[Congressional Record (Bound Edition), Volume 153 (2007), Part 20]
[Senate]
[Pages 27416-27430]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. HARKIN:
  S. 2173. A bill to amend the Elementary and Secondary Education Act 
of 1965 to improve standards for physical education; to the Committee 
on Health, Education, Labor, and Pensions.
  Mr. HARKIN. Mr. President, today I am introducing the FIT Kids Act. 
That first word, FIT, is an acronym for ``Fitness Integrated with 
Teaching''. The FIT Kids Act encourages schools to provide children 
with quality physical education that can help them lead healthier 
lives.
  Since the 1970s, the incidence of obesity has more than doubled for 
preschool children aged 2-5 years and for young people aged 12-19 
years, and has more than tripled for children aged 6-11 years. There 
are many reasons of this public health crisis, and addressing this 
crisis will require multiple solutions as well. One critical place to 
start is in our schools. The Centers for Disease Control and Prevention 
has found that fewer than 10 percent of our public schools at all 
levels offer daily physical education or its equivalent for the entire 
school year for all students.
  The FIT Kids Act would amend the No Child Left Behind Act to support 
quality physical education for all public school children through grade 
12, and ensure they receive important health and nutritional 
information. As a senior member of the Senate Health, Education, Labor 
and Pensions Committee, I have been working with Chairman Kennedy and 
my other colleagues to reauthorize the No Child Left Behind Act in a 
way that improves on existing law, and gives schools and educators the 
resources they need to succeed.
  It is truly alarming to see the discrepancies in achievement between 
children in the United States and children abroad. Here in the U.S., we 
have a wide and persistent achievement gap that is leaving behind 
children of color, young people from disadvantaged backgrounds, and 
children with disabilities. I believe that the No Child Left Behind Act 
gives us a framework to reduce, and hopefully close, this achievement 
gap to ensure that children from all walks of life are achieving at 
high levels. I believe that we can and will reauthorize the No Child 
Left Behind Act in a way that preserves its essential reforms and 
continues the progress we have made over the nearly 6 years since the 
act became law.
  Unfortunately, despite the law's lofty goals, many educators have 
come to see it as a burden and a hindrance to effective classroom 
practices. I admit I share many of their concerns. I am particularly 
concerned about reports of imbalances and distortions that have come 
about as various States and the Federal Government have pushed for 
higher standards and greater accountability. Earlier this year, the 
Center on Education Policy, here in Washington, released a study 
showing that, as a result of NCLB, many school districts have cut back 
on the time spent teaching subjects other than math and reading.
  I am especially concerned by the finding that time spent on physical 
education has dropped by 9 percent, and recess by 6 percent. A new 
elementary school in Atlanta was actually built without a playground! 
This is just plain wrong-headed and short-sighted for two big reasons: 
one, we are fighting a childhood obesity epidemic of frightening 
proportions. Two, as any teacher or parent knows, kids have got to have 
time to play and burn off energy if they are going to be in a proper 
frame of mind to learn.
  This legislation will provide parents with information on the time 
and resources devoted to giving their children a quality physical 
education. Specifically, the bill will amend the State, local education 
agency, and school report cards to include measures of physical 
education tied to nationally recognized guidelines and standards. It is 
important to note, however, that this legislation will not amend the 
school accountability process to include measures of physical 
education. However, by including this new information on report cards 
we will give parents the data they need in order to assess whether 
their children are receiving an appropriate physical education.
  In addition, the bill promotes teacher professionalism in the field 
of physical education in order to promote healthy lifestyles and 
physical activity, and thereby to boost students' readiness to learn. 
The bill promotes physical activity in after-school programs. It amends 
the school counseling program to take into account students' emotional 
and physical wellbeing. It supports efforts to train parents to 
encourage healthy behaviors and physical activity.
  Finally, this legislation authorizes research into the ways physical 
activity can be incorporated into all aspects of the school day, as 
well as research into the impact of physical activity on students' 
ability to learn, and into the best ways to measure student progress in 
increasing physical activity.
  I am pleased that this bill is strongly supported by the American 
Heart Association, the National Parent Teacher Association, the 
American School Counselor Association, YMCA of the USA, National 
Association for Sport and Physical Education, the Campaign to End 
Obesity, and many other leading organizations in the fields of 
education and health.
  The FIT Kids Act shines a spotlight on children's heath and how our 
schools can play a greater role in teaching our children healthy 
behaviors. As we move forward in reauthorizing the No Child Left Behind 
Act, we cannot neglect the importance of proper physical education. 
Students should be learning healthy behaviors and the importance of 
physical activity, and why these lessons will be important throughout 
their lives. The FIT Kids Act provides the framework to accomplish 
this. I urge my colleagues to support this bill.
                                 ______
                                 
      By Mr. VOINOVICH (for himself and Mr. Brown):
  S. 2174. A bill to designate the facility of the United States Postal 
Service located at 175 South Monroe Street in Tiffin, Ohio, as the 
``Paul E. Gillmor Post Office Building''; to the Committee on Homeland 
Security and Governmental Affairs.
  Mr. VOINOVICH. Mr. President, I rise today to introduce legislation 
to name the Post Office in Tiffin, Ohio, after the late U.S. 
Representative Paul E. Gillmor. It is my honor to introduce this bill 
because of my close relationship with Congressman Gillmor, and the 
utmost respect I have for him and his service to the people of Ohio. I

[[Page 27417]]

would like to thank Senator Brown for his cosponsorship.
  Paul and I met four decades ago in 1967 when we began our careers 
together, Paul as a State senator and I as a member of the Ohio House. 
Paul was immensely successful and well-respected because he treated 
others with dignity and respect.
  During his tenure as president of the Ohio Senate, he was able to put 
partisan politics aside and work together with Governor Celeste for the 
best interests of the state.
  Paul had a wonderful knack for being able to work with people to get 
things done. He led by example, and his enthusiasm and ability always 
made you want to be on his team. He left an indelible mark on the 
people he worked with which is a part of his wonderful, lasting legacy.
  When I came to the Senate I knew I had a real friend in Paul Gillmor. 
My only regret is that I did not have more time to spend with him.
  Because of Paul's diligent and devoted service to his country, it is 
fitting that the post office in Tiffin, Ohio, should soon bear his 
name. Not far from his small home town of Old Fort, Ohio; Tiffin was 
chosen in concurrence with the wishes of his wife, Karen Gillmor.
                                 ______
                                 
      By Mrs. CLINTON:
  S. 2175. A bill to amend the Public Health Service Act with regard to 
research on asthma, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Mrs. CLINTON. Mr. President, I rise today to reintroduce the Family 
Asthma Act, legislation that would improve our federal government's 
response to this epidemic. The number of people with asthma has more 
than doubled in the past twenty years, and today, more than 32 million 
Americans, including more than 9 million children, have been diagnosed 
with asthma. By 2020, asthma is expected to strike 1 in 14 Americans 
and 1 in 5 families.
  While deaths and hospitalizations from asthma are decreasing, the 
disease has a disproportionate impact among racial and ethnic minority 
populations. The emergency department visit rate for blacks seeking 
asthma treatment was 350 percent higher than that of the rates of 
whites, while the hospitalization rate for blacks with asthma was 240 
percent higher than the rate of whites with asthma. Puerto Rican 
populations are 95 percent more likely to be diagnosed with asthma than 
white populations. Women are also disproportionately impacted, with 
asthma hospitalization rates approximately 35 percent higher among 
females than males.
  Our legislation seeks to reverse these disparities. It would set up 
pilot projects to increase patient self-management, and allow for a 
better understanding of the environmental factors, like indoor and 
outdoor air pollution, that contribute to asthma. It would improve our 
surveillance and education efforts through the Centers for Disease 
Control and Prevention, so that we identify and target interventions to 
the populations with the highest burdens of asthma. And it would train 
providers to recognize the links between environmental pollution and 
asthma, in order to better treat and manage this condition.
  This legislation contains the following components: it establishes 
pilot projects to improve asthma management and increase our knowledge 
of the environmental and genetic links to asthma. The Family Asthma Act 
establishes a $10 million annual grant program through the National 
Institutes of Health to establish pilot research projects that assist 
patients with asthma management. These projects will also allow 
scientists to engage in research on the environmental and genetic 
factors that contribute to severe, persistent asthma.
  It directs our Government's asthma coordinating body to review and 
make recommendations for future directions in research and 
interventions. This legislation directs the National Asthma Education 
and Prevention Program to review current private and public sector 
efforts in combating asthma, and make recommendations as to how to 
strengthen those efforts in order to reduce the impact of this disease 
upon our health care system.
  It increases funding to the CDC for education and surveillance. The 
bill provides $10 million annually to increase CDC's educational 
efforts, with state, local and nonprofit partners, to raise awareness 
of both asthma and ways to manage the disease. It also increases the 
scope of CDC's asthma surveillance activities to include 
hospitalization data, so as to better measure the impact of asthma at 
both the national and local level.
  It creates a fellowship program to train providers about the links 
between the environment and asthma. Through this bill, the National 
Institutes of Environmental Health Sciences will set up a $2 million 
fellowship program to help a broad spectrum of health care providers 
learn about the links between the environment and asthma, and increase 
their ability to address those links in clinical practice and asthma 
management programs.
  I look forward to working with my colleagues in the Senate to move 
this legislation forward and address the growing incidence of asthma in 
our country.
  I ask unanimous consent that a letter of support be printed in the 
Record.
       There being no objection, the material was ordered to be 
     placed in the Record, as follows:

