[Congressional Record (Bound Edition), Volume 150 (2004), Part 10]
[Senate]
[Pages 12714-12739]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. GRAHAM of Florida (for himself and Mr. Durbin):
  S. 2535. A bill to amend title XVIII of the Social Security Act to 
modernize the medicare program by ensuring that appropriate preventive 
services are covered under such program; to the Committee on Finance.
  Mr. GRAHAM of Florida. Mr. President, I am very pleased to introduce 
the Medicare Preventive Services Coverage Act of 2004, and to be joined 
by Senator Richard Durbin.
  This legislation would change the basic charter of Medicare to one 
that not only diagnoses and treats, but also prevents illness.
  On July 30, 1965, Medicare was created under title 18 of the Social 
Security Act to provide health insurance coverage for the elderly.
  The coverage provided through the program was limited to diagnostic 
and treatment services that were considered reasonable and necessary.
  There was little demand to cover preventive services under Medicare 
or any other health plan at that time because we were not yet cognizant 
of the vital role of prevention on the health and quality of human 
life.
  The basic charter of Medicare reflects this lack of understanding.
  However, since Medicare's inception, we have learned a lot about the 
enormous burden of chronic disease on our Nation.
  According to the Centers for Disease Control and Prevention, CDC, 
more than 1.7 million Americans die of a chronic disease each year, 
accounting for about 70 percent of all deaths.
  Not only does chronic disease lead to a majority of deaths and 
disabilities in America, it also accounts for about 75 percent of 
health care costs each year,

[[Page 12715]]

placing a huge economic demand on our Nation.
  Medicare bears a lion's share of this cost. In 2003, Medicare spent 
nearly $7,000 per beneficiary; much of this cost is attributable to 
treating chronic illnesses.
  The percentage of the population over age 65 has increased 
dramatically and will continue to do so. This will place an even 
greater economic burden on Medicare.
  What is the bottom line? In short, Medicare cannot afford this 
spiraling cost.
  The good news is that we now have decades of research demonstrating 
that although chronic diseases are the most common and costly of all 
health problems, they are also the most preventable.
  For example, according to the CDC regular eye exams and timely 
treatment could prevent up to 90 percent of diabetes related blindness.
  Eye chart screening for visual acuity is currently recommended by the 
United States Preventive Services Task Force, USPSTF, but is not 
covered by Meidcare.
  The impact of prevention on chronic disease is well known by the 
President's Secretary for Health and Human Services.
  HHS Secretary Thompson said in September 2003:

       There is clear evidence that the costs of chronic 
     conditions are enormous, as are the potential savings from 
     preventing them, even if there may not always be agreement on 
     the exact amounts of these cost savings.

  He goes on to say:

       . . . the Nation simply cannot afford not to step up 
     efforts to reverse the growing prevalence of chronic 
     disorders. Resources and energy need to be marshaled in all 
     sectors and at all levels of society.

  Partnership for Prevention, a Washington, DC, think tank on health 
policy takes Thompson's comments one step further. A recent Partnership 
report makes the following logical assumption:

       As the primary source of health insurance coverage for 
     millions of older Americans and persons with permanent 
     disabilities, Medicare has the potential to have a 
     substantial impact on the health of beneficiaries by 
     promoting and covering cost-effective preventive services.

  Congress has added coverage for some preventive services over the 
last two decades, including the flu vaccine, mammograms, and cancer 
screening.
  As HHS does not have the authority to add preventive services to 
Medicare--despite the growing body of evidence that has proved their 
efficacy--these benefits were only added to Medicare because of 
congressional action.
  The benefits that Congress have added are extremely important, and I 
am glad that we have taken the steps to make them available to our 
seniors.
  However, the congressional process is slow, and subject to political 
winds and influences that are not always based purely in science.
  The legislation I am introducing would change the basic charter of 
Medicare from a program focused on diagnosing and treating illnesses to 
one that also prevents illnesses by giving the Department of Health and 
Human Services the authority to make coverage decisions for preventive 
services.
  Why change the current system of passing legislation each time we 
want to add coverage of preventive service to Medicare? There are some 
very logical reasons.
  The reliance on Congress to cover preventive services has resulted 
in: Coverage for only half of clinical preventive services that experts 
recommend for the 65+ age group; coverage that not only fails to keep 
up with changes in scientific evidence but is often in consistent with 
authoritative recommendations; a confusing array of cost sharing 
requirements across covered preventive services; and lack of coverage 
of some preventive services that provide great health benefits in favor 
of others that do not meet current evidence standards as a result of 
vocal advocacy groups.
  Luckily, the fundamental reform of the program that I am proposing 
does not require extensive statutory or bureaucratic change.
  Medicare already has a process in place for the Secretary of Health 
and Human Services to make coverage decisions on diagnostic, treatment, 
and durable medical equipment options.
  My bill would authorize the Secretary to make coverage decisions on 
preventive services using that same process, based on the 
recommendations of the federally-convened United States Preventive 
Services Task Force, USPSTF, and other groups.
  This authorization would not entail dramatic new administrative 
expenses or a major reorganization of CMS coverage processes and staff.
  My legislation would put preventive services on an equal footing with 
diagnostic and treatment services by allowing the Secretary to make 
coverage decisions for all services needed to prevent, diagnose, and 
treat illness.
  Providing beneficiaries with the most cost-effective and current 
preventive services should no longer require an ``Act of Congress.''
  It should, instead, require the insight of the experts in the field, 
and be based on the same careful process HHS is currently using.
  Let us untie their hands and improve the lives of our Medicare 
beneficiaries by building coverage of preventive services into the 
currently established coverage decision process.
  This legislation is supported by the following groups: American 
College of Preventive Medicine; HealthPartners; Deafness Research 
Foundation; Partnership for Prevention; American Dietetic Association; 
American Public Health Association; Families USA; American Physical 
Therapy Association; American Academy of Family Physicians; United 
Cerebral Palsy Association; National Mental Health Association; 
Campaign for Tobacco-Free Kids, and the Emergency Department Practice 
Management Association.
  If Medicare were created today, it would certainly not exclude 
coverage of preventive services.
  Today we know how important preventive services are; they save money 
and lives. Let us give Medicare the authority to do its job.
  I urge my colleagues to join me in sponsoring this important piece of 
legislation.
  I ask unanimous consent to print letters of support from the above-
listed groups in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                   American Public


                                           Health Association,

                                     Washington, DC, June 1, 2004.
     Hon. Bob Graham,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: On behalf of the American Public 
     Health Association (APHA), the largest and oldest 
     organization of public health professionals in the country, 
     representing more than 50,000 members from over 50 public 
     health occupations, I write in support of the Medicare 
     Preventive Services Coverage Act of 2004.
       As outlined in position paper 7633, ``Policy Statement on 
     Prevention,'' APHA has long supported measures to 
     increasingly utilize the fund preventive services in federal 
     health programs. In this vein, the Medicare Preventive 
     Services Coverage Act of 2004 demonstrates a significant 
     commitment to addressing the underlying factors responsible 
     for the underutilization of prevention strategies that 
     optimize the health and independence of the elderly by 
     granting the Secretary the authority to approve Medicare 
     coverage of preventive services based on recommendations of 
     the U.S. Preventive Services Task Force and other groups. By 
     allowing decisions about coverage of preventive services to 
     be made in the same timely, evidence-based manner as other 
     services under Medicare, the legislation would enable 
     Medicare to take a vital step towards focusing more on 
     disease prevention, which is cost-effective and has the 
     ability to prevent or delay the occurrence of chronic 
     disease.
       Since the creation of Medicare, the American Public Health 
     Association has supported measures to protect Medicare 
     beneficiaries against significant financial exposure that 
     imposes barriers to the receipt of needed care. The 
     provisions of the Medicare Preventive Services Act of 2004 
     that aim to eliminate co-payments and deductibles from all 
     future preventive benefits serve to ensure that Medicare 
     beneficiaries will not be restricted from accessing needed 
     preventive medical care because of financial hardship.
       Thank you for your attention to and leadership on this 
     important public health issue. We look forward to working 
     with you to move legislation forward this year.
           Sincerely
                                    Georges C. Benjamin, MD, FACP,
                                               Executive Director.

[[Page 12716]]

     
                                  ____
                                                     June 2, 2004.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: Congratulations on the introduction of 
     your new legislation to provide a permanent solution to 
     Medicare's long-standing failure to cover appropriate 
     preventive health services. Families USA, the health consumer 
     advocacy organization, strongly endorses your effort.
       Currently, life-saving and life-improving preventive 
     screening services have been covered only by an act of 
     Congress--and usually only after long and difficult debates. 
     Your proposal will place this basic scientific and technical 
     issue in the excellent medical staff of the Centers for 
     Medicare and Medicaid Services, where decisions can be made 
     on a more timely, professional and scientific basis. We 
     believe that this will help ensure that important preventive 
     care services will be implemented in a more timely and 
     rational way. The result will be an improvement in the 
     quality of life of Medicare beneficiaries.
       Congratulations again on this proposal--one of a long-line 
     of creative and helpful health initiatives that you have 
     championed in your outstanding Senate career.
           Sincerely,
                                                Ronald F. Pollack,
     Executive Director.
                                  ____

                                                 American Physical


                                          Therapy Association,

                                     Alexandria, VA, June 2, 2004.
     Hon. Bob Graham,
     U.S. Senate, Senate Hart Office Building, Washington, DC.
       Dear Senator Graham: On behalf of the 64,000 members of the 
     American Physical Therapy Association (APTA), I commend you 
     for your efforts to promote the full continuum of health care 
     for our nation's seniors and persons with disabilities served 
     by the Medicare program. APTA appreciates the introduction of 
     your legislation, the Medicare Preventative Services Coverage 
     Act of 2004 and fully supports its enactment by the 108th 
     Congress. Prevention services are an essential part of the 
     health care continuum that needs better integration into the 
     Medicare program, and your legislation goes a long way toward 
     achieving that objective.
       Physical therapists provide prevention services that 
     forestall or prevent functional decline and the need for more 
     intense care. Through timely and appropriate screening, 
     examination, evaluation, diagnosis, prognosis, and 
     intervention, physical therapists frequently reduce or 
     eliminate the need for more costly forms of care and also may 
     shorten or even eliminate institutional stays. Physical 
     therapists are actively involved in promoting health, 
     wellness and fitness initiatives, including the provision of 
     services and education of patients that stimulate the public 
     to engage in healthy behaviors. An example of physical 
     therapist involvement in preventive services is the use of 
     therapeutic interventions to improve strength, mobility, and 
     balance to reduce falls that often lead to more costly health 
     care and disability under Medicare.
       Thank you for your commitment to improving the Medicare 
     program. The addition of appropriate preventative services to 
     the Medicare program will help our nations' seniors and 
     persons with disability lead more healthy and productive 
     lives within our communities. Please feel free to contact 
     Justin Moore on APTA's Government Affairs staff at 
     [email protected] or 703/706-3162, if you have any 
     questions or need additional information.
           Sicnerely,
                                       Ben F. Massey, Jr., PT, MA,
     President.
                                  ____

                                               American Academy of


                                            Family Physicians,

                                     Washington, DC, June 9, 2004.
     Hon. Robert Graham,
     Hart Senate Office Building,
     U.S. Senate, Washington, DC.
       Dear Senator Graham: Thank you for the opportunity to 
     review the draft of your legislation, the Medicare Preventive 
     Services Coverage Act. On behalf of the 93,700 members of the 
     American Academy of Family Physicians, I am pleased to inform 
     you that the AAFP strongly endorses the bill, and we 
     congratulate you for your efforts on behalf of the nation's 
     seniors.
       This legislation would help make Medicare more responsive 
     to the people that it directly serves. By allowing CMS to 
     cover preventive services that are based on evidence and 
     current science and that have been reviewed and approved by 
     the United States Preventive Services Task Force and other 
     appropriate organizations, the bill helps direct Medicare 
     toward proven health care services that will keep seniors 
     healthier. The AAFP commends your commitment to evidence-
     based measures that will prevent accidents and illness and 
     provide more effective health care. We believe that sound 
     science should always be the basis of medical decisions.
       The Academy would urge you and your colleagues in Congress 
     to consider giving CMS the authority to review current 
     preventive services in the light of the U.S. Preventive 
     Services Task Force recommendations and to alter 
     reimbursement accordingly. And we would also suggest that 
     Congress might want to make more explicit the agency's 
     authority to review and revise payments as the evidence of 
     previously approved services changes.
       Thank you, Senator Graham, for your commitment to the 
     health of Medicare patients and for your leadership in 
     improving this important program that serves them.
           Sincerely,
                                       James C. Martin, MD, FAAFP,
     Board Chair.
                                  ____

                                               American College of


                                          Preventive Medicine,

                                                     June 4, 2004.
       The American College of Preventive Medicine (ACPM) is very 
     pleased to support Senator Bob Graham's bill granting the 
     Secretary of Health and Human Services the authority to 
     approve Medicare coverage of preventive medical services from 
     the recommendations of the United States Preventive Services 
     Task Force (USPSTF) and other appropriate organizations.
       As the representative organization for preventive medicine 
     physicians, ACPM understands the potential long-term benefits 
     from clinical preventive services supported by evidence to 
     have a beneficial impact on survival and quality of life. As 
     the population of the United States ages, preventive services 
     will become the best strategy to keep people healthy and to 
     conserve medical expenditures.
       Therefore, the ACPM offers its full support of Senator 
     Graham's proposed legislation to include preventive services 
     under Medicare coverage.
                                                       Mike Barry,
     Deputy Director.
                                  ____



                                American Dietetic Association,

                                        Chicago, IL, June 2, 2004.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: The American Dietetic Association 
     (ADA) is the largest organization of food and nutrition 
     professionals in the U.S. We promote optimal nutrition and 
     well being of all people, by relying on evidence-based 
     practices and policies. To that end, ADA is pleased to 
     support the Medicare Preventive Services Coverage Act of 
     2004.
       Nutrition is a critical element to any comprehensive health 
     care program and in particular preventive services. According 
     to the Department of Health and Human Services, 40 percent of 
     Americans age 40 to 74 suffer from pre-diabetes. The evidence 
     shows that proper nutrition and physical activity can prevent 
     many, if not most of these Americans from developing type II 
     diabetes. In cardiovascular care, the evidence shows that 
     proper preventive nutrition intervention can slow or reverse 
     conditions such as hypertension or dyslipidemia. 
     Unfortunately, Medicare does not recognize the importance of 
     preventive care in general and preventive nutrition therapy 
     specifically.
       When Congress passed the Medicare Modernization Act last 
     year, it included a new provision for preventive care under 
     Sec. 611, the Initial Preventive Physical Examination. While 
     referral to medical nutrition therapy is specifically 
     mentioned in the bill, CMS is interpreting this new language 
     as limited to only those diseases (diabetes and renal) that 
     are already eligible for MNT. As a result of this 
     interpretation, patients diagnosed during the initial 
     preventive physical exam as having pre-diabetes, must wait 
     until their conditions progress to type II diabetes before 
     Medicare will cover nutrition therapy.
       Such an approach to preventive care is poor health policy 
     and poor fiscal management of the program. Your Medicare 
     Preventive Services Coverage Act if enacted, will promote 
     preventive care within Medicare to the status it deserves. 
     ADA commends your efforts and foresight.
           Sincerely,
                                                  Ronald E. Smith,
     Director of Government Relations.
                                  ____

                                                      Campaign for


                                            Tobacco-Free Kids,

                                                    June 14, 2004.
     Hon. Bob Graham,
     U.S. Senator, Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: The Campaign for Tobacco-Free Kids is 
     pleased to lend its support to your bill, The Medicare 
     Preventive Services Coverage Act of 2004.
       This bill will help provide the scientific foundation and 
     evidence-based decisions that are critical for ensuring that 
     the Medicare program provides the most effective preventive 
     services to all Medicare beneficiaries. This bill will help 
     shift the emphasis of the Medicare program from treating 
     illness to one where the focus is more on wellness, health 
     promotion and prevention. With nearly three-quarters of all 
     illnesses in this country related to preventable conditions 
     such as tobacco use, lack of proper nutrition and physical 
     fitness, obesity and diabetes, it makes perfect health and 
     fiscal sense to enact such changes into the Medicare program.
       With the recent inclusion of prescription drug coverage to 
     the Medicare program, including coverage for prescription 
     tobacco use

[[Page 12717]]

     cessation medications such as nicotine nasal spray and 
     bupropion SR, this bill represents a tremendous opportunity 
     to enhance and compliment this new coverage through the 
     provision of tobacco use cessation counseling services. 
     According to the U.S. Preventive Services Task Force, next to 
     childhood immunizations, tobacco cessation counseling is the 
     most clinically effective preventive service that we have. 
     Furthermore, we know that counseling services double the 
     number of successful quit smoking attempts versus people who 
     try to quit ``cold turkey''. And when combined with 
     medications, there is nearly a four-fold increase in 
     successful quit attempts. With about 10 percent of all 
     Medicare beneficiaries still smoking, about 4.5 million 
     people, such a benefit would have a tremendous impact on the 
     health and quality of life of our nation's seniors.
       Again, the Campaign for Tobacco-Free Kids is proud to 
     support this important piece of public health legislation.
           Sincerely,
                                                 Matthew L. Myers,
     President.
                                  ____



                                   Partnership for Prevention,

                                     Washington, DC, June 2, 2004.
     Hon. Bob Graham,
     U.S. Senator, Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: Thank you for requesting Partnership 
     for Prevention's comments on Medicare policy concerning 
     disease prevention and health promotion.
       Partnership strongly recommends that Congress modernize 
     Medicare by directing the Centers for Medicare and Medicaid 
     Services to make coverage decisions for disease prevention 
     and health promotion services based on evidence-based 
     recommendations such as those of the U.S. Preventive Services 
     Task Force and the Advisory Committee on Immunization 
     Practices. This was one of the principal policy 
     recommendations in Partnership's 2003 report, A Better 
     Medicare for Healthier Seniors: Recommendations to Modernize 
     Medicare's Prevention Policies. We understand that you plan 
     to introduce legislation that would bring about such a policy 
     change.
       When Congress created Medicare in 1965, it designed the 
     program based on the knowledge of health, medicine and health 
     care at that time. Thus, Medicare focused on hospitalization 
     and visits to doctors' offices to treat or diagnose seniors 
     who were already showing signs of illness. Medicine has made 
     great progress since then, including development of proven 
     ways to prevent disease and promote longer, healthier lives. 
     But Medicare has consistently lagged behind the curve, 
     failing to cover proven disease prevention and health 
     promotion services or providing coverage years later than 
     private insurers.
       Allowing Medicare coverage decisions for preventive 
     services to be made following a similar process as diagnosis 
     and treatment decisions is an important step in modernizing 
     Medicare. It is also critical that these coverage decisions 
     be informed by systematic reviews of evidence conducted by 
     independent experts, such as the U.S. Preventive Services 
     Task Force. We understand that your bill would address these 
     issues and enable Medicare to keep pace with progress in 
     preventive medicine and health promotion.
       Partnership's Better Medicare report also noted that use 
     rates for most preventive services that are covered by 
     Medicare fall short of national targets, in part because of a 
     confusing array of cost sharing requirements, such as 
     deductibles and co-payments for these services. We understand 
     that your bill would eliminate these impediments for 
     preventive services covered in the future.
       Most Americans understand that it is preferable to help 
     people stay healthy instead of waiting to treat them after 
     they become sick. It is in our nation's interest for seniors 
     to be healthy instead of infirm, active instead of 
     hospitalized, productive instead of costly, independent 
     instead of dependent. Cost-saving and cost-effective disease 
     prevention and health promotion are sound investments for our 
     country.
       Thank you again for requesting our comments on these 
     important facets of Medicare policy.
           Sincerely,
                                                   John M. Clymer,
     President.
                                  ____



                                 Deafness Research Foundation,

                                     Washington, DC, June 2, 2004.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: On behalf of the Deafness Research 
     Foundation and World Council on Hearing Health, we fully 
     support the Amendment to Title XVII of the Social Security 
     Act to modernize the Medicare program so as to ensure 
     preventive services be covered under the program.
       The Deafness Research Foundation and its public education 
     and advocacy arm, called the World Council on Hearing 
     Health's mission is to make a lifetime of hearing possible 
     for all people through quality research, public education and 
     advocacy. We espouse the program platforms of detection, 
     prevention, intervention and research about hearing loss. 
     Therefore, we fully support your draft bill that will allow 
     for the Secretary of Health and Human Services be granted the 
     authority to approve Medicare coverage of preventive services 
     based on recommendations of the U.S. Preventive Services Task 
     Force and other organizations if enacted.
       Early detection of hearing loss through regular hearing 
     checkups (at least once every two years) from childhood to 
     adulthood is a key to early intervention as needed. For 
     babies and children it is especially important so their 
     educational, emotional and social development is not halted 
     nor compromised. In adults, early detection of hearing loss 
     is the best prevention against further damaging one's hearing 
     not to mention the impact hearing loss can have on one's 
     career and quality of life. In the elderly, the ability to 
     diagnose hearing loss early on is an imperative to combat 
     misdiagnoses of dementia and senility.
       We commend you on taking the initiative to propose this 
     bill and we will tell the 40,000 donors and members of 
     Deafness Research Foundation to fervently follow its 
     progress.
           Sincerely,
                                                      Susan Greco,
     Executive Director.
                                  ____

                                                     June 3, 2004.
     Hon. Robert Graham,
     Hart Senate Office Building,
     Washington, DC.
       Dear Senator Graham: I am writing on behalf of 
     HealthPartners in support of the ``Medicare Preventive 
     Services Coverage Act of 2004''. HealthPartners is a 
     consumer-governed family of nonprofit Minnesota health care 
     organizations focused on improving the health of its members, 
     its patients and the community. HealthPartners and its 
     related organizations provide health care services, insurance 
     and HMO coverage to more than 670,000 members. The key 
     features of this bill would go far in helping to improve the 
     health of Medicare enrollees.
       This bill would put disease prevention on a level playing 
     field with disease detection and treatment under Medicare. It 
     would also permit preventive service coverage decisions to be 
     based on evidence. We believe strongly that appropriate 
     preventive services should be included in the Medicare 
     benefit set and that those benefits should be evidence-based. 
     Using the United States Preventive Services Task Force (and 
     other appropriate organizations') recommendations as a guide 
     for the addition of preventive services is an excellent step.
       We encourage the Secretary and Congress to continue to 
     focus benefits in both the Medicare and Medicaid programs on 
     evidence based medicine. Evidence based care provides the 
     structure for the right services to be delivered at the right 
     time in the right location for enrollees of all ages. This, 
     in turn, supports achieving the six aims for care as outlined 
     by the Institute of Medicine: care that is patient-centered, 
     timely, effective, efficient, equitable and safe. We support 
     your efforts to achieve these ends.
           Sincerely,

                                           George Isham, M.D.,

                                              Medical Director and
     Chief Health Officer.
                                  ____

         Emergency Department Practice Management Association,
                                        McLean, VA, June 16, 2004.
     Hon. Senator Graham,
     Hart Senate Office Building,
     U.S. Senate, Washington, DC.
       Dear Senator Graham: Thank you for the opportunity to 
     review your draft legislation, the Medicare Preventive 
     Services Coverage Act. On behalf of the Emergency Department 
     Practice Management Association's members, we congratulate 
     you on your efforts in this area and strongly support this 
     legislation as it reflects sound health policy.
       EDPMA members work with their hospital partners to provide 
     quality patient care in the emergency departments across the 
     country. As you know, overcrowding in emergency departments 
     is a serious problem. By expanding Medicare's coverage of 
     preventative services, we believe that Medicare patients will 
     have incentives to get treatment in less acute settings.
       Emergency departments are a key element of the nation's 
     safety net. While we support expansion of Medicare benefits, 
     we believe it is of critical importance that Medicare's 
     physician fee schedule appropriately capture emergency 
     physician's uncompensated care costs. We look forward to 
     working with you to address this problem.
       Like you, EDPMA is dedicated to providing quality care to 
     Medicare's patients. We join you in support of this 
     legislation and appreciate your on-going leadership in health 
     policy.
           Sincerely,
                                                  Emily R. Wilson,
     Managing Director.
                                  ____

