanctions on this illegitimate regime. They worked for us in 
     South Africa. If applied conscientiously, they will work in 
     Burma too. Freeze the assets of the regime and impose 
     stringent travel restrictions on them and their supporters. 
     We need a regime change [in Burma].

  I supported sanctions against the apartheid regime in South Africa 
then, and I support sanctions against the military junta in Burma now.
  Sanctions will empower Burma's democrats who have already 
demonstrated their support for freedom by overwhelmingly electing the 
NLD in the 1990 elections. These polls were never recognized by the 
SPDC. Instead, the junta has spent the past decade trying to suffocate 
the aspirations for democracy by all of Burma's people and imprisoning 
their leader, Suu Kyi.
  In addition to the import ban, the act also freezes the assets of the 
SPDC in the United States and requires the U.S. to oppose and vote 
against loans or other assistance proposed for Burma by international 
financial institutions.
  It expands the visa ban to former and present SPDC leadership and the 
Union Solidarity Development Association and requires coordination with 
the European Union's visa ban list. Let me be clear that the SPDC 
leadership includes all officer-level individuals associated with the 
regime.
  Finally, the act requires the Secretary of State to promote greater 
awareness of the abuses of the SPDC, requires the State Department to 
more proactively promote awareness of U.S. policy toward Burma, and 
encourages greater support for Burmese democracy activists.
  Let me close with a few words and observations about Daw Aung San Suu 
Kyi. Over the years, the daughter of the father of Burma's independence 
has stood squarely between the people of Burma and the thuggish regime. 
Against great odds and often in great danger, Suu Kyi has consistently 
and successfully stared down SPDC generals and their military might. 
She has never wavered--not once--in her support for democracy and the 
rule of law for Burma.
  Our thoughts and prayers continue to be with Suu Kyi and the people 
she so ably represents. She is obviously the greatest hope for that 
country.
  I ask my colleagues: If America does not stand with Suu Kyi and the 
NLD now, whither freedom and justice in Burma? Without us, it has no 
chance.
  Pressure, patience and persistence will bring political change to 
Burma. Suu Kyi knows this in her heart and mind, as we all do. America 
must lead. And if we do, others will rally.
  I thank my friend from New Mexico. I yield the floor and ask 
unanimous consent that the text of the bill be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DOMENICI. Mr. President, I commend the distinguished majority 
whip for his eloquent statement today and compliment him on his 
persistence with reference to the cause of freedom and democracy in 
Burma.
  Mr. DASCHLE. Mr. President, for 6 days, Aung San Suu Kyi--the 
courageous voice of democracy and freedom in Burma--has been in jail. 
Her crime? Support for reform and democracy in one of the world's most 
isolated and repressive countries.
  One of the world's great democrats is currently being held by a 
military junta disingenuously named State Peace and Development 
Council. Late last week, the Junta announced that it had Suu Kyi in 
``protective custody.'' The truth, of course, is that she was beaten 
with a bamboo pole and detained in an ambush that killed four of her 
supporters. Several observers noted that her arrest is the latest in a 
vicious and coordinated attack which has claimed 70 of her supporters.
  This is evidence of the junta's deplorable disregard for 
international standards of decency and for the people it rules. It also 
tells us what we can expect from the junta. A year ago, after Suu Kyi 
was released from her 15 year long detention, there was a glimmer of 
hope for reform and democracy in Burma. Rather than re-engaging the

[[Page 13703]]

world, however, the junta holds fast to its failed policies of the 
past.
  The Special Envoy from the United Nations is scheduled to travel to 
Burma this weekend as part of a larger effort to promote democracy. Yet 
with its actions this past week, the SPDC confirms what we had all 
feared--and what Suu Kyi warned: the military junta in power in Burma 
cannot and will not take the necessary steps to bring about democracy 
and freedom. I hope the UN Envoy will make clear his disappointment, 
indeed the world's disappointment, with these latest developments.
  Given the gravity of this situation in Burma, I am pleased to join 
with Senators Feinstein and McConnell, among others, in introducing 
legislation that underscores the depth of our concern and the strength 
of our resolve in ensuring democracy in Burma. The bill would ban 
imports from Burma, freeze SPDC assets in this country, tighten the 
visa ban on Burmese officials, and urge specific diplomatic steps to 
raise the importance of this issue with our friends in the 
international community.
  In the National Security Strategy, President Bush proclaimed that 
``our first imperative is to clarify what we stand for: the United 
States must defend liberty and justice because these principles are 
right and true for all people everywhere. No nation owns these 
aspirations, and no nation is exempt from them . . . We will champion 
the cause of human dignity and oppose those who resist it.'' The SPDC 
is doing everything it can to rob the Burmese people of liberty, of 
justice, and of human dignity. It is time for the Senate to make clear 
just where the United States stands in the face of this injustice.
  Mrs. FEINSTEIN. Mr. President, I rise along with my distinguished 
colleague from Kentucky, Senator McConnell, to introduce the Burmese 
Freedom and Democracy Act of 2003, which would establish a complete 
import ban on all products from Burma.
  On May 30, Aung San Suu Kyi and at least 17 officials of the National 
League for Democracy, NLD, were detained after a clash in the town of 
Ye-u, after reportedly being attacked by members of the Union 
Solidarity Development Association, a paramilitary organization created 
by the ruling military junta, the State Peace and Development Council, 
SPDC.
  Four people were killed and 50 injured in the attacks. Aung San Suu 
Kyi has been officially placed in ``protective custody'', but her 
whereabouts remain unconfirmed.
  Still more disturbing are reports in today's Washington Post that Suu 
Kyi may have suffered a head wound and a broken arm in the attacks and 
is possibly being held at a military hospital near Rangoon. The 
military junta continues to insist that she is in good health and in a 
``safe place'', yet they are unwilling to allow independent 
verification of Suu Kyi's condition.
  One year ago the military junta freed Suu Kyi following 19 months of 
house arrest, while promising cooperation and dialogue toward political 
accommodation. Had I discussed Burma on the floor of the Senate back 
then, I would have sounded a note of cautious optimism, echoing Aung 
San Suu Kyi's own statement that ``it's a new dawn for the country''.
  But as the events of May 30 have so tragically illustrated, the SPDC 
have broken every promise to work towards political dialogue and, in 
fact, have launched a new campaign of repression.
  Given the military regime's utter contempt for the welfare and safety 
of its people and the repeated and ongoing human rights abuses against 
Aung San Suu Kyi and the members of the NLD, I now feel we have no 
choice but to strengthen the sanctions imposed in 1997.
  The actions of the SPDC are simply outrageous and I join the State 
Department, the United Nations and the many voices from around the 
world in demanding that Suu Kyi and the others be released immediately, 
and to allow the U.N. Special Rapporteur on Human Rights in Burma to 
conduct an independent investigation into the attack on Aung San Suu 
Kyi and her party.
  Not content to stop with arresting the leadership of the NLD, the 
regime has tightened its crackdown on the pro-democracy movement, 
closing universities and shutting down at least six NLD offices. In 
addition, two NLD leaders have been arrested on charges of 
``subversion''.
  Let us recall, the NLD overwhelmingly won Burma's national elections 
in 1990. The NLD are Burma's rightful leaders, not the military junta 
which seized power in 1988, crushing a widespread popular uprising.
  Such actions are only the tip of the iceberg of the regime's 
brutality. According to the Council on Foreign Relations Task Force 
report on Burma, which both the Senator from Kentucky, and I had the 
honor of serving on, gross human rights violations continue under the 
SPDC: over 1,300 political prisoners are still in jail; the practice of 
rape as a form of repression has been sanctioned by the Burmese 
military; the use of forced labor is widespread; trafficking in young 
boys and girls as sex slaves is rampant; the government engages in the 
production and distribution of opium and methamphetamine.
  In addition, the report notes that because of SPDC mismanagement, the 
Burmese economy is in shambles, with poor rice harvests and, most 
recently, a February 2003 financial crisis sparked by government 
closure of private deposit companies.
  In the face of such brutality it is imperative that the United States 
take strong and decisive action to express our disapproval of the SPDC 
and its tactics, and our support of those forces working for peace in 
Burma.
  The United States must act. Although in general I do not support the 
use of trade embargoes as an effective instrument of foreign policy, in 
certain circumstances and when faced with certain conditions I believe 
they are necessary and proper and can, in fact, provide effective 
leverage.
  Burma, I believe, is such a case and an import ban is a proper and 
much needed step to take.
  Our legislation: imposes a complete ban on all imports from Burma 
until the President determines and certifies to Congress that Burma has 
made substantial and measurable progress on a number of democracy and 
human rights issues; allows the President to waive the import ban 
should he determine and notify Congress that it is in the national 
security interests of the United States to do so; allows the President 
to waive any provision of the bill found to be in violation of any 
international obligations of the U.S. pursuant to World Trade 
Organization dispute settlement procedures; freezes the assets of the 
Burmese regime in the United States; directs United States executive 
directors at international financial institutions to vote against loans 
to the Burma; expands the visa ban against the past and present 
leadership of the military junta; encourages the Secretary of State to 
highlight the abysmal record of the SPDC in the international 
community, and; authorizes the President to use all available resources 
to assist democracy activists in Burma.
  Both business and labor are united in support of a ban. The American 
Apparel and Footwear Association, which represents apparel, footwear, 
and sewn products companies and their suppliers, has called for a ban.
  President and CEO Kevin M. Burke stated, ``The government of Burma 
continues to abuse its citizens through force and intimidation, and 
refuses to respect the basic human rights of its people. AAFA believes 
this unacceptable behavior should be met with condemnation from not 
only the international public community, but from private industry as 
well.''
  A number of stores, including Saks, Macy's, Bloomingdale's, Ames, and 
The Gap have already voluntarily stopped importing or selling goods 
from Burma. The AFL-CIO and other labor groups also support a ban.
  In addition, the International Labor Organization, for the first time 
in its history, called on all ILO members to impose sanctions on Burma.
  Such diversity in support of this legislation speaks volumes about 
the brutality of the SPDC regime and its single-minded unwillingness to 
take even

[[Page 13704]]

a modest step towards democracy and national reconciliation.
  Currently, Burma exports approximately $400 million in goods per year 
to the United States. These exports are the regime's major source of 
foreign currency. Rest assured, the regime will take notice if this 
bill becomes law.
  As events of the past few days have shown, all other avenues have 
been tried and failed. There is no other resource but to introduce this 
legislation, that would put pressure on the military junta to cease its 
violations of human rights and respect the free will of the Burmese 
people as expressed in the 1990 elections.
  We must make a stand on the side of the people of Burma. I urge my 
colleagues to support this bill.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1182

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Burmese Freedom and 
     Democracy Act of 2003''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The State Peace and Development Council (SPDC) has 
     failed to transfer power to the National League for Democracy 
     (NLD) whose parliamentarians won an overwhelming victory in 
     the 1990 elections in Burma.
       (2) The SPDC has failed to enter into meaningful, political 
     dialogue with the NLD and ethnic minorities and has dismissed 
     the efforts of United Nations Special Envoy Razali bin Ismail 
     to further such dialogue.
       (3) According to the State Department's ``Report to the 
     Congress Regarding Conditions in Burma and U.S. Policy Toward 
     Burma'' dated March 28, 2003, the SPDC has become ``more 
     confrontational'' in its exchanges with the NLD.
       (4) On May 30, 2003, the SPDC, threatened by continued 
     support for the NLD throughout Burma, brutally attacked NLD 
     supporters, killed and injured scores of civilians, and 
     arrested democracy advocate Aung San Suu Kyi and other 
     activists.
       (5) The SPDC continues egregious human rights violations 
     against Burmese citizens, uses rape as a weapon of 
     intimidation and torture against women, and forcibly 
     conscripts child-soldiers for the use in fighting indigenous 
     ethnic groups.
       (6) The SPDC has demonstrably failed to cooperate with the 
     United States in stopping the flood of heroin and 
     methamphetamines being grown, refined, manufactured, and 
     transported in areas under the control of the SPDC serving to 
     flood the region and much of the world with these illicit 
     drugs.
       (7) The SPDC provides safety, security, and engages in 
     business dealings with narcotics traffickers under indictment 
     by United States authorities, and other producers and 
     traffickers of narcotics.
       (8) The International Labor Organization (ILO), for the 
     first time in its 82-year history, adopted in 2000, a 
     resolution recommending that governments, employers, and 
     workers organizations take appropriate measures to ensure 
     that their relations with the SPDC do not abet the 
     government-sponsored system of forced, compulsory, or slave 
     labor in Burma, and that other international bodies 
     reconsider any cooperation they may be engaged in with Burma 
     and, if appropriate, cease as soon as possible any activity 
     that could abet the practice of forced, compulsory, or slave 
     labor.
       (9) The SPDC has integrated the Burmese military and its 
     surrogates into all facets of the economy effectively 
     destroying any free enterprise system.
       (10) Investment in Burmese companies and purchases from 
     them serve to provide the SPDC with currency that is used to 
     finance its instruments of terror and repression against the 
     Burmese people.
       (11) On April 15, 2003, the American Apparel and Footwear 
     Association expressed its ``strong support for a full and 
     immediate ban on U.S. textiles, apparel and footwear imports 
     from Burma'' and called upon the United States Government to 
     ``impose an outright ban on U.S. imports'' of these items 
     until Burma demonstrates respect for basic human and labor 
     rights of its citizens.
       (12) The policy of the United States, as articulated by the 
     President on April 24, 2003, is to officially recognize the 
     NLD as the legitimate representative of the Burmese people as 
     determined by the 1990 election.