                                    American Lung Association,

                                 Washington, DC, October 17, 2007.
     Hon. Hillary Rodham Clinton,
     U.S. Senate,
     Washington, DC.
       Dear Senator Clinton: The American Lung Association 
     strongly supports your Family Asthma Act. Once enacted into 
     law, this measure will result in much-needed research into 
     factors contributing to asthma and the alarming effects of 
     asthma on the health of Americans, particularly children, 
     minorities, women and the elderly.
       As you know, over 22 million Americans currently have 
     asthma, including more than six million children. Asthma is 
     the leading cause of chronic illness among children in the 
     U.S. and the third-leading cause of hospitalization among 
     kids under 15 years of age. It also results in almost 13 
     million days of missed school annually. Asthma takes a 
     significant toll on the public, increasing absenteeism from 
     work, as well as the financial burden of asthma treatment. 
     The Centers for Disease Control and Prevention (CDC) 
     estimates that 11 million workdays are missed annually as a 
     result of asthma and it is estimated to cost almost $15 
     billion in direct health care costs each year. Asthma also 
     disproportionately affects women and minorities.
       The introduction of this legislation comes at an important 
     time: this week, the National Asthma Education and Prevention 
     Program is issuing revised guidelines, emphasizing the 
     importance of asthma control and suggesting new approaches 
     for monitoring asthma. The new guidelines will help doctors 
     and their patients select a treatment based on the patient's 
     needs and level of asthma, emphasizing the importance of 
     regularly monitoring the patient's asthma level so that 
     treatments can be adjusted necessary.
       However, despite these new guidelines, nationwide efforts 
     to monitor asthma prevalence are hampered by a lack of 
     consistent data. Your legislation will require that asthma 
     surveillance activities be conducted so that critical 
     information on the prevalence and severity of asthma, the 
     effectiveness of public health asthma interventions and the 
     quality of asthma management is collected. The Family Asthma 
     Act will also require greater federal coordination to create 
     a national plan to combat asthma.
       Thank you for your leadership on this critical public 
     health issue. The American Lung Association looks forward to 
     working with you to see the Family Asthma Act become law.
           Sincerely,
                                             Bernadette A. Toomey,
                                                President and CEO.
                                 ______
                                 
      By Mr. KERRY (for himself and Mr. Hatch):
  S. 2178. A bill to expedite the adjudication of employer petitions 
for aliens with extraordinary artistic ability; to the Committee on the 
Judiciary.
  Mr. KERRY. Mr. President, one of the best ways that the United States 
can gain understanding and appreciation of other cultures is through 
the arts. Exposing children and adults alike to the creativity of other 
countries enriches our own artistic talents and helps bridge the gap 
between nations. It is for those reasons my colleague Senator Hatch and 
I have introduced the Arts Require Timely Service, ARTS, Act.

[[Page 27418]]

  This legislation helps streamline the visa process and waive fees so 
that foreign artists and musicians can share their talents in the 
United States. Currently, the visa process for visiting artists is slow 
and costly, often times prohibiting artists from coming to the United 
States to share their talents. Breaking down these barriers is 
important and we shouldn't let the politics of immigration interfere 
with expanding our cultural horizons.
  I am proud to stand with Senator Hatch and the Performing Arts Visa 
Task Force to try and help artists visit our country and inspire our 
communities. I hope our colleagues will join us and pass this sensible 
reform to expedite cultural exchanges and artistic expression.
  Mr. HATCH. Mr. President, I rise today to join with Senator John 
Kerry in introducing the Arts Require Timely Service, ARTS, Act. The 
ARTS Act would reduce the current processing times for ``O'' and ``P'' 
arts-related visa petitions filed by, or on behalf of, nonprofit arts-
related organizations to a maximum of 45 days.
  Unfortunately, delays by the U.S. Citizenship and Immigration 
Services are making it increasingly difficult for international artists 
to appear in the U.S. Nonprofit arts organizations confront long waits 
and uncertainty in gaining approval for visa petitions for foreign 
artists. Most nonprofit arts cannot afford the Premium Processing 
Service, guaranteeing processing within 15 days upon payment of an 
additional $1,000 fee per petition. This is burdensome for many 
nonprofit arts organizations leaving them to await the unpredictability 
of the regular visa process.
  Performances and other cultural events are date, time and location-
specific. The nature of scheduling, booking, and confirming highly 
sought-after guest soloists and performing groups requires that the 
timing of the visa process be efficient and reliable. There is a 
continuing risk that foreign guest artists will be unable to enter the 
U.S. in time for their engagements, causing burdens on nonprofit arts 
organizations, international artists, and the local artists who were 
scheduled to perform alongside the international guest.
  In my home State of Utah, the Utah Symphony & Opera has witnessed 
first-hand how delays and unpredictability in artist visa processing 
have denied Utahns the opportunity to experience international 
artistry. To make matters worse, cancellations create high economic 
risks for these nonprofit arts institutions as they must sell tickets 
in advance, creating a financial obligation to their audiences.
  Congress has already indicated strong, bipartisan support for the 
ARTS Act. In fact, the provision enjoys support from key House and 
Senate Judiciary Committee members and it was included in the 2006 
Senate comprehensive immigration reform bill. I agree with Homeland 
Security Secretary Michael Chertoff when he said, ``Our heritage and 
our national character inspire us to create a more welcoming society 
for those who lawfully come to our shores to work, learn, and visit.'' 
Indeed, this noncontroversial improvement to the artist visa process 
will strengthen our ties with other countries, enrich our Nation's 
culture, and provide a wonderful opportunity to learn from foreign 
artists.
  I encourage my colleagues to support the ARTS Act.
                                 ______
                                 
      By Ms. COLLINS (for herself, Mr. Casey, Mr. Bond, Ms. Cantwell, 
        Mr. Roberts, and Mr. Reed):
  S. 2181, A bill to amend title XVIII of the Social Security Act to 
protect Medicare beneficiaries' access to home health services under 
the Medicare program; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I am pleased to join Senators Casey, 
Bond, Cantwell, Roberts and Reed in introducing legislation, the Home 
Health Care Access Protection Act, to prevent the devastating 11.75 
percent cut that the Centers for Medicare and Medicaid Services, CMS, 
is planning to make in Medicare home health payment rates over the next 
4 years.
  Home health has become an increasingly important part of our health 
care system. The kinds of highly skilled and often technically complex 
services that our Nation's home health agencies provide have helped to 
keep families together and enabled millions of our most frail and 
vulnerable older and disabled persons to avoid hospitals and nursing 
homes and stay just where they want to be--in the comfort and security 
of their own homes. Moreover, by helping these individuals to avoid 
more costly institutional care, they are saving Medicare millions of 
dollars each year.
  That is why I find it so ironic that the Medicare home health benefit 
is once again under attack.
  The House version of the SCHIP reauthorization bill proposed cutting 
Medicare home health spending by $2.6 billion over 5 years, and the 
Senate may soon be considering similar cuts.
  To make matters worse, CMS has proposed additional administrative 
cuts that are estimated to total more than $6 billion over the next 5 
years. If allowed to go forward, this ``double whammy'' for home care 
will result in cuts in excess of $8.6 billion over 5 years from a 
program that costs less than $15 billion a year. This simply is not 
right, and it certainly is not in the best interest of our Nation's 
seniors who rely on home care to keep them out of hospitals, nursing 
homes and other institutions.
  The administrative cuts proposed by CMS are based on the assertion 
that home health agencies have intentionally ``gamed the system'' by 
claiming that their patients have conditions of higher clinical 
severity than they actually have in order to receive higher Medicare 
payments. This unfounded allegation of ``case mix creep'' is based on 
what CMS contends to be an increase in the average clinical assessment 
``score'' of home health patients over the last few years.
  In fact, there are very real clinical and policy explanations for why 
the average clinical severity of home care patients' health conditions 
may have increased over the years. For example, the incentives built 
into the hospital DRG reimbursement system have led to the faster 
discharge of sicker patients. Advances in technology and changes in 
medical practice have also enabled home health agencies to treat more 
complicated medical conditions that earlier could only be treated in 
hospitals, nursing homes, or inpatient rehabilitation facilities.
  These administrative cuts are proposed to go into effect on January 
l. This would be devastating to home health agencies in Maine and 
across the Nation, particularly given that there is no evidence of 
intentional ``gaming'' on the part of home health agencies to warrant 
such a severe financial penalty.
  Moreover, CMS has not made public any of the details of the research 
method, data and findings they used to justify the planned cuts, making 
it impossible for Congress or the public to evaluate the reliability or 
the validity of its actions.
  What is of most concern to me, however, is that this unfair penalty 
is being assessed across the board, even for home health agencies that 
showed a decrease in their clinical assessment scores. If an individual 
home health agency is truly gaming the system, CMS should target that 
one agency, not penalize everyone.
  The fact is that the Medicare home health benefit has already taken a 
larger hit in spending cuts over the past 10 years than any other 
Medicare benefit. In fact, home health as a share of Medicare spending 
has dropped from 8.7 percent in 1997 to 3.2 percent today, and is 
projected to decline to 2.6 percent of Medicare spending in 2015.
  This downward spiral in home health spending began with provisions in 
the Balanced Budget Act of 1997, which resulted in a 50 percent cut in 
Medicare home health spending by 2001--far more than the Congress 
intended or the Congressional Budget Office projected.
  And home health spending continues to be much lower than CBO 
projections. In 2000, the CBO projected that home health spending in 
2006 would total $21.1 billion under the new home health prospective 
payment system. The actual total expenditures for home health last year 
were $13.2 billion. If

[[Page 27419]]

home health agencies were engaging in the kind of widespread 
``upcoding'' that CMS has alleged, home health spending would be 
exceeding CBO's projections. In fact, home health spending has been far 
less than expected.
  Home health care has consistently proven to be a compassionate and 
cost-effective alternative to institutional care. Additional deep cuts 
will be completely counterproductive to our efforts to control overall 
health care costs. They will also place the quality of home health 
services at risk, particularly given ever-rising transportation, 
staffing, and technology costs. Cuts of this magnitude could leave some 
providers with no alternative but to reduce the number of home health 
visits or patient admissions, which would ultimately threaten seniors' 
access to care and clinical outcomes. Or they could cause them to close 
their doors altogether.
  The legislation that we are introducing today will block the ``case 
mix creep'' cuts that were proposed by CMS as part of the final home 
health prospective payment system regulation in August. It will also 
establish a reliable and transparent process that the Department of 
Health and Human Services must use to justify that payment rate cuts 
are needed to account for improper changes in ``case mix scoring.'' A 
companion bill to our legislation is being introduced in the House by 
Representative Jim McGovern. 
  The Home Health Care Access Protection Act of 2007 will help to 
ensure that our seniors and disabled Americans continue to have access 
to the quality home health services they deserve, and I encourage all 
of my colleagues to sign on as cosponsors.
                                 ______
                                 