                                                   National Mental


                                           Health Association,

                                    Alexandria, VA, June 16, 2004.
     Hon. Bob Graham,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: On behalf of the National Mental 
     Health Association (NMHA), I am writing to commend you for 
     introducing the Medicare Preventive Services Coverage Act of 
     2004. Prevention and

[[Page 12718]]

     early detection of mental illness are critical components to 
     ensuring overall well-being that have long been overlooked, 
     particularly with regard to Medicare beneficiaries. Your bill 
     represents a major step forward in recognizing that mental 
     illness can be prevented and successfully treated, especially 
     if detected early. Prevention services provided through this 
     legislation will undoubtedly lead to improved access to and 
     utilization of mental health treatment among a population in 
     which mental illness has been severely under-diagnosed.
       NMHA is the nation's oldest and largest advocacy 
     organization addressing all aspects of mental health and 
     mental illness. With more than 340 affiliates nationwide, we 
     work to improve the mental health of all Americans through 
     advocacy, education, research, and service. Prevention of 
     mental illness is a key element of our mission, and we are 
     heartened by your efforts to ensure that Medicare 
     beneficiaries receive a full complement of preventive 
     services, including mental health services.
       As you know, mental illness affects a very large segment of 
     the Medicare population, but few receive the treatment they 
     need. According to the Surgeon General's 1999 Report on 
     Mental Health, some 20 percent of those 55 and older 
     experience specific mental disorders that are not part of 
     normal aging, including phobias, obsessive-compulsive 
     disorder, and depression, and 40 percent of those on Medicare 
     because of a disability, face mental illness. Major 
     depression is particularly prevalent among older Americans: 
     in primary care settings, 37 percent of seniors display 
     symptoms of depression.
       However, all too often seniors and people with disabilities 
     struggle with mental illness alone and without treatment and 
     support. It is estimated that only half of older adults who 
     acknowledge mental health problems actually are treated. A 
     very small percentage of older adults--less than 3 percent--
     report seeing mental health professionals for treatment. This 
     lack of care has tragic consequences as illustrated by the 
     fact that Americans 65 and older have the highest rate of 
     suicide in the country, accounting for 20 percent of suicide 
     deaths.
       The President's New Freedom Commission on Mental Health 
     found that ``[t]he number of older adults with mental 
     illnesses is expected to double to 15 million in the next 30 
     years [and that] [m]ental illnesses have a significant impact 
     on the health and functioning of older people and are 
     associated with increased health care use and higher costs.'' 
     New Freedom Commission on Mental Health, Achieving the 
     Promise: Transforming Mental Health Care in America. Final 
     Report, p. 59. The Commission recommended that ``[a]ny effort 
     to strengthen or improve the Medicare and Medicaid programs 
     should offer beneficiaries options to effectively use the 
     most up-to-date [mental health] treatments and services.'' 
     Id., p. 26.
       Early detection and intervention services are essential for 
     preventing mental health problems from compounding and for 
     lessening long-term disability that can result from mental 
     illness. The President's Commission stated that early 
     assessment and treatment are critical across the life span 
     and found that ``[n]ew understanding of the brain indicates 
     that early identification and intervention can sharply 
     improve outcomes and that longer periods of abnormal thoughts 
     and behavior have cumulative effects and can limit capacity 
     for recovery.'' Id., p. 57. Numerous studies have indicated 
     that prevention and early intervention services for seniors 
     result in improved mental health conditions, positive 
     behavioral changes, and decreased use of inpatient care.
       Thank you again for introducing the Medicare Preventive 
     Services Coverage Act of 2004. By incorporating preventive 
     mental health services into the Medicare program, this bill 
     will substantially improve access to treatment for a 
     population with tremendous mental health needs.
           Sincerely,
                                          Michael M. Faenza, MSSW,
     President and CEO.
                                  ____

     Hon. Bob Graham,
     U.S. Senate, Hart Office Building, Washington, DC.
       Dear Senator Graham: United Cerebral Palsy would like to 
     lend our wholehearted support to the Medicare Preventive 
     Services Coverage Act of 2004 that would amend the Social 
     Security Act and the Medicare Prescription Drug Improvement 
     and Modernization Act of 2003 to make a broad array of 
     preventive health care services a standard part of Medicare. 
     To date, the Congress has added selected preventive services 
     to Medicare but has not included other services that are 
     proven effective; nor has it encouraged Medicare to take a 
     comprehensive approach to disease prevention and health 
     promotion for American seniors and people with disabilities. 
     Passage of this legislation would mean that, for the first 
     time and to the benefit of millions of Americans, prevention 
     would be placed on a level playing field with disease 
     detection, diagnosis and treatment under Medicare.
       We thank you for recognizing that prevention is a good 
     investment, diminishing disability and discomfort, leading to 
     less time spent in hospitals and in nursing homes and more 
     time spent at home and in the community. In many cases, 
     effective preventive services will generate cost savings for 
     Medicare, as well as providing beneficiaries with more 
     productive years of life.
       About one in eight of Medicare's 40+ million beneficiaries, 
     about 5 million people, are people with disabilities under 
     age 65, people who have worked and become disabled, or who 
     are the adult dependents or survivors of eligible workers. 
     According to the National Economic Council, these 
     beneficiaries are 35 percent less likely to have any sort of 
     employer-based coverage, compared to elderly beneficiaries 
     who sometimes have coverage through retiree health plans. 
     Thus, access to any prevention benefits outside their 
     Medicare coverage is severely limited.
       For individuals with disabilities, prevention is truly no 
     less important than medical treatment. A primary disability 
     can often mean that a person is extremely at risk for, or 
     susceptible to, secondary health or disabling conditions. 
     Compounding this fact is the fact that many of these 
     secondary conditions may be low-incidence conditions that 
     affect only a small population and would, therefore, not 
     necessarily be those that come to the attention of Congress 
     when new coverage decisions are made.
       Additionally, as people with a wide range of disabilities 
     grow older, the impact of their disability may lead to 
     premature occurrence of age-related conditions. Clearly, the 
     Medicare Preventive Services Coverage Acts of 2004 would be 
     of great assistance to these beneficiaries by allowing 
     decisions about coverage of preventive services to be made in 
     the same manner as coverage decisions for other services, 
     making preventive service coverage decisions more timely, 
     individualized and evidence-based.
       We are also pleased that the bill would eliminate co-
     payments and deductibles from all future preventive benefits. 
     There is currently a confusing array of cost-sharing 
     requirements across Medicare's covered preventive benefits, 
     and Medicare beneficiaries with disabilities are more likely 
     to have lower incomes. By definition, people receiving 
     disability insurance often are unable to engage in full-time 
     work due to their conditions, and more than three-fourths of 
     these beneficiaries have income below 200 percent of the 
     poverty level, compared to half of elderly beneficiaries.
       United Cerebral Palsy wishes you the best and offers our 
     support in gaining passage of this critical legislation.
           Sincerely,

                                              Stephen Bennett,

                            President and Chief Executive Officer,
                                            United Cerebral Palsy.
                                 ______
                                 
      By Ms. COLLINS (for herself and Mr. Wyden):
  S. 2536. A bill to enumerate the responsibilities of the Officer for 
Civil Rights and Civil Liberties of the Department of Homeland 
Security, to require the Inspector General of the Department of 
Homeland Security to designate a senior official to investigate civil 
rights complaints, and for other purposes; to the Committee on 
Governmental Affairs.
  Mr. COLLINS. Mr. President, today Senator Wyden and I are introducing 
the Homeland Security Civil Rights and Civil Liberties Protection Act 
of 2004. It has been a pleasure to work with my colleague from Oregon 
on this legislation to strengthen protections for civil rights and 
civil liberties. In the wake of the terrorist attacks on September 11, 
2001, during his joint address to Congress, the President called on all 
Americans to ``uphold the values of America and remember why so many 
have come here. We're in a fight for our principles, and our first 
responsibility is to live by them.''
  In response to the need to safeguard our homeland, Congress enacted 
the Homeland Security Act of 2002 that created the Department of 
Homeland Security, the most significant government restructuring in 
more than 50 years. But in focusing our attention on protecting the 
homeland from future terrorist attacks, we also must ensure that we do 
not trample on the very values that the terrorists seek to destroy. In 
enacting the Homeland Security Act, Congress understood the importance 
of providing checks and balances to protect civil rights and civil 
liberties. To this end, Congress created within the Department three 
positions devoted wholly or in part to ensuring respect for civil 
liberties as the Department carries out its mandate to protect our 
homeland. These positions are the Officer for Civil Rights and Civil 
Liberties, the Privacy Officer, and the Department's Inspector General. 
These three officials have crucial roles in assessing actions of the 
Department that may affect personal privacy, civil rights, and civil 
liberties.

[[Page 12719]]

  The nature of the mission of the Department of Homeland Security 
makes safeguards especially important. The Department is now our 
country's biggest law enforcement agency. It has more Federal officers 
with arrest and firearm authority than the Department of Justice. In 
addition, DHS law enforcement personnel have contact with thousands of 
people every day. In this post 9/11 world, DHS law enforcement 
personnel must be especially sensitive to maintaining civil liberties 
as they work to strengthen security and detect and deter terrorist 
attacks.
  I am pleased that the leadership of the Department recognizes the 
fundamental importance of protecting the rights of all of us while 
fighting terrorism. Under the leadership of Secretary Ridge, the new 
Department of Homeland Security has won praise for its commitment to 
the protection of our freedoms. Secretary Ridge has provided the 
Officer for Civil Rights and Civil Liberties and the Privacy Officer 
with the tools they need to be effective. These officials have 
functioned at the senior level, regularly providing advice to the 
Secretary and his deputies. The Officer for Civil Rights and Civil 
Liberties, the Privacy Officer and the Inspector General have met 
regularly with organizations concerned about civil liberties, privacy, 
human rights, and immigrant rights and have been responsive to their 
concerns.
  It is time for Congress to build on the foundation Secretary Ridge 
has laid in protecting civil rights and civil liberties. I believe the 
Homeland Security Civil Rights and Civil Liberties Protection Act of 
2004 does exactly that.
  The bill would write into law the activities of the Officer for Civil 
Rights and Civil Liberties. As enacted, the Homeland Security Act did 
not clearly define the duties of that position. Over the past year, 
however, a strong Officer, with the support of the Department's 
leadership, has charted an important course for his office. The Officer 
has worked closely with the senior leadership of the Department. He has 
assisted in the development of departmental policies to ensure that 
civil liberties are given due consideration. He has overseen compliance 
with constitutional and other requirements relating to the rights and 
liberties of individuals affected by the Department's programs. He has 
coordinated with the Privacy Officer to ensure that overlapping privacy 
and civil rights concerns are addressed in a comprehensive way. And he 
has investigated alleged abuses of civil rights and civil liberties.
  None of these activities is expressly addressed in the statutory 
language creating the Department, and there is no assurance in the law 
that future Officers for Civil Rights and Civil Liberties will work so 
energetically to carry out these vital duties. It is time for the law 
to catch up with practice, and the Homeland Security Civil Rights and 
Civil Liberties Protection Act ensures that goal.
  The bill also clarifies that the Officer for Civil Rights and Civil 
Liberties as well as the Privacy Officer should report directly to the 
Secretary, and requires coordination between those officers to ensure 
an integrated and comprehensive approach to the important issues they 
address.
  The Homeland Security Civil Rights and Civil Liberties Protection Act 
of 2004 strengthens the ability of the Department's Inspector General 
to safeguard civil rights and civil liberties by requiring the DHS 
Inspector General to designate a senior official to coordinate 
investigation of abuses, ensure public awareness of complaint 
procedures, and coordinate his or her work with the Officer for Civil 
Rights and Civil Liberties. This position is similar to one Congress 
created in the Office of the Inspector General of the Department of 
Justice.
  Finally, the Homeland Security Civil Rights and Civil Liberties 
Protection Act of 2004 amends the mission statement of the Department 
of Homeland Security to ensure that actions taken by the Department to 
protect the homeland do not diminish civil liberties and civil rights. 
This important revision places into the statutory language that the 
protection of civil rights and civil liberties is crucial in this time 
of heightened security.
  The battle against terror will last for many years, perhaps decades. 
During that long struggle, we must continue to secure our nation 
against future attacks, but at the same time protect those American 
values that define our free society. The Homeland Security Civil Rights 
and Civil Liberties Protection Act of 2004 will strengthen the 
protection of civil rights and civil liberties and will help to ensure 
that that protection will continue in the years to come.
  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. 2536

       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 ``Homeland Security Civil 
     Rights and Civil Liberties Protection Act of 2004''.

     SEC. 2. MISSION OF DEPARTMENT OF HOMELAND SECURITY.

       Section 101(b)(1) of the Homeland Security Act of 2002 (6 
     U.S.C. 111(b)(1)) is amended--
       (1) in subparagraph (F), by striking ``and'' after the 
     semicolon;
       (2) by redesignating subparagraph (G) as subparagraph (H); 
     and
       (3) by inserting after subparagraph (F) the following:
       ``(G) ensure that the civil rights and civil liberties of 
     persons are not diminished by efforts, activities, and 
     programs aimed at securing the homeland; and''.

     SEC. 3. OFFICER FOR CIVIL RIGHTS AND CIVIL LIBERTIES.

       Section 705(a) of the Homeland Security Act of 2002 (6 
     U.S.C. 345(a)) is amended--
       (1) in the matter preceding paragraph (1), by inserting 
     ``report directly to the Secretary and shall'' after ``who 
     shall'';
       (2) in paragraph (1), by striking ``and'' at the end;
       (3) in paragraph (2), by striking the period at the end and 
     inserting a semicolon; and
       (4) by adding at the end the following:
       ``(3) assist the Secretary, directorates, and offices of 
     the Department to develop, implement, and periodically review 
     Department policies and procedures to ensure that the 
     protection of civil rights and civil liberties is 
     appropriately incorporated into Department programs and 
     activities;
       ``(4) oversee compliance with constitutional, statutory, 
     regulatory, policy, and other requirements relating to the 
     civil rights and civil liberties of individuals affected by 
     the programs and activities of the Department;
       ``(5) coordinate with the Privacy Officer to ensure that--
       ``(A) programs, policies, and procedures involving civil 
     rights, civil liberties, and privacy considerations are 
     addressed in an integrated and comprehensive manner; and
       ``(B) Congress receives appropriate reports regarding such 
     programs, policies, and procedures; and
       ``(6) investigate complaints and information indicating 
     possible abuses of civil rights or civil liberties, unless 
     the Inspector General of the Department determines that any 
     such complaint or information should be investigated by the 
     Inspector General.''.

     SEC. 4. PROTECTION OF CIVIL RIGHTS AND CIVIL LIBERTIES BY 
                   OFFICE OF INSPECTOR GENERAL.

       Section 8I of the Inspector General Act of 1978 (5 U.S.C. 
     App.) is amended by adding at the end the following:
       ``(f)(1) The Inspector General of the Department of 
     Homeland Security shall designate a senior official within 
     the Office of Inspector General, who shall be a career member 
     of the civil service at the equivalent to the GS-15 level or 
     a career member of the Senior Executive Service, to perform 
     the functions described in paragraph (2).
       ``(2) The senior official designated under paragraph (1) 
     shall--
       ``(A) coordinate the activities of the Office of Inspector 
     General with respect to investigations of abuses of civil 
     rights or civil liberties;
       ``(B) receive and review complaints and information from 
     any source alleging abuses of civil rights and civil 
     liberties by employees or officials of the Department and 
     employees or officials of independent contractors or grantees 
     of the Department;
       ``(C) initiate investigations of alleged abuses of civil 
     rights or civil liberties by employees or officials of the 
     Department and employees or officials of independent 
     contractors or grantees of the Department;
       ``(D) ensure that personnel within the Office of Inspector 
     General receive sufficient training to conduct effective 
     civil rights and civil liberties investigations;
       ``(E) consult with the Officer for Civil Rights and Civil 
     Liberties regarding--
       ``(i) alleged abuses of civil rights or civil liberties; 
     and
       ``(ii) any policy recommendations regarding civil rights 
     and civil liberties that may be founded upon an investigation 
     by the Office of Inspector General;

[[Page 12720]]

       ``(F) provide the Officer for Civil Rights and Civil 
     Liberties with information regarding the outcome of 
     investigations of alleged abuses of civil rights and civil 
     liberties;
       ``(G) refer civil rights and civil liberties matters that 
     the Inspector General decides not to investigate to the 
     Officer for Civil Rights and Civil Liberties;
       ``(H) ensure that the Office of the Inspector General 
     publicizes and provides convenient public access to 
     information regarding--
       ``(i) the procedure to file complaints or comments 
     concerning civil rights and civil liberties matters; and
       ``(ii) the status of investigations initiated in response 
     to public complaints; and
       ``(I) inform the Officer for Civil Rights and Civil 
     Liberties of any weaknesses, problems, and deficiencies 
     within the Department relating to civil rights or civil 
     liberties.''.

     SEC. 5. PRIVACY OFFICER.

       Section 222 of the Homeland Security Act of 2002 (6 U.S.C. 
     142) is amended--
       (1) in the matter preceding paragraph (1), by inserting ``, 
     who shall report directly to the Secretary,'' after ``in the 
     Department'';
       (2) in paragraph (4), by striking ``and'' at the end;
       (3) by redesignating paragraph (5) as paragraph (6); and
       (4) by inserting after paragraph (4) the following:
       ``(5) coordinating with the Officer for Civil Rights and 
     Civil Liberties to ensure that--
       ``(A) programs, policies, and procedures involving civil 
     rights, civil liberties, and privacy considerations are 
     addressed in an integrated and comprehensive manner; and
       ``(B) Congress receives appropriate reports on such 
     programs, policies, and procedures; and''.

  Mr. WYDEN. Mr. President, the threat of terrorism is an unfortunate 
fact of life today, and it is not going to go away any time soon. 
Protecting American citizens against this threat will continue to be an 
essential and urgent task for the foreseeable future.
  However, I do not believe that fighting terrorism aggressively 
requires tossing civil liberties protections into the scrap heap. This 
is not an ``either or'' choice. This country's tradition of high 
standards of civil rights and civil liberties should not and need not 
become the first casualty of the war on terrorism.
  I have made this point repeatedly in the time since the terrorist 
attacks of 9/11. Still, all too often, we have seen well-meaning 
government agencies take the approach of designing a security system or 
program first, and worrying about the civil liberties and privacy 
implications later.
  I am convinced that the approach of making civil liberties an 
afterthought doesn't work and isn't acceptable. Civil liberties and 
privacy considerations need to be built into the DNA of the Homeland 
Security Department and its various programs.
  The legislation that created the Homeland Security Department 
included some very positive steps in that regard, by creating an 
Officer for Civil Rights and Civil Liberties and a Privacy Officer.
  Today, I am joining Senator Collins in introducing new legislation to 
flesh out the role and stature of these key offices within the 
Department.
  Specifically, the legislation would add a reference to civil 
liberties to the statutory mission statement of the Department of 
Homeland Security. It would provide further detail as to the duties of 
the Officer for Civil Rights and Civil Liberties. It would specify that 
both the Officer for Civil Rights and Civil Liberties and the Privacy 
Officer shall report directly to the Secretary. And it would direct the 
DHS Inspector General to designate a point person within the I.G. 
office to focus expressly on civil liberties matters.
  None of these items represents a radical departure from the original 
Homeland Security legislation or the current practice of the 
department. Rather, this new bill codifies much of what is already 
going on, giving it a firm statutory basis.
  I hope my colleagues will join Senator Collins and me in supporting 
this legislation, and in delivering a strong message that civil 
liberties matters remain a core factor in this country's homeland 
security efforts. I ask unanimous consent that the text of the bill be 
printed in the Record.
                                 ______
                                 
      By Mr. LIEBERMAN (for himself and Mr. Dodd):
  S. 2538. A bill to provide a grant program to support the 
establishment and operation of Teachers Institutes; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. LIEBERMAN. Mr. President, today I am introducing legislation, 
along with my colleague from Connecticut, Mr. Dodd, that will 
strengthen the content and pedagogy knowledge of our present K-12 
teacher workforce and thus ultimately raise student achievement.
  My proposal would establish eight new Teacher Professional 
Development Institutes throughout the Nation each year over the next 
five years based on the model which has been operating at Yale 
University for over 25 years. Every Teacher Institute would consist of 
a partnership between an institution of higher education and the local 
public school system in which a significant proportion of the students 
come from low-income households. These Institutes will strengthen the 
present teacher workforce by giving each participant an opportunity to 
gain more sophisticated content knowledge and a chance to develop 
curriculum units with other colleagues that can be directly applied in 
their classrooms. We know that teachers gain confidence and enthusiasm 
when they have a deeper understanding of the subject matter that they 
teach and this translates into higher expectations for their students 
and thus, an increase in student achievement.
  The Teacher Professional Development Institutes are based on the 
Yale-New Haven Teachers Institute model that has been in existence 
since 1978. For over 25 years, the Institute has offered six or seven 
thirteen-session seminars each year, led by Yale faculty, on topics 
that teachers have selected to enhance their mastery of the specific 
subject area that they teach. The subject selection process begins with 
representatives from the Institutes soliciting ideas from teachers 
throughout the school district for topics on which teachers feel they 
need to have additional preparation, topics that will assist them in 
preparing materials they need for their students, or topics that will 
assist them in addressing the standards that the school district 
requires. As a consensus emerges about desired seminar subjects, the 
Institute director identifies university faculty members with the 
appropriate expertise, interest and desire to lead the seminar. 
University faculty members, especially those who have led Institute 
seminars before, may sometimes suggest seminars they would like to 
lead, and these ideas are circulated by the representatives as well. 
The final decisions on which seminar topics are offered are ultimately 
made by the teachers who participate. In this way, the offerings are 
designed to respond to what teachers believe is needed and useful for 
both themselves and their students.
  The cooperative nature of the Institute seminar planning process 
ensures its success: Institutes offer seminars and relevant materials 
on topics teachers have identified and feel are needed for their own 
preparation as well as what they know will motivate and engage their 
students. Teachers enthusiastically take part in rigorous seminars they 
have requested, and as part of the program, practice using the 
materials they have obtained and developed. This helps ensure that the 
experience not only increases their preparation in the subjects they 
are assigned to teach, but also their participation in an Institute 
seminar gives them immediate hands-on active learning materials that 
can be used in the classroom. In short, by allowing teachers to 
determine the seminar subjects and providing them the resources to 
develop relevant curricula for their classroom and their students, the 
Institutes empower teachers. Teachers know their students best and they 
know what should be done to improve schools and increase student 
learning. The Teacher Professional Development Institutes promote this 
philosophy.
  From 1999-2002, the Yale-New Haven Teachers Institute launched a 
National Demonstration Project to create comparable Institutes at four 
diverse sites with large concentrations of disadvantaged students. 
These demonstration projects are located in Pittsburgh, PA, Houston, 
TX, Albuquerque, NM, and Santa Ana, CA.