     SEC. 3. BAN AGAINST TRADE THAT SUPPORTS THE MILITARY REGIME 
                   OF BURMA.

       (a) General Ban.--
       (1) In general.--Notwithstanding any other provision of 
     law, until such time as the President determines and 
     certifies to Congress that Burma has met the conditions 
     described in paragraph (3), no article may be imported into 
     the United States that is produced, mined, manufactured, 
     grown, or assembled in Burma.
       (2) Ban on imports from certain companies.--The import 
     restrictions contained in paragraph (1) shall apply to, among 
     other entities--
       (A) the SPDC, any ministry of the SPDC, a member of the 
     SPDC or an immediate family member of such member;
       (B) known narcotics traffickers from Burma or an immediate 
     family member of such narcotics trafficker;
       (C) the Union of Myanmar Economics Holdings Incorporated 
     (UMEHI) or any company in which the UMEHI has a fiduciary 
     interest;
       (D) the Myanmar Economic Corporation (MEC) or any company 
     in which the MEC has a fiduciary interest;
       (E) the Union Solidarity and Development Association 
     (USDA); and
       (F) any successor entity for the SPDC, UMEHI, MEC, or USDA.
       (3) Conditions described.--The conditions described in this 
     paragraph are the following:
       (A) The SPDC has made substantial and measurable progress 
     to end violations of internationally recognized human rights 
     including rape, and the Secretary of State, after 
     consultation with the ILO Secretary General and relevant 
     nongovernmental organizations, reports to the appropriate 
     congressional committees that the SPDC no longer 
     systematically violates workers rights, including the use of 
     forced and child labor, and conscription of child-soldiers.
       (B) The SPDC has made measurable and substantial progress 
     toward implementing a democratic government including--
       (i) releasing all political prisoners;
       (ii) allowing freedom of speech and the press;
       (iii) allowing freedom of association;
       (iv) permitting the peaceful exercise of religion; and
       (v) bringing to a conclusion an agreement between the SPDC 
     and the democratic forces led by the NLD and Burma's ethnic 
     nationalities on the transfer of power to a civilian 
     government accountable to the Burmese people through 
     democratic elections under the rule of law.
       (C) Pursuant to the terms of section 706 of the Foreign 
     Relations Authorization Act, Fiscal Year 2003 (Public Law 
     107-228), Burma has not failed demonstrably to make 
     substantial efforts to adhere to its obligations under 
     international counternarcotics agreements and to take other 
     effective counternarcotics measures, including the arrest and 
     extradition of all individuals under indictment in the United 
     States for narcotics trafficking, and concrete and measurable 
     actions to stem the flow of illicit drug money into Burma's 
     banking system and economic enterprises and to stop the 
     manufacture and export of methamphetamines.
       (4) Appropriate congressional committees.--In this 
     subsection, the term ``appropriate congressional committees'' 
     means the Committees on Foreign Relations and Appropriations 
     of the Senate and the Committees on International Relations 
     and Appropriations of the House of Representatives.
       (b) Waiver Authorities.--
       (1) In general.--The President may waive the prohibitions 
     described in this section for any or all products imported 
     from Burma to the United States if the President determines 
     and notifies the Committees on Appropriations and Foreign 
     Relations of the Senate and the Committees on Appropriations 
     and International Relations of the House of Representatives 
     that to do so is in the national security interest of the 
     United States.
       (2) International obligations.--The President may waive any 
     provision of this Act found to be in violation of any 
     international obligations of the United States pursuant to 
     any final ruling relating to Burma under the dispute 
     settlement procedures of the World Trade Organization.
       (c) Duration of Trade Ban.--The President may terminate the 
     restrictions contained in this Act upon the request of a 
     democratically elected government in Burma, provided that all 
     the conditions in subsection (a)(3) have been met.

     SEC. 4. FREEZING ASSETS OF THE BURMESE REGIME IN THE UNITED 
                   STATES.

       Not later than 60 days after the date of enactment of this 
     Act, the Secretary of the Treasury shall direct, and 
     promulgate regulations to the same, that any United States 
     financial institution holding funds belonging to the SPDC or 
     the assets of those individuals who hold senior positions in 
     the SPDC or its political arm, the Union Solidarity 
     Development Association, shall promptly report those assets 
     to the Office of Foreign Assets Control. The Secretary of the 
     Treasury may take such action as may be necessary to secure 
     such assets or funds.

     SEC. 5. LOANS AT INTERNATIONAL FINANCIAL INSTITUTIONS.

       The Secretary of the Treasury shall instruct the United 
     States executive director to each appropriate international 
     financial institution in which the United States 
     participates, to oppose, and vote against the extension by 
     such institution of any loan or financial or technical 
     assistance to Burma until such time as the conditions 
     described in section 3(a)(3) are met.

     SEC. 6. EXPANSION OF VISA BAN.

       (a) In General.--

[[Page 13705]]

       (1) Visa ban.--The President is authorized to deny visas 
     and entry to the former and present leadership of the SPDC or 
     the Union Solidarity Development Association.
       (2) Updates.--The Secretary of State shall coordinate on a 
     biannual basis with representatives of the European Union to 
     ensure that an individual who is banned from obtaining a visa 
     by the European Union for the reasons described in paragraph 
     (1) is also banned from receiving a visa from the United 
     States.
       (b) Publication.--The Secretary of State shall post on the 
     Department of State's website the names of individuals whose 
     entry into the United States is banned under subsection (a).

     SEC. 7. CONDEMNATION OF THE REGIME AND DISSEMINATION OF 
                   INFORMATION.

       (a) In General.--Congress encourages the Secretary of State 
     to highlight the abysmal record of the SPDC to the 
     international community and use all appropriate fora, 
     including the Association of Southeast Asian Nations Regional 
     Forum and Asian Nations Regional Forum, to encourage other 
     states to restrict financial resources to the SPDC and 
     Burmese companies while offering political recognition and 
     support to Burma's democratic movement including the National 
     League for Democracy and Burma's ethnic groups.
       (b) United States Embassy.--The United States embassy in 
     Rangoon shall take all steps necessary to provide access of 
     information and United States policy decisions to media 
     organs not under the control of the ruling military regime.

     SEC. 8. SUPPORT DEMOCRACY ACTIVISTS IN BURMA.

       (a) In General.--The President is authorized to use all 
     available resources to assist Burmese democracy activists 
     dedicated to nonviolent opposition to the regime in their 
     efforts to promote freedom, democracy, and human rights in 
     Burma, including a listing of constraints on such 
     programming.
       (b) Reports.--
       (1) First report.--Not later than 3 months after the date 
     of enactment of this Act, the Secretary of State shall 
     provide the Committees on Appropriations and Foreign 
     Relations of the Senate and the Committees on Appropriations 
     and International Relations of the House of Representatives a 
     comprehensive report on its short- and long-term programs and 
     activities to support democracy activists in Burma, including 
     a list of constraints on such programming.
       (2) Report on resources.--Not later than 6 months after the 
     date of enactment of this Act, the Secretary of State shall 
     provide the Committees on Appropriations and Foreign 
     Relations of the Senate and the Committees on Appropriations 
     and International Relations of the House of Representatives a 
     report identifying resources that will be necessary for the 
     reconstruction of Burma, after the SPDC is removed from 
     power, including--
       (A) the formation of democratic institutions;
       (B) establishing the rule of law;
       (C) establishing freedom of the press;
       (D) providing for the successful reintegration of military 
     officers and personnel into Burmese society; and
       (E) providing health, educational, and economic 
     development.
                                 ______
                                 
      By Mr. KYL (for himself and Mr. Wyden):
  S. 1183. A bill to develop and deploy technologies to defeat Internet 
jamming and censorship, and for other purposes; to the Committee on 
Foreign Relations.
  Mr. KYL. Mr. President, I ask unanimous consent that the ``Global 
Internet Freedom Act of 2003'' be printed in today's Congressional 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1183

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Global Internet Freedom Act 
     of 2003''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Freedom of speech, freedom of the press, and freedom of 
     association are fundamental characteristics of a free 
     society. The first amendment to the Constitution of the 
     United States guarantees that ``Congress shall make no law . 
     . . abridging the freedom of speech, or of the press; or the 
     right of the people peaceably to assemble.''. These 
     constitutional provisions guarantee the rights of Americans 
     to communicate and associate with one another without 
     restriction, including unfettered communication and 
     association via the Internet. Article 19 of the United 
     Nation's Universal Declaration of Human Rights explicitly 
     guarantees the freedom to ``receive and impart information 
     and ideas through any media and regardless of frontiers''.
       (2) All people have the right to communicate freely with 
     others, and to have unrestricted access to news and 
     information, on the Internet.
       (3) With nearly 10 percent of the world's population now 
     online, and more gaining access each day, the Internet stands 
     to become the most powerful engine for democratization and 
     the free exchange of ideas ever invented.
       (4) Unrestricted access to news and information on the 
     Internet is a check on repressive rule by authoritarian 
     regimes around the world.
       (5) The governments of Burma, Cuba, Laos, North Korea, the 
     People's Republic of China, Saudi Arabia, Syria, and Vietnam, 
     among others, are taking active measures to keep their 
     citizens from freely accessing the Internet and obtaining 
     international political, religious, and economic news and 
     information.
       (6) Intergovernmental, nongovernmental, and media 
     organizations have reported the widespread and increasing 
     pattern by authoritarian governments to block, jam, and 
     monitor Internet access and content using methods that 
     include--
       (A) firewalls, filters, and ``black boxes'';
       (B) surveillance of e-mail messages and message boards;
       (C) the use of particular words to identify content to be 
     monitored;
       (D) ``stealth blocking'' individuals from visiting 
     websites;
       (E) the development of ``black lists'' of users that visit 
     certain websites; and
       (F) the denial of access to the Internet.
       (7) The transmission of the Voice of America and Radio Free 
     Asia, as well as hundreds of news sources with an Internet 
     presence, are routinely being jammed by repressive 
     governments.
       (8) Since the 1940s, the United States has deployed anti-
     jamming technologies to make Voice of America and other 
     United States Government sponsored broadcasting available to 
     people in nations with governments that seek to block news 
     and information.
       (9) The United States Government has thus far commenced 
     only modest steps to fund and deploy technologies to defeat 
     Internet censorship. As of January 2003, the Voice of America 
     and Radio Free Asia have committed a total of $1,000,000 for 
     technology to counter Internet jamming by the People's 
     Republic of China. This technology, which has been successful 
     in attracting 100,000 electronic hits per day from the 
     People's Republic of China, has been relied upon by Voice of 
     America and Radio Free Asia to ensure access to their 
     programming by citizens of the People's Republic of China, 
     but United States Government financial support for the 
     technology has lapsed. In most other countries there is no 
     meaningful United States support for Internet freedom.
       (10) The success of United States policy in support of 
     freedom of speech, press, and association requires new 
     initiatives to defeat totalitarian and authoritarian controls 
     on news and information over the Internet.

     SEC. 3. PURPOSES.