      By Mr. REED (for himself and Mr. Smith):
  S. 2182. A bill to amend the Public Health Service Act with respect 
to mental health services; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. REED. Mr. President, today I introduce the Community Mental 
Health Services Improvement Act. For decades, we have known that people 
suffering from mental illness die sooner, on average 25 years sooner, 
and have higher rates of disability than the general population. People 
with mental illness are at greater risk of preventable health 
conditions such as heart disease and diabetes. With this legislation, 
we are taking steps to address these disturbing trends.
  We know that mental health and physical health are inter-related: 
each contributes to the other. Yet historically mental health and 
physical health have been treated separately. The vision of this 
legislation is that the two should be integrated in a single medical 
home.
  In a recent survey, 91 percent of community mental health centers 
said that improving the quality of health care is a priority. However, 
only one-third have the capacity to provide health care on site, and 
only one-fifth provide medical referrals off site. The centers 
identified a lack of financial resources as the biggest barrier to 
integrating treatment.
  Accordingly, this legislation provides grants to integrate treatment 
for mental health, substance abuse, and primary and specialty care. 
Grantees can use the funds for screenings, basic health care services 
on site, referrals, or information technology.
  This legislation is also a comprehensive response to the workforce 
crisis identified by the President's New Freedom Commission on Mental 
Health. It provides grants for a wide range of innovative recruitment 
and retention efforts, from loan forgiveness and repayment programs, to 
placement and support for new mental health professionals, to expanding 
mental health education and training programs.
  Finally, this legislation provides grants for tele-mental health in 
medically-underserved areas, and invests in health IT for mental health 
providers. These proposals address the twin goals of improving the 
quality of mental health treatment while expanding access to that 
treatment in rural and underserved areas.
  This bipartisan legislation, which I am introducing with my colleague 
Senator Smith, has the overwhelming support of the mental health 
community. It has been endorsed by the National Council for Community 
Behavioral Healthcare, the National Alliance on Mental Illness, Mental 
Health America, the Campaign for Mental Health Reform, and the American 
Psychological Association. I am especially grateful for the support of 
the Rhode Island Council of Community Mental Health Organizations, 
whose members treat close to 15,000 Rhode Islanders of all ages.
  Today Senator Smith and I are also introducing the Community Mental 
Health Infrastructure Improvements Act. It should be obvious that this 
legislation is a necessary complement to the Community Mental Health 
Services Improvement Act: Without community mental health centers, 
there can be no services to improve. Accordingly, this legislation 
provides grants to states for the construction and modernization of 
facilities that provide mental health services.
  As a member of the Senate Committee on Health, Education, Labor, and 
Pensions, I will work to include these important initiatives in 
legislation that renews and improves Substance Abuse and Mental Health 
Services Administration, SAMHSA, programs. It is my hope that with its 
passage, we can begin to address the challenge of improving and 
expanding access to mental health services in a comprehensive way.
  Mr. President, 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. 2182

       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 ``Community Mental Health 
     Services Improvement Act''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) almost 60,000,000 Americans, or one in four adults and 
     one in five children, have a mental illness that can be 
     diagnosed and treated in a given year;
       (2) mental illness costs our economy more than 
     $80,000,000,000 annually, accounting for 15 percent of the 
     total economic burden of disease;
       (3) alcohol and drug abuse contributes to the death of more 
     than 100,000 people and costs society upwards of half a 
     trillion dollars a year;
       (4) individuals with serious mental illness die on average 
     25 years sooner than individuals in the general population; 
     and
       (5) community mental and behavioral health organizations 
     provide cost-efficient and evidence-based treatment and care 
     for millions of Americans with mental illness and addiction 
     disorders.

     SEC. 3. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-
                   BASED MENTAL HEALTH SETTINGS.

       Subpart 3 of part B of title V of the Public Health Service 
     Act (42 U.S.C. 290bb-31 et seq.) is amended by adding at the 
     end the following:

     ``SEC. 520K. GRANTS FOR CO-LOCATING PRIMARY AND SPECIALTY 
                   CARE IN COMMUNITY-BASED MENTAL HEALTH SETTINGS.

       ``(a) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means a 
     qualified community mental health program defined under 
     section 1913(b)(1).
       ``(2) Special populations.--The term `special populations' 
     refers to the following 3 groups:
       ``(A) Children and adolescents with mental and emotional 
     disturbances who have co-occurring primary care conditions 
     and chronic diseases.
       ``(B) Adults with mental illnesses who have co-occurring 
     primary care conditions and chronic diseases.
       ``(C) Older adults with mental illnesses who have co-
     occurring primary care conditions and chronic diseases.
       ``(b) Program Authorized.--The Secretary, acting through 
     the Administrator of the Substance Abuse and Mental Health 
     Services Administration and in coordination with the Director 
     of the Health Resources and Services Administration, shall 
     award grants to eligible entities to establish demonstration 
     projects for the provision of coordinated and integrated 
     services to special populations through the co-location of 
     primary and specialty care services in community-based mental 
     and behavioral health settings.
       ``(c) Application.--To be eligible to receive a grant under 
     this section, an eligible entity shall submit an application 
     to the Administrator at such time, in such manner, and 
     accompanied by such information as the Administrator may 
     require. Each such application shall include--

[[Page 27420]]

       ``(1) an assessment of the primary care needs of the 
     patients served by the eligible entity and a description of 
     how the eligible entity will address such needs; and
       ``(2) a description of partnerships, cooperative 
     agreements, or other arrangements with local primary care 
     providers, including community health centers, to provide 
     services to special populations.
       ``(d) Use of Funds.--
       ``(1) In general.--For the benefit of special populations, 
     an eligible entity shall use funds awarded under this section 
     for--
       ``(A) the provision, by qualified primary care 
     professionals on a reasonable cost basis, of--
       ``(i) primary care services on site at the eligible entity;
       ``(ii) diagnostic and laboratory services; or
       ``(iii) adult and pediatric eye, ear, and dental 
     screenings;
       ``(B) reasonable costs associated with medically necessary 
     referrals to qualified specialty care professionals as well 
     as to other coordinators of care or, if permitted by the 
     terms of the grant, for the provision, by qualified specialty 
     care professionals on a reasonable cost basis on site at the 
     eligible entity, of--
       ``(i) endocrinology services;
       ``(ii) oncology services;
       ``(iii) pulmonary/respiratory services; or
       ``(iv) cardiovascular services;
       ``(C) information technology required to accommodate the 
     clinical needs of primary and specialty care professionals; 
     or
       ``(D) facility improvements or modifications needed to 
     bring primary and specialty care professionals on site at the 
     eligible entity.
       ``(2) Limitation.--Not to exceed 15 percent of grant funds 
     may be used for activities described in subparagraphs (C) and 
     (D) of paragraph (1).
       ``(e) Geographic Distribution.--The Secretary shall ensure 
     that grants awarded under this section are equitably 
     distributed among the geographical regions of the United 
     States and between urban and rural populations.
       ``(f) Evaluation.--Not later than 3 months after a grant or 
     cooperative agreement awarded under this section expires, an 
     eligible entity shall submit to the Secretary the results of 
     an evaluation to be conducted by the entity concerning the 
     effectiveness of the activities carried out under the grant 
     or agreement.
       ``(g) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     that shall evaluate the activities funded under this section. 
     The report shall include an evaluation of the impact of co-
     locating primary and specialty care in community mental and 
     behavioral health settings on overall patient health status 
     and recommendations on whether or not the demonstration 
     program under this section should be made permanent.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $50,000,0000 for fiscal year 2009 and such sums as may be 
     necessary for each of fiscal years 2010 through 2013.''.

     SEC. 4. INTEGRATING TREATMENT FOR MENTAL HEALTH AND SUBSTANCE 
                   ABUSE CO-OCCURRING DISORDERS.

       Section 520I of the Public Health Service Act (42 U.S.C. 
     290bb-40) is amended--
       (1) by striking subsection (i) and inserting the following:
       ``(j) Funding.--The Secretary shall make available to carry 
     out this section, $14,000,000 for fiscal year 2009, 
     $20,000,000 for fiscal year 2010, and such sums as may be 
     necessary for each of fiscal years 2011 through 2013. Such 
     sums shall be made available in equal amount from amounts 
     appropriated under sections 509 and 520A.''; and
       (2) by inserting before subsection (j), the following:
       ``(i) Community Mental Health Program.--For purposes of 
     eligibility under this section, the term `private nonprofit 
     organization' includes a qualified community mental health 
     program as defined under section 1913(b)(1).''.

     SEC. 5. IMPROVING THE MENTAL HEALTH WORKFORCE.

       (a) National Health Service Corps.--Section 332(a) of the 
     Public Health Service Act (42 U.S.C. 254e(a)) is amended--
       (1) in paragraph (1), by inserting after ``that meet the 
     requirements of section 334'' the following: ``and qualified 
     community mental health programs as defined in section 
     1913(b)(1),''; and
       (2) in paragraph (2)(A), by striking ``community mental 
     health center,''.
       (b) Recruitment and Retention of Mental Health 
     Professionals.--Subpart X of part D of title III of the 
     Public Health Service Act (42 U.S.C. 256f et seq.) is amended 
     by adding at the end the following:

     ``SEC. 340H. GRANTS FOR RECRUITMENT AND RETENTION OF MENTAL 
                   HEALTH PROFESSIONALS.