[[Page 12721]]

  Follow-up evaluations have earned very positive results from the 
teacher participants in the Yale-New Haven Institute, as well as the 
four demonstration sites. The data strongly support the conclusion that 
virtually all teachers felt substantially strengthened in their mastery 
of content knowledge and they also developed increased expectations for 
what their students could achieve. In addition, because of their 
involvement in the course selection and curriculum development process, 
teacher participants have found these seminars to be especially 
relevant and useful in their classroom practices. Ninety-five percent 
of all participating teachers reported that the seminars were useful. 
These Institutes have also served to foster teacher leadership, to 
develop supportive teacher networks, to heighten university faculty 
commitments to improving K-12 public education, and to foster more 
positive partnerships between school districts and institutions of 
higher education.
  By some studies, teacher quality is the single most important school-
related factor in determining student achievement. In support of this, 
the No Child Left Behind Act requires a ``highly qualified'' teacher to 
be in every classroom by the end of 2005-2006. Effective teacher 
professional development programs that focus on subject and pedagogy 
knowledge are a proven method for enhancing the success of a teacher in 
the classroom and in helping them meet the highly qualified criteria.
  Though a K-12 teacher shortage is forecast in the near-term and many 
new teachers will be entering our schools, those teachers who are 
presently on the job will do the majority of teaching in the classrooms 
in the very near future. For this reason, it is imperative to invest in 
methods to strengthen our present teaching workforce. Like many 
professions, the quality of our teachers could diminish if their 
professional development is neglected. Research has shown that positive 
educational achievements occur when coursework in a teachers' specific 
content area is combined with pedagogy techniques. This is what the 
Teacher Professional Development Institutes Act strives to accomplish.
  The Yale-New Haven Institutes have already proven to be a successful 
model for teacher professional development as demonstrated by the high 
caliper curriculum unit plans that teacher participants have developed 
and placed on the web and by the evaluations that support the 
conclusion that virtually all the teacher participants felt 
substantially strengthened in their mastery of content knowledge and 
their teaching skills. My proposal would open this opportunity to many 
more urban teachers throughout the nation.
  I urge my colleagues to act favorably on this measure. 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. 2538

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

     SECTION 1. TEACHER PROFESSIONAL DEVELOPMENT INSTITUTES.

       Title II of the Higher Education Act of 1965 (20 U.S.C. 
     1021 et seq.) is amended by adding at the end the following:

         ``PART C--TEACHER PROFESSIONAL DEVELOPMENT INSTITUTES

     ``SEC. 241. SHORT TITLE.

       ``This part may be cited as the `Teacher Professional 
     Development Institutes Act'.

     ``SEC. 242. FINDINGS AND PURPOSE.

       ``(a) Findings.--Congress makes the following findings:
       ``(1) The ongoing professional development of teachers in 
     the subjects the teachers teach is essential for improved 
     student learning.
       ``(2) Attaining the goal of the No Child Left Behind Act of 
     2001, of having a teacher who is highly qualified in every 
     core subject classroom, will require innovative and effective 
     approaches to improving the quality of teaching.
       ``(3) The Teachers Institute Model is an innovative 
     approach that encourages a collaboration between urban school 
     teachers and university faculty. The Teachers Institute Model 
     focuses on the continuing academic preparation of school 
     teachers and the application of what the teachers study to 
     their classrooms and potentially to the classrooms of other 
     teachers.
       ``(4) The Teachers Institute Model has also been 
     successfully demonstrated over a 3-year period in a National 
     Demonstration Project (hereafter in this part referred to as 
     the `National Demonstration Project') in several cities.
       ``(b) Purpose.--The purpose of this part is to provide 
     Federal assistance to support the establishment and operation 
     of Teachers Institutes for local educational agencies that 
     serve significant low-income populations in States throughout 
     the Nation--
       ``(1) to improve student learning; and
       ``(2) to enhance the quality of teaching by strengthening 
     the subject matter mastery of current teachers through 
     continuing teacher preparation.

     ``SEC. 243. DEFINITIONS.

       ``In this part:
       ``(1) Poverty line.--The term `poverty line' means the 
     poverty line (as defined by the Office of Management and 
     Budget, and revised annually in accordance with section 
     673(2) of the Community Services Block Grant Act) applicable 
     to a family of the size involved.
       ``(2) Significant low-income population.--The term 
     `significant low-income population' means a student 
     population of which not less than 25 percent are from 
     families with incomes below the poverty line.
       ``(3) State.--The term `State' means each of the several 
     States of the United States, the District of Columbia, and 
     the Commonwealth of Puerto Rico.
       ``(4) Teachers institute.--The term `Teachers Institute' 
     means a partnership or joint venture between or among 1 or 
     more institutions of higher education, and 1 or more local 
     educational agencies serving a significant low-income 
     population, which partnership or joint venture--
       ``(A) is entered into for the purpose of improving the 
     quality of teaching and learning through collaborative 
     seminars designed to enhance both the subject matter and the 
     pedagogical resources of the seminar participants; and
       ``(B) works in collaboration to determine the direction and 
     content of the collaborative seminars.

     ``SEC. 244. GRANT AUTHORITY.

       ``(a) In General.--The Secretary is authorized--
       ``(1) to award grants to Teachers Institutes to encourage 
     the establishment and operation of Teachers Institutes; and
       ``(2) to provide technical assistance, either directly or 
     through existing Teachers Institutes, to assist local 
     educational agencies and institutions of higher education in 
     preparing to establish and in operating Teachers Institutes.
       ``(b) Selection Criteria.--In selecting a Teachers 
     Institute for a grant under this part, the Secretary shall 
     consider--
       ``(1) the extent to which the proposed Teachers Institute 
     will serve a community with a significant low-income 
     population;
       ``(2) the extent to which the proposed Teachers Institute 
     will follow the Understandings and Necessary Procedures that 
     have been developed following the National Demonstration 
     Project;
       ``(3) the extent to which the local educational agency 
     participating in the proposed Teachers Institute has a high 
     percentage of teachers who are unprepared or under prepared 
     to teach the core academic subjects the teachers are assigned 
     to teach; and
       ``(4) the extent to which the proposed Teachers Institute 
     will receive a level of support from the community and other 
     sources that will ensure the requisite long-term commitment 
     for the success of a Teachers Institute.
       ``(c) Consultation.--
       ``(1) In general.--In evaluating applications under 
     subsection (b), the Secretary may request the advice and 
     assistance of existing Teachers Institutes.
       ``(2) State agencies.--If the Secretary receives 2 or more 
     applications for new Teachers Institutes that propose serving 
     the same State, the Secretary shall consult with the State 
     educational agency regarding the applications.
       ``(d) Fiscal agent.--For the purpose of this part, an 
     institution of higher education participating in a Teachers 
     Institute shall serve as the fiscal agent for the receipt of 
     grant funds under this part.
       ``(e) Limitations.--A grant under this part--
       ``(1) shall be awarded for a period not to exceed 5 years; 
     and
       ``(2) shall not exceed 50 percent of the total costs of the 
     eligible activities, as determined by the Secretary.

     ``SEC. 245. ELIGIBLE ACTIVITIES.

       ``(a) In General.--Grant funds awarded under this part may 
     be used--
       ``(1) for the planning and development of applications for 
     the establishment of Teachers Institutes;
       ``(2) to provide assistance to the Teachers Institutes 
     established during the National Demonstration Project to 
     enable the Teachers Institutes--
       ``(A) to develop further the Teachers Institutes; or
       ``(B) to support the planning and development of 
     applications for new Teachers Institutes;
       ``(3) for the salary and necessary expenses of a full-time 
     director to plan and manage

[[Page 12722]]

     the Teachers Institute and to act as liaison between the 
     local educational agency and the institution of higher 
     education participating in the Teachers Institute;
       ``(4) to provide suitable office space, staff, equipment, 
     and supplies, and to pay other operating expenses, for the 
     Teachers Institute;
       ``(5) to provide a stipend for teachers participating in 
     collaborative seminars in the sciences and humanities, and to 
     provide remuneration for those members of the faculty of the 
     institution of higher education participating in the Teachers 
     Institute who lead the seminars; and
       ``(6) to provide for the dissemination through print and 
     electronic means of curriculum units prepared in the seminars 
     conducted by the Teachers Institute.
       ``(b) Technical Assistance.--The Secretary may use not more 
     than 50 percent of the funds appropriated to carry out this 
     part to provide technical assistance to facilitate the 
     establishment and operation of Teachers Institutes. For the 
     purpose of this subsection, the Secretary may contract with 
     existing Teachers Institutes to provide all or a part of the 
     technical assistance under this subsection.

     ``SEC. 246. APPLICATION, APPROVAL, AND AGREEMENT.

       ``(a) In General.--To receive a grant under this part, a 
     Teachers Institute shall submit an application to the 
     Secretary that--
       ``(1) meets the requirement of this part and any 
     regulations under this part;
       ``(2) includes a description of how the Teachers Institute 
     intends to use funds provided under the grant;
       ``(3) includes such information as the Secretary may 
     require to apply the criteria described in section 244(b);
       ``(4) includes measurable objectives for the use of the 
     funds provided under the grant; and
       ``(5) contains such other information and assurances as the 
     Secretary may require.
       ``(b) Approval.--The Secretary shall--
       ``(1) promptly evaluate an application received for a grant 
     under this part; and
       ``(2) notify the applicant within 90 days of the receipt of 
     a completed application of the Secretary's approval or 
     disapproval of the application.
       ``(c) Agreement.--Upon approval of an application, the 
     Secretary and the Teachers Institute shall enter into a 
     comprehensive agreement covering the entire period of the 
     grant.

     ``SEC. 247. REPORTS AND EVALUATIONS.

       ``(a) Report.--Each Teachers Institute receiving a grant 
     under this part shall report annually on the progress of the 
     Teachers Institute in achieving the purpose of this part and 
     the purposes of the grant.
       ``(b) Evaluation and Dissemination.--
       ``(1) Evaluation.--The Secretary shall evaluate the 
     activities funded under this part and submit an annual report 
     regarding the activities to the Committee on Health, 
     Education, Labor, and Pensions of the Senate and the 
     Committee on Education and the Workforce of the House of 
     Representatives.
       ``(2) Dissemination.--The Secretary shall broadly 
     disseminate successful practices developed by Teachers 
     Institutes.
       ``(c) Revocation.--If the Secretary determines that a 
     Teachers Institute is not making substantial progress in 
     achieving the purpose of this part and the purposes of the 
     grant by the end of the second year of the grant under this 
     part, the Secretary may take appropriate action, including 
     revocation of further payments under the grant, to ensure 
     that the funds available under this part are used in the most 
     effective manner.

     ``SEC. 248. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated to carry out this 
     part--
       ``(1) $4,000,000 for fiscal year 2005;
       ``(2) $5,000,000 for fiscal year 2006;
       ``(3) $6,000,000 for fiscal year 2007;
       ``(4) $7,000,000 for fiscal year 2008; and
       ``(5) $8,000,000 for fiscal year 2009.''.
                                 ______
                                 
      By Mr. CAMPBELL (for himself, Mr. Inouye, Mr. Domenici, and Mr. 
        Smith):
  S. 2539. A bill to amend the Tribally Controlled Colleges or 
University Assistance Act and the Higher Education Act to improve 
Tribal Colleges and Universities, and for other purposes; to the 
Committee on Indian Affairs.
  Mr. CAMPBELL. Mr. President, today I am pleased to introduce 
legislation to update and improve the Tribally Controlled Colleges or 
University Assistance Act and amend the Indian sections of the Higher 
Education Act.
  Indian tribal colleges were first created about 30 years ago in 
response to the higher education needs of Native populations living in 
remote and isolated areas of the country where access to higher 
education is extremely difficult.
  There are 33 tribally- or Federally-chartered Indian colleges in the 
Nation and they do a superb job despite the many obstacles they face.
  In recent years the cost of higher education has far exceeded the 
rate of inflation. Tribal colleges face other problems as well: a 
growing population and growing demand for services; increased demand 
for additional facilities; geographical isolation; and difficulty 
attracting quality professors to teach.
  Tribal colleges not only provide a quality higher education but also 
enhance the cultural knowledge, knowledge depositories, college 
preparatory work, and other important educational needs of Indian 
communities.
  Tribal colleges also enhance the economies of tribes. The national 
unemployment rate in the U.S. today is about 5.6 percent, while the 
rate for Native Americans is many times that and in some parts of 
Indian country hovers above 50 percent.
  Tribal colleges serve as centers for business incubation and small 
business development in order to encourage private business development 
and job creation.
  Tribal colleges are also being called on to help Indian communities 
in the often-difficult transition from welfare to work. These 
institutions also provide education and training to people ready to 
join the workforce.
  To continue the vital work of these colleges, the bill I am 
introducing will provide additional resources and means to develop 
facilities, increase quality faculty and improve the overall education 
of Indian people within their reservations.
  I urge my colleagues to join me in supporting this important 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. 2539

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

               TITLE I--TRIBAL COLLEGES AND UNIVERSITIES

     SEC. 101. TRIBALLY CONTROLLED COLLEGE OR UNIVERSITY ACT OF 
                   1978.

       (a) Formula.--Section 108(a)(2) of the Tribally Controlled 
     College or University Assistance Act of 1978 (25 U.S.C. 1808) 
     is amended by striking ``$6,000'' and inserting ``$8,000''.
       (b) Title I Reauthorization.--Section 110(a) of the 
     Tribally Controlled College or University Assistance Act of 
     1978 (25 U.S.C. 1810(a)) is amended--
       (1) in paragraphs (1), (2), (3), and (4), by striking 
     ``1999'' and inserting ``2004'';
       (2) in paragraphs (1), (2), and (3), by striking ``4 
     succeeding'' and inserting ``5 succeeding'';
       (3) in paragraph (2), by striking ``$40,000,000'' and 
     inserting ``$55,000,000'';
       (4) in paragraph (3), by striking ``$10,000,000'' and 
     inserting ``$20,000,000''; and
       (5) in paragraph (4), by striking ``succeeding 4'' and 
     inserting ``5 succeeding''.
       (c) Title III Reauthorization.--Section 306(a) of the 
     Tribally Controlled College or University Assistance Act of 
     1978 (25 U.S.C. 1836(a)) is amended--
       (1) by striking ``1999'' and inserting ``2004''; and
       (2) by striking ``4 succeeding'' and inserting ``5 
     succeeding''.
       (d) Title IV Reauthorization.--Section 403 of the Tribal 
     Economic Development and Technology Related Education 
     Assistance Act of 1990 (25 U.S.C. 1852) is amended--
       (1) by striking ``$2,000,000 for fiscal year 1999'' and 
     inserting ``$5,000,000 for fiscal year 2004''; and
       (2) by striking ``4 succeeding'' and inserting ``5 
     succeeding''.
       (e) Clarification of the Definition of National Indian 
     Organization.--Section 2(a)(6) of the Tribally Controlled 
     College or University Assistance Act of 1978 (25 U.S.C. 
     1801(a)(6)) is amended by striking ``in the field of Indian 
     education'' and inserting ``in the field of Tribal Colleges 
     and Universities and Indian higher education''.
       (f) Indian Student Count.--Section 2(a) of the Tribally 
     Controlled College or University Assistance Act (25 U.S.C. 
     1801(a)) is amended--
       (1) by redesignating paragraphs (7) and (8) as paragraphs 
     (8) and (9), respectively; and
       (2) by inserting after paragraph (6) the following:
       ``(7) `Indian student' means a person who is--
       ``(A) a member of an Indian tribe; or
       ``(B) a biological child of a member of an Indian tribe, 
     living or deceased;''.
       (g) Continuing Education.--Section 2(b) of the Tribally 
     Controlled College or University Assistance Act (25 U.S.C. 
     1801(b)) is amended by striking paragraph (5) and inserting 
     the following:
       ``(5) Determination of credits.--Eligible credits earned in 
     a continuing education program--
       ``(A) shall be determined as 1 credit for every 10 contact 
     hours in the case of an institution on a quarter system, or 
     15 contact

[[Page 12723]]

     hours in the case of an institution on a semester system, of 
     participation in an organized continuing education experience 
     under responsible sponsorship, capable direction, and 
     qualified instruction, as described in the criteria 
     established by the International Association for Continuing 
     Education and Training; and
       ``(B) shall be limited to 10 percent of the Indian student 
     count of a tribally controlled college or university.''.
       (h) Accreditation Requirement.--Section 103 of the Tribally 
     Controlled College or University Assistance Act (25 U.S.C. 
     1804) is amended--
       (1) in paragraph (2), by striking ``and'' at the end;
       (2) in paragraph (3), by striking the period at the end and 
     inserting ``; and''; and
       (3) by inserting after paragraph (3), the following:
       ``(4)(A) is accredited by a nationally recognized 
     accrediting agency or association determined by the Secretary 
     of Education to be a reliable authority with regard to the 
     quality of training offered; or
       ``(B) is, according to such an agency or association, 
     making reasonable progress toward accreditation.''.
       (i) Technical Assistance Contract Awards.--Section 105 of 
     the Tribally Controlled College or University Assistance Act 
     (25 U.S.C. 1805) is amended in the second sentence by 
     striking ``In the awarding of contracts for technical 
     assistance, preference shall be given'' and inserting ``The 
     Secretary shall direct that contracts for technical 
     assistance be awarded''.

     SEC. 102. TITLE III GRANTS FOR AMERICAN INDIAN TRIBALLY 
                   CONTROLLED COLLEGES AND UNIVERSITIES.

       (a) Definition of Tribal College or University.--Section 
     316(b) of the Higher Education Act of 1965 (20 U.S.C. 
     1059c(b)) is amended by striking paragraph (3) and inserting 
     the following:
       ``(3) Tribal college or university.--
       ``(A) In general.--The term `Tribal College or University' 
     means an institution that meets the definition of tribally 
     controlled college or university in section 2 of the Tribally 
     Controlled College or University Assistance Act of 1978 (25 
     U.S.C. 1801).
       ``(B) Inclusions.--The term `Tribal College or University' 
     includes Bay Mills Community College; Blackfeet Community 
     College; Cankdeska Cikana Community College; Chief Dull Knife 
     College; College of Menominee Nation; Crownpoint Institute of 
     Technology; Dine College; D-Q University; Fond Du Lac Tribal 
     and Community College; Fort Belknap College; Fort Berthold 
     Community College; Fort Peck Community College; Haskell 
     Indian Nations University; Institute of American Indian and 
     Alaska Native Culture and Arts Development; Lac Courte 
     Oreilles Ojibwa Community College; Leech Lake Tribal College; 
     Little Big Horn College; Little Priest Tribal College; 
     Nebraska Indian Community College; Northwest Indian College; 
     Oglala Lakota College; Saginaw Chippewa Tribal College; 
     Salish Kootenai College; Si Tanka University-Eagle Butte 
     Campus; Sinte Gleska University; Sisseton Wahpeton Community 
     College; Sitting Bull College; Southwestern Indian 
     Polytechnic Institute; Stone Child College; Tohono O'odham 
     Community College; Turtle Mountain Community College; United 
     Tribes Technical College; and White Earth Tribal and 
     Community College.''.
       (b) Distance Learning.--Section 316(c)(2) of the Higher 
     Education Act of 1965 (20 U.S.C. 1059c(c)(2)) is amended--
       (1) in subparagraph (B), by inserting before the semicolon 
     at the end the following: ``and the acquisition of real 
     property adjacent to the campus of the institution on which 
     to construct such facilities'';
       (2) in subparagraph (K), by striking ``and'' at the end;
       (3) by redesignating subparagraph (L) as subparagraph (M); 
     and
       (4) by inserting after subparagraph (K) the following:
       ``(L) developing or improving facilities for Internet use 
     or other distance learning academic instruction capabilities; 
     and''.
       (c) Application, Plan, and Allocation.--Section 316 of the 
     Higher Education Act of 1965 (20 U.S.C. 1059c) is amended by 
     striking subsection (d) and inserting the following:
       ``(d) Application, Plan, and Allocation.--
       ``(1) Institutional eligibility.--To be eligible to receive 
     assistance under this section, a Tribal College or University 
     shall be an eligible institution under section 312(b).
       ``(2) Application.--
       ``(A) In general.--A Tribal College or University desiring 
     to receive assistance under this section shall submit an 
     application to the Secretary at such time, and in such 
     manner, as the Secretary may reasonably require.
       ``(B) Streamlined process.--The Secretary shall establish 
     application requirements in such a manner as to simplify and 
     streamline the process for applying for grants.
       ``(3) Allocations to institutions.--
       ``(A) Construction grants.--
       ``(i) In general.--Of the amount appropriated to carry out 
     this section for any fiscal year, the Secretary shall reserve 
     30 percent for the purpose of awarding 1-year grants of not 
     less than $1,000,000 to address construction, maintenance, 
     and renovation needs at eligible institutions.
       ``(ii) Preference.--In providing grants under clause (i), 
     the Secretary shall give preference to eligible institutions 
     that have not yet received an award under this section.
       ``(B) Allotment of remaining funds.--
       ``(i) In general.--Except as provided in clause (ii), the 
     Secretary shall distribute the remaining funds appropriated 
     for any fiscal year to each eligible institution as follows:

       ``(I) 60 percent of the remaining appropriated funds shall 
     be distributed among the eligible Tribal Colleges and 
     Universities pro rata basis, based on the respective Indian 
     student counts (as defined in section 2(a) of the Tribally 
     Controlled College or University Assistance Act of 1978 (25 
     U.S.C. 1801(a)) of the Tribal Colleges and Universities; and
       ``(II) the remaining 40 percent shall be distributed in 
     equal shares to eligible Tribal Colleges and Universities.

       ``(ii) Minimum grant.--The amount distributed to a Tribal 
     College or University under clause (i) shall not be less than 
     $500,000.
       ``(4) Special rules.--
       ``(A) Concurrent funding.--For the purposes of this part, 
     no Tribal College or University that is eligible for and 
     receives funds under this section shall concurrently receive 
     funds under other provisions of this part or part B.
       ``(B) Exemption.--Section 313(d) shall not apply to 
     institutions that are eligible to receive funds under this 
     section.''.

     SEC. 103. LOAN REPAYMENT OR CANCELLATION FOR INDIVIDUALS WHO 
                   TEACH IN TRIBAL COLLEGES OR UNIVERSITIES.

       (a) Perkins Loans.--
       (1) Amendment.--Section 465(a) of the Higher Education Act 
     of 1965 (20 U.S.C. 1087ee(a)) is amended--
       (A) in paragraph (2)--
       (i) in subparagraph (H), by striking ``or'' at the end;
       (ii) in subparagraph (I), by striking the period at the end 
     and inserting ``; or''; and
       (iii) by adding at the end the following:
       ``(J) as a full-time teacher at a Tribal College or 
     University (as defined in section 316(b)).''; and
       (B) in paragraph (3)(A)(i), by striking ``or (I)'' and 
     inserting ``(I), or (J)''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall be effective for service performed during academic year 
     1998-1999 and succeeding academic years, notwithstanding any 
     contrary provision of the promissory note under which a loan 
     under part E of title IV of the Higher Education Act of 1965 
     (20 U.S.C. 1087aa et seq.) was made.
       (b) FFEL and Direct Loans.--Part G of title IV of the 
     Higher Education Act of 1965 (20 U.S.C. 1088 et seq.) is 
     amended by adding at the end the following:

     ``SEC. 493. LOAN REPAYMENT OR CANCELLATION FOR INDIVIDUALS 
                   WHO TEACH IN TRIBAL COLLEGES OR UNIVERSITIES.