       The purposes of this Act are--
       (1) to adopt an effective and robust global Internet 
     freedom policy;
       (2) to establish an office within the International 
     Broadcasting Bureau with the sole mission of countering 
     Internet jamming and blocking by repressive regimes;
       (3) to expedite the development and deployment of 
     technology to protect Internet freedom around the world;
       (4) to authorize the commitment of a substantial portion of 
     United States international broadcasting resources to the 
     continued development and implementation of technologies to 
     counter the jamming of the Internet;
       (5) to utilize the expertise of the private sector in the 
     development and implementation of such technologies, so that 
     the many current technologies used commercially for securing 
     business transactions and providing virtual meeting space can 
     be used to promote democracy and freedom; and
       (6) to bring to bear the pressure of the free world on 
     repressive governments guilty of Internet censorship and the 
     intimidation and persecution of their citizens who use the 
     Internet.

     SEC. 4. DEVELOPMENT AND DEPLOYMENT OF TECHNOLOGIES TO DEFEAT 
                   INTERNET JAMMING AND CENSORSHIP.

       (a) Establishment of Office of Global Internet Freedom.--
     There is established in the International Broadcasting Bureau 
     the Office of Global Internet Freedom (hereinafter in this 
     section referred to as the ``Office''). The Office shall be 
     headed by a Director who shall develop and implement a 
     comprehensive global strategy to combat state-sponsored and 
     state-directed jamming of the Internet and persecution of 
     those who use the Internet.
       (b) Authorization of Appropriations.--There are authorized 
     to be appropriated to the Office $30,000,000 for each of the 
     fiscal years 2004 and 2005.
       (c) Cooperation of Other Federal Departments and 
     Agencies.--The head of each department and agency of the 
     United States Government shall cooperate fully with, and 
     assist in the implementation of, the strategy developed by 
     the Director of the Office and shall make such resources and 
     information available to the Director as is necessary for the 
     achievement of the purposes of this Act.
       (d) Report to Congress.--

[[Page 13706]]

       (1) In general.--On March 1 following the date of enactment 
     of this Act, and annually thereafter, the Director of the 
     Office shall submit to Congress a report on the status of 
     state interference with Internet use and of efforts by the 
     United States to counter such interference.
       (2) Content.--Each report required by paragraph (1) shall--
       (A) list the countries that pursue policies of Internet 
     censorship, blocking, and other abuses;
       (B) provide information concerning the government agencies 
     or quasi-governmental organizations that implement Internet 
     censorship; and
       (C) describe with the greatest particularity practicable 
     the technological means by which such blocking and other 
     abuses are accomplished.
       (3) Forms of report.--In the discretion of the Director, a 
     report required by paragraph (1) may be submitted in both a 
     classified and a nonclassified form.
       (e) Limitation on Authority.--Nothing in this Act shall be 
     interpreted to authorize any action by the United States to 
     interfere with foreign national censorship in furtherance of 
     legitimate law enforcement aims that is consistent with the 
     United Nation's Universal Declaration of Human Rights.

     SEC. 5. SENSE OF CONGRESS.

        It is the sense of Congress that the United States 
     should--
       (1) publicly, prominently, and consistently denounce 
     governments that restrict, censor, ban, and block access to 
     information on the Internet;
       (2) direct the United States Representative to the United 
     Nations to submit a resolution at the first annual meeting of 
     the United Nations Human Rights Commission after the date of 
     enactment of this Act that condemns all governments that 
     practice Internet censorship and deny individuals the freedom 
     to access and share information; and
       (3) deploy, at the earliest practicable date, technologies 
     aimed at defeating state-directed Internet censorship and the 
     persecution of those who use the Internet.
                                 ______
                                 
      By Mr. SMITH (for himself, Mrs. Clinton, Mrs. Murray, Mr. 
        Fitzgerald, and Mr. Lautenberg):
  S. 1184. A bill to establish a National Foundation for the Study of 
Holocaust Assets; to the Committee on Banking, Housing, and Urban 
Affairs.
  Mr. SMITH. Mr. President, I rise today to introduce the Holocaust 
Victims' Assets, Restitution Policy, and Remembrance Act of 2003. In 
this effort, I am joined by my colleagues: Senator Clinton from New 
York, Senator Murray from Washington, Senator, Lautenberg from New 
Jersey and Senator Dodd from Connecticut. I appreciate their support 
for this important legislation.
  We are motivated by a desire to achieve justice for Holocaust victims 
and their families, and we recognize that if such justice is to be 
attained, the United States must continue to lead the world by example.
  The United States has provided leadership in this area ever since 
American troops liberated the death camps in Nazi Germany. This 
legislation recognizes that the struggle for justice requires continued 
American leadership and that the Foundation is the appropriate 
mechanism for that leadership.
  The purpose of this act is to create a public/private Foundation 
dedicated to supporting research and education in the area of 
Holocaust-era assets and restitution policy and promoting innovative 
solutions to restitution issues.
  The need for the Foundation arises from the findings of the 
Presidential advisory Commission on Holocaust Assets in the United 
States. I was proud to serve as commissioner on that Commission. The 
Commission identified several policy initiatives that require U.S. 
leadership, including: creating mechanisms to assist claimants in 
obtaining resolution of claims; supporting databases of victims' claims 
for the restitution of personal property; reviewing the degree to which 
other nations have adhered to agreements reached at international 
conferences on Holocaust issues; synthesizing the work of other 
national commissions throughout the world; supporting further research 
and review of Holocaust-era assets; and disseminating information about 
restitution programs to survivors and their families.
  If the nations of the world are to be convinced of our lasting 
commitment to justice for Holocaust victims and if continued work on 
Holocaust assets issues is to be truly effective, the Foundation must 
have the stamp of the Federal Government. But the Federal Government 
cannot, and should not, perform these tasks by itself. It will 
coordinate the efforts of the Federal Government, State governments, 
the private sector and individuals here, and abroad, to help people 
locate and identify assets who would otherwise have no ability to do 
so. It will encourage policy makers to deal with contemporary 
restitution issues, including how best to treat unclaimed assets.
  Each passing day reveals the existence of still unclaimed assets. 
This bill will create an institution able to provide the academic 
center of research into this area of continuing importance. It will 
also show that the United States is willing to ask of itself no less 
than it asks of the international community.
  The restitution of property is part of a larger process of obtaining 
a measure of justice for the victims of Europe's major human disasters 
of the 20th century--fascism and communism. Justice for these 
individuals is long overdue. Having had justice delayed for so long, 
they are entitled to expect that democratic governments will move 
promptly to bring closure during their lifetimes.
  I ask unanimous consent that the text of the Holocaust Victims' 
assets, Restitution Policy, and Remembrance Act of 2003 be printed in 
the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1184

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Holocaust Victims' Assets, 
     Restitution Policy, and Remembrance Act''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The United States should continue to lead the 
     international effort to identify, protect, and return looted 
     assets taken by the Nazis and their collaborators from 
     victims of the Holocaust.
       (2) The citizens of the United States should understand 
     exactly how the United States Government dealt with the 
     assets looted from victims of the Nazis that came into its 
     possession.
       (3) The United States forces in Europe made extraordinary 
     efforts to locate and restitute assets taken by the Nazis and 
     their collaborators from victims of the Holocaust.
       (4) However, the restitution policy formulated by the 
     United States and implemented in the countries in Europe 
     occupied by the United States had many inadequacies and fell 
     short of realizing the goal of returning stolen property to 
     the victims.
       (5) As a result of these United States policies and their 
     implementation, there remain today many survivors or heirs of 
     survivors who have not had restored to them that which the 
     Nazis looted.
       (6) The Presidential Advisory Commission on Holocaust 
     Assets in the United States, established in Public Law 105-
     186, found the following:
       (A) Despite the undertaking by United States agencies to 
     preserve, protect, and return looted assets, United States 
     restitution policy could never fully address the unimaginable 
     dimension and complexity of restituting assets to victims of 
     the Holocaust. Many inadequacies reveal that United States 
     authorities were driven by necessity, and practical concerns 
     of restitution commingled with conflicting interests, 
     priorities, and political considerations. Restitution 
     competed with, and was often subordinated to, the desire to 
     bring American troops home, the need to rebuild devastated 
     European economies, and provide humanitarian assistance to 
     millions of displaced persons, and the Cold War.
       (B) With respect to many types of assets, the United States 
     followed international legal tradition and undertook only to 
     restore property to national governments, which it assumed 
     would be responsible for satisfying the claims of their 
     citizens. Because this practice excluded those who no longer 
     had a nation to represent their interests, or who had fallen 
     victim to the Nazi genocide, the United States also 
     designated certain ``successor organizations'' to sell 
     heirless and unclaimed property and apply the proceeds to the 
     care, resettlement, and rehabilitation of surviving victims. 
     This practice led many assets to be too hastily labeled as 
     heirless or unidentifiable, with the result that they were 
     assigned to the successor organizations, rather than returned 
     to their rightful owners.
       (C) Far more regrettable is the United States failure to 
     adequately assist victims, heirs, and successor organizations 
     to identify victims' assets, instead relying upon them to 
     present their own claims, often within unrealistically short 
     deadlines, with the result

[[Page 13707]]

     that much victim property was never recovered.
       (D) Even when property was returned to individual owners or 
     their heirs, it was often only after protracted, cumbersome, 
     and expensive administrative proceedings that yielded 
     settlements far less than the full value of the assets 
     concerned.
       (E) While the overall record of the United States is one in 
     which its citizens can legitimately take pride, even the most 
     farsighted and best-intentioned policies intended to 
     restitute stolen property to its country of origin failed to 
     realize the goal of returning property to the victims who 
     suffered the loss.
       (F) In many instances, policy and circumstance combined and 
     led to results that can be improved upon now, to provide a 
     modicum of justice to Holocaust victims and their heirs and 
     in memory of those who did not survive.
       (7) The United States Government should promote both the 
     review of Holocaust-era assets in Federal, State, and private 
     institutions, and the return of such assets to victims or 
     their heirs.
       (8) The best way to achieve this is to create a single 
     institution to serve as a centralized repository for research 
     and information about Holocaust-era assets.
       (9) Enhancing these policies will also assist victims of 
     future armed conflicts around the world.
       (10) The Government of the United States has worked to 
     address the consequences of the National Socialist era with 
     other governments and nongovernmental organizations, 
     including the Conference on Jewish Material Claims Against 
     Germany, which has worked since 1951 with the Government of 
     the United States and with other governments to accomplish 
     material restitution of the looted assets of Holocaust 
     victims, wherever those assets were identified, and has 
     played a major role in allocating restitution funds and funds 
     contributed by the United States and other donor countries to 
     the Nazi Persecutee Relief Fund.

     SEC. 3. ESTABLISHMENT AND PURPOSES.

       (a) Establishment.--There is established a National 
     Foundation for the Study of Holocaust Assets (in this Act 
     referred to as the ``Foundation'').
       (b) Purposes.--The purposes of the Foundation are--
       (1) to serve as a centralized repository for research and 
     information about Holocaust-era assets by--
       (A) compiling and publishing a comprehensive report that 
     integrates and supplements where necessary the research on 
     Holocaust-era assets prepared by various countries' 
     commissions on the Holocaust;
       (B) working with the Department of State's Special Envoy 
     for Holocaust Issues to review the degree to which foreign 
     governments have implemented the principles adopted at the 
     Washington Conference on Holocaust-era Assets and the Vilnius 
     International Forum on Holocaust-era Looted Cultural 
     Property, and should encourage the signatories that have not 
     yet implemented those principles to do so; and
       (C) collecting and disseminating information about 
     restitution programs around the world;
       (2) to create tools to assist individuals and institutions 
     to determine the ownership of Holocaust victims' assets and 
     to enable claimants to obtain the speedy resolution of their 
     personal property claims by--
       (A) ensuring the implementation of the agreements entered 
     into by the Presidential Advisory Commission on Holocaust 
     Assets in the United States with the American Association of 
     Museums and the Association of Art Museum Directors to 
     provide for the establishment and maintenance of a searchable 
     central registry of Holocaust-era cultural property in the 
     United States, beginning with European paintings and Judaica;
       (B) funding grants to museums, libraries, universities, and 
     other institutions that hold Holocaust-era cultural property 
     and adhere to the agreements referred to in subparagraph (A), 
     to conduct provenance research;
       (C) encouraging the creation and maintenance of mechanisms 
     such as an Internet-based, searchable portal of Holocaust 
     victims' claims for the restitution of personal property;
       (D) funding a cross match of records developed by the 50 
     States of escheated property from the Holocaust era against 
     databases of victims' names and publicizing the results of 
     this effort;
       (E) assisting State governments in the preservation and 
     automation of records of unclaimed property that may include 
     Holocaust-era property; and
       (F) regularly publishing lists of Holocaust-era artworks 
     returned to claimants by museums in the United States;
       (3) to work with private sector institutions to develop and 
     promote common standards and best practices for research and 
     information gathering on Holocaust-era assets by--
       (A) promoting and monitoring banks' implementation of the 
     suggested best practices developed by the Presidential 
     Advisory Commission on Holocaust Assets in the United States 
     and the New York Bankers' Association;
       (B) promoting the development of common standards and best 
     practices for research by United States corporations into 
     their records concerning whether they conducted business with 
     Nazi Germany in the period preceding the onset of hostilities 
     in December 1941;
       (C) encouraging the International Commission on Holocaust 
     Era Insurance Claims (ICHEIC) to prepare a report on the 
     results of its claims process; and
       (D) promoting the study and development of policies 
     regarding the treatment of cultural property in circumstances 
     of armed conflict; and
       (4) other purposes the Board considers appropriate.