       ``(a) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall award grants to States, territories, 
     and Indian tribes or tribal organizations for innovative 
     programs to address the behavioral and mental health 
     workforce needs of designated mental health professional 
     shortage areas.
       ``(b) Use of Funds.--An eligible entity shall use grant 
     funds awarded under this section for--
       ``(1) loan forgiveness and repayment programs (to be 
     carried out in a manner similar to the loan repayment 
     programs carried out under subpart III of part D) for 
     behavioral and mental health professionals who--
       ``(A) agree to practice in designated mental health 
     professional shortage areas;
       ``(B) are graduates of programs in behavioral or mental 
     health;
       ``(C) agree to serve in community-based non-profit 
     entities, or as public mental health professionals for the 
     Federal, State or local government; and
       ``(D) agree to--
       ``(i) provide services to patients regardless of such 
     patients' ability to pay; and
       ``(ii) use a sliding payment scale for patients who are 
     unable to pay the total cost of services;
       ``(2) behavioral and mental health professional recruitment 
     and retention efforts, with a particular emphasis on 
     candidates from racial and ethnic minority and medically-
     underserved communities;
       ``(3) grants or low-interest or no-interest loans for 
     behavioral and mental health professionals who participate in 
     the Medicaid program under title XIX of the Social Security 
     Act to establish or expand practices in designated mental 
     health professional shortage areas, or to serve in qualified 
     community mental health programs as defined in section 
     1913(b)(1);
       ``(4) placement and support for behavioral and mental 
     health students, residents, trainees, and fellows or interns; 
     or
       ``(5) continuing behavioral and mental health education, 
     including distance-based education.
       ``(c) Application.--
       ``(1) In general.--Each eligible entity desiring a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may reasonably require.
       ``(2) Assurances.--The application shall include assurances 
     that the applicant will meet the requirements of this 
     subsection and that the applicant possesses sufficient 
     infrastructure to manage the activities to be funded through 
     the grant and to evaluate and report on the outcomes 
     resulting from such activities.
       ``(d) Matching Requirement.--The Secretary may not make a 
     grant to an eligible entity under this section unless that 
     entity agrees that, with respect to the costs to be incurred 
     by the entity in carrying out the activities for which the 
     grant was awarded, the entity will provide non-Federal 
     contributions in an amount equal to not less than 35 percent 
     of Federal funds provided under the grant. The entity may 
     provide the contributions in cash or in kind, fairly 
     evaluated, including plant, equipment, and services, and may 
     provide the contributions from State, local, or private 
     sources.
       ``(e) Supplement Not Supplant.--A grant awarded under this 
     section shall be expended to supplement, and not supplant, 
     the expenditures of the eligible entity and the value of in-
     kind contributions for carrying out the activities for which 
     the grant was awarded.
       ``(f) Geographic Distribution.--The Secretary shall ensure 
     that grants awarded under this section are equitably 
     distributed among the geographical regions of the United 
     States and between urban and rural populations.
       ``(g) Evaluation.--Not later than 3 months after a grant 
     awarded under this section expires, an eligible entity shall 
     submit to the Secretary the results of an evaluation to be 
     conducted by the entity concerning the effectiveness of the 
     activities carried out under the grant.
       ``(h) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     containing data relating to whether grants provided under 
     this section have increased access to behavioral and mental 
     health services in designated mental health professional 
     shortage areas.
       ``(i) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     fiscal year 2009, and such sums as may be necessary for each 
     of fiscal years 2010 through 2013.''.
       (c) Behavioral and Mental Health Education and Training 
     Programs.--Part A of title V of the Public Health Service Act 
     (42 U.S.C. 290aa et seq.) is amended by adding at the end the 
     following:

     ``SEC. 506C. GRANTS FOR BEHAVIORAL AND MENTAL HEALTH 
                   EDUCATION AND TRAINING PROGRAMS.

       ``(a) Definition.--For the purposes of this section, the 
     term `related mental health personnel' means an individual 
     who--
       ``(1) facilitates access to a medical, social, educational, 
     or other service; and
       ``(2) is not a mental health professional, but who is the 
     first point of contact with persons who are seeking mental 
     health services.
       ``(b) Establishment.--The Secretary, acting through the 
     Administrator of the Substance Abuse and Mental Health 
     Services Administration, shall establish a program to 
     increase the number of trained behavioral

[[Page 27421]]

     and mental health professionals and related mental health 
     personnel by awarding grants on a competitive basis to mental 
     and behavioral health nonprofit organizations or accredited 
     institutions of higher education to enable such entities to 
     establish or expand accredited mental and behavioral health 
     education programs.
       ``(c) Application.--
       ``(1) In general.--Each eligible entity desiring a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may reasonably require.
       ``(2) Assurances.--The application shall include assurances 
     that the applicant will meet the requirements of this 
     subsection and that the applicant possesses sufficient 
     infrastructure to manage the activities to be funded through 
     the grant and to evaluate and report on the outcomes 
     resulting from such activities.
       ``(d) Priority.--In awarding grants under this section, the 
     Secretary shall give priority to applicants that--
       ``(1) demonstrate a familiarity with the use of evidenced-
     based methods in behavioral and mental health services;
       ``(2) provide interdisciplinary training experiences; and
       ``(3) demonstrate a commitment to training methods and 
     practices that emphasize the integrated treatment of mental 
     health and substance abuse disorders.
       ``(e) Use of Funds.--Funds awarded under this section shall 
     be used to--
       ``(1) establish or expand accredited behavioral and mental 
     health education programs, including improving the 
     coursework, related field placements, or faculty of such 
     programs; or
       ``(2) establish or expand accredited mental and behavioral 
     health training programs for related mental health personnel.
       ``(f) Requirements.--The Secretary may award a grant to an 
     eligible entity only if such entity agrees that--
       ``(1) any behavioral or mental health program assisted 
     under the grant will prioritize cultural competency and the 
     recruitment of trainees from racial and ethnic minority and 
     medically-underserved communities; and
       ``(2) with respect to any violation of the agreement 
     between the Secretary and the entity, the entity will pay 
     such liquidated damages as prescribed by the Secretary.
       ``(g) Geographic Distribution.--The Secretary shall ensure 
     that grants awarded under this section are equitably 
     distributed among the geographical regions of the United 
     States and between urban and rural populations.
       ``(h) Evaluation.--Not later than 3 months after a grant 
     awarded under this section expires, an eligible entity shall 
     submit to the Secretary the results of an evaluation to be 
     conducted by the entity concerning the effectiveness of the 
     activities carried out under the grant.
       ``(i) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     containing data relating to whether grants provided under 
     this section have increased access to behavioral and mental 
     health services in designated mental health professional 
     shortage areas.
       ``(j) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $4,000,0000 for 
     fiscal year 2009, and such sums as may be necessary for each 
     of fiscal years 2010 through 2013.''.

     SEC. 6. IMPROVING ACCESS TO MENTAL HEALTH SERVICES IN 
                   MEDICALLY-UNDERSERVED AREAS.

       Subpart 3 of part B of title V of the Public Health Service 
     Act (42 U.S.C. 290bb-31 et seq.) is amended by inserting 
     after section 520A the following:

     ``SEC. 520B. GRANTS FOR TELE-MENTAL HEALTH IN MEDICALLY-
                   UNDERSERVED AREAS.

       ``(a) Program Authorized.--The Secretary, acting through 
     the Administrator of the Substance Abuse and Mental Health 
     Services Administration, shall award grants to eligible 
     entities to provide tele-mental health in medically-
     underserved areas.
       ``(b) Eligible Entity.--To be eligible for assistance under 
     the program under subsection (a), an entity shall be a 
     qualified community mental health program (as defined in 
     section 1913(b)(1)).
       ``(c) Application.--
       ``(1) In general.--Each eligible entity desiring a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may reasonably require.
       ``(2) Assurances.--The application shall include assurances 
     that the applicant will meet the requirements of this 
     subsection and that the applicant possesses sufficient 
     infrastructure to manage the activities to be funded through 
     the grant and to evaluate and report on the outcomes 
     resulting from such activities.
       ``(d) Use of Funds.--An eligible entity shall use funds 
     received under a grant under this section for--
       ``(1) the provision of tele-mental health services; or
       ``(2) infrastructure improvements for the provision of 
     tele-mental health services.
       ``(e) Geographic Distribution.--The Secretary shall ensure 
     that grants awarded under this section are equitably 
     distributed among the geographical regions of the United 
     States and between urban and rural populations.
       ``(f) Evaluation.--Not later than 3 months after a grant 
     awarded under this section expires, an eligible entity shall 
     submit to the Secretary the results of an evaluation to be 
     conducted by the entity concerning the effectiveness of the 
     activities carried out under the grant.
       ``(g) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     that shall evaluate the activities funded under this section.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $20,000,000 for fiscal year 2009, and such sums as may be 
     necessary for each of fiscal years 2010 through 2013.''.

     SEC. 7. IMPROVING HEALTH INFORMATION TECHNOLOGY FOR MENTAL 
                   HEALTH PROVIDERS.

       Part A of title V of the Public Health Service Act (42 
     U.S.C. 290aa et seq.), as amended by section 5(c), is further 
     amended by adding at the end the following:

     ``SEC. 506D. IMPROVING HEALTH INFORMATION TECHNOLOGY FOR 
                   MENTAL HEALTH PROVIDERS.

       ``(a) In General.--The Secretary, in consultation with the 
     Secretary of Veterans Affairs, shall collaborate with the 
     Administrator of the Substance Abuse and Mental Health 
     Services Administration and the National Coordinator for 
     Health Information Technology to--
       ``(1) develop and implement a plan for ensuring that 
     various components of the National Health Information 
     Infrastructure, including data and privacy standards, 
     electronic health records, and community and regional health 
     networks, address the needs of mental health and substance 
     abuse treatment providers; and
       ``(2) finance related infrastructure improvements, 
     technical support, personnel training, and ongoing quality 
     improvements.
       ``(b) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $10,000,000 for fiscal year 2009, and such sums as may be 
     necessary for each of fiscal years 2010 through 2013.''.