       ``(a) Definition of Year.--In this section, the term 
     `year', as applied to employment as a teacher, means an 
     academic year (as defined by the Secretary).
       ``(b) Program.--The Secretary shall carry out a program, 
     through the holder of a loan, of assuming or canceling the 
     obligation to repay a qualified loan amount, in accordance 
     with subsection (c), for any new borrower on or after the 
     date of enactment of this section, who--
       ``(1) has been employed as a full-time teacher at a Tribal 
     College or University (as defined in section 316(b)); and
       ``(2) is not in default on a loan for which the borrower 
     seeks repayment or cancellation.
       ``(c) Qualified Loan Amounts.--
       ``(1) Percentages.--Subject to paragraph (2), the Secretary 
     shall assume or cancel the obligation to repay under this 
     section--
       ``(A) 15 percent of the amount of all loans made, insured, 
     or guaranteed after the date of enactment of this section to 
     a student under part B or D, for the first or second year of 
     employment described in subsection (b)(1);
       ``(B) 20 percent of such total amount, for the third or 
     fourth year of such employment; and
       ``(C) 30 percent of such total amount, for the fifth year 
     of such employment.
       ``(2) Maximum.--The Secretary shall not repay or cancel 
     under this section more than $15,000 in the aggregate of 
     loans made, insured, or guaranteed under parts B and D for 
     any student.
       ``(3) Treatment of consolidation loans.--A loan amount for 
     a loan made under section 428C may be a qualified loan amount 
     for the purposes of this subsection only to the extent that 
     the loan amount was used to repay a loan made, insured, or 
     guaranteed under part B or D for a borrower who meets the 
     requirements of subsection (b), as determined in accordance 
     with regulations promulgated by the Secretary.
       ``(d) Regulations.--The Secretary may promulgate such 
     regulations as are necessary to carry out this section.
       ``(e) Effect of Section.--Nothing in this section 
     authorizes any refunding of any repayment of a loan.
       ``(f) Prevention of Double Benefits.--No borrower may, for 
     the same service, receive a benefit under both this section 
     and subtitle D of title I of the National and Community 
     Service Act of 1990 (42 U.S.C. 12571 et seq.).''.

[[Page 12724]]

       (c) Amounts Forgiven Not Treated as Gross Income.--Rules 
     similar to the rules under section 108(f) of the Internal 
     Revenue Code of 1986 shall apply to the amount of any loan 
     that is assumed or canceled under this section.

                   TITLE II--NAVAJO HIGHER EDUCATION

     SEC. 201. SHORT TITLE.

       This title may be cited as the ``Navajo Nation Higher 
     Education Act of 2004''.

     SEC. 202. CONGRESSIONAL FINDINGS.

       Congress finds that--
       (1) the Treaty of 1868 between the United States of America 
     and the Navajo Tribe of Indians (15 Stat. 667) provides for 
     the education of the citizens of the Navajo Nation;
       (2) in 1998, the Navajo Nation created and chartered the 
     Navajo Community College by Resolution CN-95-68 as a wholly 
     owned educational entity of the Navajo Nation;
       (3) in 1971, Congress enacted the Navajo Community College 
     Act (25 U.S.C. 640a et seq.);
       (4) in 1997, the Navajo Nation officially changed the name 
     of the Navajo Community College to Dine College by Resolution 
     CAP-35-97;
       (5) the purpose of Dine College is to provide educational 
     opportunities to the Navajo people and others in areas 
     important to the economic and social development of the 
     Navajo Nation;
       (6) the mission of Dine College is to apply the principles 
     of Sa'ah Naaghi Bik'eh Hozhoon (Dine Philosophy) to advance 
     student learning through training of the mind and heart--
       (A) through Nitshkees (Thinking), Nahat (Planning), Iin 
     (Living), and Sihasin (Assurance);
       (B) in study of the Dine language, history, philosophy, and 
     culture;
       (C) in preparation for further studies and employment in a 
     multicultural and technological world; and
       (D) in fostering social responsibility, community service, 
     and scholarly research that contribute to the social, 
     economic, and cultural well-being of the Navajo Nation;
       (7) the United States has a trust and treaty responsibility 
     to the Navajo Nation to provide for the educational 
     opportunities for Navajo people;
       (8) significant portions of the infrastructure of the 
     College are dilapidated and pose a serious health and safety 
     risk to students, employees and the public; and
       (9) the purposes and intent of this Act--
       (A) are consistent with--
       (i) Executive Order 13270 (3 C.F.R. 242 (2002); relating to 
     tribal colleges and universities)); and
       (ii) Executive Order 13336 (69 Fed. Reg. 25295; relating to 
     American Indian and Alaska Native education), issued on April 
     30, 2004; and
       (B) fulfill the responsibility of the United States to 
     serve the education needs of the Navajo people.

     SEC. 203. DEFINITIONS.

       In this title:
       (1) College.--The term ``College'' means Dine College.
       (2) Costs of operation and maintenance.--The term 
     ``operation and maintenance'' means all costs and expenses 
     associated with the customary daily operation of the College 
     and necessary maintenance costs.
       (3) Infrastructure.--
       (A) In general.--The term ``infrastructure'' means College 
     buildings, water and sewer facilities, roads, foundation, 
     information technology, and telecommunications.
       (B) Inclusions.--The term ``infrastructure'' includes--
       (i) classrooms; and
       (ii) external structures, such as walkways.
       (4) Nation.--The term ``Nation'' means the Navajo Nation.
       (5) Renovations and repairs.--The term ``renovations and 
     repairs'' means modernization and improvements to the 
     infrastructure.
       (6) Secretary.--The term ``Secretary'' means the Secretary 
     of the Interior.

     SEC. 204. REAUTHORIZATION OF DINE COLLEGE.

       Congress authorizes the College to receive all Federal 
     funding and resources under this Act and other laws for the 
     operation, improvement, and growth of the College, 
     including--
       (1) provision of programs of higher education for citizens 
     of the Nation and others;
       (2) provision of vocational and technical education for 
     citizens of the Nation and others;
       (3) preservation and protection of the Navajo language, 
     philosophy, and culture for citizens of the Nation and 
     others;
       (4) provision of employment and training opportunities to 
     Navajo communities and people;
       (5) provision of economic development and community 
     outreach for Navajo communities and people; and
       (6) provision of a safe learning, working, and living 
     environment for students, employees, and the public.

     SEC. 205. FACILITIES AND CAPITAL PROJECTS.

       The College may expend money received under section 209(c) 
     to undertake all renovations and repairs to the 
     infrastructure of the College, as identified by a strategic 
     plan approved by the College and submitted to the Secretary.

     SEC. 206. STATUS OF FUNDS.

       Funds provided to the College under this title may be 
     treated as non-Federal, private funds of the College for 
     purposes of any provision of Federal law that requires that 
     non-Federal or private funds of the College be used in a 
     project for a specific purpose.

     SEC. 207. SURVEY, STUDY, AND REPORT.

       (a) Report.--The Secretary shall--
       (1) conduct a detailed study of all capital projects and 
     facility needs of the College; and
       (2) submit to Congress a report that --
       (A) describes the results of the study not later than 
     October 31, 2009; and
       (B) includes detailed recommendations of the Secretary and 
     any recommendations or views submitted by the College and the 
     Nation.
       (b) Administrative Expenses.--Funds to carry out this 
     section may be drawn from general administrative 
     appropriations to the Secretary.

     SEC. 208. CONTINUING ELIGIBILITY FOR OTHER FEDERAL FUNDS.

       Except as explicitly provided for in other Federal law, 
     nothing in this Act precludes the eligibility of the College 
     to received Federal funding and resources under any program 
     authorized under--
       (1) the Higher Education Act of 1965 (20 U.S.C. 1001 et 
     seq.); and
       (2) the Equity in Educational Land Grant Status Act (Title 
     V, Part C, of Public Law 103-382; 7 U.S.C. 301 note); or
       (3) any other applicable program for the benefit of 
     institutions of higher education, community colleges, or 
     postsecondary educational institutions.

     SEC. 209. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated 
     for each fiscal year such amounts as are necessary to pay the 
     costs of operation and maintenance.
       (b) Budget Placement.--The Secretary shall fund the costs 
     of operation and maintenance of the College separately from 
     tribal colleges and universities recognized and funded by the 
     Tribally Controlled College or University Assistance Act of 
     1978 (25 U.S.C. 1801 et seq.).
       (c) Facilities and Capital Projects.--
       (1) In general.--In addition to amounts made available 
     under subsection (a), there are authorized to be appropriated 
     to carry out section 205 $15,000,000 for each of fiscal years 
     2005 through 2009.
       (2) Agencies.--Amounts made available under paragraph (1) 
     may be funded through any 1 or more of--
       (A) the Department of the Interior;
       (B) the Department of Education;
       (C) the Department of Heath and Human Services;
       (D) the Department of Housing and Urban Development;
       (E) the Department of Commerce;
       (F) the Environmental Protection Agency;
       (G) the Department of Veterans Affairs;
       (H) the Department of Agriculture;
       (I) the Department of Homeland Security;
       (J) the Department of Defense;
       (K) the Department of Labor; and
       (L) the Department of Transportation.

     SEC. 210. REPEAL OF NAVAJO COMMUNITY COLLEGE ACT.

       This Act supersedes the Navajo Community College Act (25 
     U.S.C. 640a et seq.).
                                 ______
                                 
      By Ms. CANTWELL:
  S. 2540. A bill to protect educational FM radio stations providing 
public service broadcasting from commercial encroachment; to the 
Committee on Commerce, Science, and Transportation.
  Ms. CANTWELL. Mr. President, I stand today to offer a bill to protect 
educational radio stations.
  Broadcaster Linda Ellerbee has compared radio to a national campfire: 
a place where a variety of voices bring us stories, news, opinion, 
culture and entertainment. But it seems these days that those 
representing the biggest business interests have the best seats at that 
campfire.
  Current regulations allow commercial broadcasters to move into the 
spaces of some, lower-powered educational stations.
  Last year the FCC ordered an educational station at a high school in 
Pennsylvania to be closed because a commercial broadcaster wanted to 
move into that space. That high school station had been serving the 
students and the community in Havertown, PA for fifty years. But no 
more. The high school station's voice was silenced. And that same FCC 
order also closed a radio station operated by a school district in 
Princeton, NJ. Both stations lost their licenses so a commercial 
broadcaster could get a frequency closer to the very profitable radio 
market in Philadelphia.
  In my State of Washington, a high school station that has served a 
Seattle community for 35 years is now

[[Page 12725]]

threatened with closure. That's because a commercial broadcaster 
located in another State wants to relocate to a larger city to increase 
its profits at the expense of the students of Mercer Island High School 
and the community the station serves. And in this case, the school's 
station also serves an important tool in the lives of those working in 
the local music community. The station focuses on introducing new and 
local bands to the airways. These artists are frequently later picked 
up for airplay by other radio stations. Few stations across the U.S. 
perform this role in the music industry. No other station serves this 
role so well in the Seattle music community.
  If the FCC allows this move, it could be worth millions to the 
commercial broadcasters. But what is the cost to the local community 
when this voice is silenced? What is the educational cost to the 
students at this high school? What benefits and experiences will they 
be losing in the future?
  This is a classic example of commercial interests trumping the public 
service interest in preserving local educational broadcasters. These 
small public service stations usually don't have anyone to stand up for 
them. Since the 1970's, we have seen more than a hundred of these 
stations disappear, to be replaced by larger, often national 
broadcasters, with little if any connection to the local community.
  The examples I've given you here today are not the only ones. Radio 
stations run by universities in Pittsburgh and North Carolina are also 
vulnerable to similar attempts.
  This is why I am introducing the Educational Radio Protection Act.
  My legislation is very simple: educational stations that are able to 
meet certain qualifying standards, similar to the requirements for 
primary, Class A, stations on FM radio, will be given the same 
protected status that these primary stations receive.
  This is an important measure to protect community broadcasters. And 
the bottom line is that commercial broadcasters won't be able to bump 
these educational stations off the radio dial.
  I thank you for the time today to discuss an issue that really is a 
cornerstone of democracy. For only in a democracy are the voices of the 
many heard to bring about a functioning government. I urge my 
colleagues to support this bill, and yield the floor.
                                 ______
                                 
      By Mr. McCAIN (for himself, Mr. Brownback, Mrs. Hutchison, and 
        Mr. Allen):
  S. 2541. A bill to reauthorize and restructure the National 
Aeronautics and Space Administration, and for other purposes; to the 
Committee on Commerce, Science, and Transportation.
  Mr. McCAIN. Mr. President, I am pleased to be joined today by 
Senators Brownback, Hutchison, and Allen in introducing legislation to 
re-authorize the National Aeronautics and Space Administration. This 
legislation marks the beginning of a new age of exploration, and the 
extension of humanity's quest for knowledge to a manned mission to 
Mars.
  NASA is currently responsible for a number of programs that create 
greater knowledge about the Earth and the universe around us. As we 
speak today, the two robots, Spirit and Opportunity, are exploring 
craters on Mars in search of ancient lake beds. The Hubble telescope 
continues to show us new discoveries about the universe. NASA 
satellites also help us to develop a better scientific understanding of 
the Earth's atmosphere and its response to natural and human-induced 
changes. NASA is in the process of developing airplanes with morphing 
wings that will change shape during flight.
  Despite all of these wondrous achievements, NASA is an agency in 
search of a new mission. For many Americans, the Apollo landings remain 
a moment of inspiration, but also a fading memory of the past. Many 
space enthusiasts have complained that the manned space program has 
been stuck in low Earth orbit and harnessed to a costly space station 
and aging Space Shuttle infrastructure. Just last year, we again 
witnessed the inherent danger in manned spaceflight, and some 
questioned the need for such a risky and expensive program.
  To his credit, President Bush announced on the day of the Columbia 
tragedy that ``our journey into space will go on.'' In January, the 
President offered a bold new space vision and made a firm commitment to 
return the Space Shuttle to flight, finish construction of the 
International Space Station, and return astronauts to the Moon in 
preparation for a manned mission to Mars. This bill would authorize 
these activities consistent with the President's overall requested 
budget amounts, and set the nation firmly on a course for manned 
exploration beyond low Earth orbit.
  However, we also have learned from the mistakes of the past. 
Unfortunately, NASA's recent history of managing projects, such as the 
X-33 and X-34, has been full of disappointment and failure. Many 
Members have seen the wisdom of President Reagan's adage to ``trust, 
but verify,'' when analyzing NASA's budget numbers. With these lessons 
in mind, the bill contains a number of provisions to ensure that NASA 
stays on track.
  The bill would require the submission of a baseline technical 
requirements document and life cycle cost estimate, so that Congress 
can find out exactly what is required to implement the President's 
vision and begin to determine its cost. The bill also would require an 
industrial assessment of the private sector's ability to support manned 
missions to the Moon and Mars, and a commercialization plan to identify 
opportunities for the private sector to participate in future missions. 
Most importantly, the bill would require quarterly life cycle reports 
on major systems of the new initiative, and include cost-control 
measures when the cost overruns of these systems exceed 15 percent and 
25 percent over the total life cycle cost of the system.
  The bill also would codify many of the recommendations of the 
Columbia Accident Investigation Board (CAIB). Admiral Gehman and the 
other board members did an admirable job in thoroughly investigating 
the causes of this tragic accident. The bill would establish a lessons-
learned and best practices program to ensure that NASA does not repeat 
the mistakes of the past. In addition, the Office of Safety and Mission 
Assurance is given independent funding and direct line authority over 
the entire Space Shuttle Safety organization. An Independent Technical 
Engineering Authority is established within NASA with its own budgetary 
line to maintain technical standards, be the sole waiver-granting 
authority for technical standards, and perform other tasks. The bill 
also would ensure that the Independent Technical Engineering Authority 
would recertify the Space Shuttle orbiters for operation prior to any 
operations beyond 2010. The bill would include an assessment of NASA's 
culture and organization, and an action plan to fix the cultural and 
organizational problems that the CAIB identified as a major cause of 
the accident. The men and women of the Columbia gave their lives to 
further America's knowledge of the Earth and the stars, and we should 
honor their memory by ensuring that such an accident never occurs 
again.
  In addition, the bill would address the problems concerning the 
Hubble Space Telescope. As my colleagues know, NASA has indicated that 
it cannot use the Space Shuttle for another human mission to service 
this national treasure. Both NASA and the National Academy of Sciences 
are reviewing options for using robots and other means to save the 
telescope. Sixty days after the National Academy releases its report, 
the Administrator would be directed to report to Congress on the future 
servicing options for Hubble and how much it will cost.
  I realize that concerns have been raised regarding some of the cuts 
that NASA is proposing to pay for the President's exploration vision. 
In order to pay for this new program, we must realize that there is 
limited funding and that NASA funding has to be re-allocated. However, 
this bill should not be construed as supporting each and every proposed 
reduction. Instead, the bill simply would authorize the funding levels 
buy the major budget accounts.

[[Page 12726]]

  Curiosity and a drive to explore have always been quintessential 
American traits. This has been most evident in the space program, which 
continues to show great advances in human knowledge. However, we are 
fully aware of the inherent risks and costs of space exploration, and 
the need to mitigate them wherever possible. Based on this knowledge, 
let us now embark upon this great journey into the stars to find 
whatever may await us.
  I urge my colleagues to support this legislation, and look forward to 
working with them to ensure passage of this bill this year.
                                 ______
                                 
      By Mr. KENNEDY (for himself and Mr. Edwards):
  S. 2542. A bill to provide for review of determinations on whether 
schools and local educational agencies made adequate yearly progress 
for the 2002-2003 school year taking into consideration subsequent 
regulations and guidance applicable to those determinations, and for 
other purposes; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. KENNEDY. Mr. President, it's a privilege to join my colleagues in 
introducing the No Child Left Behind Fairness Act. Our goal is to 
achieve accurate and fair determinations of accountability in current 
law. The bill does not change the accountability provisions of the law, 
but it does require the Department of Education to play by its own 
rules in considering the progress of each school.
  The accountability provisions in the No Child Left Behind Act are 
critical to accomplishing the goal of closing the achievement gap. 
Before its enactment, many communities ignored the gaps between some 
children and others in school, even though some groups of students were 
consistently falling behind. Communities are now beginning to provide 
the help those schools need to meet higher standards for all students, 
such as better teacher training, better curriculums, and better support 
and attention.
  It makes sense to identify schools as needing improvement. There's 
nothing wrong with shining a light on areas that need improvement--even 
in the best schools. That doesn't mean they are failures.
  But for the accountability provisions in the law to be useful, they 
must be accurate. We need accurate determinations of whether schools 
are making progress.
  A full two years after passage of the No Child Left Behind Act, the 
Department of Education finally issued the regulations and guidance 
that schools need to accurately calculate accountability under the law. 
Those rules were a step in the right direction. They specifically 
addressed the achievement of children with disabilities and limited 
English proficient children.
  The Department's rules were effective immediately, but many schools 
had already made their evaluations for the year as best they could. 
They shouldn't have had to make these assessments and calculations 
without adequate guidance. They certainly shouldn't be penalized for 
the Department's delay in issuing this guidance.
  So far, 28,000 schools have been identified by States as failing to 
make adequate yearly progress. Many of those schools were identified in 
the 2002-2003 school year, before the new rule were released. A number 
of schools and districts identified as failing to make adequate yearly 
progress might have succeeded if the new rules had been in effect from 
the start. The Department's delay in issuing adequate rules and 
guidance has created unnecessary confusion, caused a potential 
mislabeling of schools, and misdirected resources from the schools and 
students who actually need them.
  Some States have asked the Department of Education for permission to 
review their scores from last year under the new rules, and submit a 
more accurate calculation of accountability. Many of us in Congress 
have urged the Secretary of Education to apply the new regulations 
retroactively, so that States, school districts, and schools can review 
last year's data
  On accountability and correct it if necessary. The Secretary of 
Education has refused, stating that he lacks the authority to do so.
  This bill provides that authority. It enables the new regulations to 
be applied retroactively, so that schools will be judged on the same 
standards for the past year as they will be in the future, not by 
different criteria for different years.
  Schools across the country are struggling to comply with the 
requirements of the No Child Left Behind Act. If we want schools to be 
held accountable, we need to make the process fair. I urge my 
colleagues to pass this legislation s soon as possible. Schools are 
waiting for our response. They don't deserve an unfair burden in 
complying with the act and improving their schools.
  I ask unanimous consent that the text of this bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2542

       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 ``No Child Left Behind 
     Fairness Act of 2004''.

     SEC. 2. REVIEW OF ADEQUATE YEARLY PROGRESS DETERMINATIONS FOR 
                   SCHOOLS FOR THE 2002-2003 SCHOOL YEAR.

       (a) In General.--The Secretary shall require each local 
     educational agency to provide each school served by the 
     agency with an opportunity to request a review of a 
     determination by the agency that the school did not make 
     adequate yearly progress for the 2002-2003 school year.
       (b) Final Determination.--Not later than 30 days after 
     receipt of a request by a school for a review under this 
     section, a local educational agency shall issue and make 
     publicly available a final determination on whether the 
     school made adequate yearly progress for the 2002-2003 school 
     year.
       (c) Evidence.--In conducting a review under this section, a 
     local educational agency shall--
       (1) allow the principal of the school involved to submit 
     evidence on whether the school made adequate yearly progress 
     for the 2002-2003 school year; and
       (2) consider that evidence before making a final 
     determination under subsection (b).
       (d) Standard of Review.--In conducting a review under this 
     section, a local educational agency shall revise, consistent 
     with the applicable State plan under section 1111 of the 
     Elementary and Secondary Education Act of 1965 (20 U.S.C. 
     6311), the local educational agency's original determination 
     that a school did not make adequate yearly progress for the 
     2002-2003 school year if the agency finds that the school 
     made such progress taking into consideration--
       (1) the amendments made to part 200 of title 34 of the Code 
     of Federal Regulations on December 9, 2003 (68 Fed. Reg. 
     68698) (relating to accountability for the academic 
     achievement of students with the most significant cognitive 
     disabilities); or
       (2) any regulation or guidance that, subsequent to the date 
     of such original determination, was issued by the Secretary 
     relating to--
       (A) the assessment of limited English proficient children;
       (B) the inclusion of limited English proficient children as 
     part of the subgroup described in section 
     1111(b)(2)(C)(v)(II)(dd) of the Elementary and Secondary 
     Education Act of 1965 (20 U.S.C. 6311(b)(2)(C)(v)(II)(dd)) 
     after such children have obtained English proficiency; or
       (C) any requirement under section 1111(b)(2)(I)(ii) of the 
     Elementary and Secondary Education Act of 1965 (20 U.S.C. 
     6311(b)(2)(I)(ii)).
       (e) Effect of Revised Determination.--
       (1) In general.--If pursuant to a review under this section 
     a local educational agency determines that a school made 
     adequate yearly progress for the 2002-2003 school year, upon 
     such determination--
       (A) any action by the Secretary, the State educational 
     agency, or the local educational agency that was taken 
     because of a prior determination that the school did not make 
     such progress shall be terminated; and
       (B) any obligations or actions required of the local 
     educational agency or the school because of the prior 
     determination shall cease to be required.
       (2) Exceptions.--Notwithstanding paragraph (1), a 
     determination under this section shall not affect any 
     obligation or action required of a local educational agency 
     or school under the following:
       (A) Section 1116(b)(13) of the Elementary and Secondary 
     Education Act of 1965 (20 U.S.C. 6316(b)(13)) (requiring a 
     local educational agency to continue to permit a child who 
     transferred to another school under such section to remain in 
     that school until completion of the highest grade in the 
     school).
       (B) Section 1116(e)(8) of the Elementary and Secondary 
     Education Act of 1965 (20

[[Page 12727]]

     U.S.C. 6316(e)(8)) (requiring a local educational agency to 
     continue to provide supplemental educational services under 
     such section until the end of the school year).
       (3) Subsequent determinations.--In determining whether a 
     school is subject to school improvement, corrective action, 
     or restructuring as a result of not making adequate yearly 
     progress, the Secretary, a State educational agency, or a 
     local educational agency may not take into account a 
     determination that the school did not make adequate yearly 
     progress for the 2002-2003 school year if such determination 
     was revised under this section and the school received a 
     final determination of having made adequate yearly progress 
     for the 2002-2003 school year.
       (f) Notification.--The Secretary--
       (1) shall require each State educational agency to notify 
     each school served by the agency of the school's ability to 
     request a review under this section; and
       (2) not later than 30 days after the date of the enactment 
     of this section, shall notify the public by means of the 
     Department of Education's website of the review process 
     established under this section.