     SEC. 4. BOARD OF DIRECTORS.

       (a) Membership and Terms.--The Foundation shall have a 
     Board of Directors (in this Act referred to as the 
     ``Board''), which shall consist of 17 members, each of whom 
     shall be a United States citizen.
       (b) Appointment.--Members of the Board shall be appointed 
     as follows:
       (1) Nine members of the Board shall be representatives of 
     government departments, agencies and establishments, 
     appointed by the President, by and with the advice and 
     consent of the Senate as follows:
       (A) One representative each from the Department of State, 
     Department of Justice, Department of the Treasury, Department 
     of the Army, National Archives and Records Administration, 
     and Library of Congress.
       (B) One representative each from the United States 
     Holocaust Memorial Council, National Gallery of Art, and 
     National Foundation on the Arts and Humanities.
       (2) Eight members of the Board shall be individuals who 
     have a record of demonstrated leadership relating to the 
     Holocaust or in the fields of commerce, culture, or 
     education, appointed by the President, by and with the advice 
     and consent of the Senate, after consideration of the 
     recommendations of the congressional leadership, as follows:
       (A) Two members each shall be appointed after consideration 
     of the recommendations of the Majority Leader of the Senate 
     and after consideration of the recommendations of the 
     Minority Leader of the Senate.
       (B) Two members each shall be appointed after consideration 
     of the recommendations of the Speaker of the House of 
     Representatives and after consideration of the 
     recommendations of the Minority Leader of the House of 
     Representatives.
       (c) Chairman.--The President shall appoint a Chair from 
     among the members of the Board.
       (d) Quorum and Voting.--A majority of the membership of the 
     Board shall constitute a quorum for the transaction of 
     business. Voting shall be by simple majority of those members 
     voting.
       (e) Meetings and Consultations.--The Board shall meet at 
     the call of the Chairman at least twice a year. Where 
     appropriate, members of the Board shall consult with relevant 
     agencies of the Federal Government, and with the United 
     States Holocaust Memorial Council and Museum.
       (f) Reimbursements.--Members of the Board shall serve 
     without pay, but shall be reimbursed for the actual and 
     necessary traveling and subsistence expenses incurred by them 
     in the performance of the duties of the Foundation.

     SEC. 5. OFFICERS AND EMPLOYEES.

       (a) Executive Director.--The Foundation shall have an 
     Executive Director appointed by the Board and such other 
     officers as the Board may appoint. The Executive Director and 
     the other officers of the Foundation shall be compensated at 
     rates fixed by the Board and shall serve at the pleasure of 
     the Board.
       (b) Employees.--Subject to the approval of the Board, the 
     Foundation may employ such individuals at such rates of 
     compensation as the Executive Director determines 
     appropriate.
       (c) Volunteers.--Subject to the approval of the Board, the 
     Foundation may accept the services of volunteers in the 
     performance of the functions of the Foundation.

     SEC. 6. FUNCTION AND CORPORATE POWERS.

       The Foundation--
       (1) may conduct business in the United States and abroad;
       (2) shall have its principal offices in the District of 
     Columbia or its environs; and
       (3) shall have the power--
       (A) to accept, receive, solicit, hold, administer, and use 
     any gift, devise, or bequest, either absolutely or in trust, 
     of real or personal property or any income therefrom, or 
     other interest therein;
       (B) to acquire by purchase or exchange any real or personal 
     property or interest therein;
       (C) to sell, donate, lease, invest, reinvest, retain, or 
     otherwise dispose of any real or personal property or income 
     therefrom;
       (D) to enter into contracts or other arrangements with 
     public agencies, private organizations, and other persons, 
     and to make such payments as may be necessary to carry out 
     its purposes; and
       (E) to do any and all acts necessary and proper to carry 
     out the purposes of the Foundation.

     SEC. 7. REPORTING REQUIREMENTS.

       The Foundation shall, as soon as practicable after the end 
     of each fiscal year, transmit to Congress a report of its 
     proceedings and activities during that fiscal

[[Page 13708]]

     year, including a full and complete statement of its 
     receipts, expenditures, and investments, and a description of 
     all acquisition and disposal of real property.

     SEC. 8. ADMINISTRATIVE SERVICES AND SUPPORT.

       The Secretary of the Treasury, the Secretary of Education, 
     the Secretary of State, and the heads of any other Federal 
     agencies may provide personnel, facilities, and other 
     administrative services to the Foundation.

     SEC. 9. SUNSET PROVISION.

       The Foundation shall exist until September 30, 2013, at 
     which time the Foundation's functions and research materials 
     and products shall be transferred to the United States 
     Holocaust Memorial Museum, or to other appropriate entities, 
     as determined by the Board.

     SEC. 10. AUTHORIZATION OF APPROPRIATIONS.

       (a) Authorization.--There are authorized to be appropriated 
     to the Foundation such sums as may be necessary to carry out 
     this Act.
       (b) Limitation.--No funds appropriated to carry out this 
     Act may be used to pay attorneys' fees in the pursuit of 
     private claims.
                                 ______
                                 
      By Mr. THOMAS (for himself, Mr. Harkin, Mr. Domenici, Mr. 
        Bingaman, Mr. Roberts, Mr. Dayton, Mr. Smith, Ms. Cantwell, Mr. 
        Inouye, Mr. Burns, Mr. Johnson, Mr. Enzi, Mrs. Lincoln, Ms. 
        Collins, Mr. Daschle, Mr. Hagel, and Mr. Conrad):
  S. 1185. A bill to amend title XVIII of the Social Security Act and 
the Public Health Service Act to improve outpatient health care for 
Medicare beneficiaries who reside in rural areas, and for other 
purposes; to the Committee on Finance.
  Mr. THOMAS. Mr. President, I am pleased to rise today to introduce 
the ``Rural Provider Equity Act of 2003'' with Senator Harkin and other 
members of the Senate Rural Health Caucus. This legislation 
comprehensively addresses the Medicare payment issues of rural 
physicians, rural health clinics, ambulance providers, home health 
agencies, community health centers, mental health providers and other 
critical mid-level clinicians.
  The current Medicare program has many payment formula disparities 
that are biased against rural providers, which result in them being 
paid significantly less than their urban counterparts for the same 
services. The geographic inequities that exist within the Medicare 
program continually put rural providers at a disadvantage and adversely 
affect seniors' access to quality health care in these communities.
  Many physicians are being forced to limit the number of Medicare 
patients they serve because of poor reimbursement rates. The ``Rural 
Providers Equity Act'' is necessary to adequately pay physicians so 
they can continue caring for the elderly. In addition to establishing a 
work geographic index of 1.0, physicians practicing in federally 
designated Health Professional Shortage Areas will automatically start 
receiving the Medicare ten percent bonus payment to which they are 
entitled.
  In recognition of the difficulties rural and frontier communities 
face in recruiting and retaining primary care clinicians, this 
legislation includes a provision providing tax exemptions to National 
Health Service Corps, NHSC, loan-repayments. The NHSC provides 
scholarships, loan-repayments, and stipends for clinicians who agree to 
serve in nationally designated underserved urban and rural communities. 
In the current NHSC loan program, recipients are given money to offset 
their tax liabilities. If this money was made available, more 
clinicians would be able to participate in the program and care for the 
underserved.
  Home health care agencies and ambulance services are critical 
elements of the continuum of care in rural areas. These providers face 
unique circumstances in the distances they are required to travel to 
provide services. The current Medicare payment system does not make 
adequate adjustments to reflect the reality of rural and frontier 
health care. The ``Rural Provider Equity Act of 2003'' recognizes the 
situation of these providers by increasing their Medicare payments to 
better cover their costs of providing services to seniors.
  By caring for folks in underserved areas, rural health clinics and 
community health centers are a key component of the rural health care 
delivery system. As not every small town can sustain a hospital, we 
need to ensure these types of facilities are paid adequately and are 
provided enough flexibility to meet the health care needs of the 
communities they serve.
  The ``Rural Providers Equity Act of 2003'' also permits mental health 
counselors and marriage and family therapists to bill Medicare for 
services provided to seniors. This will result in an increased choice 
of mental health providers for seniors and enhance their ability to 
access mental health services where they live.
  Rural seniors are often forced to travel long distances to utilize 
the services of mental health providers currently recognized by the 
Medicare program. Rural communities have difficulty recruiting and 
retaining providers, especially mental health providers. In many small 
towns, a mental health counselor or a marriage and family therapist is 
the only mental health care provider in the area. Medicare law--as it 
exists today--compounds the situation because only psychiatrists, 
clinical psychologists, clinical social workers and clinical nurse 
specialists are able to bill Medicare for their services.
  Virtually all of Wyoming is designated a mental health professional 
shortage area and will greatly benefit from this legislation. Wyoming 
has 174 psychologists, 37 psychiatrists and 263 clinical social workers 
for a total of 474 Medicare eligible mental health providers. Enactment 
of this provision will more than double the number of mental health 
providers available to seniors in my state with the addition of 528 
mental health counselors and 61 marriage and family therapists 
currently licensed in the State.
  Health care in rural America is at a critical juncture, and Congress 
must act now so providers receive this down payment towards Medicare 
equity to ensure rural seniors continue to have access to the health 
care services they deserve. I urge all my colleagues interested in 
rural health to cosponsor the ``Rural Provider Equity Act of 2003.''
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1185

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

     SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; 
                   TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Rural 
     Provider Equity Act of 2003''.
       (b) Amendments to Social Security Act.--Except as otherwise 
     specifically provided, whenever in this Act an amendment is 
     expressed in terms of an amendment to or repeal of a section 
     or other provision, the reference shall be considered to be 
     made to that section or other provision of the Social 
     Security Act.
       (c) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; amendments to Social Security Act; table of 
              contents.
Sec. 2. Rural physician reimbursement improvements.
Sec. 3. Physician assistant, nurse practitioner, and clinical nurse 
              specialist improvements.
Sec. 4. Rural health clinic improvements.
Sec. 5. Extension of temporary increase for home health services 
              furnished in a rural area.
Sec. 6. Rural community health center improvements.
Sec. 7. Ensuring appropriate coverage of ambulance services under 
              ambulance fee schedule.
Sec. 8. Rural mental health care accessibility improvements.
Sec. 9. Rural health services research improvements.
Sec. 10. Exclusion for loan payments under National Health Service 
              Corps loan repayment program.
Sec. 11. Virtual pharmacist consultation service demonstration 
              projects.

     SEC. 2. RURAL PHYSICIAN REIMBURSEMENT IMPROVEMENTS.