     SEC. 8. PAPERWORK REDUCTION STUDY.

       (a) In General.--Not later than 12 months after the date of 
     enactment of this Act, the Institute of Medicine shall submit 
     to the appropriate committees of Congress a report that 
     evaluates the combined paperwork burden of qualified 
     community mental health programs as defined in section 
     1913(b)(1) of the Public Health Service Act.
       (b) Scope.--In preparing the report under subsection (a), 
     the Institute of Medicine shall examine licensing, 
     certification, service definitions, claims payment, billing 
     codes, and financial auditing requirements utilized by the 
     Office of Management and Budget, the Centers for Medicare & 
     Medicaid Services, the Health Resources and Services 
     Administration, the Substance Abuse and Mental Health 
     Services Administration, the Office of the Inspector General, 
     State Medicaid agencies, State departments of health, State 
     departments of education, and State and local juvenile 
     justice and social service agencies to--
       (1) establish an estimate of the combined nationwide cost 
     of complying with the requirements described in this 
     paragraph, in terms of both administrative funding and staff 
     time;
       (2) establish an estimate of the per capita cost to each 
     qualified community mental health program defined in section 
     1913(b)(1) of the Public Health Service Act to comply with 
     the requirements of this paragraph, in terms of both 
     administrative funding and staff time; and
       (3) make administrative and statutory recommendations to 
     Congress, which may include a uniform methodology, to reduce 
     the paperwork burden experienced by qualified community 
     mental health programs defined in section 1913(b)(1) of the 
     Public Health Service Act.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $550,000 for 
     each of fiscal years 2009 and 2010.

     SEC. 9. WAGE STUDY.

       (a) In General.--Not later than 12 months after the date of 
     enactment of this Act, the Institute of Medicine shall 
     conduct a nationwide analysis, and submit a report to the 
     appropriate committees of Congress, concerning the 
     compensation structure of professional and paraprofessional 
     personnel employed by qualified community mental health 
     programs as defined under section 1913(b)(1) of the Public 
     Health Service Act, as compared with the compensation 
     structure of comparable health safety net providers and 
     relevant private sector health care employers.
       (b) Scope.--In preparing the report under subsection (a), 
     the Institute of Medicine shall examine compensation 
     disparities, if such disparities are determined to exist, by 
     type of personnel, type of provider or private sector 
     employer, and geographic region.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to

[[Page 27422]]

     carry out this section, $550,000 for each of fiscal years 
     2009 and 20l0.
  By Mr. SMITH (for himself and Mr. Reed):
  S. 2183. A bill to amend the Public Health Service Act to provide 
grants for community-based mental health infrastructure improvement; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. SMITH. Mr. President, I rise today with my colleague, Senator 
Jack Reed of Rhode Island, to introduce two bills, S. 2182 and S. 2183, 
that we hope will have a tremendous impact on the quality and 
accessibility of mental health care throughout the U.S. Our bills, the 
Community Mental Health Services Improvement Act and the Community-
Based Mental Health Infrastructure Improvement Act, support those 
programs that serve as an important line of defense against mental 
illnesses and suicide.
  Community mental health programs are the backbone of our mental 
health system by providing access to vital mental health care services 
to those in need. Unfortunately, community mental health centers are 
suffering under tremendous fiscal constraints to provide care in their 
communities. They operate, usually, on a small budget and with little 
resources to improve their facilities. Senator Reed and I are 
introducing these 2 bills to help community mental health centers 
obtain the resources necessary to meet their needs.
  The goal of the Community Mental Health Services Improvement Act is 
to provide funding to promote the provision of mental health services 
locally. The bill would establish a grant program for community mental 
health programs to provide health care services, screenings, referrals, 
information technology or facility improvements. The bill also 
establishes grants for programs that integrate treatment for 
individuals with a serious mental illness and a co-occurring substance 
abuse disorder. Grants also would be provided to mental health 
nonprofit organizations or accredited institutions to establish or 
expand accredited mental health education and training programs. 
Finally, this bill will provide grants to community mental health 
programs for tele-mental health in medically-underserved areas.
  The second bill that we are introducing today is one that is very 
important to mental health programs in my home State of Oregon. 
Currently, patients are waiting for important mental health care due to 
lack of building capacity. Our bill, the Community-Based Mental Health 
Infrastructure Improvements Act, would provide funding for bricks and 
mortar infrastructure for mental health programs in our communities. 
There is no Federal funding currently available for construction of 
community mental health facilities. This bill ensures that individuals 
with mental illness are not turned away because a facility does not 
have the resources to keep their building up to code or because a 
building expansion could not occur to keep up with a growing population 
because no funds were available.
  In developing this legislation, I worked with the Health Resources 
and Services Administration, HRSA, and the Substance Abuse and Mental 
Health Services Administration, SAMHSA, to determine how best to make 
funding available for community mental health programs. This bill would 
encourage a continuation of this important partnership between SAMHSA, 
HRSA and States to ensure that competitive grant funding is made 
available to community mental health programs throughout the country.
  We know that mental illness can affect people of any age, of any race 
and of any income. As a parent with a son who struggled with mental 
illness, I know all too well the indiscriminate nature of the illness 
and the frightening statistics of its regular occurrence for those we 
love. In any given year, more than a quarter of our Nation's adults, 60 
million people, suffer from a diagnosable mental disorder, many of whom 
suffer in silence. Mental disorders are the leading cause of disability 
for those aged 15-44 in the U.S. and in Canada.
  Mental illness is just as deadly and serious as a physical illness. 
Suicide takes the lives of more than 30,000 people each year, with more 
than 700,000 attempts. Suicides outnumber homicides 3 to 1 each year. 
People who suffer from mental illness also suffer from much higher 
rates of other chronic conditions, such as cardiovascular disease. 
However, unlike heart attacks and strokes, mental illness is not 
something that we, as a Nation, want to talk about.
  In a 2004 report by the Oregon Governor's Mental Health Taskforce, 
they found that in any given year 175,000 adults and 75,000 children 
under the age of 18 are in need of mental health services in my home 
State. Effective treatment exists for most people suffering. Help is 
out there, and these bills will help ensure that this help can be 
accessed effectively.
  I urge my colleagues on both sides of the aisle to support the 
important work of community mental health centers by voting for these 
bills.
  Mr. President, 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 
placed in the Record, as follows:

                                S. 2183

       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 ``Community-Based Mental 
     Health Infrastructure Improvements Act''.

     SEC. 2. COMMUNITY-BASED MENTAL HEALTH INFRASTRUCTURE 
                   IMPROVEMENT.

       Title V of the Public Health Service Act (42 U.S.C. 280g et 
     seq.) is amended by adding at the end the following:

  ``PART H--COMMUNITY-BASED MENTAL HEALTH INFRASTRUCTURE IMPROVEMENTS

     ``SEC. 560. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH 
                   INFRASTRUCTURE IMPROVEMENTS.

       ``(a) Grants Authorized.--The Secretary may award grants to 
     eligible entities to expend funds for the construction or 
     modernization of facilities used to provide mental health and 
     behavioral health services to individuals.
       ``(b) Eligible Entity.--In this section, the term `eligible 
     entity' means--
       ``(1) a State that is the recipient of a Community Mental 
     Health Services Block Grant under subpart I of part B of 
     title XIX and a Substance Abuse Prevention and Treatment 
     Block Grant under subpart II of such part; or
       ``(2) an Indian tribe or a tribal organization (as such 
     terms are defined in sections 4(b) and 4(c) of the Indian 
     Self-Determination and Education Assistance Act).
       ``(c) Application.--A eligible entity desiring a grant 
     under this section shall submit to the Secretary an 
     application at such time, in such manner, and containing--
       ``(1) a plan for the construction or modernization of 
     facilities used to provide mental health and behavioral 
     health services to individuals that--
       ``(A) designates a single State or tribal agency as the 
     sole agency for the supervision and administration of the 
     grant;
       ``(B) contains satisfactory evidence that such agency so 
     designated will have the authority to carry out the plan;
       ``(C) provides for the designation of an advisory council, 
     which shall include representatives of nongovernmental 
     organizations or groups, and of the relevant State or tribal 
     agencies, that aided in the development of the plan and that 
     will implement and monitor any grant awarded to the eligible 
     entity under this section;
       ``(D) in the case of an eligible entity that is a State, 
     includes a copy of the State plan under section 1912(b) and 
     section 1932(b);
       ``(E)(i) includes a listing of the projects to be funded by 
     the grant; and
       ``(ii) in the case of an eligible entity that is a State, 
     explains how each listed project helps the State in 
     accomplishing its goals and objectives under the Community 
     Mental Health Services Block Grant under subpart I of part B 
     of title XIX and the Substance Abuse Prevention and Treatment 
     Block Grant under subpart II of such part;
       ``(F) includes assurances that the facilities will be used 
     for a period of not less than 10 years for the provision of 
     community-based mental health or substance abuse services for 
     those who cannot pay for such services, subject to subsection 
     (e); and
       ``(G) in the case of a facility that is not a public 
     facility, includes the name and executive director of the 
     entity who will provide services in the facility; and
       ``(2) with respect to each construction or modernization 
     project described in the application--
       ``(A) a description of the site for the project;
       ``(B) plans and specifications for the project and State or 
     tribal approval for the plans and specifications;

[[Page 27423]]