     SEC. 3. REVIEW OF ADEQUATE YEARLY PROGRESS DETERMINATIONS FOR 
                   LOCAL EDUCATIONAL AGENCIES FOR THE 2002-2003 
                   SCHOOL YEAR.

       (a) In General.--The Secretary shall require each State 
     educational agency to provide each local educational agency 
     in the State with an opportunity to request a review of a 
     determination by the State educational agency that the local 
     educational agency did not make adequate yearly progress for 
     the 2002-2003 school year.
       (b) Application of Certain Provisions.--Except as 
     inconsistent with, or inapplicable to, this section, the 
     provisions of section 2 shall apply to review by a State 
     educational agency of a determination described in subsection 
     (a) in the same manner and to the same extent as such 
     provisions apply to review by a local educational agency of a 
     determination described in section 2(a).

     SEC. 4. DEFINITIONS.

       In this Act:
       (1) The term ``adequate yearly progress'' has the meaning 
     given to that term in section 1111(b)(2)(C) of the Elementary 
     and Secondary Education Act of 1965 (20 U.S.C. 
     6311(b)(2)(C)).
       (2) The term ``local educational agency'' means a local 
     educational agency (as that term is defined in section 9101 
     of the Elementary and Secondary Education Act of 1965 (20 
     U.S.C. 7801)) receiving funds under part A of title I of such 
     Act (20 U.S.C. 6311 et seq.).
       (3) The term ``Secretary'' means the Secretary of 
     Education.
       (4) The term ``school'' means an elementary school or a 
     secondary school (as those terms are defined in section 9101 
     of the Elementary and Secondary Education Act of 1965 (20 
     U.S.C. 7801)) served under part A of title I of such Act (20 
     U.S.C. 6311 et seq.).
       (5) The term ``State educational agency'' means a State 
     educational agency (as that term is defined in section 9101 
     of the Elementary and Secondary Education Act of 1965 (20 
     U.S.C. 7801)) receiving funds under part A of title I of such 
     Act (20 U.S.C. 6311 et seq.).
                                 ______
                                 
      By Mr. THOMAS (for himself and Mr. Burns):
  S. 2543. A bill to establish a program and criteria for National 
Heritage Areas in the United States, and for other purposes; to the 
Committee on Energy and Natural Resources.
  Mr. THOMAS. Mr. President, I rise today to introduce the ``National 
Heritage Partnership Act.'' The first Heritage area was created on 
August 24, 1984--the Illinois and Michigan National Heritage Corridor. 
Little or no growth occurred in this program for the first 10 years. 
However, in the last couple of years the Congress has added 23 more 
Heritage areas!
  The Park Service provides technical assistance and funding but 
Heritage areas are not National Parks. About 30 bills have been 
introduced this Congress to study or designate new areas. There are no 
Federal guidelines requiring what a heritage bill must contain, the 
program has very little requirements and it is out of control.
  As a result, I have conducted two oversight hearings in the National 
Parks Subcommittee. I also had the General Accounting Office conduct a 
review of Heritage Areas. The following concerns were identified: 
individual areas are designated with specific legislation, but a 
National Heritage Area Program does not exist in the National Park 
Service; there are no official standards or criteria; existing heritage 
areas range in scope and size from ``Rivers of Steel'' in Pennsylvania 
to the entire State of Tennessee; the potential exists for unlimited 
designations which are impacting funding for other Park Service 
programs; and oversight and accountability of funding is lacking.
  Today, I am introducing legislation with the Chairman of the Interior 
Appropriations Subcommittee which will establish National Heritage Area 
guidelines and criteria. The bill considers the recommendations from 
the GAO report about Heritage Areas and raises the standard for 
designation and requires specific criteria for national significance 
before an area can be designated. In addition, a cap has been placed on 
annual funding for the Heritage Area Program to avoid impacting other 
National Park Service programs.
  This program is out of control. We are continuing to put unnecessary 
fiscal and resource demands on the Park Service. We have no established 
criteria to ensure the recognition of truly nationally significant 
areas. Consequently, we have compromised the integrity of all existing 
and future National Heritage Areas. I am pleased Senator Burns has 
joined me in this effort and I look forward to moving this bill through 
the Senate in the near future.
  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. 2543

       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 ``National 
     Heritage Partnership Act''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents..
Sec. 2. Definitions..
Sec. 3. National Heritage Areas program..
Sec. 4. Suitability-feasibility studies..
Sec. 5. Management plans..
Sec. 6. Local coordinating entities..
Sec. 7. Relationship to other Federal agencies..
Sec. 8. Private property and regulatory protections..
Sec. 9. Authorization of appropriations..

     SEC. 2. DEFINITIONS.

        In this Act:
       (1) Local coordinating entity.--The term ``local 
     coordinating entity'' means the entity designated by 
     Congress--
       (A) to develop, in partnership with others, the management 
     plan for a National Heritage Area; and
       (B) to act as a catalyst for the implementation of projects 
     and programs among diverse partners in the National Heritage 
     Area.
       (2) Management plan.--The term ``management plan'' means 
     the plan prepared by the local coordinating entity for a 
     National Heritage Area designated by Congress that specifies 
     actions, policies, strategies, performance goals, and 
     recommendations to meet the goals of the National Heritage 
     Area, in accordance with section 5.
       (3) National heritage area.--The term ``National Heritage 
     Area'' means an area designated by Congress that is 
     nationally significant to the heritage of the United States 
     and meets the criteria established under section 4(a).
       (4) National significance.--The term ``national 
     significance'' means possession of--
       (A) unique natural, historical, cultural, educational, 
     scenic, or recreational resources of exceptional value or 
     quality; and
       (B) a high degree of integrity of location, setting, or 
     association in illustrating or interpreting the heritage of 
     the United States.
       (5) Program.--The term ``program'' means the National 
     Heritage Areas program established under section 3(a).
       (6) Proposed national heritage area.--The term ``proposed 
     National Heritage Area'' means an area under study by the 
     Secretary or other parties for potential designation by 
     Congress as a National Heritage Area.
       (7) Secretary.--The term ``Secretary'' means the Secretary 
     of the Interior.
       (8) Suitability-feasibility study.--The term ``suitability-
     feasibility study'' means a study conducted by the Secretary, 
     or conducted by 1 or more other interested parties and 
     reviewed by the Secretary, in accordance with the criteria 
     and processes established under section 4, to determine 
     whether an area meets the criteria to be designated as a 
     National Heritage Area by Congress.

     SEC. 3. NATIONAL HERITAGE AREAS PROGRAM.

       (a) In General.--Subject to the availability of funds, the 
     Secretary shall establish a National Heritage Areas program 
     under which the Secretary shall provide technical and 
     financial assistance to local coordinating entities to 
     support the establishment of National Heritage Areas.
       (b) Duties.--Under the program, the Secretary shall--
       (1)(A) conduct suitability-feasibility studies, as directed 
     by Congress, to assess the suitability and feasibility of 
     designating proposed National Heritage Areas; or

[[Page 12728]]

       (B) review and comment on suitability-feasibility studies 
     undertaken by other parties to make such assessment;
       (2) provide technical assistance, on a reimbursable or non-
     reimbursable basis (as determined by the Secretary), for the 
     development and implementation of management plans for 
     designated National Heritage Areas;
       (3) enter into cooperative agreements with interested 
     parties to carry out this Act;
       (4) provide information, promote understanding, and 
     encourage research on National Heritage Areas in partnership 
     with local coordinating entities;
       (5) provide national oversight, analysis, coordination, and 
     technical assistance and support to ensure consistency and 
     accountability under the program; and
       (6) submit annually to the Committee on Resources of the 
     House of Representatives and the Committee on Energy and 
     Natural Resources of the Senate a report describing the 
     allocation and expenditure of funds for activities conducted 
     with respect to National Heritage Areas under this Act.

     SEC. 4. SUITABILITY-FEASIBILITY STUDIES.

       (a) Criteria.--In conducting or reviewing a suitability-
     feasibility study, the Secretary shall apply the following 
     criteria to determine the suitability and feasibility of 
     designating a proposed National Heritage Area:
       (1) An area--
       (A) has an assemblage of natural, historic, cultural, 
     educational, scenic, or recreational resources that together 
     are nationally significant to the heritage of the United 
     States;
       (B) represents distinctive aspects of the heritage of the 
     United States worthy of recognition, conservation, 
     interpretation, and continuing use;
       (C) is best managed as such an assemblage through 
     partnerships among public and private entities at the local 
     or regional level;
       (D) reflects traditions, customs, beliefs, and folklife 
     that are a valuable part of the heritage of the United 
     States;
       (E) provides outstanding opportunities to conserve natural, 
     historical, cultural, or scenic features;
       (F) provides outstanding recreational or educational 
     opportunities; and
       (G) has resources and traditional uses that have national 
     significance.
       (2) Residents, business interests, nonprofit organizations, 
     and governments (including relevant Federal land management 
     agencies) within the proposed area are involved in the 
     planning and have demonstrated significant support through 
     letters and other means for National Heritage Area 
     designation and management.
       (3) The local coordinating entity responsible for preparing 
     and implementing the management plan is identified.
       (4) The proposed local coordinating entity and units of 
     government supporting the designation are willing and have 
     documented a significant commitment to work in partnership to 
     protect, enhance, interpret, fund, manage, and develop 
     resources within the National Heritage Area.
       (5) The proposed local coordinating entity has developed a 
     conceptual financial plan that outlines the roles of all 
     participants (including the Federal Government) in the 
     management of the National Heritage Area.
       (6) The proposal is consistent with continued economic 
     activity within the area.
       (7) A conceptual boundary map has been developed and is 
     supported by the public and participating Federal agencies.
       (b) Consultation.--In conducting or reviewing a 
     suitability-feasibility study, the Secretary shall consult 
     with the managers of any Federal land within the proposed 
     National Heritage Area and secure the concurrence of the 
     managers with the findings of the suitability-feasibility 
     study before making a determination for designation.
       (c) Transmittal.--On completion or receipt of a 
     suitability-feasibility study for a National Heritage Area, 
     the Secretary shall--
       (1) review, comment, and make findings (in accordance with 
     the criteria specified in subsection (a)) on the feasibility 
     of designating the National Heritage Area;
       (2) consult with the Governor of each State in which the 
     proposed National Heritage Area is located; and
       (3) transmit to the Committee on Resources of the House of 
     Representatives and the Committee on Energy and Natural 
     Resources of the Senate, the suitability-feasibility study, 
     including--
       (A) any comments received from the Governor of each State 
     in which the proposed National Heritage Area is located; and
       (B) a finding as to whether the proposed National Heritage 
     Area meets the criteria for designation.
       (d) Disapproval.--
       (1) In general.--If the Secretary determines that any 
     proposed National Heritage Area does not meet the criteria 
     for designation, the Secretary shall include within the 
     suitability-feasibility study submitted under subsection 
     (c)(3) a description of the reasons for the determination.
       (2) Other factors.--A finding by the Secretary that a 
     proposed National Heritage Area meets the criteria for 
     designation shall not preclude the Secretary from 
     recommending against designation of the proposed National 
     Heritage Area based on the budgetary impact of the 
     designation or any other factor unrelated to the criteria.
       (e) Designation.--The designation of a National Heritage 
     Area shall be--
       (1) by Act of Congress; and
       (2) contingent on the prior completion of a suitability-
     feasibility study and an affirmative determination by the 
     Secretary that the area meets the criteria established under 
     subsection (a).

     SEC. 5. MANAGEMENT PLANS.

       (a) Requirements.--The management plan for any National 
     Heritage Area shall--
       (1) describe comprehensive policies, goals, strategies, and 
     recommendations for telling the story of the heritage of the 
     area covered by the National Heritage Area and encouraging 
     long-term resource protection, enhancement, interpretation, 
     funding, management, and development of the National Heritage 
     Area;
       (2) include a description of actions and commitments that 
     governments, private organizations, and citizens will take to 
     protect, enhance, interpret, fund, manage, and develop the 
     natural, historical, cultural, educational, scenic, and 
     recreational resources of the National Heritage Area;
       (3) specify existing and potential sources of funding or 
     economic development strategies to protect, enhance, 
     interpret, fund, manage, and develop the National Heritage 
     Area;
       (4) include an inventory of the natural, historical, 
     cultural, educational, scenic, and recreational resources of 
     the National Heritage Area related to the national 
     significance and themes of the National Heritage Area that 
     should be protected, enhanced, interpreted, managed, funded, 
     and developed;
       (5) recommend policies and strategies for resource 
     management, including the development of intergovernmental 
     and interagency agreements to protect, enhance, interpret, 
     fund, manage, and develop the natural, historical, cultural, 
     educational, scenic, and recreational resources of the 
     National Heritage Area;
       (6) describe a program for implementation for the 
     management plan, including--
       (A) performance goals;
       (B) plans for resource protection, enhancement, 
     interpretation, funding, management, and development; and
       (C) specific commitments for implementation that have been 
     made by the local coordinating entity or any government 
     agency, organization, business, or individual;
       (7) include an analysis of, and recommendations for, means 
     by which Federal, State, and local programs may best be 
     coordinated (including the role of the National Park Service 
     and other Federal agencies associated with the National 
     Heritage Area) to further the purposes of this Act; and
       (8) include a business plan that--
       (A) describes the role, operation, financing, and functions 
     of the local coordinating entity and of each of the major 
     activities contained in the management plan; and
       (B) provides adequate assurances that the local 
     coordinating entity has the partnerships and financial and 
     other resources necessary to implement the management plan 
     for the National Heritage Area.
       (b) Deadline.--
       (1) In general.--Not later than 3 years after the date on 
     which funds are first made available to develop the 
     management plan after designation as a National Heritage 
     Area, the local coordinating entity shall submit the 
     management plan to the Secretary for approval.
       (2) Termination of funding.--If the management plan is not 
     submitted to the Secretary in accordance with paragraph (1), 
     the local coordinating entity shall not qualify for any 
     additional financial assistance under this Act until such 
     time as the management plan is submitted to and approved by 
     the Secretary.
       (c) Approval of Management Plan.--
       (1) Review.--Not later than 180 days after receiving the 
     plan, the Secretary shall review and approve or disapprove 
     the management plan for a National Heritage Area on the basis 
     of the criteria established under paragraph (3).
       (2) Consultation.--The Secretary shall consult with the 
     Governor of each State in which the National Heritage Area is 
     located before approving a management plan for the National 
     Heritage Area.
       (3) Criteria for approval.--In determining whether to 
     approve a management plan for a National Heritage Area, the 
     Secretary shall consider whether--
       (A) the local coordinating entity represents the diverse 
     interests of the National Heritage Area, including 
     governments, natural and historic resource protection 
     organizations, educational institutions, businesses, 
     recreational organizations, community residents, and private 
     property owners;
       (B) the local coordinating entity--
       (i) has afforded adequate opportunity for public and 
     governmental involvement (including through workshops and 
     hearings) in the preparation of the management plan; and
       (ii) provides for at least semiannual public meetings to 
     ensure adequate implementation of the management plan;
       (C) the resource protection, enhancement, interpretation, 
     funding, management, and development strategies described in 
     the management plan, if implemented, would adequately 
     protect, enhance, interpret, fund,

[[Page 12729]]

     manage, and develop the natural, historic, cultural, 
     educational, scenic, and recreational resources of the 
     National Heritage Area;
       (D) the management plan would not adversely affect any 
     activities authorized on Federal land under public land laws 
     or land use plans;
       (E) the local coordinating entity has demonstrated the 
     financial capability, in partnership with others, to carry 
     out the plan;
       (F) the Secretary has received adequate assurances from the 
     appropriate State and local officials whose support is needed 
     to ensure the effective implementation of the State and local 
     elements of the management plan; and
       (G) the management plan demonstrates partnerships among the 
     local coordinating entity, Federal, State, and local 
     governments, regional planning organizations, nonprofit 
     organizations, or private sector parties for implementation 
     of the management plan.
       (4) Disapproval.--
       (A) In general.--If the Secretary disapproves the 
     management plan, the Secretary--
       (i) shall advise the local coordinating entity in writing 
     of the reasons for the disapproval; and
       (ii) may make recommendations to the local coordinating 
     entity for revisions to the management plan.
       (B) Deadline.--Not later than 180 days after receiving a 
     revised management plan, the Secretary shall approve or 
     disapprove the revised management plan.
       (5) Amendments.--
       (A) In general.--An amendment to the management plan that 
     substantially alters the purposes of the National Heritage 
     Area shall be reviewed by the Secretary and approved or 
     disapproved in the same manner as the original management 
     plan.
       (B) Implementation.--The local coordinating entity shall 
     not use Federal funds authorized by this Act to implement an 
     amendment to the management plan until the Secretary approves 
     the amendment.

     SEC. 6. LOCAL COORDINATING ENTITIES.

       (a) Duties.--To further the purposes of the National 
     Heritage Area, the local coordinating entity shall--
       (1) prepare a management plan for the National Heritage 
     Area, and submit the management plan to the Secretary, in 
     accordance with section 5;
       (2) submit an annual report to the Secretary for each 
     fiscal year for which the local coordinating committee 
     receives Federal funds under this Act, specifying--
       (A) the specific performance goals and accomplishments of 
     the local coordinating committee;
       (B) the expenses and income of the local coordinating 
     committee;
       (C) the amounts and sources of matching funds;
       (D) the amounts leveraged with Federal funds and sources of 
     the leveraging; and
       (E) grants made to any other entities during the fiscal 
     year;
       (3) make available for audit for each fiscal year for which 
     the local coordinating entity receives Federal funds under 
     this Act, all information pertaining to the expenditure of 
     the funds and any matching funds; and
       (4) encourage economic viability and sustainability that is 
     consistent with the purposes of the National Heritage Area.
       (b) Authorities.--For the purposes of preparing and 
     implementing the approved management plan for the National 
     Heritage Area, the local coordinating entity may use Federal 
     funds made available under this Act to--
       (1) make grants to political jurisdictions, nonprofit 
     organizations, and other parties within the National Heritage 
     Area;
       (2) enter into cooperative agreements with or provide 
     technical assistance to political jurisdictions, nonprofit 
     organizations, Federal agencies, and other interested 
     parties;
       (3) hire and compensate staff, including individuals with 
     expertise in--
       (A) natural, historical, cultural, educational, scenic, and 
     recreational resource conservation;
       (B) economic and community development; and
       (C) heritage planning;
       (4) obtain funds or services from any source, including 
     other Federal laws or programs;
       (5) contract for goods or services; and
       (6) support activities of partners and any other activities 
     that further the purposes of the National Heritage Area and 
     are consistent with the approved management plan.
       (c) Prohibition on Acquisition of Real Property.--The local 
     coordinating entity may not use Federal funds authorized 
     under this Act to acquire any interest in real property.

     SEC. 7. RELATIONSHIP TO OTHER FEDERAL AGENCIES.

       (a) In General.--Nothing in this Act affects the authority 
     of a Federal agency to provide technical or financial 
     assistance under any other law.
       (b) Consultation and Coordination.--The head of any Federal 
     agency planning to conduct activities that may have an impact 
     on a National Heritage Area is encouraged to consult and 
     coordinate the activities with the Secretary and the local 
     coordinating entity to the maximum extent practicable.
       (c) Other Federal Agencies.--Nothing in this Act--
       (1) modifies, alters, or amends any law or regulation 
     authorizing a Federal agency to manage Federal land under the 
     jurisdiction of the Federal agency;
       (2) limits the discretion of a Federal land manager to 
     implement an approved land use plan within the boundaries of 
     a National Heritage Area; or
       (3) modifies, alters, or amends any authorized use of 
     Federal land under the jurisdiction of a Federal agency.

     SEC. 8. PRIVATE PROPERTY AND REGULATORY PROTECTIONS.

       Nothing in this Act--
       (1) abridges the rights of any property owner (whether 
     public or private), including the right to refrain from 
     participating in any plan, project, program, or activity 
     conducted within the National Heritage Area;
       (2) requires any property owner to permit public access 
     (including access by Federal, State, or local agencies) to 
     the property of the property owner, or to modify public 
     access or use of property of the property owner under any 
     other Federal, State, or local law;
       (3) alters any duly adopted land use regulation, approved 
     land use plan, or other regulatory authority of any Federal, 
     State or local agency, or conveys any land use or other 
     regulatory authority to any local coordinating entity;
       (4) authorizes or implies the reservation or appropriation 
     of water or water rights;
       (5) diminishes the authority of the State to manage fish 
     and wildlife, including the regulation of fishing and hunting 
     within the National Heritage Area; or
       (6) creates any liability, or affects any liability under 
     any other law, of any private property owner with respect to 
     any person injured on the private property.

     SEC. 9. AUTHORIZATION OF APPROPRIATIONS.