       (a) Medicare Incentive Payment Program Improvements.--
       (1) Procedures for secretary, and not physicians, to 
     determine when bonus payments under medicare incentive 
     payment program should be made.--Section 1833(m) (42 U.S.C. 
     1395l(m)) is amended--
       (A) by inserting ``(1)'' after ``(m)''; and
       (B) by adding at the end the following new paragraph:
       ``(2) The Secretary shall establish procedures under which 
     the Secretary, and not the

[[Page 13709]]

     physician furnishing the service, is responsible for 
     determining when a payment is required to be made under 
     paragraph (1).''.
       (2) Educational program regarding the medicare incentive 
     payment program.--The Secretary of Health and Human Services 
     shall establish and implement an ongoing educational program 
     to provide education to physicians under the Medicare program 
     on the Medicare incentive payment program under section 
     1833(m) of the Social Security Act (42 U.S.C. 1395l(m)).
       (3) Ongoing study and annual report on the medicare 
     incentive payment program.--
       (A) Ongoing study.--The Secretary of Health and Human 
     Services shall conduct an ongoing study on the Medicare 
     incentive payment program under section 1833(m) of the Social 
     Security Act (42 U.S.C. 1395l(m)). Such study shall focus on 
     whether such program increases the access of Medicare 
     beneficiaries who reside in an area that is designated (under 
     section 332(a)(1)(A) of the Public Health Service Act (42 
     U.S.C. 254e(a)(1)(A))) as a health professional shortage area 
     to physicians' services under the Medicare program.
       (B) Annual reports.--Not later than 1 year after the date 
     of enactment of this Act, and annually thereafter, the 
     Secretary of Health and Human Services shall submit to 
     Congress a report on the study conducted under subparagraph 
     (A), together with recommendations for such legislation and 
     administrative actions as the Secretary considers 
     appropriate.
       (b) Physician Fee Schedule Wage Index Revision.--Section 
     1848(e)(1) (42 U.S.C. 1395w-4(e)(1)) is amended--
       (1) in subparagraph (A), by striking ``subparagraphs (B) 
     and (C)'' and inserting ``subparagraphs (B), (C), and (E)''; 
     and
       (2) by adding at the end the following new subparagraph:
       ``(E) Floor for work geographic indices.--
       ``(i) In general.--After calculating the work geographic 
     indices in subparagraph (A)(iii) for a year (beginning with 
     2004), the Secretary shall increase the work geographic index 
     for the year to the applicable floor index for the year for 
     any locality for which such geographic index is less than 
     such applicable floor index.
       ``(ii) Applicable floor index.--For purposes of clause (i), 
     the term `applicable floor index' means--

       ``(I) 0.900 for services furnished during 2004;
       ``(II) 1.000 for services furnished during 2005 and 
     subsequent years.''.

     SEC. 3. PHYSICIAN ASSISTANT, NURSE PRACTITIONER, AND CLINICAL 
                   NURSE SPECIALIST IMPROVEMENTS.

       (a) Broadening Medicare Beneficiaries Access to Home Health 
     Services and Hospice Care.--Section 1861(r) (42 U.S.C. 
     1395f(x)) is amended by adding at the end the following new 
     sentences: ``For purposes of sections 1814(a)(2)(C), 
     1814(a)(7)(B), 1835(a)(2)(A), 1861(m), 1861(dd), and 
     1895(c)(1), the term `physician' includes a nurse 
     practitioner, a clinical nurse specialist, and a physician 
     assistant (as such terms are defined in subsection (aa)(5)) 
     who does not have a direct or indirect employment 
     relationship with the home health agency or hospice program 
     (as the case may be), and is legally authorized to perform 
     the services of a nurse practitioner, a clinical nurse 
     specialist, or a physician assistant (as the case may be) in 
     the jurisdiction in which the services are performed. For 
     purposes of the preceding sentence, the provisions of section 
     1833(a)(1)(O) shall continue to apply with respect to amounts 
     paid for services furnished by such a nurse practitioner, a 
     clinical nurse specialist, and a physician assistant.''.
       (b) Skilled Nursing Facilities.--Section 1819(b)(6) (42 
     U.S.C. 1395i-3(b)(6)) is amended--
       (1) in the paragraph heading, by inserting ``or nurse 
     practitioner'' after ``Physician''; and
       (2) in subparagraph (A), by inserting ``or nurse 
     practitioner, including approving in writing a recommendation 
     that an individual be admitted to a skilled nursing facility, 
     admitting an individual to a skilled nursing facility, and 
     performing the initial admitting assessment and all visits 
     thereafter'' before the semicolon.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 2004.

     SEC. 4. RURAL HEALTH CLINIC IMPROVEMENTS.

       (a) Improvement in Rural Health Clinic Reimbursement Under 
     Medicare.--Section 1833(f) (42 U.S.C. 1395l(f)) is amended--
       (1) in paragraph (1), by striking ``, and'' at the end and 
     inserting a semicolon;
       (2) in paragraph (2)--
       (A) by striking ``in a subsequent year'' and inserting ``in 
     1989 through 2002''; and
       (B) by striking the period at the end and inserting a 
     semicolon; and
       (3) by adding at the end the following new paragraphs:
       ``(3) in 2003, at $82 per visit; and
       ``(4) in a subsequent year, at the limit established under 
     this subsection for the previous year increased by the 
     percentage increase in the MEI (as so defined) applicable to 
     primary care services (as so defined) furnished as of the 
     first day of that year.''.
       (b) Exclusion of Certain Rural Health Clinic and Federally 
     Qualified Health Center Services From the Medicare 
     Prospective Payment System for Skilled Nursing Facilities.--
       (1) In general.--Section 1888(e)(2)(A) (42 U.S.C. 
     1395yy(e)(2)(A)) is amended--
       (A) in clause (i)(II), by striking ``clauses (ii) and 
     (iii)'' and inserting ``clauses (ii), (iii), and (iv)''; and
       (B) by adding at the end the following new clause:
       ``(iv) Exclusion of certain rural health clinic and 
     federally qualified health center services.--Services 
     described in this clause are--

       ``(I) rural health clinic services (as defined in paragraph 
     (1) of section 1861(aa)); and
       ``(II) Federally qualified health center services (as 
     defined in paragraph (3) of such section);

     that would be described in clause (ii) if such services were 
     not furnished by an individual affiliated with a rural health 
     clinic or a Federally qualified health center.''.
       (2) Effective date.--The amendments made by subsection (a) 
     shall apply to services furnished on or after January 1, 
     2003.

     SEC. 5. EXTENSION OF TEMPORARY INCREASE FOR HOME HEALTH 
                   SERVICES FURNISHED IN A RURAL AREA.

       (a) In General.--Section 508(a) of the Medicare, Medicaid, 
     and SCHIP Benefits Improvement and Protection Act of 2000 
     (114 Stat. 2763A-533), as enacted into law by section 1(a)(6) 
     of Public Law 106-554, is amended--
       (1) in the heading, by striking ``24-Month Increase 
     Beginning April 1, 2001'' and inserting ``In General'';
       (2) by striking ``April 1, 2003'' and inserting ``April 1, 
     2004''; and
       (3) by inserting before the period at the end the 
     following: ``(or 5 percent in the case of such services 
     furnished on or after April 1, 2003, and before April 1, 
     2004)''.
       (b) Conforming Amendment.--Section 547(c)(2) of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (114 Stat. 2763A-553), as enacted into 
     law by section 1(a)(6) of Public Law 106-554, is amended by 
     striking ``the period beginning on April 1, 2001, and ending 
     on September 30, 2002,'' and inserting ``a period under such 
     section''.
       (c) Retroactive Application.--The amendments made by this 
     section shall apply with respect to home health services 
     furnished in a rural area on or after April 1, 2003.

     SEC. 6. RURAL COMMUNITY HEALTH CENTER IMPROVEMENTS.

       (a) Delivery of Medicare-Covered Primary and Preventive 
     Services at Federally Qualified Health Centers.--
       (1) Coverage of medicare-covered ambulatory services by 
     fqhcs.--Section 1861(aa)(3) (42 U.S.C. 1395x(aa)(3)) is 
     amended to read as follows:
       ``(3) The term `Federally qualified health center services' 
     means--
       ``(A) services of the type described in subparagraphs (A) 
     through (C) of paragraph (1), and such other services 
     furnished by a Federally qualified health center for which 
     payment may otherwise be made under this title if such 
     services were furnished by a health care provider or health 
     care professional other than a Federally qualified health 
     center; and
       ``(B) preventive primary health services that a center is 
     required to provide under section 330 of the Public Health 
     Service Act,

     when furnished to an individual as a patient of a Federally 
     qualified health center and such services when provided by a 
     health care provider or health care professional employed by 
     or under contract with a Federally qualified health center 
     shall be treated as billable visits for purposes of payment 
     to the Federally qualified health center.''.
       (2) Ensuring fqhc reimbursement under hospital and skilled 
     nursing facility prospective payment systems.--Section 
     1862(a)(14) (42 U.S.C. 1395y(a)) is amended by inserting 
     ``Federally qualified health center services,'' after 
     ``qualified psychologist services,''.
       (3) Technical corrections.--Clauses (i) and (ii)(II) of 
     section 1861(aa)(4)(A) (42 U.S.C. 1395x(aa)(4)(A)) are each 
     amended by striking ``(other than subsection (h))''.
       (4) Effective dates.--The amendments made--
       (A) by paragraphs (1) and (2) shall apply to services 
     furnished on or after January 1, 2004; and
       (B) by paragraph (3) shall take effect on the date of 
     enactment of this Act.
       (b) Providing Safe Harbor for Certain Collaborative Efforts 
     That Benefit Medically Underserved Populations.--
       (1) In general.--Section 1128B(b)(3) (42 U.S.C. 1320a-
     7(b)(3)) is amended--
       (A) in subparagraph (E), by striking ``and'' after the 
     semicolon at the end;
       (B) in subparagraph (F), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(G) any remuneration between a public or nonprofit 
     private health center entity described under clause (i) or 
     (ii) of section 1905(l)(2)(B) and any individual or entity 
     providing goods, items, services, donations or loans, or a 
     combination thereof, to such health center entity pursuant to 
     a contract, lease, grant, loan, or other agreement, if

[[Page 13710]]

     such agreement contributes to the ability of the health 
     center entity to maintain or increase the availability, or 
     enhance the quality, of services provided to a medically 
     underserved population served by the health center entity.''.
       (2) Rulemaking for exception for health center entity 
     arrangements.--
       (A) Establishment.--
       (i) In general.--The Secretary of Health and Human Services 
     (in this paragraph referred to as the ``Secretary'') shall 
     establish, on an expedited basis, standards relating to the 
     exception described in section 1128B(b)(3)(G) of the Social 
     Security Act, as added by paragraph (1), for health center 
     entity arrangements to the antikickback penalties.
       (ii) Factors to consider.--The Secretary shall consider the 
     following factors, among others, in establishing standards 
     relating to the exception for health center entity 
     arrangements under clause (i):

       (I) Whether the arrangement between the health center 
     entity and the other party results in savings of Federal 
     grant funds or increased revenues to the health center 
     entity.
       (II) Whether the arrangement between the health center 
     entity and the other party restricts or limits a patient's 
     freedom of choice.
       (III) Whether the arrangement between the health center 
     entity and the other party protects a health care 
     professional's independent medical judgment regarding 
     medically appropriate treatment.

     The Secretary may also include other standards and criteria 
     that are consistent with the intent of Congress in enacting 
     the exception established under this section.
       (B) Interim final effect.--No later than 180 days after the 
     date of enactment of this Act, the Secretary shall publish a 
     rule in the Federal Register consistent with the factors 
     under subparagraph (A)(ii). Such rule shall be effective and 
     final immediately on an interim basis, subject to such change 
     and revision, after public notice and opportunity (for a 
     period of not more than 60 days) for public comment, as is 
     consistent with this paragraph.

     SEC. 7. ENSURING APPROPRIATE COVERAGE OF AMBULANCE SERVICES 
                   UNDER AMBULANCE FEE SCHEDULE.