       ``(C) assurance that the title for the site is or will be 
     vested with either the public entity or private nonprofit 
     entity who will provide the services in the facility;
       ``(D) assurance that adequate financial resources will be 
     available for the construction or major rehabilitation of the 
     project and for the maintenance and operation of the 
     facility;
       ``(E) estimates of the cost of the project; and
       ``(F) the estimated length of time for completion of the 
     project.
       ``(d) Subgrants by States.--
       ``(1) In general.--A State that receives a grant under this 
     section may award a subgrant to a qualified community program 
     (as such term is used in section 1913(b)(1)).
       ``(2) Use of funds.--Subgrants awarded pursuant to 
     paragraph (1) may be used for activities such as--
       ``(A) the construction, expansion, and modernization of 
     facilities used to provide mental and behavioral health 
     services to individuals;
       ``(B) acquiring and leasing facilities and equipment 
     (including paying the costs of amortizing the principal of, 
     and paying the interest on, loans for such facilities and 
     equipment) to support or further the operation of the 
     subgrantee; and
       ``(C) the construction and structural modification 
     (including equipment acquisition) of facilities to permit the 
     integrated delivery of behavioral health and primary care of 
     specialty medical services to individuals with co-occurring 
     mental illnesses and chronic medical or surgical diseases at 
     a single service site.
       ``(e) Request To Transfer Obligation.--An eligible entity 
     that receives a grant under this section may submit a request 
     to the Secretary for permission to transfer the 10-year 
     obligation of facility use, as described in subsection 
     (c)(1)(F), to another facility.
       ``(f) Agreement to Federal Share.--As a condition of 
     receipt of a grant under this section, an eligible entity 
     shall agree, with respect to the costs to be incurred by the 
     entity in carrying out the activities for which such grant is 
     awarded, that the entity will make available non-Federal 
     contributions (which may include State or local funds, or 
     funds from the qualified community program) in an amount 
     equal to not less than $1 for every $1 of Federal funds 
     provided under the grant.
       ``(g) Reporting.--
       ``(1) Reporting by states.--During the 10-year period 
     referred to in subsection (c)(1)(F), the Secretary shall 
     require that a State that receives a grant under this section 
     submit, as part of the report of the State required under the 
     Community Mental Health Services Block Grant under subpart I 
     of part B of title XIX and the Substance Abuse Prevention and 
     Treatment Block Grant under subpart II of such part, a 
     description of the progress on--
       ``(A) the projects carried out pursuant to the grant under 
     this section; and
       ``(B) the assurances that the facilities involved continue 
     to be used for the purpose for which they were funded under 
     such grant during such 10-year period.
       ``(2) Reporting by indian tribes and tribal 
     organizations.--The Secretary shall establish reporting 
     requirements for Indian tribes and tribal organizations that 
     receive a grant under this section. Such reporting 
     requirements shall include that such Indian tribe or tribal 
     organization provide a description of the progress on--
       ``(A) the projects carried out pursuant to the grant under 
     this section; and
       ``(B) the assurances that the facilities involved continue 
     to be used for the purpose for which they were funded under 
     such grant during the 10-year period referred to in 
     subsection (c)(1)(F).
       ``(h) Failure to Meet Obligations.--
       ``(1) In general.--If an eligible entity that receives a 
     grant under this section fails to meet any of the obligations 
     of the entity required under this section, the Secretary 
     shall take appropriate steps, which may include--
       ``(A) requiring that the entity return the unused portion 
     of the funds awarded under this section for the projects that 
     are incomplete; and
       ``(B) extending the length of time that the entity must 
     ensure that the facility involved is used for the purposes 
     for which it is intended, as described in subsection 
     (c)(1)(F).
       ``(2) Hearing.--Prior to requesting the return of the funds 
     under paragraph (1)(B), the Secretary shall provide the 
     entity notice and opportunity for a hearing.
       ``(i) Collaboration.--The Secretary may establish 
     intergovernmental and interdepartmental memorandums of 
     agreement as necessary to carry out this section.
       ``(j) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $20,000,000 for 
     fiscal year 2008 and such sums as may be necessary for each 
     of fiscal years 2009 through 2012.''.
                                 ______
                                 
      By Mr. SMITH (for himself, Mr. Bingaman, Mr. Salazar, and Mr. 
        Sanders):
  S. 2186. A bill to permit individuals who are employees of a grantee 
that is receiving funds under section 330 of the Public Health Service 
Act to enroll in health insurance coverage provided under the Federal 
Employees Health Benefits Program; to the Committee on Homeland 
Security and Governmental Affairs.
  Mr. SMITH. Mr. President, today I am introducing the Community Health 
Center Employee Health Coverage Act of 2007, a bill that will help 
provide community health centers, or CHCs, better access to more 
affordable health insurance for their employees. I am pleased to have 
my colleagues Senators Bingaman, Salazar and Sanders join me as 
original cosponsors on this important proposal.
  CHCs form the backbone of the Nation's health care safety net. They 
provide essential medical services to some of our most vulnerable 
citizens, including the uninsured and Medicaid and Medicare 
beneficiaries. In my home State of Oregon, health centers provide over 
130 points of access, where upwards of 180,000 individuals receive care 
each year. Approximately 41 percent of those served are uninsured and 
36 percent are on Medicaid, and most all reside in either a rural or 
economically depressed area. Clearly, CHCs have an important role in 
ensuring that those who otherwise might be unable to afford health 
coverage have access to the care they need.
  CHCs also serve their patients in a very efficient manner. Studies 
have shown that care provided Medicaid patients at CHCs costs 30 
percent less than care provided in other settings. This is mainly due 
to a lower number of specialty referrals and fewer overall hospital 
admissions. CHCs effectively demonstrate how focusing on primary and 
preventive care can help keep individuals healthier, which ultimately 
enhances their lives and saves the broader health care system money. 
Above and beyond the efficiencies CHCs have achieved in service 
delivery, patients report overwhelming satisfaction for the treatment 
they are provided. Health care providers across the spectrum would be 
well-served by emulating CHCs' example of delivering affordable, high-
quality health care in an efficient manner.
  Given the enormous value CHCs have to the U.S. health care system, I 
believe Congress should do all it can to support their mission. I 
commend President Bush's commitment to increasing funding for health 
center expansion in recent years. I am pleased the administration's 
request for $180 million in new funding in fiscal year 2007 was 
included in the Senate's version of the budget resolution. As the 
appropriations process continues to move forward, I hope that those 
much-needed funds are ultimately approved by Congress.
  The bill I am filing today will complement the increased funding CHCs 
have received in recent years. Just like businesses across the nation, 
health centers are coping with the rising cost of providing health 
benefit to their employees. Premiums for private health insurance grew 
by 9.5 percent in 2005, the fifth consecutive year of increases over 9 
percent. Because CHCs operate on very limited budgets, it has become 
more and more difficult for them to absorb these increased costs while 
continuing to provide affordable health care to their patients.
  It is important to note that CHCs rely upon the Federal Government 
for more than half of their operating revenues. Each year, health 
centers receive 26 percent of their funding from direct Federal grants 
and another 36 percent from the Medicaid Program. Because CHCs are 
predominantly a Federal enterprise, I believe it makes sense for them 
to be able to reap many of the same benefits of other Federal entities. 
That is why the bill I am filing today would allow CHCs to purchase 
more affordable health insurance coverage for their employees through 
the Federal Employee Health Benefits Program, FEHBP.
  Allowing federally funded entities to purchase health coverage 
through FEHBP is not unprecedented. Employees of Gallaudet University 
and certain U.S. Department of Agriculture grantees already are able to 
participate in FEHBP as if they were directly employed by the Federal 
Government.

[[Page 27424]]

Considering that CHC providers are already deemed ``Federal employees'' 
for the purpose of receiving medical liability protection through the 
Federal Government, it is a logical next step to allow them to purchase 
health coverage through FEHBP. In doing so, we will be able to provide 
CHCs much needed security in knowing that their employees will have 
steady access to affordable health insurance.
  I believe that in the long run, CHCs will be able to achieve a great 
deal of savings by purchasing health coverage for their employees 
through FEHBP. Premiums for policies purchased through FEHBP 
consistently grow at a much slower rate than other commercial policies. 
Every dollar CHCs save in employee benefit costs can be redirected into 
medical care for the vulnerable populations they serve. Access to FEHBP 
coverage also may help some CHCs provide health benefits to their 
employees for the first time. This could help recruit much needed 
medical personnel in underserved and rural communities. I am hopeful 
health centers in rural parts of my State will be able to attract the 
physicians they so desperately need by offering them FEHBP coverage.
  There is wide support for CHCs in the Senate, as evidenced by the 
development of a number of CHC-related measures. Earlier this year, I 
joined a group of bipartisan Senators in filing the Community Health 
Center Reauthorization Act, to ensure that vulnerable populations have 
access to basic health care for the next several years. I hope the 
Senate's leadership will move these bills quickly through the process, 
as a sign of appreciation for the important role CHCs play in the U.S. 
health care system.
  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 
placed in the Record, as follows:

                                S. 2186

       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 ``Community Health Center 
     Employee Health Coverage Act of 2007''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Federally Qualified Health Centers (referred to in this 
     section as ``FQHCs'') are required under section 330 of the 
     Public Health Service Act (42 U.S.C. 254b) to be located in, 
     and serve, a community that is designated as ``medically 
     underserved''.
       (2) FQHCs are required under such section 330 to make its 
     services available to all residents of the community, without 
     regard to ability to pay, and to make those services 
     affordable by discounting charges for otherwise uncovered 
     care to low-income families in accordance with family income.
       (3) FQHCs are required under such section 330 to provide 
     comprehensive primary health care services, including 
     preventive care, care for illness or injury, services which 
     improve the accessibility of care, and the effectiveness of 
     care.
       (4) FQHCs are required under such section 330 to be 
     governed by a board of directors, a majority of whose members 
     are active, registered patients of the health center, thus 
     ensuring that the center is responsive to the health care 
     needs of the community it serves.
       (5) FQHCs delivered comprehensive primary and preventive 
     care to more than 16,000,000 people in 2006, more than 
     6,000,000 of whom had no health insurance coverage.
       (6) FQHCs employ nearly 100,000 people across the United 
     States.
       (7) FQHCs are being challenged by increasing financial 
     pressures that jeopardize their ability to provide health 
     services to medically underserved populations, including the 
     elderly, the uninsured, and lower-income individuals.
       (8) Health insurance costs in the small employer market 
     have risen more than 30 percent in the past 2 years, forcing 
     many FQHCs to use additional Federal funding to continue to 
     provide health insurance coverage for their employees.
       (9) The Federal Government negotiates premiums with health 
     insurance companies for millions of Federal employees, 
     thereby ensuring the best possible rates under the Federal 
     Employee Health Benefit Program (referred to in this section 
     as ``FEHBP'').
       (10) Last year FEHBP premiums increased 6.6 percent, far 
     less than that of even large employers.
       (11) FQHCs receive Federal grants from the Health Resource 
     and Services Administration that help cover the cost of 
     providing high quality, affordable health care for everyone 
     in their communities, including the uninsured.
       (12) FQHCs use a portion of their Federal grant to cover 
     the cost of health insurance for their employees.
       (13) As health insurance premiums rise, FQHCs may be forced 
     to reduce health insurance coverage for their own employees, 
     or reduce the availability of care in their communities.
       (14) Last year, almost 1,400,000 Americans joined the ranks 
     of the uninsured--bringing our Nation's total to more than 
     47,000,000 people without health insurance, while another 
     30,000,000 or more are underinsured.
       (15) The uninsured are in significantly worse health than 
     those with health insurance, receive fewer preventive 
     services, are less likely to receive regular care for chronic 
     diseases, and are more likely to be hospitalized for a 
     condition that could have been treated more effectively with 
     timely access to ambulatory care.
       (16) Adding FQHC employees to the list of those covered 
     under the FEHBP would help control rising health insurance 
     costs, reduce the cost of providing health insurance to their 
     employees, and enable centers to use scarce funds to continue 
     providing care in their communities.