       (a) Suitability-Feasibility Studies.--There is authorized 
     to be appropriated to conduct and review suitability-
     feasibility studies under section 4 $750,000 for each fiscal 
     year, of which not more than $250,000 for any fiscal year may 
     be used for any individual suitability-feasibility study for 
     a proposed National Heritage Area.
       (b) Local Coordinating Entities.--
       (1) In general.--There is authorized to be appropriated to 
     carry out section 6 $15,000,000 for each fiscal year, of 
     which not more than--
       (A) $1,000,000 may be made available for any fiscal year 
     for any individual National Heritage Area, to remain 
     available until expended; and
       (B) a total of $10,000,000 may be made available for all 
     such fiscal years for any individual National Heritage Area.
       (2) Termination date.--
       (A) In general.--The authority of the Secretary to provide 
     financial assistance to an individual local coordinating 
     entity under this Act (excluding technical assistance and 
     administrative oversight) shall terminate on the date that is 
     15 years after the date of the initial receipt of the 
     assistance by the local coordinating committee.
       (B) Designation.--A National Heritage Area shall retain the 
     designation as a National Heritage Area after the termination 
     date prescribed in subparagraph (A).
       (3) Administration.--Not more than 5 percent of the amount 
     of funds made available under paragraph (1) for a fiscal year 
     may be used by the Secretary for technical assistance, 
     oversight, and administrative purposes.
       (c) Matching Funds.--
       (1) In general.--As a condition of receiving a grant under 
     this Act, the recipient of the grant shall provide matching 
     funds in an amount that is equal to the amount of the grant.
       (2) Administration.--The recipient matching funds--
       (A) shall be derived from non-Federal sources; and
       (B) may be made in the form of in-kind contributions of 
     goods or services fairly valued.
                                 ______
                                 
      By Ms. STABENOW (for herself, Mrs. Lincoln, and Mr. Levin):
  S. 2544. A bill to provide for the certification of programs to 
provide uninsured employees of small businesses access to health 
coverage, and for other purposes; to the Committee on Finance.
  Ms. STABENOW. Mr. President, today I rise to introduce the Health 
Care Access for Small Businesses Act of 2004. I am pleased to be joined 
in this endeavor by my colleagues, Senator Lincoln and Michigan's 
senior Senator Levin. My bill would help small businesses provide 
health coverage for their employees, an important first step in 
providing access to health care for all Americans.
  Last month, thousands of Americans participated in the annual Cover 
the Uninsured week, a discussion about the urgent need to cover the 
uninsured. The sheer breadth of the groups that participated in the 
unprecedented effort demonstrates the urgency of this

[[Page 12730]]

issue. Labor unions were united with business groups, doctors with 
nurses, and charity health care providers with for-profit hospitals and 
insurance companies.
  And yesterday, the consumer group Families USA and the governors of 
Iowa, Kansas, and Maine released even more disturbing news. Using 
Census Bureau data, they found that approximately 81.8 million 
Americans--one out of three people under 65 years of age--were 
uninsured at some point of time for the past two years. Almost two-
thirds were uninsured for six months or more; and over half were 
uninsured for at least nine months.
  We need to stop having discussions and start finding solutions. Too 
many hard working Americans are going without health insurance. There 
is a great misconception that uninsured Americans are largely 
unemployed or on welfare. That is simply not the case. More than 80 
percent of uninsured Americans are part of working families, and almost 
half work for small businesses. If we can help small businesses cover 
their employees, we will have made great progress in covering the 
uninsured.
  The bill I am introducing today is aimed at making coverage more 
affordable for employees of small businesses through what is called a 
``three-share'' program. It would not impose any new funding mandates 
on state or local governments nor would it create new bureaucracy. It 
is an innovative community-based approach that could work throughout 
the country.
  And it's aimed at ensuring primary care services are more available. 
We know that the primary care model through federally qualified health 
centers has been a tremendous success. This would build on this success 
by empowering communities--health care providers, small businesses, 
churches, civic groups--to form their own health care programs.
  The three-share model is an innovative community-based idea that has 
been working across the U.S. from California to Arkansas to Maryland 
and, of course, Michigan. The name ``three-share'' stems from the 
program's payment structure. Premiums are shared between the employer 
who pays 30 percent, the employee who pays 30 percent, and the 
community which covers the remaining 40 percent of the cost.
  In a three share model, a non-profit or local government entity 
serves as the manager of the plan. They design a benefit package by 
negotiating directly with providers or contracting through an insurance 
company. Then, they recruit small businesses that have not offered 
insurance coverage to their employees for the past year. The average 
cost for coverage is about $1,800 per year, much lower than the 
national average for commercial insurance, which on average costs about 
$3,400 for a single person and $9,000 for a family, according to the 
2003 Kaiser survey of employer benefits. Of the $1,800, the employer 
and employee would each pay approximately $540 and the community would 
pay about $720.
  And they have been successful. For example, in Muskegon, Michigan, 
the three-share program Access Health has been working with about 400 
small businesses to cover some 1,500 uninsured full and part-time 
employees. Wayne County has operated Health Choice for a decade. 
Although it is undergoing some changes, it has nearly 1,300 businesses 
enrolled and covers everyone from cab drivers, nail salon technicians, 
and nursing aides. Kent County, where Grand Rapids is located, began 
enrolling small businesses and employees in their program in 2002 and 
hope to grow to cover 2,500 individuals this year.
  Different three share plans have received funds for the community 
portion from various places. In Michigan, most of the money has come 
from Medicaid funds. A plan in California uses money from the tobacco 
settlement, while a plan in Arkansas raises funds through church events 
and other community initiatives.
  Unfortunately, despite the nuances that distinguish three share plans 
from one another, they all share a common challenge: they all lack a 
stable and sustainable funding source for the community share. This 
bill will help provide a steady stream of funding and analyze what 
three shares do right and how communities can develop their own three 
share model programs.
  Insuring more working families will also take the pressure off state 
Medicaid budgets. Adequate care for those presently uninsured will also 
help slash the billions that is spent on uncompensated care.
  Providing health care for these families fulfills a moral commitment. 
No one in America who gets up in the morning and goes to work should go 
to sleep at night fearful that an illness or injury in the family could 
wipe out everything they have worked hard for. This is a great nation, 
and together we can ensure that no American has to go without health 
care again.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2544

       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 ``Health Care Access for Small 
     Businesses Act of 2004''.

     SEC. 2. THREE-SHARE PROGRAMS.

       The Social Security Act (42 U.S.C. 301 et seq.) is amended 
     by adding at the end the following:

               ``TITLE XXII--PROVIDING FOR THE UNINSURED

     ``SEC. 2201. THREE-SHARE PROGRAMS.

       ``(a) Pilot Programs.--The Secretary, acting through the 
     Administrator, shall award grants under this section for the 
     startup and operation of 50 eligible three-share pilot 
     programs for a 5-year period.
       ``(b) Grants for Three-Share Programs.--
       ``(1) Establishment.--The Administrator may award grants to 
     eligible entities--
       ``(A) to establish three-share programs;
       ``(B) to provide for contributions to the premiums assessed 
     for coverage under a three-share program as provided for in 
     subsection (c)(2)(B)(iii); and
       ``(C) to establish risk pools.
       ``(2) Three-share program plan.--Each entity desiring a 
     grant under this subsection shall develop a plan for the 
     establishment and operation of a three-share program that 
     meets the requirements of paragraphs (2) and (3) of 
     subsection (c).
       ``(3) Application.--Each entity desiring a grant under this 
     subsection shall submit an application to the Administrator 
     at such time, in such manner and containing such information 
     as the Administrator may require, including--
       ``(A) the three-share program plan described in paragraph 
     (2); and
       ``(B) an assurance that the eligible entity will--
       ``(i) determine a benefit package;
       ``(ii) recruit businesses and employees for the three-share 
     program;
       ``(iii) build and manage a network of health providers or 
     contract with an existing network or licensed insurance 
     provider;
       ``(iv) manage all administrative needs; and
       ``(v) establish relationships among community, business, 
     and provider interests.
       ``(4) Priority.--In awarding grants under this section the 
     Secretary shall give priority to an applicant--
       ``(A) that is an existing three-share program;
       ``(B) that is an eligible three-share program that has 
     demonstrated community support; or
       ``(C) that is located in a State with insurance laws and 
     regulations that permit three-share program expansion.
       ``(c) Grant Eligibility.--
       ``(1) In general.--The Secretary, acting through the 
     Administrator, shall promulgate regulations providing for the 
     eligibility of three-share programs for participation in the 
     pilot program under this section.
       ``(2) Three-share program requirements.--
       ``(A) In general.--To be determined to be an eligible 
     three-share program for purposes of participation in the 
     pilot program under this section a three-share program 
     shall--
       ``(i) be either a non-profit or local governmental entity;
       ``(ii) define the region in which such program will provide 
     services;
       ``(iii) have the capacity to carry out administrative 
     functions of managing health plans, including monthly 
     billings, verification/enrollment of eligible employers and 
     employees, maintenance of membership rosters, development of 
     member materials (such as handbooks and identification 
     cards), customer service, and claims processing; and
       ``(iv) have demonstrated community involvement.
       ``(B) Payment.--To be eligible under paragraph (1), a 
     three-share program shall pay

[[Page 12731]]

     the costs of services provided under subparagraph (A)(ii) by 
     charging a monthly premium for each covered individual to be 
     divided as follows:
       ``(i) Not more than 30 percent of such premium shall be 
     paid by a qualified employee desiring coverage under the 
     three-share program.
       ``(ii) Not more than 30 percent of such premium shall be 
     paid by the qualified employer of such a qualified employee.
       ``(iii) At least 40 percent of such premium shall be paid 
     from amounts provided under a grant under this section.
       ``(iv) Any remaining amount shall be paid by the three-
     share program from other public, private, or charitable 
     sources.
       ``(C) Program flexibility.--A three-share program may set 
     an income eligibility guideline for enrollment purposes.
       ``(3) Coverage.--
       ``(A) In general.--To be an eligible three-share program 
     under this section, the three-share program shall provide at 
     least the following benefits:
       ``(i) Physicians services.
       ``(ii) In-patient hospital services.
       ``(iii) Out-patient services.
       ``(iv) Emergency room visits.
       ``(v) Emergency ambulance services.
       ``(vi) Diagnostic lab fees and x-rays.
       ``(vii) Prescription drug benefits.
       ``(B) Limitation.--Nothing in subparagraph (A) shall be 
     construed to require that a three-share program provide 
     coverage for services performed outside the region described 
     in paragraph (2)(A)(i).
       ``(C) Preexisting conditions.--A program described in 
     subparagraph (A) shall not be an eligible three-share program 
     under paragraph (1) if any individual can be excluded from 
     coverage under such program because of a preexisting health 
     condition.
       ``(d) Grants for Existing Three-Share Programs To Meet 
     Certification Requirements.--
       ``(1) In general.--The Administrator may award grants to 
     three-share programs that are operating on the date of 
     enactment of this section.
       ``(2) Application.--Each eligible entity desiring a grant 
     under this subsection shall submit an application to the 
     Administrator at such time, in such manner, and containing 
     such information as the Administrator may require.
       ``(e) Application of State Laws.--Nothing in this section 
     shall be construed to preempt State law.
       ``(f) Distressed Business Formula.--
       ``(1) In general.--Not later than 60 days after the date of 
     enactment of this section, the Administrator of the Health 
     Resources and Services Administration shall develop a formula 
     to determine which businesses qualify as distressed 
     businesses for purposes of this section.
       ``(2) Effect on insurance market.--Granting eligibility to 
     a distressed business using the formula under paragraph (1) 
     shall not interfere with the insurance market. Any business 
     found to have reduced benefits to qualify as a distressed 
     business under the formula under paragraph (1) shall not be 
     eligible to be a three-share program for purposes of this 
     section.
       ``(g) Definitions.--In this section:
       ``(1) Administrator.--The term `Administrator' means the 
     Administrator of the Health Resources and Services 
     Administration.
       ``(2) Covered individual.--The term `covered individual' 
     means--
       ``(A) a qualified employee; or
       ``(B) a child under the age of 23 or a spouse of such 
     qualified employee who--
       ``(i) lacks access to health care coverage through their 
     employment or employer;
       ``(ii) lacks access to health coverage through a family 
     member;
       ``(iii) is not eligible for coverage under the medicare 
     program under title XVIII or the medicaid program under title 
     XIX; and
       ``(iv) does not qualify for benefits under the State 
     Children's Health Insurance Program under title XXI.
       ``(3) Distressed business.--The term `distressed business' 
     means a business that--
       ``(A) in light of economic hardship and rising health care 
     premiums may be forced to discontinue or scale back its 
     health care coverage; and
       ``(B) qualifies as a distressed business according to the 
     formula under subsection (g).
       ``(4) Eligible entity.--The term `eligible entity' means an 
     entity that meets the requirements of subsection (a)(2)(A).
       ``(5) Qualified employee.--The term `qualified employee' 
     means any individual employed by a qualified employer who 
     meets certain criteria including--
       ``(A) lacking access to health coverage through a family 
     member or common law partner;
       ``(B) not being eligible for coverage under the medicare 
     program under title XVIII or the medicaid program under title 
     XIX; and
       ``(C) agreeing that the share of fees described in 
     subsection (a)(2)(B)(i) shall be paid in the form of payroll 
     deductions from the wages of such individual.
       ``(6) Qualified employer.--The term `qualified employer' 
     means an employer as defined in section 3(d) of the Fair 
     Labor Standards Act of 1938 (29 U.S.C. 203(d)) who--
       ``(A) is a small business concern as defined in section 
     3(a) of the Small Business Act (15 U.S.C. 632);
       ``(B) is located in the region described in subsection 
     (a)(2)(A)(i); and
       ``(C) has not contributed to the health care benefits of 
     its employees for at least 12 months consecutively or 
     currently provides insurance but is classified as a 
     distressed business.
       ``(g) Evaluation.--Not later than 90 days after the end of 
     the 5-year period during which grants are available under 
     this section, the General Accounting Office shall submit to 
     the Secretary and the appropriate committees of Congress a 
     report concerning--
       ``(1) the effectiveness of the programs established under 
     this section;
       ``(2) the number of individuals covered under such 
     programs;
       ``(3) any resulting best practices; and
       ``(4) the level of community involvement.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $100,000,000 for each of fiscal years 2005 through 2010.''.
                                 ______
                                 
      By Mr. NELSON of Florida (for himself and Mr. Rockefeller):
  S. 2545. A bill to amend title XVIII and XIX of the Social Security 
Act and title III of the Public Health Service Act to improve access to 
information about individual's health care options and legal rights for 
care near the end of life, to promote advance care planning and 
decisionmaking so that individuals' wishes are known should they become 
unable to speak for themselves, to engage health care providers in 
disseminating information about and assisting in the preparation of 
advance directives, which include living wills and durable powers of 
attorney for health care, and for other purposes; to the Committee on 
Finance.
  Mr. NELSON of Florida. Mr. President, I am pleased to be joined by my 
colleague and cosponsor Senator Jay Rockefeller as we introduce the 
Advance Directives Improvement and Education Act of 2004. Senators 
Rockefeller and Collins, along with Senator Wyden, sponsored a bill 
with similar goals in the 107th Congress and have provided invaluable 
support and counsel in drafting the bill we introduce today.
  The Advance Directives Improvement and Education Act of 2004 has a 
simple purpose: to encourage all adults in America, especially those 65 
and older, to think about, talk about and write down their wishes for 
medical care near the end-of-life should they become unable to make 
decisions for themselves. Advance directives, which include a living 
will, stating the individual's preferences for care, and a power of 
attorney for health care, are critical documents that each of us should 
have. The goal is clear, but reaching it requires that we educate the 
public about the importance of advance directives, offer opportunities 
for discussion of the issues, and reinforce the requirement that health 
care providers honor patients' wishes. This bill is designed to do just 
that.
  Americans are afraid of death. We don't like to think about it, talk 
about it, or plan for it. Any yet, we will all face it. Not only our 
own deaths, but our parents, siblings, friends, and sometimes, 
tragically, children. Today, most Americans face death unprepared. 
Family members frequently end up making critical medical decisions for 
incapacitated patients, yet they, too, are unprepared. Only 15 to 20 
percent of adults have advance directives. Among this group, many have 
not discussed the contents of these important documents with their 
families or even the person named as the health care proxy.
  It is time to bring this discussion into the mainstream. Too much is 
at stake to continue to deny our mortality. You all know about the 
tragic situation going on in Florida with Terri Schiavo. Here is a 
young woman in a persistent vegetative state who is the subject of a 
debate about her treatment between her husband and her parents, a 
debate that has now become a court case and a legislative quagmire. 
Why? Because she didn't write down what type of care she would want in 
the event an accident, illness or other medical condition caused her to 
be in an incapacitated state. She is young and didn't think about death 
or dying. If she had an advance directive that made her wishes clear 
and named a health care proxy to make decisions for her should she be 
unable to do so for

[[Page 12732]]

herself, the treatment debate might continue, but there would be no 
question as to who could decide. The Supreme Court has clearly affirmed 
that competent adults have the right to refuse unwanted medical 
treatment Washington v. Glucksburg and Vacco v. Quill, 1997, but it 
also stressed that advance directives are a means of safeguarding that 
right should adults become incapable of deciding for themselves.
  Fortunately, situations like Mrs. Schiavo's are rare. Of the 2.5 
million people who die each year 83 percent are Medicare beneficiaries. 
In fact, 27 percent of Medicare expenditures cover care in the last 
year of life. Remember, everyone who enrolls in Medicare will die on 
Medicare. The Advance Directives Improvement and Education Act 
encourages all Medicare beneficiaries to prepare advance directives by 
providing a free physician office visit for the purpose of discussing 
end-of-life care choices and other issues around medical decision-
making in a time of incapacitation. Physicians will be reimbursed for 
spending time with their patients to help them understand situations in 
which an advance directive would be useful, medical options, the 
Medicare hospice benefit and other concerns. The conversation will also 
enable phyisicans to learn about their patients' wishes, fears, 
religious beliefs, and life experiences that might influence their 
medical care wishes. These are important aspects of a physician-patient 
relationship that are too often unaddressed.
  Another part of our bill will provide funds for the Department of 
Health and Human Services to conduct a public education campaign to 
raise awareness of the importance of planning for care near the end of 
life. This campaign would explain what advance directives are, where 
they are available, what questions need to be asked and answered, and 
what to do with the executed documents. HHS, directly or through 
grants, would also establish an information clearinghouse where 
consumers could receive state-specific information and consumer-
friendly documents and publications.
  State-specific information is needed because in addition to the 
federal Patients Self-Determination Act passed in 1990, most states 
also have enacted advance directive laws. Because the state laws 
differ, some states may be reluctant to honor advance directives that 
were executed in another state. The bill we introduce today contains 
language that would make all advance directives ``portable,'' that is, 
useful from one state to another. As long as the documents were 
lawfully executed in the state of origin, they must be accepted and 
honored in the state in which they are presented, unless to do so would 
violate state law.
  All of the provisions in the Advance Directives Improvement and 
Education Act of 2004 are there for one reason: to increase the number 
of people in the United States who have advance directives, who have 
discussed their wishes with their physicians and families, and who have 
given copies of the directives to their loved ones, health care 
providers, and legal representatives.
  Senator Rockefeller and I all believe that as our Medicare population 
grows and life expectancy lengthens, improving care near the end of 
life must be a priority. Helping people complete these critical 
documents is an essential part of making the final journey as 
meaningful and peaceful as possible.
  Over the next decade or two our elderly population will grow. Baby-
boomers, used to having control of their lives and demanding the best, 
will be stunned to discover that good end-of-life care is hard to find. 
I recommend to all of you a report called Means to a Better End: A 
Report on Dying in America Today that was published in November 2002 by 
Last Acts Partnership. In it, every state and the District of Columbia 
was rated on eight different criteria to assess the state of end-of-
life care in this country. Not one state--not mine, not yours--received 
a high grade. Some did well in one or two areas, but none did well in 
half or more of the measures; all were mediocre at best. The 
researchers found that too many people end their days in hospitals and 
nursing homes, attached to machines, alone, in pain. Doctors, not 
wanting to admit ``failure,'' as many of them see death, urge 
aggressive treatments such as chemotherapy on patients who have little 
chance of responding to it. Pain medication is often underprescribed or 
withheld for fear that the dying patient--dying patient--might become 
addicted to the drug.
  The good news is that growing numbers of health care providers, 
nonprofit organizations and consumer advocates recognize the need for 
change. New palliative care programs, pain protocols and hospice 
services are being instituted in facilities around the country. Another 
Last Acts Partnership publication, On the Road from Theory to Practice 
highlights the best programs and practices for others to emulate.
  This body is a legislative institution not a medical one--with the 
exception of the distinguished majority leader, of course. We cannot 
legislate good medical care or compassion. What we can do, what I hope 
we will do, is to enact this bill so that the American public can 
participate in improving end-of-life care--first, by filling out their 
own advice directives and talking to their families about them; and by 
raising their voices to demand that our health care systems honor their 
wishes and improve the way they care for people who are near the end of 
life. If we can do that, we will have done a great deal.
  I ask unanimous consent that the full text of the bill be printed in 
the Record.
  Mr. President, I also ask that a letter of support for this 
legislation from the Last Acts Partnership also be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2545

       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 ``Advance 
     Directives Improvement and Education Act of 2004''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
Sec. 3. Medicare coverage of end-of-life planning consultations.
Sec. 4. Improvement of policies related to the use and portability of 
              advance directives.
Sec. 5. Increasing awareness of the importance of end-of-life planning.
Sec. 6. GAO studies and reports on end-of-life planning issues.

     SEC. 2. FINDINGS AND PURPOSES.

       (a) Findings.--Congress makes the following findings:
       (1) Every year 2,500,000 people die in the United States. 
     Eighty percent of those people die in institutions such as 
     hospitals, nursing homes, and other facilities. Chronic 
     illnesses, such as cancer and heart disease, account for 2 
     out of every 3 deaths.
       (2) In January 2004, a study published in the Journal of 
     the American Medical Association concluded that many people 
     dying in institutions have unmet medical, psychological, and 
     spiritual needs. Moreover, family members of decedents who 
     received care at home with hospice services were more likely 
     to report a favorable dying experience.
       (3) In 1997, the Supreme Court of the United States, in its 
     decisions in Washington v. Glucksberg and Vacco v. Quill, 
     reaffirmed the constitutional right of competent adults to 
     refuse unwanted medical treatment. In those cases, the Court 
     stressed the use of advance directives as a means of 
     safeguarding that right should those adults become incapable 
     of deciding for themselves.
       (4) A study published in 2002 estimated that the overall 
     prevalence of advance directives is between 15 and 20 percent 
     of the general population, despite the passage of the Patient 
     Self-Determination Act in 1990, which requires that health 
     care providers tell patients about advance directives.
       (5) Competent adults should complete advance care plans 
     stipulating their health care decisions in the event that 
     they become unable to speak for themselves. Through the 
     execution of advance directives, including living wills and 
     durable powers of attorney for health care according to the 
     laws of the State in which they reside, individuals can 
     protect their right to express their wishes and have them 
     respected.
       (b) Purposes.--The purposes of this Act are to improve 
     access to information about individuals' health care options 
     and legal rights for care near the end of life, to promote 
     advance care planning and decisionmaking so that individuals' 
     wishes are known should they become unable to speak for 
     themselves, to engage health care providers in disseminating 
     information about

[[Page 12733]]

     and assisting in the preparation of advance directives, which 
     include living wills and durable powers of attorney for 
     health care, and for other purposes.

     SEC. 3. MEDICARE COVERAGE OF END-OF-LIFE PLANNING 
                   CONSULTATIONS.

       (a) Coverage.--Section 1861(s)(2) of the Social Security 
     Act (42 U.S.C. 1395x(s)(2)), as amended by section 642(a) of 
     the Medicare Prescription Drug, Improvement, and 
     Modernization Act of 2003 (Public Law 108-173; 117 Stat. 
     2322), is amended--
       (1) in subparagraph (Y), by striking ``and'' at the end;
       (2) in subparagraph (Z), by inserting ``and'' at the end; 
     and
       (3) by adding at the end the following new subparagraph:
       ``(AA) end-of-life planning consultations (as defined in 
     subsection (bbb));''.
       (b) Services Described.--Section 1861 of the Social 
     Security Act (42 U.S.C. 1395x), as amended by section 706(b) 
     of the Medicare Prescription Drug, Improvement, and 
     Modernization Act of 2003 (Public Law 108-173; 117 Stat. 
     2339), is amended by adding at the end the following new 
     subsection:

                  ``End-of-Life Planning Consultation

       ``(bbb) The term `end-of-life planning consultation' means 
     physicians' services--
       ``(1) consisting of a consultation between the physician 
     and an individual regarding--
       ``(A) the importance of preparing advance directives in 
     case an injury or illness causes the individual to be unable 
     to make health care decisions;
       ``(B) the situations in which an advance directive is 
     likely to be relied upon;
       ``(C) the reasons that the development of a comprehensive 
     end-of-life plan is beneficial and the reasons that such a 
     plan should be updated periodically as the health of the 
     individual changes;
       ``(D) the identification of resources that an individual 
     may use to determine the requirements of the State in which 
     such individual resides so that the treatment wishes of that 
     individual will be carried out if the individual is unable to 
     communicate those wishes, including requirements regarding 
     the designation of a surrogate decision maker (health care 
     proxy); and
       ``(E) whether or not the physician is willing to follow the 
     individual's wishes as expressed in an advance directive; and
       ``(2) that are furnished to an individual on an annual 
     basis or immediately following any major change in an 
     individual's health condition that would warrant such a 
     consultation (whichever comes first).''.
       (c) Waiver of Deductible and Coinsurance.--
       (1) Deductible.--The first sentence of section 1833(b) of 
     the Social Security 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 end-of-life planning consultation (as defined 
     in section 1861(bbb))''.
       (2) Coinsurance.--Section 1833(a)(1) of the Social Security 
     Act (42 U.S.C. 1395l(a)(1)) is amended--
       (A) in clause (N), by inserting ``(or 100 percent in the 
     case of an end-of-life planning consultation, as defined in 
     section 1861(bbb))'' after ``80 percent''; and
       (B) in clause (O), by inserting ``(or 100 percent in the 
     case of an end-of-life planning consultation, as defined in 
     section 1861(bbb))'' after ``80 percent''.
       (d) Payment for Physicians' Services.--Section 1848(j)(3) 
     of the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as 
     amended by section 611(c) of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (Public Law 108-
     173; 117 Stat. 2304), is amended by inserting ``(2)(AA),'' 
     after ``(2)(W),''.
       (e) Frequency Limitation.--Section 1862(a)(1) of the Social 
     Security Act (42 U.S.C. 1395y(a)(1)), as amended by section 
     613(c) of the Medicare Prescription Drug, Improvement, and 
     Modernization Act of 2003 (Public Law 108-173; 117 Stat. 
     2306), is amended--
       (1) by striking ``and'' at the end of subparagraph (L);
       (2) by striking the semicolon at the end of subparagraph 
     (M) and inserting ``, and''; and
       (3) by adding at the end the following new subparagraph:
       ``(N) in the case of end-of-life planning consultations (as 
     defined in section 1861(bbb)), which are performed more 
     frequently than is covered under paragraph (2) of such 
     section;''.
       (f) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after January 1, 
     2005.