       (a) Air Ambulance Service.--
       (1) Coverage.--Section 1834(l) (42 U.S.C. 1395m(l)) is 
     amended--
       (A) by redesignating paragraph (8), as added by section 
     221(a) of Medicare, Medicaid, and SCHIP Benefits Improvement 
     and Protection Act of 2000 (114 Stat. 2763A-486), as enacted 
     into law by section 1(a)(6) of Public Law 106-554, as 
     paragraph (9); and
       (B) by adding at the end the following new paragraph:
       ``(10) Ensuring appropriate coverage of air ambulance 
     services.--
       ``(A) In general.--The regulations described in section 
     1861(s)(7) shall ensure that air ambulance services (as 
     defined in subparagraph (C)) are reimbursed under this 
     subsection at the air ambulance rate if the air ambulance 
     service--
       ``(i) is medically necessary based on the health condition 
     of the individual being transported at or immediately prior 
     to the time of the transport; and
       ``(ii) complies with equipment and crew requirements 
     established by the Secretary.
       ``(B) Medically necessary.--An air ambulance service shall 
     be considered to be medically necessary for purposes of 
     subparagraph (A)(i) if such service is requested--
       ``(i) by a physician or a hospital in accordance with the 
     physician's or hospital's responsibilities under section 1867 
     (commonly known as the `Emergency Medical Treatment and 
     Active Labor Act');
       ``(ii) as a result of a protocol established by a State or 
     regional emergency medical service (EMS) agency;
       ``(iii) by a physician, nurse practitioner, physician 
     assistant, registered nurse, or emergency medical responder 
     who reasonably determines or certifies that the patient's 
     condition is such that the time needed to transport the 
     individual by land or the lack of an appropriate ground 
     ambulance, significantly increases the medical risks for the 
     individual; or
       ``(iv) by a Federal or State agency to relocate patients 
     following a natural disaster, an act of war, or a terrorist 
     attack.
       ``(C) Air ambulance services defined.--For purposes of this 
     paragraph, the term `air ambulance service' means fixed wing 
     and rotary wing air ambulance services.''.
       (2) Conforming Amendment.--Section 1861(s)(7) (42 U.S.C. 
     1395x(s)(7)) is amended by inserting ``, subject to section 
     1834(l)(10),'' after ``but''.
       (b) Ground Ambulance Service.--
       (1) Payment rates.--
       (A) In general.--Section 1834(l)(3) (42 U.S.C. 1395m(l)(3)) 
     is amended to read as follows:
       ``(3) Payment rates.--
       ``(A) In general.--Subject to any adjustment under 
     subparagraph (B) and paragraph (9) and the full payment of a 
     national mileage rate pursuant to paragraph (2)(E), in 
     establishing such fee schedule, the following rules shall 
     apply:
       ``(i) Payment rates in 2003.--

       ``(I) Ground ambulance services.--In the case of ground 
     ambulance services furnished under this part in 2003, the 
     Secretary shall set the payment rates under the fee schedule 
     for such services at a rate based on the average costs (as 
     determined by the Secretary on the basis of the most recent 
     and reliable information available) incurred by full cost 
     ambulance suppliers in providing nonemergency basic life 
     support ambulance services covered under this title, with 
     adjustments to the rates for other ground ambulance service 
     levels to be determined based on the rule established under 
     paragraph (1). For the purposes of the preceding sentence, 
     the term `full cost ambulance supplier' means a supplier for 
     which volunteers or other unpaid staff comprise less than 20 
     percent of the supplier's total staff and which receives less 
     than 20 percent of space and other capital assets free of 
     charge.
       ``(II) Other ambulance services.--In the case of ambulance 
     services not described in subclause (I) that are furnished 
     under this part in 2003, the Secretary shall set the payment 
     rates under the fee schedule for such services based on the 
     rule established under paragraph (1).

       ``(ii) Payment rates in subsequent years for all ambulance 
     services.--In the case of any ambulance service furnished 
     under this part in 2004 or any subsequent year, the Secretary 
     shall set the payment rates under the fee schedule for such 
     service at amounts equal to the payment rate under the fee 
     schedule for that service furnished during the previous year, 
     increased by the percentage increase in the Consumer Price 
     Index for all urban consumers (United States city average) 
     for the 12-month period ending with June of the previous 
     year.
       ``(B) Adjustment in rural rates.--For years beginning with 
     2004, the Secretary, after taking into consideration the 
     recommendations contained in the report submitted under 
     section 221(b)(3) the Medicare, Medicaid, and SCHIP Benefits 
     Improvements and Protection Act of 2000, shall adjust the fee 
     schedule payment rates that would otherwise apply under this 
     subsection for ambulance services provided in low density 
     rural areas based on the increased cost (if any) of providing 
     such services in such areas.''.
       (B) Conforming amendment.--Section 221(c) of the Medicare, 
     Medicaid, and SCHIP Benefits Improvement and Protection Act 
     of 2000 (114 Stat. 2763A-487), as enacted into law by section 
     1(a)(6) of Public Law 106-554, is repealed.
       (2) Use of medical conditions for coding ambulance 
     services.--Section 1834(l)(7) (42 U.S.C. 1395m(l)(7)) is 
     amended to read as follows:
       ``(7) Coding system.--
       ``(A) In general.--The Secretary shall, in accordance with 
     section 1173(c)(1)(B), establish a system or systems for the 
     coding of claims for ambulance services for which payment is 
     made under this subsection, including a code set specifying 
     the medical condition of the individual who is transported 
     and the level of service that is appropriate for the 
     transportation of an individual with that medical condition.
       ``(B) Medical conditions.--The code set established under 
     subparagraph (A) shall--
       ``(i) take into account the list of medical conditions 
     developed in the course of the negotiated rulemaking process 
     conducted under paragraph (1); and
       ``(ii) notwithstanding any other provision of law, be 
     adopted as a standard code set under section 1173(c).''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after the date of the 
     enactment of this Act.

     SEC. 8. RURAL MENTAL HEALTH CARE ACCESSIBILITY IMPROVEMENTS.

       (a) Interdisciplinary Grant Program.--Subpart I of part D 
     of title III of the Public Health Service Act (42 U.S.C. 254b 
     et seq.) is amended by adding at the end the following new 
     section:

     ``SEC. 330L. INTERDISCIPLINARY GRANT PROGRAM.

       ``(a) Program Authorized.--The Director of the Office of 
     Rural Health Policy (of the Health Resources and Services 
     Administration) shall award grants to eligible entities to 
     establish interdisciplinary training programs that include 
     significant mental health training in rural areas for certain 
     health care providers.
       ``(b) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means a 
     public university or other educational institution that 
     provides training for mental health care providers or primary 
     health care providers.
       ``(2) Mental health care provider.--The term `mental health 
     care provider' means--
       ``(A) a physician with postgraduate training in a residency 
     program of psychiatry;
       ``(B) a licensed psychologist (as defined by the Secretary 
     for purposes of section 1861(ii) of such Act (42 U.S.C. 
     1395x(ii)));
       ``(C) a clinical social worker (as defined in section 
     1861(hh)(1) of such Act (42 U.S.C. 1395x(hh)(1)); or
       ``(D) a clinical nurse specialist (as defined in section 
     1861(aa)(5)(B) of such Act (42 U.S.C. 1395x(aa)(5)(B))).
       ``(3) Primary health care provider.--The term `primary 
     health care provider' includes family practice, internal 
     medicine, pediatrics, obstetrics and gynecology, geriatrics,

[[Page 13711]]

     and emergency medicine physicians as well as physician 
     assistants and nurse practitioners.
       ``(4) Rural area.--The term `rural area' means a rural area 
     as defined in section 1886(d)(2)(D) of the Social Security 
     Act, or such an area in a rural census tract of a 
     metropolitan statistical area (as determined under the most 
     recent modification of the Goldsmith Modification, originally 
     published in the Federal Register on February 27, 1992 (57 
     Fed. Reg. 6725)), or any other geographical area that the 
     Director designates as a rural area.
       ``(c) Duration.--Grants awarded under subsection (a) shall 
     be awarded for a period of 5 years.
       ``(d) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use funds received through 
     such grant to administer an interdisciplinary, side-by-side 
     training program for mental health care providers and primary 
     health care providers, that includes providing, under 
     appropriate supervision, health care services to patients in 
     underserved, rural areas without regard to patients' ability 
     to pay for such services.
       ``(e) Application.--An eligible entity desiring a grant 
     under subsection (a) shall submit an application to the 
     Director at such time, in such manner, and containing such 
     information as the Director may reasonably require, 
     including--
       ``(1) a description of the activities which the eligible 
     entity intends to carry out using amounts provided under the 
     grant;
       ``(2) a description of the manner in which the activities 
     funded under the grant will meet the mental health care needs 
     of underserved rural populations within the State; and
       ``(3) a description of the network agreement with 
     partnering facilities.
       ``(f) Evaluations; Report.--Each eligible entity that 
     receives a grant under this section shall submit to the 
     Director of the Office of Rural Health Policy (of the Health 
     Resources and Services Administration) an evaluation 
     describing the programs authorized under this section and any 
     other information that the Director deems appropriate. After 
     receiving such evaluations, the Director shall submit to the 
     appropriate committees of Congress a report describing such 
     evaluations.
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $100,000,000 
     for fiscal year 2002 and such sums as may be necessary for 
     each of the fiscal years 2003 through 2006.''.
       (b) Coverage of Marriage and Family Therapist Services and 
     Mental Health Counselor Services Under Part B of the Medicare 
     Program.--
       (1) Coverage of services.--
       (A) In general.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) 
     is amended--
       (i) in subparagraph (U), by striking ``and'' after the 
     semicolon at the end;
       (ii) in subparagraph (V)(iii), by inserting ``and'' after 
     the semicolon at the end; and
       (iii) by adding at the end the following new subparagraph:
       ``(W) marriage and family therapist services (as defined in 
     subsection (ww)(1)) and mental health counselor services (as 
     defined in subsection (ww)(3));''.
       (B) Definitions.--Section 1861 (42 U.S.C. 1395x) is amended 
     by adding at the end the following new subsection:

     ``Marriage and Family Therapist Services; Marriage and Family 
  Therapist; Mental Health Counselor Services; Mental Health Counselor

       ``(ww)(1) The term `marriage and family therapist services' 
     means services performed by a marriage and family therapist 
     (as defined in paragraph (2)) for the diagnosis and treatment 
     of mental illnesses, which the marriage and family therapist 
     is legally authorized to perform under State law (or the 
     State regulatory mechanism provided by State law) of the 
     State in which such services are performed, as would 
     otherwise be covered if furnished by a physician or as an 
     incident to a physician's professional service, but only if 
     no facility or other provider charges or is paid any amounts 
     with respect to the furnishing of such services.
       ``(2) The term `marriage and family therapist' means an 
     individual who--
       ``(A) possesses a master's or doctoral degree which 
     qualifies for licensure or certification as a marriage and 
     family therapist pursuant to State law;
       ``(B) after obtaining such degree has performed at least 2 
     years of clinical supervised experience in marriage and 
     family therapy; and
       ``(C) in the case of an individual performing services in a 
     State that provides for licensure or certification of 
     marriage and family therapists, is licensed or certified as a 
     marriage and family therapist in such State.
       ``(3) The term `mental health counselor services' means 
     services performed by a mental health counselor (as defined 
     in paragraph (4)) for the diagnosis and treatment of mental 
     illnesses which the mental health counselor is legally 
     authorized to perform under State law (or the State 
     regulatory mechanism provided by the State law) of the State 
     in which such services are performed, as would otherwise be 
     covered if furnished by a physician or as incident to a 
     physician's professional service, but only if no facility or 
     other provider charges or is paid any amounts with respect to 
     the furnishing of such services.
       ``(4) The term `mental health counselor' means an 
     individual who--
       ``(A) possesses a master's or doctor's degree in mental 
     health counseling or a related field;
       ``(B) after obtaining such a degree has performed at least 
     2 years of supervised mental health counselor practice; and
       ``(C) in the case of an individual performing services in a 
     State that provides for licensure or certification of mental 
     health counselors or professional counselors, is licensed or 
     certified as a mental health counselor or professional 
     counselor in such State.''.
       (C) Provision for payment under part b.--Section 
     1832(a)(2)(B) (42 U.S.C. 1395k(a)(2)(B)) is amended by adding 
     at the end the following new clause:
       ``(v) marriage and family therapist services and mental 
     health counselor services;''.
       (D) Amount of payment.--Section 1833(a)(1) (42 U.S.C. 
     1395l(a)(1)) is amended--
       (i) by striking ``and (U)'' and inserting ``(U)''; and
       (ii) by inserting before the semicolon at the end the 
     following: ``, and (V) with respect to marriage and family 
     therapist services and mental health counselor services under 
     section 1861(s)(2)(W), the amounts paid shall be 80 percent 
     of the lesser of the actual charge for the services or 75 
     percent of the amount determined for payment of a 
     psychologist under subparagraph (L)''.
       (E) Exclusion of marriage and family therapist services and 
     mental health counselor services from skilled nursing 
     facility prospective payment system.--
       (i) In general.--Section 1888(e)(2)(A) (42 U.S.C. 
     1395yy(e)(2)(A)), as amended by section 4(b)(1)(B), is 
     amended--