     SEC. 3. ADDITION OF HEALTH CENTER EMPLOYEES TO FEHBP.

       (a) Definitions.--Section 8901(l) of title 5, United States 
     Code, is amended--
       (1) in subparagraph (H), by striking ``and'' at the end;
       (2) in subparagraph (I), by striking the period and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(J) an individual who is an employee of a federally 
     qualified health center (as defined in section 1905(l)(2)(B) 
     of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))) that 
     has elected to offer coverage under this chapter or who is an 
     employee of a grantee that is receiving funds under section 
     330(l) of the Public Health Service Act (42 U.S.C. 254b(l)) 
     that has elected to offer coverage under this chapter.''.
       (b) Employees Health Benefits Fund.--Section 8909 of title 
     5, United States Code, is amended by adding at the end the 
     following:
       ``(h) An individual who is an employee of a federally 
     qualified health center (as defined in section 1905(l)(2)(B) 
     of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))) who 
     has elected coverage under this chapter or who is an employee 
     of a grantee that is receiving funds under section 330(l) of 
     the Public Health Service Act (42 U.S.C. 254b(l)) who has 
     elected coverage under this chapter shall be required to pay 
     currently into the Employees Health Benefits Fund, under 
     arrangements satisfactory to the Office, an amount equal to 
     the sum of--
       ``(1) the employee and agency contributions which would be 
     required in the case of an employee enrolled in the same 
     health benefits plan and level of benefits; and
       ``(2) an amount, determined under regulations prescribed by 
     the Office, necessary for administrative expenses, but not to 
     exceed 2 percent of the total amount under clause (i).''.
                                 ______
                                 
      By Mr. BINGAMAN (for himself, Ms. Snowe, Mr. Salazar, Mr. Smith, 
        Mr. Akaka, and Mr. Sanders):
  S. 2188. A bill to amend title XVIII of the Social Security Act to 
establish a prospective payment system instead of the reasonable cost-
based reimbursement method for Medicare-covered services provided by 
Federally qualified health centers and to expand the scope of such 
covered services to account for expansions in the scope of services 
provided by Federally qualified health centers since the inclusion of 
such services for coverage under the Medicare Program; to the Committee 
on Finance.
  Mr. BINGAMAN. Mr. President, I rise today with Senators Snowe, 
Salazar, Smith, Akaka, and Sanders to introduce the Medicare Access to 
Community Health Center, MATCH, Act, which would address a long 
standing problem for a key component of our Nation's health care safety 
net, community health centers. These facilities serve as medical homes 
to nearly 16 million underserved patients. Over 1 million of those 
patients are Medicare beneficiaries. Health centers are known for 
providing high quality, comprehensive care to some of our Nation's most 
vulnerable populations.
  Over 15 years ago, Congress created the Federally Qualified Health 
Center, FQHC, Medicare benefit to ensure that health centers were not 
forced to subsidize Medicare payments with Federal grant dollars. 
Congress required centers to be paid their reasonable costs for 
providing care to their patients. The Centers for Medicare and Medicaid 
Services later established a per visit payment cap in regulations based 
on a statute applicable to Rural Health

[[Page 27425]]

Clinics. CMS applied the cap to FQHCs without meaningful data to 
support the payment limit but with the promise of future reviews to 
guarantee that health centers were adequately reimbursed. However, 
these reviews have not taken place. Now, 15 years later, over \3/4\ of 
health centers are losing money serving Medicare beneficiaries, with 
losses totaling over $50 million annually according to an analysis done 
by the National Association of Community Health Centers. In my home 
State of New Mexico, NACHC estimates that health centers have lost more 
than a million dollars annually.
  I have repeatedly asked CMS to review this antiquated cap but I have 
had little success. So I rise today to introduce legislation to improve 
the Medicare payment mechanism for FQHCs. MATCH will establish a 
Prospective Payment System for FQHCs, based on actual cost of providing 
care to health center patients. This new mechanism mirrors the 
successful Medicaid FQHC Prospective Payment System. By reforming the 
payment structure at FQHCs, we will ensure health centers are able to 
dedicate their Federal grant dollars for their original intent, 
providing care to the uninsured. This new mechanism will also increase 
efficiency and stability in the Medicare program for health centers.
  This legislation is long overdue. I ask my colleagues to join me in 
strengthening the Medicare FQHC program to ensure that health centers 
can continue to provide high quality, affordable primary and preventive 
care to our Nation's seniors and people with disabilities.
  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 
placed in the Record, as follows:

                                S. 2188

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Access to Community 
     Health Centers (MATCH) Act of 2007''.

     SEC. 2. FINDINGS.

       Congress finds that:
       (1) National importance.--Community health centers serve as 
     the medical home and family physician to over 16,000,000 
     people nationally. Patients of community health centers 
     represent 1 in 7 low-income persons, 1 in 8 uninsured 
     Americans, 1 in 9 Medicaid beneficiaries, 1 in 10 minorities, 
     and 1 in 10 rural residents.
       (2) Health care safety net.--Because Federally qualified 
     health centers (FQHCs) are generally located in medically 
     underserved areas, the patients of Federally qualified health 
     centers are disproportionately low income, uninsured or 
     publicly insured, and minorities, and they frequently have 
     poorer health and more complicated, costly medical needs than 
     patients nationally. As a chief component of the health care 
     safety net, Federally qualified health centers are required 
     by regulation to serve all patients, regardless of insurance 
     status or ability to pay.
       (3) Medicare beneficiaries.--Medicare beneficiaries are 
     typically less healthy and, therefore, costlier to treat than 
     other patients of Federally qualified health centers. 
     Medicare beneficiaries tend to have more complex health care 
     needs as--
       (A) more than half of Medicare patients have at least 2 
     chronic conditions;
       (B) 45 percent take 5 or more medications; and
       (C) over half of Medicare beneficiaries have more than 1 
     prescribing physician.
       (4) Need to improve fqhc payment.--While the Centers for 
     Medicare & Medicaid Services have nearly 15 years' worth of 
     cost report data from Federally qualified health centers, 
     which would equip the agency to develop a new Medicare 
     reimbursement system, the agency has failed to update and 
     improve the Medicare FQHC payment system.

     SEC. 3. EXPANSION OF MEDICARE-COVERED PRIMARY AND PREVENTIVE 
                   SERVICES AT FEDERALLY QUALIFIED HEALTH CENTERS.

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

     when furnished to an individual as a patient of a Federally 
     qualified health center and such services when provided by a 
     health care provider or health care professional employed by 
     or under contract with a Federally qualified health center 
     and for this purpose, any reference to a rural health clinic 
     or a physician described in paragraph (2)(B) is deemed a 
     reference to a Federally qualified health center or a 
     physician at the center, respectively. Services described in 
     the previous sentence shall be treated as billable visits for 
     purposes of payment to the Federally qualified health 
     center.''.
       (b) Conforming Amendment To Permit Payment for Hospital-
     Based Services.--Section 1862(a)(14) of such Act (42 U.S.C. 
     1395y(a)(14)) is amended by inserting ``Federally qualified 
     health center services,'' after ``qualified psychologist 
     services,''.
       (c) Effective Dates.--The amendments made by subsections 
     (a) and (b) shall apply to services furnished on or after 
     January 1, 2008.

     SEC. 4. ESTABLISHMENT OF A MEDICARE PROSPECTIVE PAYMENT 
                   SYSTEM FOR FEDERALLY QUALIFIED HEALTH CENTER 
                   SERVICES.