     SEC. 4. IMPROVEMENT OF POLICIES RELATED TO THE USE AND 
                   PORTABILITY OF ADVANCE DIRECTIVES.

       (a) Medicare.--Section 1866(f) of the Social Security Act 
     (42 U.S.C. 1395cc(f)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (B), by inserting ``and if presented by 
     the individual (or on behalf of the individual), to include 
     the content of such advance directive in a prominent part of 
     such record'' before the semicolon at the end;
       (B) in subparagraph (D), by striking ``and'' after the 
     semicolon at the end;
       (C) in subparagraph (E), by striking the period at the end 
     and inserting ``; and''; and
       (D) by inserting after subparagraph (E) the following new 
     subparagraph:
       ``(F) to provide each individual with the opportunity to 
     discuss issues relating to the information provided to that 
     individual pursuant to subparagraph (A) with an appropriately 
     trained professional.'';
       (2) in paragraph (3), by striking ``a written'' and 
     inserting ``an''; and
       (3) by adding at the end the following new paragraph:
       ``(5)(A) In addition to the requirements of paragraph (1), 
     a provider of services, Medicare Advantage organization, or 
     prepaid or eligible organization (as the case may be) shall 
     give effect to an advance directive executed outside the 
     State in which such directive is presented, even one that 
     does not appear to meet the formalities of execution, form, 
     or language required by the State in which it is presented to 
     the same extent as such provider or organization would give 
     effect to an advance directive that meets such requirements, 
     except that a provider or organization may decline to honor 
     such a directive if the provider or organization can 
     reasonably demonstrate that it is not an authentic expression 
     of the individual's wishes concerning his or her health care. 
     Nothing in this paragraph shall be construed to authorize the 
     administration of medical treatment otherwise prohibited by 
     the laws of the State in which the directive is presented.
       ``(B) The provisions of this paragraph shall preempt any 
     State law to the extent such law is inconsistent with such 
     provisions. The provisions of this paragraph shall not 
     preempt any State law that provides for greater portability, 
     more deference to a patient's wishes, or more latitude in 
     determining a patient's wishes.''.
       (b) Medicaid.--Section 1902(w) of the Social Security Act 
     (42 U.S.C. 1396a(w)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (B)--
       (i) by striking ``in the individual's medical record'' and 
     inserting ``in a prominent part of the individual's current 
     medical record''; and
       (ii) by inserting ``and if presented by the individual (or 
     on behalf of the individual), to include the content of such 
     advance directive in a prominent part of such record'' before 
     the semicolon at the end;
       (B) in subparagraph (D), by striking ``and'' after the 
     semicolon at the end;
       (C) in subparagraph (E), by striking the period at the end 
     and inserting ``; and''; and
       (D) by inserting after subparagraph (E) the following new 
     subparagraph:
       ``(F) to provide each individual with the opportunity to 
     discuss issues relating to the information provided to that 
     individual pursuant to subparagraph (A) with an appropriately 
     trained professional.'';
       (2) in paragraph (4), by striking ``a written'' and 
     inserting ``an''; and
       (3) by adding at the end the following paragraph:
       ``(6)(A) In addition to the requirements of paragraph (1), 
     a provider or organization (as the case may be) shall give 
     effect to an advance directive executed outside the State in 
     which such directive is presented, even one that does not 
     appear to meet the formalities of execution, form, or 
     language required by the State in which it is presented to 
     the same extent as such provider or organization would give 
     effect to an advance directive that meets such requirements, 
     except that a provider or organization may decline to honor 
     such a directive if the provider or organization can 
     reasonably demonstrate that it is not an authentic expression 
     of the individual's wishes concerning his or her health care. 
     Nothing in this paragraph shall be construed to authorize the 
     administration of medical treatment otherwise prohibited by 
     the laws of the State in which the directive is presented.
       ``(B) The provisions of this paragraph shall preempt any 
     State law to the extent such law is inconsistent with such 
     provisions. The provisions of this paragraph shall not 
     preempt any State law that provides for greater portability, 
     more deference to a patient's wishes, or more latitude in 
     determining a patient's wishes.''.
       (c) Effective Dates.--
       (1) In general.--Subject to paragraph (2), the amendments 
     made by subsections (a) and (b) shall apply to provider 
     agreements and contracts entered into, renewed, or extended 
     under title XVIII of the Social Security Act (42 U.S.C. 1395 
     et seq.), and to State plans under title XIX of such Act (42 
     U.S.C. 1396 et seq.), on or after such date as the Secretary 
     of Health and Human Services specifies, but in no case may 
     such date be later than 1 year after the date of enactment of 
     this Act.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     legislation in order for the plan to meet the additional 
     requirements imposed by the amendments made by subsection 
     (b), the State plan shall not be regarded as failing to 
     comply with the requirements of such title solely on the 
     basis of its failure to meet these additional requirements 
     before the first day of the first calendar quarter beginning 
     after the close of

[[Page 12734]]

     the first regular session of the State legislature that 
     begins after the date of enactment of this Act. For purposes 
     of the previous sentence, in the case of a State that has a 
     2-year legislative session, each year of the session is 
     considered to be a separate regular session of the State 
     legislature.

     SEC. 5. INCREASING AWARENESS OF THE IMPORTANCE OF END-OF-LIFE 
                   PLANNING.

       Title III of the Public Health Service Act is amended by 
     adding at the end the following new part:

``PART R--PROGRAMS TO INCREASE AWARENESS OF ADVANCE DIRECTIVE PLANNING 
                                 ISSUES

     ``SEC. 399Z-1. ADVANCE DIRECTIVE EDUCATION CAMPAIGNS AND 
                   INFORMATION CLEARINGHOUSES.

       ``(a) Advance Directive Education Campaign.--The Secretary 
     shall, directly or through grants awarded under subsection 
     (c), conduct a national public education campaign--
       ``(1) to raise public awareness of the importance of 
     planning for care near the end of life;
       ``(2) to improve the public's understanding of the various 
     situations in which individuals may find themselves if they 
     become unable to express their health care wishes;
       ``(3) to explain the need for readily available legal 
     documents that express an individual's wishes, through 
     advance directives (including living wills, comfort care 
     orders, and durable powers of attorney for health care); and
       ``(4) to educate the public about the availability of 
     hospice care and palliative care.
       ``(b) Information Clearinghouse.--The Secretary, directly 
     or through grants awarded under subsection (c), shall provide 
     for the establishment of a national, toll-free, information 
     clearinghouse as well as clearinghouses that the public may 
     access to find out about State-specific information regarding 
     advance directive and end-of-life decisions.
       ``(c) Grants.--
       ``(1) In general.--The Secretary shall use at least 60 
     percent of the funds appropriated under subsection (d) for 
     the purpose of awarding grants to public or nonprofit private 
     entities (including States or political subdivisions of a 
     State), or a consortium of any of such entities, for the 
     purpose of conducting education campaigns under subsection 
     (a) and establishing information clearinghouses under 
     subsection (b).
       ``(2) Period.--Any grant awarded under paragraph (1) shall 
     be for a period of 3 years.
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $25,000,000.''.

     SEC. 6. GAO STUDIES AND REPORTS ON END-OF-LIFE PLANNING 
                   ISSUES.

       (a) Study and Report on Compliance With Advance Directives 
     and Other Advance Planning Documents.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct a study on the effectiveness of advance 
     directives in making patients' wishes known and honored by 
     health care providers.
       (2) Report.--Not later than the date that is 18 months 
     after the date of enactment of this Act, the Comptroller 
     General shall submit to Congress a report on this study 
     conducted under paragraph (1) together with recommendations 
     for such legislation and administrative action as the 
     Comptroller General determines to be appropriate.
       (b) Study and Report on Establishment of National Advance 
     Directive Registry.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct a study on the implementation of the amendments 
     made by section 3 (relating to medicare coverage of end-of-
     life planning consultations).
       (2) Report.--Not later than 2 years after the date of 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report on this study conducted under paragraph 
     (1) together with recommendations for such legislation and 
     administrative action as the Comptroller General determines 
     to be appropriate.
       (c) Study and Report on Establishment of National Advance 
     Directive Registry.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct a study on the feasibility of a national 
     registry for advance directives, taking into consideration 
     the constraints created by the privacy provisions enacted as 
     a result of the Health Insurance Portability and 
     Accountability Act.
       (2) Report.--Not later than 18 months after the date of 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report on this study conducted under paragraph 
     (1) together with recommendations for such legislation and 
     administrative action as the Comptroller General determines 
     to be appropriate.
                                  ____



                                        Last Acts Partnership,

                                    Washington, DC, June 17, 2004.
     Senator Bill Nelson,
     U.S. Senate,
     Washington, DC.
       Dear Senator Nelson: On behalf of Last Acts Partnership, a 
     national nonprofit organization dedicated to improving care 
     and caring near the end of life, I thank you for introducing 
     the ``Advance Directives Improvement and Education Act of 
     2004.'' Your recognition of the importance of advance care 
     planning and your leadership in crafting this legislation is 
     greatly appreciated. We applaud your commitment to educating 
     Americans about the need for these critical documents and 
     support the goal of encouraging all Medicare beneficiaries to 
     discuss advance directives with their physicians and 
     families.
       A life-threatening or terminal illness or a tragic accident 
     takes its toll not only on the patient but on his or her 
     family as well. After more than 60 years of working in the 
     end-of-life care field, Last Acts Partnership (formerly 
     Partnership for Caring and Choice in Dying) knows full well 
     how much worse it is when people are asked to make decisions 
     for a loved one having never discussed his or her wishes for 
     care at the end of life. Advance directives and the necessary 
     conversations that should accompany them are a gift to guide 
     those who find themselves responsible for another's care.
       Ensuring that each of us receives the kind of care we want 
     if we are incapacitated or approaching death must be a policy 
     priority as we look to the future of health care. The 
     portability provision in your bill is another necessary step 
     toward that goal. Providing an information clearinghouse is 
     also key because too many people, including health care 
     providers, are unaware of options such as hospice and 
     palliative care, home care, spiritual counseling and other 
     resources.
       Again, Senator, we thank you, your cosponsors, and all of 
     the senators who join in support of this important 
     legislation. Last Acts Partnership looks forward to assisting 
     you and your staff as it moves through the legislative 
     process. Our membership and our collegial organizations will 
     be working to support the passage of the ``Advance Directives 
     Improvement and Education Act of 2004'' and, more 
     importantly, to assure that the health care wishes of our 
     loved ones and ourselves will be honored.
           Sincerely,

                                          Karen Orloff Kaplan,

                                                    MSW, MPH, ScD,
                                                President and CEO.
                                 ______
                                 
      By Mr. DURBIN:
  S. 2546. A bill to amend the Federal Food, Drug, and Cosmetic Act to 
require premarket consultation and approval with respect to genetically 
engineered foods, and for other purposes; to the Committee on 
Agriculture, Nutrition, and Forestry.
  Mr. DURBIN. Mr. President, today I am introducing legislation that 
will strengthen consumer confidence in the safety of genetically 
engineered food and genetically engineered animals that may enter the 
food supply. This bill, known as the Genetically Engineered Food Act 
(GEFA) of 2004, requires the Federal Food and Drug Administration (FDA) 
to conduct an environmental and safety review of all genetically 
engineered plants and animals that may enter the food supply.
  Our country has been blessed with one of the safest and most abundant 
food supplies in the world but we can do better. Genetically engineered 
foods have become a major portion of the American food supply and 
promise to become a larger part in the future. The next generation of 
genetically engineered foods will be more complex, will possess more 
novel genetic variations and will challenge regulatory agencies' 
ability to assess and manage their food safety and potential 
environmental effects.
  Currently, the FDA screens genetically engineered foods through a 
voluntary consultation program. Despite assurances from the FDA for the 
past two years that the proposed and more stringent ``pre-market 
biotechnology notification'' (PBN) rules governing genetically 
engineered foods were imminent, those rules have yet to appear.
  The Genetically Engineered Food Act of 2004 will create a transparent 
process that promotes public participation as decisions are made 
regarding the safety and environmental impact of genetically engineered 
plants and animals.
  This bill will make the review process mandatory in place of the 
current voluntary system, which will reduce the chance that a 
potentially harmful product could bypass or receive inadequate 
regulatory oversight. The measure will establish unambiguous and 
predictable pathways for developers of genetically modified foods to 
gain approval to go to market and will ensure consumer confidence in 
the integrity of the system through a fully transparent review process.
  An improved regulatory system for genetically engineered foods will 
boost consumer confidence in biotechnology derived foods, give federal 
agencies

[[Page 12735]]

clear legal authority to deal with new technology and provide a process 
to detect problems even after genetically engineered foods are 
approved.
  The Genetically Engineered Food Act of 2004 will strengthen 
government oversight in several important ways.
  Mandatory Review: Producers of genetically engineered foods will be 
required to receive approval from the FDA before introducing their 
products into interstate commerce. The FDA will ensure, based on the 
best scientific evidence, that genetically engineered foods are just as 
safe as comparable food products before allowing them on the market.
  Public Involvement and Transparency: In order for our country to gain 
the benefits that genetically engineered plants and animals can offer 
as additional sources of food, public confidence must be maintained in 
the safety of these products. My bill will provide for public 
involvement in the approval process by providing information to 
consumers, and giving them the opportunity to provide comments. Adding 
transparency will increase the public's understanding and confidence in 
the safety of these animals as they enter the food supply.
  Scientific studies and other materials submitted to the FDA as part 
of the mandatory review of genetically engineered foods will be made 
available for public review and comment. Members of the public will be 
able to submit any new information on genetically engineered foods not 
previously available to the FDA and request a new review of a 
particular genetically engineered food product even if that food is 
already on the market.
  Testing: The FDA, in conjunction with other Federal agencies, will be 
given the authority to conduct scientifically-sound testing to 
determine whether genetically engineered foods are inappropriately 
entering the food supply.
  Communication: The FDA and other Federal agencies will establish a 
registry of genetically engineered foods for easy access to information 
about those foods that have been cleared for market. The genetically 
engineered food review process will be fully transparent to give the 
public access to all non-confidential information.
  Environmental Review with Respect to Animals: While genetically 
engineered foods such as corn and soybeans are already part of our food 
supply, genetically engineered animals will also soon be ready for 
market approval. These animals hold much promise as an additional 
source of food for our nation. However, we must ensure not only the 
safety of these genetically engineered animals as they enter the food 
supply, but also the impact of these animals as they come in contact 
with the environment.
  The provisions of my bill are consistent with the recommendations 
made in the 2004 National Academy of Sciences report, ``Biological 
Confinement of Genetically Engineered Organisms''; the Pew Initiative 
on Food and Biotechnology 2004 report, ``Issues in the Regulation of 
Genetically Engineered Plants and Animals''; and the 2004 report from 
the Ecological Society of America, ``Genetically Engineered Organisms 
and the Environment''.
  The FDA has a mandatory review process in place that is used to 
review the food safety of genetically engineered animals before they 
enter the food supply. However, this bill will provide the FDA with 
additional oversight authorities to address the potential environmental 
impact of genetically engineered animals prior to their safety 
approval.
  Environmental issues have been identified as a major science-based 
concern associated with genetically engineered animals. Therefore, to 
obtain approval to market a genetically engineered animal, the 
developer must include an environmental assessment that analyzes the 
potential effects of the genetically engineered animal on the 
environment. A plan must also be in place to reduce or eliminate any 
negative effects. If the environmental assessment is not adequate, 
approval will not be granted.
  I urge my colleagues to join me in this effort to strengthen consumer 
confidence in the safety of genetically engineered foods and 
genetically engineered animals that may enter the food supply. The 
Genetically Engineered Foods Act of 2004 will help provide the public 
with the added assurance that genetically engineered foods and animals 
are safe to produce and consume. I ask unanimous consent that the text 
of the legislation be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2546

       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 ``Genetically Engineered Foods 
     Act''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) genetically engineered food is rapidly becoming an 
     integral part of domestic and international food supplies;
       (2) the potential positive effects of genetically 
     engineered foods are enormous;
       (3) the potential for both anticipated and unanticipated 
     effects exists with genetic engineering of foods;
       (4) genetically engineered food not approved for human 
     consumption has, in the past, entered the human food supply;
       (5) environmental issues have been identified as a major 
     science-based concern associated with animal biotechnology;
       (6) it is essential to maintain--
       (A) public confidence in--
       (i) the safety of the food supply; and
       (ii) the ability of the Federal Government to exercise 
     adequate oversight of genetically engineered foods; and
       (B) the ability of agricultural producers and other food 
     producers of the United States to market, domestically and 
     internationally, foods that have been genetically engineered;
       (7) public confidence can best be maintained through 
     careful review and formal determination of the safety of 
     genetically engineered foods, and monitoring of the positive 
     and negative effects of genetically engineered foods as the 
     foods become integrated into the food supply, through a 
     review and monitoring process that--
       (A) is scientifically sound, open, and transparent;
       (B) fully involves the general public; and
       (C) does not subject most genetically engineered foods to 
     the lengthy food additive approval process; and
       (8) because genetically engineered foods are developed 
     worldwide and imported into the United States, it is 
     imperative that imported genetically engineered food be 
     subject to the same level of oversight as domestic 
     genetically engineered food.

     SEC. 3. DEFINITIONS.

       (a) This Act.--In this Act, the terms ``genetic engineering 
     technique'', ``genetically engineered animal'', ``genetically 
     engineered food'', ``interstate commerce'', ``producer'', 
     ``safe'', and ``Secretary'' have the meanings given those 
     terms in section 201 of the Federal Food, Drug, and Cosmetic 
     Act (21 U.S.C. 321) (as amended by subsection (b)).
       (b) Federal Food, Drug, and Cosmetic Act.--Section 201 of 
     the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321) is 
     amended--
       (1) in subsection (v)--
       (A) by striking ``(v) The term'' and inserting the 
     following:
       ``(v) New Animal Drug.--
       ``(1) In general.--The term'';
       (B) by striking ``(1) the composition'' and inserting ``(A) 
     the composition'';
       (C) by striking ``(2) the composition'' and inserting ``(B) 
     the composition''; and
       (D) by adding at the end the following:
       ``(2) Inclusion.--The term `new animal drug' includes--
       ``(A) a genetic engineering technique intended to be used 
     to produce an animal; and
       ``(B) a genetically engineered animal.''; and
       (2) by adding at the end the following:
       ``(nn) Genetically Engineered Animal.--
       (1) In general.--The term `genetically engineered animal' 
     means an animal that--
       ``(A) is intended to be used--
       ``(i) in the production of a food or dietary supplement; or
       ``(ii) for any other purpose;
       ``(B)(i) is produced in the United States; or
       ``(ii) is offered for import into the United States; and
       ``(C) is produced using a genetic engineering technique.
       ``(2) Exclusion.--The term `genetically engineered animal' 
     does not include an established line of a genetically 
     modified animal that--
       ``(A) is used solely in scientific research; and
       ``(B) is not intended or expected--
       ``(i) to enter the food supply; or
       ``(ii) to be released into the environment.
       ``(oo) Genetically Engineered Food.--
       ``(1) In general.--The term `genetically engineered food' 
     means a food or dietary supplement, or a seed, microorganism, 
     or ingredient intended to be used to produce a food or 
     dietary supplement, that--
       ``(A)(i) is produced in the United States; or
       ``(ii) is offered for import into the United States; and

[[Page 12736]]

       ``(B) is produced using a genetic engineering technique.
       ``(2) Inclusion.--The term `genetically engineered food' 
     includes a split use food.
       ``(3) Exclusion.--The term `genetically engineered food' 
     does not include a genetically engineered animal.
       ``(pp) Genetic Engineering Technique.--The term `genetic 
     engineering technique' means the use of a transformation 
     event to derive food from a plant or animal or to produce an 
     animal.
       ``(qq) Producer.--The term `producer', with respect to a 
     genetically engineered animal, genetically engineered food, 
     or genetic engineering technique, means a person that--
       ``(1) develops, manufactures, or imports the genetically 
     engineered animal or genetically engineered food;
       ``(2) uses the genetic engineering technique; or
       ``(3) takes other action to introduce the genetically 
     engineered animal, genetically engineered food, or genetic 
     engineering technique into interstate commerce.
       ``(rr) Safe.--The term `safe', with respect to a 
     genetically engineered food, means--
       ``(1) as safe as comparable food that is not produced using 
     a genetic engineering technique; or
       ``(2) if there is no such comparable food, having a 
     reasonable certainty of causing no harm.
       ``(ss) Split Use Food.--The term `split use food' means a 
     product that--
       ``(1)(A) is produced in the United States; or
       ``(B) is offered for import into the United States;
       ``(2) is produced using a genetic engineering technique; 
     and
       ``(3) could be used as food by both humans and animals but 
     that the producer does not intend to market as food for 
     humans.
       ``(tt) Transformation Event.--The term `transformation 
     event' means the introduction into a plant or an animal of 
     genetic material that has been manipulated in vitro.''.

     SEC. 4. GENETICALLY ENGINEERED FOODS.

       Chapter IV of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 341 et seq.) is amended--
       (1) by inserting after the chapter heading the following:

               ``Subchapter A--General Provisions''; and

       (2) by adding at the end the following:

              ``Subchapter B--Genetically Engineered Foods

     ``SEC. 421. PREMARKET CONSULTATION AND APPROVAL.