       (I) in clause (i)(II), by striking ``clauses (ii), (iii), 
     and (iv)'' and inserting ``clauses (ii), (iii), (iv), and 
     (v)''; and
       (II) by adding at the end the following new clause:

       ``(v) Exclusion of marriage and family therapist services 
     and mental health counselor services.--Services described in 
     this clause are marriage and family therapist services (as 
     defined in subsection (ww)(1)) and mental health counselor 
     services (as defined in section 1861(ww)(3)).''.
       (ii) Effective date.--The amendments made by clause (i) 
     shall apply to services furnished on or after January 1, 
     2003.
       (F) Inclusion of marriage and family therapists and mental 
     health counselors as practitioners for assignment of 
     claims.--Section 1842(b)(18)(C) (42 U.S.C. 1395u(b)(18)(C)) 
     is amended by adding at the end the following new clauses:
       ``(vii) A marriage and family therapist (as defined in 
     section 1861(ww)(2)).
       ``(viii) A mental health counselor (as defined in section 
     1861(ww)(4)).''.
       (b) Coverage of Certain Mental Health Services Provided in 
     Certain Settings.--
       (1) Rural health clinics and federally qualified health 
     centers.--Section 1861(aa)(1)(B) (42 U.S.C. 1395x(aa)(1)(B)) 
     is amended by striking ``or by a clinical social worker (as 
     defined in subsection (hh)(1)),'' and inserting ``, by a 
     clinical social worker (as defined in subsection (hh)(1)), by 
     a marriage and family therapist (as defined in subsection 
     (ww)(2)), or by a mental health counselor (as defined in 
     subsection (ww)(4)),''.
       (2) Hospice programs.--Section 1861(dd)(2)(B)(i)(III) (42 
     U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by inserting ``or 
     a marriage and family therapist (as defined in subsection 
     (ww)(2))'' after ``social worker''.
       (c) Authorization of Marriage and Family Therapists To 
     Develop Discharge Plans for Post-Hospital Services.--Section 
     1861(ee)(2)(G) (42 U.S.C. 1395x(ee)(2)(G)) is amended by 
     inserting ``marriage and family therapist (as defined in 
     subsection (ww)(2)),'' after ``social worker,''.
       (d) Effective Date.--The amendments made by this subsection 
     shall apply with respect to services furnished on or after 
     January 1, 2004.

     SEC. 9. RURAL HEALTH SERVICES RESEARCH IMPROVEMENTS.

       (a) In General.--Section 711(b) (42 U.S.C. 912(b)) is 
     amended--
       (1) in paragraph (3), by striking ``and'' after the comma 
     at the end;
       (2) in paragraph (4), by striking the period at the end and 
     inserting ``, and''; and
       (3) by adding at the end the following new paragraph:
       ``(5) have the authority to administer grants to support 
     rural health services research.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect on January 1, 2004.

     SEC. 10. EXCLUSION FOR LOAN PAYMENTS UNDER NATIONAL HEALTH 
                   SERVICE CORPS LOAN REPAYMENT PROGRAM.

       (a) In General.--Section 117 of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subsection:

[[Page 13712]]

       ``(e) Loan Payments Under National Health Service Corps 
     Loan Repayment Program.--Gross income shall not include any 
     amount received under section 338B(g) of the Public Health 
     Service Act.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to amounts received by an individual in taxable 
     years beginning after December 31, 2002.

     SEC. 11. VIRTUAL PHARMACIST CONSULTATION SERVICE 
                   DEMONSTRATION PROJECTS.

       (a) Definitions.--In this section:
       (1) Demonstration project.--The term ``demonstration 
     project'' means a demonstration project established by the 
     Secretary under subsection (b)(1).
       (2) Drug.--The term ``drug'' means any drug or biological 
     (as those terms are defined in section 1861(t) of the Social 
     Security Act (42 U.S.C. 1395x(t)), regardless of whether 
     payment may be made for such drug or biological under the 
     medicare program.
       (3) Eligible beneficiary.--The term ``eligible 
     beneficiary'' means an individual enrolled under part B of 
     the medicare program for whom a drug is being prescribed.
       (4) Eligible originating site.--The term ``eligible 
     originating site'' means the site at which a health care 
     provider (as defined by the Secretary) is located at the time 
     a drug is prescribed which may be--
       (A) the office of a physician (as defined in section 
     1861(r) of the Social Security Act (42 U.S.C. 1395x(r))) or a 
     practitioner (as described in section 1842(b)(18)(C) of such 
     Act (42 U.S.C. 1395u(b)(18)(C)));
       (B) a rural health clinic (as defined in section 
     1861(aa)(2) of the Social Security Act (42 U.S.C. 
     1395x(aa)(2)));
       (C) a hospital (as defined in section 1861(e) of such Act 
     (42 U.S.C. 1395x(e))) located in a rural area (as defined in 
     section 1886(d)(2) of such Act (42 U.S.C. 1395ww(d)(2)));
       (D) a critical access hospital (as defined in section 
     1861(mm)(1) of such Act (42 U.S.C. 1395x(mm)(1)));
       (E) a community mental health center (as described in 
     section 1861(ff)(2)(B) of such Act (42 U.S.C. 
     1395x(ff)(2)(B))); or
       (F) a sole community hospital (as defined in section 
     1886(d)(5)(D)(iii) of such Act).
       (5) Eligible pharmacist.--The term ``eligible pharmacist'' 
     means a pharmacist who meets such requirements as the 
     Secretary may establish for purposes of the demonstration 
     projects and who is a full-time employee of a school of 
     pharmacy.
       (6) Medicare program.--The term ``medicare program'' means 
     the health benefits program under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.).
       (7) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (8) Virtual pharmacist consultation service.--The term 
     ``virtual pharmacist consultation service'' means 
     professional consultations furnished by an eligible 
     pharmacist and any additional service specified by the 
     Secretary that is furnished by such a pharmacist.
       (b) Virtual Pharmacist Consultation Service Demonstration 
     Projects.--
       (1) Establishment.--The Secretary shall establish 
     demonstration projects in accordance with the provisions of 
     this section to provide virtual pharmacist consultation 
     services with respect to drugs being prescribed to eligible 
     beneficiaries.
       (2) Participation.--Any eligible pharmacist located at a 
     school of pharmacy may furnish virtual pharmacist 
     consultation services under the demonstration projects and 
     any eligible originating site that does not have a pharmacist 
     on staff may participate in the demonstration projects on a 
     voluntary basis.
       (c) Payment for Virtual Pharmacist Consultation Services.--
       (1) In general.--The Secretary shall pay for virtual 
     pharmacist consultation services that are furnished via a 
     telecommunications system by an eligible pharmacist with 
     respect to a drug that is being prescribed to an eligible 
     beneficiary.
       (2) Payment amount.--
       (A) Eligible pharmacists at schools of pharmacy.--The 
     Secretary shall pay an amount determined by the Secretary for 
     purposes of the demonstration projects to an eligible 
     pharmacist who furnishes a virtual pharmacist consultation 
     service while such pharmacist is located at a school of 
     pharmacy that furnishes a virtual pharmacist consultation 
     service with respect to a drug prescribed to an eligible 
     beneficiary.
       (B) Facility fee for eligible originating site.--If the 
     Secretary determines that it is appropriate, the Secretary 
     may pay the eligible originating site a facility fee 
     determined by the Secretary for purposes of the demonstration 
     projects which may not exceed the facility fee determined 
     under section 1834(m)(2)(B) of the Social Security Act (42 
     U.S.C. 1395m(m)(2)(B)).
       (3) No beneficiary charges.--An eligible beneficiary may 
     not be charged any amount by an eligible pharmacist, eligible 
     originating site, the Secretary or any other individual or 
     entity for a virtual pharmacist service furnished under a 
     demonstration project.
       (d) Conduct of Demonstration Projects.--
       (1) Demonstration areas.--
       (A) In general.--The Secretary shall conduct demonstration 
     projects in 5 demonstration areas selected on the basis of 
     proposals submitted under subparagraph (B). Such 
     demonstration areas shall be geographically disparate.
       (B) Proposals.--The Secretary shall accept proposals to 
     furnish virtual pharmacist consultation services under the 
     demonstration projects from any school of pharmacy that is 
     able to furnish virtual pharmacist services to an underserved 
     rural area.
       (2) Duration.--The Secretary shall complete the 
     demonstration projects by the date that is 3 years after the 
     date on which the first demonstration project is implemented.
       (e) Report to Congress.--Not later than the date that is 6 
     months after the date on which the demonstration projects 
     end, the Secretary shall submit to Congress a report on the 
     demonstration projects together with such recommendations for 
     legislation or administrative action as the Secretary 
     determines is appropriate.
       (f) Waiver of Medicare Requirements.--The Secretary shall 
     waive compliance with such requirements of the medicare 
     program to the extent and for the period the Secretary finds 
     necessary to conduct the demonstration projects.
       (g) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as may be necessary to carry out 
     the demonstration projects under this section, including such 
     sums as may be necessary to develop, implement, and evaluate 
     such projects.
                                 ______
                                 
      By Mrs. CLINTON:
  S. 1187. A bill to amend the Federal Meat Inspection Act and the 
Poultry Products Inspection Act to require that ready-to-eat meat or 
poultry products that are not produced under a scientifically validated 
program to address Listeria monocytogenes be required to bear a label 
advising pregnant women and other at-risk consumers of the 
recommendations of the Department of Agriculture and the Food and Drug 
Administration regarding consumption of ready-to-eat products, and for 
other purposes; to the Committee on Agriculture, Nutrition, and 
Forestry.
  Mrs. CLINTON. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1187

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

     SECTION. 1. SHORT TITLE.

       This Act may be cited as the ``At-Risk Consumer Protection 
     Through Food Safety Labeling Act''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) consumption of food contaminated with microbial 
     pathogens such as bacteria, parasites, viruses, and their 
     toxins causes an estimated 76,000,000 illnesses, 325,000 
     hospitalizations, and 5,000 deaths each year in the United 
     States;
       (2) Government economists estimate that illnesses from 
     Campylobacter, Salmonella, E. coli O157:H7, E. coli non-
     O157:H7 STEC, Listeria, and Toxoplasma gondii cause 
     $6,900,000,000 in medical costs, lost productivity, and 
     premature death in the United States each year;
       (3) in particular, Listeria monocytogenes is the cause of 
     2,500 illnesses and 500 deaths annually, with economic costs 
     of $2,300,000,000;
       (4) people that face relatively higher risks from foodborne 
     illness and associated complications include the very young, 
     the very old, pregnant women, and the immunocompromised, such 
     as persons with AIDS and cancer;
       (5) outbreaks of foodborne illness are becoming 
     increasingly widespread in both geographic area and duration, 
     making detection and containment difficult;
       (6) in 1998, following a major listeriosis outbreak from 
     deli meats, many ready-to-eat meat and poultry processors 
     established Listeria testing programs, but others have no 
     Listeria testing and control program at all, giving them an 
     unfair advantage in production costs over firms that are 
     taking steps to protect public health;
       (7)(A) in 1989, the Secretary of Agriculture established a 
     performance standard allowing zero tolerance for Listeria 
     monocytogenes that prohibits detectable levels of the 
     pathogen in ready-to-eat meat and poultry products; and
       (B) a performance standard for Listeria monocytogenes of 
     nondetectable levels in ready-to-eat meat products--
       (i) is appropriate to protect at-risk consumers (including 
     pregnant women) (referred to in this section as ``at-risk 
     consumers'') from severe health consequences or death from 
     exposure to Listeria monocytogenes; and
       (ii) is necessary to provide an adequate safety margin for 
     at-risk consumers;
       (8) in February 2001, the Secretary of Agriculture proposed 
     regulations establishing

[[Page 13713]]

     performance standards for the production of processed meat 
     and poultry products, including requirements for controlling 
     Listeria monocytogenes, but, in the time since the public 
     comment period closed in September 2001, little progress has 
     been made in finalizing the regulation;
       (9) in 2002, an outbreak of foodborne listeriosis linked to 
     ready-to-eat turkey deli meat in Pennsylvania, New York, New 
     Jersey, Delaware, Maryland, Connecticut, and Michigan--
       (A) sickened 53 persons;
       (B) killed 8 persons; and
       (C) caused at least 3 pregnant women to suffer miscarriages 
     or stillbirths;
       (10) in a March 21, 2003, speech to the North American Meat 
     Processors, Food Safety and Inspection Service Administrator 
     Dr. Gary McKee said the agency's December 2002 directive 
     outlining Listeria testing procedures for agency inspectors 
     is only an interim measure;
       (11) to ensure the safety of at-risk consumers, ready-to-
     eat meat and poultry products not produced under a 
     scientifically validated program to address Listeria 
     monocytogenes should be required to bear a label advising at-
     risk consumers of the Government's recommendations not to 
     consume ready-to-eat meat and poultry products without 
     heating the products until steaming hot; and
       (12) all data generated through scientifically validated 
     programs to address Listeria monocytogenes should be shared 
     with the Department of Agriculture and used to improve 
     scientific research regarding the safety of ready-to-eat 
     foods.