       ``(a) In General.--A producer of genetically engineered 
     food, before introducing a genetically engineered food into 
     interstate commerce, shall first obtain approval through the 
     use of a premarket consultation and approval process.
       ``(b) Regulations.--The Secretary shall promulgate 
     regulations that describe--
       ``(1) all information that is required to be submitted for 
     the premarketing approval process, including--
       ``(A) specification of the species or other taxonomic 
     classification of plants for which approval is sought;
       ``(B) identification of the genetically engineered food;
       ``(C)(i) a description of each type of genetic manipulation 
     made to the genetically engineered food;
       ``(ii) identification of the manipulated genetic material; 
     and
       ``(iii) the techniques used in making the manipulation;
       ``(D) the effect of the genetic manipulation on the 
     composition of the genetically engineered food (including 
     information describing the specific substances that were 
     expressed, removed, or otherwise manipulated);
       ``(E) a description of the actual or proposed applications 
     and uses of the genetically engineered food;
       ``(F) information pertaining to--
       ``(i) the safety of the genetically engineered food as a 
     whole; and
       ``(ii) the safety of any specific substances introduced, 
     altered, or produced as a result of the genetic manipulation 
     (including information on allergenicity and toxicity);
       ``(G) test methods for detection of the genetically 
     engineered ingredients in food;
       ``(H) a summary and overview of information and issues that 
     have been or will be addressed by other regulatory programs 
     for the review of genetically engineered food;
       ``(I) procedures to be followed to initiate and complete 
     the premarket approval process (including any preconsultation 
     and consultation procedures); and
       ``(J) any other matters that the Secretary determines to be 
     necessary.
       ``(2) Split use food.--
       ``(A) In general.--The regulations under paragraph (1) 
     shall provide for the approval of--
       ``(i) split use foods that are not approved for human 
     consumption;
       ``(ii) split use foods that are intended for human use but 
     are marketed under restricted conditions; and
       ``(iii) other categories of split use food.
       ``(B) Issues.--For each category of split use food, the 
     regulations shall address--
       ``(i)(I) whether a protocol is needed for segregating a 
     restricted split use food from the food supply; and
       ``(II) if so, what the protocol shall be;
       ``(ii)(I) whether action is needed to ensure the purity of 
     any seed to prevent unintended introduction of a genetically 
     engineered trait into a seed that is not designed for that 
     trait; and
       ``(II) if so, what action is needed and what industry 
     practices represent the best practices for maintaining the 
     purity of the seed;
       ``(iii)(I) whether a tolerance level should exist regarding 
     cross-mixing of segregated split use foods; and
       ``(II) if so, the means by which the tolerance level shall 
     be determined;
       ``(iv) the manner in which the food safety analysis under 
     this section should be conducted, specifying different 
     standards and procedures that are permitted to be applied for 
     nonfood products grown in food crops depending on the degree 
     of containment for that product and the likelihood of the 
     product to enter the food supply;
       ``(v)(I) the kinds of surveillance that are needed to 
     ensure that appropriate segregation of split use foods is 
     being maintained;
       ``(II) the manner in which and by whom the surveillance 
     shall be conducted; and
       ``(III) the manner in which the results of surveillance 
     shall be reported; and
       ``(vi) clarification of responsibility in cases of 
     breakdown of segregation of a split use food.
       ``(C) Recall authority.--The regulations shall provide 
     that, in addition to other authority that the Secretary has 
     regarding split use food, the Secretary may order a recall of 
     any split use food (whether or not the split use food has 
     been approved under this section) that--
       ``(i) is not approved, but has entered the food supply; or
       ``(ii) has entered the food supply in violation of a 
     condition of restriction under an approval.
       ``(c) Application.--The regulations shall require that, as 
     part of the consultation and approval process, a producer 
     submit to the Secretary an application that includes a 
     summary and a complete copy of each research study, test 
     result, or other information referenced by the producer.
       ``(d) Review.--
       ``(1) In general.--After receiving an application under 
     subsection (c), the Secretary shall--
       ``(A) determine whether the producer submitted information 
     that appears to be adequate to enable the Secretary to fully 
     assess the safety of the genetically engineered food, and 
     make a description of the determination publicly available; 
     and
       ``(B) if the Secretary determines that the producer 
     submitted adequate information--
       ``(i) provide public notice regarding the initiation of the 
     consultation and approval process;
       ``(ii) make the notice, application, summaries submitted by 
     the producer, and research, test results, and other 
     information referenced by the producer publicly available, 
     including, to the maximum extent practicable, publication in 
     the Federal Register and on the Internet; and
       ``(iii) provide the public with an opportunity, for not 
     less than 45 days, to submit comments on the application.
       ``(2) Exception.--The Secretary may withhold information in 
     an application from public dissemination to protect a trade 
     secret (not including any information disclosing the results 
     of testing to determine whether the genetically engineered 
     food is safe) if--
       ``(A) the information is exempt from disclosure under 
     section 522 of title 5, United States Code, or applicable 
     trade secret law;
       ``(B) the applicant--
       ``(i) identifies with specificity the trade secret 
     information in the application; and
       ``(ii) provides the Secretary with a detailed justification 
     for each trade secret claim; and
       ``(C) the Secretary--
       ``(i) determines that the information qualifies as a trade 
     secret subject to withholding from public dissemination; and
       ``(ii) makes the determination available to the public.
       ``(3) Determination.--Not later than 180 days after 
     determining adequacy of an application under paragraph 
     (1)(A), the Secretary shall issue and make publicly available 
     a determination that--
       ``(A) summarizes the information referenced by the producer 
     in light of the public comments; and
       ``(B) contains a finding that the genetically engineered 
     food--
       ``(i) is safe and may be introduced into interstate 
     commerce;
       ``(ii) is safe under specified conditions of use and may be 
     introduced into interstate commerce if those conditions are 
     met; or
       ``(iii) is not safe and may not be introduced into 
     interstate commerce, because the genetically engineered 
     food--

       ``(I) contains genes that confer antibiotic resistance;
       ``(II) contains an allergen; or

       ``(III) presents 1 or more other safety concerns described 
     by the Secretary.

       ``(4) Extension.--The Secretary may extend the period 
     specified in paragraph (3) if the Secretary determines that 
     an extension of the period is necessary to allow the 
     Secretary to--
       ``(A) review additional information; or

[[Page 12737]]

       ``(B) address 1 or more issues or concerns of unusual 
     complexity.
       ``(e) Rescission of Approval.--
       ``(1) Reconsideration.--On the petition of any person, or 
     on the Secretary's own motion, the Secretary may reconsider 
     an approval of a genetically engineered food on the basis of 
     information that was not available before the approval.
       ``(2) Finding for reconsideration.--The Secretary shall 
     conduct a reconsideration on the basis of the information 
     described in paragraph (1) if the Secretary finds that the 
     information--
       ``(A) is scientifically credible;
       ``(B) represents significant information that was not 
     available before the approval; and
       ``(C)(i) suggests potential impacts relating to the 
     genetically engineered food that were not considered in the 
     earlier review; or
       ``(ii) demonstrates that the information considered before 
     the approval was inadequate for the Secretary to make a 
     safety finding.
       ``(3) Information from the producer.--
       ``(A) In general.--In conducting the reconsideration, the 
     Secretary may require the producer to provide, within a 
     reasonable period of time specified by the Secretary, 
     information needed to facilitate the reconsideration.
       ``(B) Information not provided.--If a producer fails to 
     provide information required under subparagraph (A) within 
     the period specified by the Secretary, the Secretary shall 
     take 1 or more of the actions described in paragraph (5).
       ``(4) Determination.--After reviewing the information by 
     the petitioner and the producer, the Secretary shall issue a 
     determination that--
       ``(A) revises the finding made in connection with the 
     approval with respect to the safety of the genetically 
     engineered food; or
       ``(B) states that, for reasons stated by the Secretary, no 
     revision of the finding is needed.
       ``(5) Action by the secretary.--If, based on a 
     reconsideration under this section, the Secretary determines 
     that the genetically engineered food is not safe, the 
     Secretary shall--
       ``(A) rescind the approval of the genetically engineered 
     food for introduction into interstate commerce;
       ``(B) recall the genetically engineered food; or
       ``(C) take such other action as the Secretary determines to 
     be appropriate.

     ``SEC. 422. MARKETPLACE TESTING AND POST-MARKETING OVERSIGHT.

       ``(a) Testing.--
       ``(1) In general.--The Secretary, in consultation with the 
     Secretary of Agriculture and the Administrator of the 
     Environmental Protection Agency, shall establish a program to 
     conduct testing that the Secretary determines to be necessary 
     to detect, at all stages of production and distribution (from 
     agricultural production to retail sale), the presence of 
     genetically engineered ingredients in food.
       ``(2) Permissible testing.--Under the program, the 
     Secretary may conduct tests on foods to detect genetically 
     engineered ingredients--
       ``(A) that have not been approved for use under this Act, 
     including foods that are developed in foreign countries that 
     have not been approved for marketing in the United States 
     under this Act; or
       ``(B) the use of which is restricted under this Act 
     (including approval for use as animal feed only, approval 
     only if properly labeled, and approval for growing or 
     marketing only in certain regions).
       ``(b) Post-Market Oversight.--
       ``(1) In general.--The Secretary shall establish a program 
     to monitor and evaluate the continued safety after 
     commercialization of genetically engineered foods approved 
     under section 421.
       ``(2) Activities.--Under the program, the Secretary shall--
       ``(A) take appropriate actions to ensure that each split-
     use food complies with any restriction or other condition on 
     the approval of the split-use food; and
       ``(B) conduct inspections and monitoring of genetically 
     engineered foods and facilities that produce genetically 
     engineered foods to ensure that only approved genetically 
     engineered foods are marketed to humans.

     ``SEC. 423. REGISTRY.

       ``(a) Establishment.--The Secretary, in consultation with 
     the Secretary of Agriculture, the Administrator of the 
     Environmental Protection Agency, and the heads of other 
     agencies, as appropriate, shall establish a registry for 
     genetically engineered food that contains a description of 
     the regulatory status of all genetically engineered foods 
     approved under section 421.
       ``(b) Requirements.--The registry under subsection (a) 
     shall contain, for each genetically engineered food--
       ``(1) the technical and common names of the genetically 
     engineered food;
       ``(2) a description of the regulatory status, under all 
     Federal programs pertaining to the testing and approval of 
     genetically engineered foods, of the genetically engineered 
     food;
       ``(3) a technical and nontechnical summary of the type of, 
     and a statement of the reason for, each genetic manipulation 
     made to the genetically engineered food;
       ``(4) the name, title, address, and telephone number of an 
     official at each producer of the genetically engineered food 
     whom members of the public may contact for information about 
     the genetically engineered food;
       ``(5) the name, title, address, and telephone number of an 
     official at each Federal agency with oversight responsibility 
     over the genetically engineered food whom members of the 
     public may contact for information about the genetically 
     engineered food; and
       ``(6) such other information as the Secretary determines 
     should be included.
       ``(c) Public Availability.--The registry under subsection 
     (a) shall be made available to the public, including 
     availability on the Internet.''.

     SEC. 5. GENETICALLY ENGINEERED ANIMALS.

       Chapter V of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 351 et seq.) is amended by inserting after section 512 
     the following:

     ``SEC. 512A. GENETICALLY ENGINEERED ANIMALS.

       ``(a) In General.--Section 512 shall apply to genetic 
     engineering techniques intended to be used to produce an 
     animal, and to genetically engineered animals, as provided in 
     this section.
       ``(b) Application.--An application under section 512(b)(1) 
     shall include--
       ``(1) specification of the species or other taxonomic 
     classification of the animal for which approval is sought;
       ``(2) an environmental assessment that analyzes the 
     potential effects of the genetically engineered animal on the 
     environment, including the potential effect on any 
     nongenetically engineered animal or other part of the 
     environment as a result of any intentional or unintentional 
     exposure of the genetically engineered animal to the 
     environment; and
       ``(3) a plan to eliminate or mitigate the potential effects 
     to the environment from the release of the genetically 
     engineered animal.
       ``(c) Dissemination of Application and Opportunity for 
     Public Comment.--
       ``(1) In general.--On receipt of an application under 
     section 512(b)(1), the Secretary shall--
       ``(A) provide public notice regarding the application, 
     including making the notice available on the Internet;
       ``(B) make the application and all supporting material 
     available to the public, including availability on the 
     Internet; and
       ``(C) provide the public with an opportunity, for not less 
     than 45 days, to submit comments on the application.
       ``(2) Exception.--
       ``(A) In general.--The Secretary may withhold information 
     in an application from public dissemination to protect a 
     trade secret (not including any information disclosing the 
     results of testing to determine whether the genetically 
     engineered food is safe) if--
       ``(i) the information is exempt from disclosure under 
     section 522 of title 5, United States Code, or applicable 
     trade secret law;
       ``(ii) the applicant--

       ``(I) identifies with specificity the trade secret 
     information in the application; and
       ``(II) provides the Secretary with a detailed justification 
     for each trade secret claim; and

       ``(iii) the Secretary--

       ``(I) determines that the information qualifies as a trade 
     secret subject to withholding from public dissemination; and
       ``(II) makes the determination available to the public.

       ``(B) Risk assessment information.--This paragraph does not 
     apply to information that assesses risks from the release 
     into the environment of a genetically engineered animal 
     (including any environmental assessment or environmental 
     impact statement performed to comply with the National 
     Environmental Policy Act of 1969 (42 U.S.C. 4321 et seq.)).
       ``(d) Denial of Application.--Under section 512(d)(1), the 
     Secretary shall deny an application if--
       ``(1) the environmental assessment for a genetically 
     engineered animal is not adequate; or
       ``(2) the plan to eliminate or mitigate the potential 
     environmental effects to the environment from the release of 
     the genetically engineered animal does not adequately protect 
     the environment.
       ``(e) Environmental Assessment.--
       ``(1) In general.--Before determining whether to approve an 
     application under section 512 for approval of a genetic 
     engineering technique intended to be used to produce an 
     animal, or of a genetically engineered animal, the Secretary 
     shall--
       ``(A) conduct an environmental assessment to evaluate the 
     potential effects of such a genetically engineered animal on 
     the environment; and
       ``(B) determine that the genetically engineered animal will 
     not have an unreasonable adverse effect on the environment.
       ``(2) Consultation.--In conducting an environmental 
     assessment under paragraph (1), the Secretary shall--
       ``(A) consult, as appropriate, with the Department of 
     Agriculture, the United States Fish and Wildlife Service, and 
     any other Federal agency that has expertise relating to the 
     animal species that is the subject of the application; and

[[Page 12738]]

       ``(B) disclose the results of the consultation in the 
     environmental assessment.
       ``(f) Safety Determination.--In determining the safety of a 
     genetic engineering technique or genetically engineered 
     animal, the Secretary shall consider the potential effects of 
     the genetically engineered animal on the environment, 
     including the potential effect on nongenetically engineered 
     animals.
       ``(g) Progeny.--If an application for approval of a genetic 
     engineering technique to produce an animal of a species or 
     other taxonomic classification, or genetically engineered 
     animal, has been approved, no additional application shall be 
     required for animals of that species or other taxonomic 
     classification produced using that genetic engineering 
     technique or for the progeny of that genetically engineered 
     animal.
       ``(h) Scope of Approval.--The scope of the genetic 
     engineering technique that the Secretary may approve shall be 
     limited to the precise procedures described in the 
     application for approval.
       ``(i) Conditions of Approval.--The Secretary may require as 
     a condition of approval of an application that any producer 
     of a genetically engineered animal that is the subject of the 
     application--
       ``(1) take specified actions to eliminate or mitigate any 
     potential harm to the environment that would be caused by a 
     release of the genetically engineered animal, including 
     actions specified in the plan submitted by the applicant; and
       ``(2) conduct post-approval monitoring for environmental 
     effects of any release of the genetically engineered animal.
       ``(j) Recall; Suspension of Approval.--
       ``(1) Recall.--The Secretary may order a recall of any 
     genetically engineered animal (whether or not the genetically 
     engineered animal, or a genetic engineering technique used to 
     produce the genetically engineered animal, has been approved) 
     that the Secretary determines is harmful to--
       ``(A) humans;
       ``(B) the environment;
       ``(C) any animal that is subjected to a genetic engineering 
     technique; or
       ``(D) any animal that is not subjected to a genetic 
     engineering technique.
       ``(2) Suspension of approval.--If the Secretary determines 
     that a genetically engineered animal is harmful to the health 
     of humans or animals or to the environment, the Secretary 
     may--
       ``(A) immediately suspend the approval of application for 
     the genetically engineered animal;
       ``(B) give the applicant prompt notice of the action; and
       ``(C) afford the applicant an opportunity for an expedited 
     hearing.
       ``(k) Rescission of Approval.--
       ``(1) Reconsideration.--On the motion of any person, or on 
     the Secretary's own motion, the Secretary may reconsider an 
     approval of a genetic engineering technique or genetically 
     engineered animal on the basis of information that was not 
     available during an earlier review.
       ``(2) Finding for reconsideration.--The Secretary shall 
     conduct a reconsideration on the basis of the information 
     described in paragraph (1) if the Secretary finds that the 
     information--
       ``(A) is scientifically credible;
       ``(B) represents significant information that was not 
     available before the approval; and
       ``(C)(i) suggests potential impacts relating to the 
     genetically engineered animal that were not considered before 
     the approval; or
       ``(ii) demonstrates that the information considered before 
     the approval was inadequate for the Secretary to make a 
     safety finding.
       ``(3) Information from the producer.--
       ``(A) In general.--In conducting the reconsideration, the 
     Secretary may require the producer to provide, within a 
     reasonable period of time specified by the Secretary, 
     information needed to facilitate the reconsideration.
       ``(B) Information not provided.--If a producer fails to 
     provide information required under subparagraph (A) within 
     the period specified by the Secretary, the Secretary shall 
     take 1 or more of the actions described in paragraph (5).
       ``(4) Determination.--After reviewing the information by 
     the petitioner and the producer, the Secretary shall issue a 
     determination that--
       ``(A) revises the finding made in connection with the 
     approval with respect to the safety of the genetically 
     engineered animal; or
       ``(B) states that, for reasons stated by the Secretary, no 
     revision of the finding is needed.
       ``(5) Action by the secretary.--If, based on a review under 
     this subsection, the Secretary determines that the 
     genetically engineered animal is not safe, the Secretary 
     shall--
       ``(A) rescind the approval of the genetic engineering 
     technique or genetically engineered animal for introduction 
     into interstate commerce;
       ``(B) recall the genetically engineered animal; or
       ``(C) take such other action as the Secretary determines to 
     be appropriate.
       ``(l) Animals Used in Development.--An animal that is used 
     in connection with an investigation intended to support 
     approval of an application under section 512 and this section 
     or that is otherwise used in connection with the development 
     of a genetic engineering technique or production of a 
     genetically engineered animal for which approval is sought 
     shall be deemed unsafe for the purposes of sections 501(a)(5) 
     and 402(a)(2)(C)(ii) unless--
       ``(1) the applicant submits information required by the 
     Secretary that addresses the food safety of the animal;
       ``(2) the Secretary publishes the information in the 
     Federal Register and provides a public comment period of not 
     less than 60 days; and
       ``(3) based on the information provided under paragraph 
     (1), any public comment, and other information available to 
     the Secretary, the Secretary--
       ``(A) makes a determination that the animal is safe; and
       ``(B) publishes the determination in the Federal Register 
     and on the Internet.''.

     SEC. 6. PROHIBITED ACTS.

       (a) Unlawful Use of Trade Secret Information.--Section 
     301(j) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     331(j)) is amended in the first sentence--
       (1) by inserting ``421,'' after ``414,''; and
       (2) by inserting ``512A,'' after ``512,''.
       (b) Adulterated Food.--Section 402 of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 342) is amended by adding 
     at the end the following:
       ``(i) Genetically Engineered Animals.--If it is a 
     genetically engineered animal, or is a genetically engineered 
     animal produced using a genetic engineering technique, that 
     is not approved under sections 512 and 512A.
       ``(j) Genetically Engineered Foods.--
       ``(1) In general.--If it is a genetically engineered food, 
     or is a genetically engineered food produced using a genetic 
     engineering technique, that is not approved under section 
     421.
       ``(2) Split use foods.--If it is a split use food that does 
     not maintain proper segregation as required under regulations 
     promulgated under section 421.''.

     SEC. 7. TRANSITION PROVISION.

       (a) In General.--A genetic engineering technique, 
     genetically engineered animal, or genetically engineered food 
     that entered interstate commerce before the date of enactment 
     of this Act shall not require approval under the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.), but 
     shall be considered to have been so approved, if--
       (1) the producer, not later than 90 days after the date of 
     enactment of this Act, submits to the Secretary--
       (A) a notice stating that the genetic engineering 
     technique, genetically engineered animal, or genetically 
     engineered food entered interstate commerce before the date 
     of enactment of this Act, providing such information as the 
     Secretary may require; and
       (B) a request that the Secretary conduct a review of the 
     genetic engineering technique, genetically engineered animal, 
     or genetically engineered food under subsection (b); and
       (2) the Secretary does not issue, on or before the date 
     that is 2 years after the date of enactment of this Act, a 
     notice under subsection (b)(2) that an application for 
     approval is required.
       (b) Review by the Secretary.--
       (1) In general.--Not later than 21 months after the date on 
     which the Secretary receives a notice and request for review 
     under subsection (a), the Secretary shall review all relevant 
     information in the possession of the Secretary, all 
     information provided by the producer, and other relevant 
     public information to determine whether a review of new 
     scientific information is necessary to ensure that the 
     genetic engineering technique, genetically engineered animal, 
     or genetically engineered food is safe.
       (2) Notice that application is required.--If the Secretary 
     determines that new scientific information is necessary to 
     determine whether a genetic engineering technique, 
     genetically engineered animal, or genetically engineered food 
     is safe, the Secretary, not later than 2 years after the date 
     of enactment of this Act, shall issue to the producer a 
     notice stating that the producer is required to submit an 
     application for approval of the genetic engineering 
     technique, genetically engineered animal, or genetically 
     engineered food under the Federal Food, Drug, and Cosmetic 
     Act (21 U.S.C. 301 et seq.).
       (c) Failure To Submit Application.--
       (1) In general.--Except as provided in paragraph (2), a 
     genetically engineered animal or genetically engineered food 
     with respect to which the Secretary issues a notice that an 
     application is required under subsection (b)(2) shall be 
     considered adulterated under section 402 or 501, as the case 
     may be, of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 342, 351) unless--
       (A) not later than 45 days after the producer receives the 
     notice, the producer submits an application for approval; and
       (B) the Secretary approves the application.
       (2) Pending application.--A genetically engineered animal 
     or genetically engineered food with respect to which the 
     producer submits an application for approval shall not be 
     considered to be adulterated during the pendency of the 
     application.

[[Page 12739]]



     SEC. 8. GENETICALLY ENGINEERED CROPS.

       To the maximum extent practicable, the Secretary of 
     Agriculture shall ensure that standards for the regulation of 
     genetically engineered field test crops to prevent cross-
     pollenation with non-genetically engineered crops and prevent 
     adverse effects on the environment are based on the most 
     recent scientific knowledge available.

     SEC. 9. REPORTS.

       (a) In General.--Not later than 2 years, 4 years, and 6 
     years after the date of enactment of this Act, the Secretary 
     and the heads of other Federal agencies, as appropriate, 
     shall jointly submit to Congress a report on genetically 
     engineered animals, genetically engineered foods, and genetic 
     engineering techniques.
       (b) Contents.--A report under subsection (a) shall 
     contain--
       (1) information on the types and quantities of genetically 
     engineered foods being offered for sale or being developed, 
     domestically and internationally;
       (2) a summary (including discussion of new developments and 
     trends) of the legal status and acceptability of genetically 
     engineered foods in major markets, including the European 
     Union and Japan;
       (3) information on current and emerging issues of concern 
     relating to genetic engineering techniques, including issues 
     relating to--
       (A) the ecological impact of, antibiotic markers for, 
     insect resistance to, nongerminating or terminator seeds for, 
     or cross-species gene transfer for genetically engineered 
     foods;
       (B) foods from genetically engineered animals;
       (C) nonfood crops (such as cotton) produced using a genetic 
     engineering technique; and
       (D) socioeconomic concerns (such as the impact of 
     genetically engineered animals and genetically engineered 
     foods on small farms);
       (4) a response to, and information concerning the status of 
     implementation of, the recommendations contained in the 
     reports entitled ``Genetically Modified Pest Protected 
     Plants'', ``Environmental Effects of Transgenic Plants'', 
     ``Animal Biotechnology Identifying Science-Based Concerns'', 
     and ``Biological Containment of Genetically Engineered 
     Organisms (2004)'', issued by the National Academy of 
     Sciences;
       (5) an assessment of the need for data relating to 
     genetically engineered animals and genetically engineered 
     foods;
       (6) a projection of--
       (A) the number of genetically engineered animals, 
     genetically engineered foods, and genetic engineering 
     techniques that will require regulatory review during the 5-
     year period following the date of the report; and
       (B) the adequacy of the resources of the Food and Drug 
     Administration; and
       (7) an evaluation of the national capacity to test foods 
     for the presence of genetically engineered ingredients in 
     food.

     SEC. 10. AUTHORIZATION OF APPROPRIATIONS.

       There are authorized to be appropriated such sums as are 
     necessary to carry out this Act and the amendments made by 
     this Act.

                          ____________________