     SEC. 3. READY-TO-EAT MEAT PRODUCTS.

       (a) In General.--Section 7 of the Federal Meat Inspection 
     Act (21 U.S.C. 607) is amended by adding at the end the 
     following:
       ``(g) Ready-To-Eat Meat Products.--
       ``(1) Definitions.--In this subsection:
       ``(A) At-risk consumer.--The term `at-risk consumer' 
     includes a pregnant woman.
       ``(B) Ready-to-eat meat product.--The term `ready-to-eat 
     meat product' means a meat product that has been processed so 
     that the meat product may be safely consumed without further 
     preparation by the consumer, that is, without cooking or 
     application of some other lethality treatment to destroy 
     pathogens.
       ``(2) Labeling requirement.--Except as provided in 
     paragraph (3) or (4), a ready-to-eat meat product shall bear 
     a label advising consumers that an at-risk consumer--
       ``(A) should not consume the ready-to-eat meat product 
     unless the ready-to-eat meat product is heated until steaming 
     hot; or
       ``(B) should follow such other instructions as the 
     Secretary may prescribe in accordance with health guidelines 
     and recommendations published by the Secretary and the 
     Secretary of Health and Human Services.
       ``(3) Exemptions for producers.--On the motion of the 
     Secretary or on petition of a producer of a ready-to-eat meat 
     product, the Secretary, after notice and opportunity for a 
     public hearing, shall, by regulation applicable to all 
     producers of the ready-to-eat meat product or by order 
     applicable to a particular producer of the ready-to-eat meat 
     product, provide an exemption from the requirement of 
     paragraph (2) if--
       ``(A) in the case of a ready-to-eat meat product that the 
     Secretary determines presents a low risk to at-risk 
     consumers, the producer--
       ``(i) has a scientifically validated program (as determined 
     by the Secretary) to control Listeria monocytogenes; and
       ``(ii) makes all Listeria control program records 
     (including the results of any testing of plant environment, 
     food-contact surfaces, or meat product) available for 
     inspection by the Secretary; or
       ``(B) in the case of any ready-to-eat meat product that the 
     Secretary determines presents a greater risk to at-risk 
     consumers, the producer of the ready-to-eat meat product has 
     a scientifically valid program to address Listeria 
     monocytogenes under which the producer--
       ``(i) tests food-contact surfaces for Listeria 
     monocytogenes--

       ``(I) at least once every 2 days of production; and
       ``(II) if a food-contact surface tests positive--

       ``(aa) at least 3 times per day until the surface tests 
     negative on 3 consecutive days; or
       ``(bb) in accordance with such other regimen as the 
     Secretary may specify;
       ``(ii) tests the plant environment in the ready-to-eat meat 
     processing area for the Listeria species--

       ``(I) at least once every 2 days of production; and
       ``(II) if any part of the plant environment in the ready-
     to-eat meat processing area tests positive--

       ``(aa) at least 3 times per day until the plant environment 
     tests negative on 3 consecutive days; or
       ``(bb) in accordance with such other regimen as the 
     Secretary may specify;
       ``(iii)(I) tests final products for Listeria monocytogenes 
     at least 5 times per month to measure the effectiveness of 
     the Listeria control program; and
       ``(II) if any food-contact surface tests positive, conducts 
     daily testing of the meat product from the line found to be 
     positive until the surface tests negative for 3 days;
       ``(iv) makes all control program records (including the 
     results of any testing of plant environment, food-contact 
     surfaces, or meat product) available for inspection by the 
     Secretary; and
       ``(v) meets any other requirement that the Secretary may 
     specify.
       ``(4) Exemptions for distributors.--On the motion of the 
     Secretary or on petition of a distributor of a ready-to-eat 
     meat product, the Secretary, after notice and opportunity for 
     a public hearing, shall, by regulation applicable to all 
     distributors of the ready-to-eat meat product or by order 
     applicable to a particular distributor of the ready-to-eat 
     meat product, provide an exemption from the requirement of 
     paragraph (2) if--
       ``(A) the distributor has purchasing specifications 
     incorporating the requirements of paragraph (3); and
       ``(B) the Secretary determines that the suppliers of the 
     distributor are in compliance with paragraph (3).
       ``(5) Reports by the secretary.--Not later than 3 years 
     after the date of enactment of this section, and at least 
     triennially thereafter, the Secretary shall compile and 
     disseminate information from records made available under 
     paragraphs (3)(A)(ii), (3)(B)(iv), and (4) to Federal 
     agencies, universities, and other research institutions and 
     other entities, as appropriate (excluding any such 
     proprietary or confidential information as is protected from 
     disclosure), for the purpose of furthering scientific 
     research.
       ``(6) Performance standard.--A performance standard of the 
     Secretary that provides zero tolerance for detectable levels 
     of Listeria monocytogenes in ready-to-eat meats--
       ``(A) shall not be modified to permit any detectable level 
     of Listeria monocytogenes in any ready-to-eat meat product; 
     and
       ``(B) shall be based on scientifically validated testing 
     methods for the detection of Listeria monocytogenes, as 
     determined by the Secretary.''.
       (b) Misbranding.--Section 1(n) of the Federal Meat 
     Inspection Act (21 U.S.C. 601(n)) is amended--
       (1) in paragraph (11), by striking ``or'' at the end;
       (2) in paragraph (12), by striking the period at the end 
     and inserting ``; or''; and
       (3) by adding at the end the following:
       ``(13) if it is a ready-to-eat meat product that is 
     required to bear a label under section 7(g), and it does not 
     bear such a label.''.

     SEC. 4. READY-TO-EAT POULTRY PRODUCTS.

       (a) In General.--Section 8 of the Poultry Products 
     Inspection Act (21 U.S.C. 457) is amended by adding at the 
     end the following:
       ``(e) Ready-To-Eat Poultry Products.--
       ``(1) Definitions.--In this subsection:
       ``(A) At-risk consumer.--The term `at-risk consumer' 
     includes a pregnant woman.
       ``(B) Ready-to-eat poultry product.--The term `ready-to-eat 
     poultry product' means a poultry product that has been 
     processed so that the poultry product may be safely consumed 
     without further preparation by the consumer, that is, without 
     cooking or application of some other lethality treatment to 
     destroy pathogens.
       ``(2) Labeling requirement.--Except as provided in 
     paragraph (3) or (4), a ready-to-eat poultry product shall 
     bear a label advising consumers that an at-risk consumer--
       ``(A) should not consume the ready-to-eat poultry product 
     unless the ready-to-eat poultry product is heated until 
     steaming hot; or
       ``(B) should follow such other instructions as the 
     Secretary may prescribe in accordance with health guidelines 
     and recommendations published by the Secretary and the 
     Secretary of Health and Human Services.
       ``(3) Exemptions for producers.--On the motion of the 
     Secretary or on petition of a producer of a ready-to-eat 
     poultry product, the Secretary, after notice and opportunity 
     for a public hearing, shall, by regulation applicable to all 
     producers of the ready-to-eat poultry product or by order 
     applicable to a particular producer of the ready-to-eat 
     poultry product, provide an exemption from the requirement of 
     paragraph (2) if--
       ``(A) in the case of a ready-to-eat poultry product that 
     the Secretary determines presents a low risk to at-risk 
     consumers, the producer--
       ``(i) has a scientifically validated program (as determined 
     by the Secretary) to control Listeria monocytogenes; and
       ``(ii) makes all Listeria control program records 
     (including the results of any testing of plant environment, 
     food-contact surfaces, or poultry product) available for 
     inspection by the Secretary; or
       ``(B) in the case of any ready-to-eat poultry product that 
     the Secretary determines presents a greater risk to at-risk 
     consumers, the producer of the ready-to-eat poultry product 
     has a scientifically valid program to address Listeria 
     monocytogenes under which the producer--
       ``(i) tests food-contact surfaces for Listeria 
     monocytogenes--

       ``(I) at least once every 2 days of production; and
       ``(II) if a food-contact surface tests positive--

       ``(aa) at least 3 times per day until the surface tests 
     negative on 3 consecutive days; or
       ``(bb) in accordance with such other regimen as the 
     Secretary may specify;

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       ``(ii) tests the plant environment in the ready-to-eat 
     poultry processing area for the Listeria species--

       ``(I) at least once every 2 days of production; and
       ``(II) if any part of the plant environment in the ready-
     to-eat poultry processing area tests positive--

       ``(aa) at least 3 times per day until the plant environment 
     tests negative on 3 consecutive days; or
       ``(bb) in accordance with such other regimen as the 
     Secretary may specify;
       ``(iii)(I) tests final products for Listeria monocytogenes 
     at least 5 times per month to measure the effectiveness of 
     the Listeria control program; and
       ``(II) if any food-contact surface tests positive, conducts 
     daily testing of the poultry product from the line found to 
     be positive until the surface tests negative for 3 days;
       ``(iv) makes all control program records (including the 
     results of any testing of plant environment, food-contact 
     surfaces, or poultry product) available for inspection by the 
     Secretary; and
       ``(v) meets any other requirement that the Secretary may 
     specify.
       ``(4) Exemptions for distributors.--On the motion of the 
     Secretary or on petition of a distributor of a ready-to-eat 
     poultry product, the Secretary, after notice and opportunity 
     for a public hearing, shall, by regulation applicable to all 
     distributors of the ready-to-eat poultry product or by order 
     applicable to a particular distributor of the ready-to-eat 
     poultry product, provide an exemption from the requirement of 
     paragraph (2) if--
       ``(A) the distributor has purchasing specifications 
     incorporating the requirements of paragraph (3); and
       ``(B) the Secretary determines that the suppliers of the 
     distributor are in compliance with paragraph (3).
       ``(5) Reports by the secretary.--Not later than 3 years 
     after the date of enactment of this section, and at least 
     triennially thereafter, the Secretary shall compile and 
     disseminate information from records made available under 
     paragraphs (3)(A)(ii), (3)(B)(iv), and (4) to Federal 
     agencies, universities, and other research institutions and 
     other entities, as appropriate (excluding any such 
     proprietary or confidential information as is protected from 
     disclosure), for the purpose of furthering scientific 
     research.
       ``(6) Performance standard.--A performance standard of the 
     Secretary that provides zero tolerance for detectable levels 
     of Listeria monocytogenes in ready-to-eat poultry products--
       ``(A) shall not be modified to permit any detectable level 
     of Listeria monocytogenes in any ready-to-eat poultry 
     product; and
       ``(B) shall be based on scientifically validated testing 
     methods for the detection of Listeria monocytogenes, as 
     determined by the Secretary.''.
       (b) Misbranding.--Section 4(h) of the Poultry Products 
     Inspection Act (21 U.S.C. 453(h)) is amended--
       (1) in paragraph (11), by striking ``or'' at the end;
       (2) in paragraph (12), by striking the period at the end 
     and inserting ``; or''; and
       (3) by adding at the end the following:
       ``(13) if it is a ready-to-eat poultry product that is 
     required to bear a label under section 8(e), and it does not 
     bear such a label.''.

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