       (a) In General.--Paragraph (3) section 1833(a) of the 
     Social Security Act (42 U.S.C. 1395l(a)) is amended to read 
     as follows:
       ``(3)(A) in the case of services described in section 
     1832(a)(2)(D)(i) the costs which are reasonable and related 
     to the furnishing of such services or which are based on such 
     other tests of reasonableness as the Secretary may prescribe 
     in regulations including those authorized under section 
     1861(v)(1)(A), less the amount a provider may charge as 
     described in clause (ii) of section 1866(a)(2)(A) but in no 
     case may the payment for such services (other than for items 
     and services described in 1861(s)(10)(A)) exceed 80 percent 
     of such costs; and
       ``(B) in the case of services described in section 
     1832(a)(2)(D)(ii) furnished by a Federally qualified health 
     center--
       ``(i) subject to clauses (iii) and (iv), for services 
     furnished on and after January 1, 2008, during the center's 
     fiscal year that ends in 2008, an amount (calculated on a per 
     visit basis) that is equal to 100 percent of the average of 
     the costs of the center of furnishing such services during 
     such center's fiscal years ending during 2006 and 2007 which 
     are reasonable and related to the cost of furnishing such 
     services, or which are based on such other tests of 
     reasonableness as the Secretary prescribes in regulations 
     including those authorized under section 1861(v)(1)(A) 
     (except that in calculating such cost in a center's fiscal 
     years ending during 2006 and 2007 and applying the average of 
     such cost for a center's fiscal year ending during fiscal 
     year 2008, the Secretary shall not apply a per visit payment 
     limit or productivity screen), less the amount a provider may 
     charge as described in clause (ii) of section 1866(a)(2)(A), 
     but in no case may the payment for such services (other than 
     for items or services described in section 1861(s)(10)(A)) 
     exceed 80 percent of such average of such costs;
       ``(ii) subject to clauses (iii) and (iv), for services 
     furnished during the center's fiscal year ending during 2009 
     or a succeeding fiscal year, an amount (calculated on a per 
     visit basis and without the application of a per visit limit 
     or productivity screen) that is equal to the amount 
     determined under this subparagraph for the center's preceding 
     fiscal year (without regard to any copayment)--
       ``(I) increased for a center's fiscal year ending during 
     2009 by the percentage increase in the MEI (as defined in 
     section 1842(i)(3)) applicable to primary care services (as 
     defined in section 1842(i)(4)) for 2009 and increased for a 
     center's fiscal year ending during 2010 or any succeeding 
     fiscal year by the percentage increase for such year of a 
     market basket of Federally qualified health center costs as 
     developed and promulgated through regulations by the 
     Secretary; and
       ``(II) adjusted to take into account any increase or 
     decrease in the scope of services, including a change in the 
     type, intensity, duration, or amount of services, furnished 
     by the center during the center's fiscal year,

     less the amount a provider may charge as described in clause 
     (ii) of section 1866(a)(2)(A), but in no case may the payment 
     for such services (other than for items or services described 
     in section 1861(s)(10)(A)) exceed 80 percent of the amount 
     determined under this clause (without regard to any 
     copayment);
       ``(iii) subject to clause (iv), in the case of an entity 
     that first qualifies as a Federally qualified health center 
     in a center's fiscal year ending after 2007--
       ``(I) for the first such center fiscal year, an amount 
     (calculated on a per visit basis and without the application 
     of a per visit payment limit or productivity screen) that is 
     equal to 100 percent of the costs of furnishing such services 
     during such center fiscal year based on the per visit payment 
     rates established under clause (i) or (ii) for a comparable 
     period for other such centers located in the same or adjacent 
     areas with a similar caseload or, in the absence of such a 
     center, in accordance with the regulations and methodology 
     referred to in clause (i) or based on such other tests of 
     reasonableness

[[Page 27426]]

     (without the application of a per visit payment limit or 
     productivity screen) as the Secretary may specify, less the 
     amount a provider may charge as described in clause (ii) of 
     section 1866 (a)(2)(A), but in no case may the payment for 
     such services (other than for items and services described in 
     section 1861(s)(10)(A)) exceed 80 percent of such costs; and
       ``(II) for each succeeding center fiscal year, the amount 
     calculated in accordance with clause (ii); and
       ``(iv) with respect to Federally qualified health center 
     services that are furnished to an individual enrolled with a 
     MA plan under part C pursuant to a written agreement 
     described in section 1853(a)(4) (or, in the case of MA 
     private fee for service plan, without such written agreement) 
     the amount (if any) by which--
       ``(I) the amount of payment that would have otherwise been 
     provided under clauses (i), (ii), or (iii) (calculated as if 
     `100 percent' were substituted for `80 percent' in such 
     clauses) for such services if the individual had not been 
     enrolled; exceeds
       ``(II) the amount of the payments received under such 
     written agreement (or, in the case of MA private fee for 
     service plans, without such written agreement) for such 
     services (not including any financial incentives provided for 
     in such agreement such as risk pool payments, bonuses, or 
     withholds) less the amount the Federally qualified health 
     center may charge as described in section 1857(e)(3)(B);''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to services furnished on or after January 1, 
     2008.
                                 ______
                                 
      By Mr. DODD (for himself and Mr. Durbin):
  S. 2189. A bill to provide for educational opportunities for all 
students in State public school systems, and for other purposes; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. DODD. Mr. President, I rise today to introduce the Student Bill 
of Rights. This bill would ensure that every child in America has an 
equal opportunity to receive a high quality education.
  The Student Bill of Rights would achieve this goal by providing 
America's children with components needed for a solid education. These 
components include highly qualified teachers, challenging curricula, 
small classes, current textbooks, quality libraries, and up-to-date 
technology.
  Currently, Federal law requires that schools within the same district 
provide comparable educational services. The Student Bill of Rights 
would extend that basic guarantee of equal opportunity to the State 
level by requiring comparability of resources across school districts 
within a State.
  More than 50 years ago, Brown v. Board of Education struck down 
segregation in law. Over 50 years later, we know that just because 
there is no segregation in law does not mean that it does not persist. 
Today, our education system remains largely separate and unequal, and 
in light of a recent Supreme Court decision, we need to find more 
creative ways to promote equity in our schools.
  All too often, where a child's family can afford to live determines 
whether that child is taught by a high quality teacher, has access to 
the best courses and instructional materials, goes to school in a new, 
modern building, and otherwise benefits from educational resources that 
have been shown to be essential to a quality education. In fact, the 
U.S. ranks at the bottom among developed countries in the disparity in 
the quality of schools available to wealthy and low-income children. 
This gap is simply unacceptable, and it is why the Student Bill of 
Rights is so important to our children's ability to gain the skills 
they need to be responsible, participating citizens in our diverse 
democracy, and to compete and succeed in the global economy.
  While other factors such as supportive parents, motivated peers, and 
positive role models in the community are also beneficial to academic 
achievement, we know that adequate resources are crucial to providing 
students with the opportunity to receive a solid education.
  The quality of a child's education should not be determined by his or 
her ZIP code. The Student Bill of Rights will help ensure that each and 
every child gets a decent education, and in turn, an equal opportunity 
for a successful future. I hope that my colleagues will join me in 
supporting the Student Bill of Rights.
  Mr. President, 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. 2189

       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 ``Student Bill of Rights''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings and purposes.

               TITLE I--ACCESS TO EDUCATIONAL OPPORTUNITY

Sec. 101. State public school systems.
Sec. 102. Fundamentals of educational opportunity.

                     TITLE II--STATE ACCOUNTABILITY

Sec. 201. State accountability plan.
Sec. 202. Consequences of failure to meet requirements.

              TITLE III--REPORT TO CONGRESS AND THE PUBLIC

Sec. 301. Annual report on State public school systems.

                            TITLE IV--REMEDY

Sec. 401. Civil action for enforcement.

                      TITLE V--GENERAL PROVISIONS

Sec. 501. Definitions.
Sec. 502. Rulemaking.
Sec. 503. Construction.

     SEC. 3. FINDINGS AND PURPOSES.

       (a) Findings.--Congress finds the following:
       (1) A high-quality, highly competitive education for all 
     students is imperative for the economic growth and 
     productivity of the United States, for its effective national 
     defense, and to achieve the historical aspiration to be one 
     Nation of equal citizens. It is therefore necessary and 
     proper to overcome the nationwide phenomenon of State public 
     school systems that do not meet the requirements of section 
     101(a), in which high-quality public schools typically serve 
     high-income communities and poor-quality schools typically 
     serve low-income, urban, rural, and minority communities.
       (2) In 2005, the National Academies found in their report 
     ``Rising Above the Gathering Storm: Energizing and Employing 
     America for a Brighter Economic Future'' that the inadequate 
     preparation of kindergarten through grade 12 students in 
     science and mathematics, including the significant lack of 
     teachers qualified to teach these subjects, threatens the 
     economic prosperity of the United States. When students do 
     not receive quality mathematics and science preparation in 
     kindergarten through grade 12, they are not prepared to take 
     advanced courses in these subjects at the postsecondary 
     level, leaving the United States with a critical shortage of 
     scientists and engineers--a shortfall being filled by 
     professionals from other countries.
       (3) There exists in the States a significant educational 
     opportunity gap for low-income, urban, rural, and minority 
     students characterized by the following:
       (A) Continuing disparities within States in students' 
     access to the fundamentals of educational opportunity 
     described in section 102.
       (B) Highly differential educational expenditures (adjusted 
     for cost and need) among school districts within States.
       (C) Radically differential educational achievement among 
     students in school districts within States as measured by the 
     following:
       (i) Achievement in mathematics, reading or language arts, 
     and science on State academic assessments required under 
     section 1111(b)(3) of the Elementary and Secondary Education 
     Act of 1965 (20 U.S.C. 6311(b)(3)) and on the National 
     Assessment of Educational Progress.
       (ii) Advanced placement courses taken.
       (iii) SAT and ACT test scores.
       (iv) Dropout rates and graduation rates.
       (v) College-going and college-completion rates.
       (4) As a consequence of this educational opportunity gap, 
     the quality of a child's education depends largely upon where 
     the child's family can afford to live, and the detriments of 
     lower quality education are imposed particularly on--
       (A) children from low-income families;
       (B) children living in urban and rural areas; and
       (C) minority children.
       (5) Since 1785, Congress, exercising the power to admit new 
     States under section 3 of article IV of the Constitution (and 
     previously, the Congress of the Confederation of States under 
     the Articles of Confederation), has imposed upon every State, 
     as a fundamental condition of the State's admission, that the 
     State provide for the establishment and maintenance of 
     systems of public schools open to all children in such State.
       (6) Over the years since the landmark ruling in Brown v. 
     Board of Education, 347 U.S. 483, 493 (1954), when a 
     unanimous Supreme

[[Page 27427]]

     Court held that ``the opportunity of an education . . . , 
     where the State has undertaken to provide it, is a right 
     which must be made available to all on equal terms'', courts 
     in 44 States have heard challenges to the establishment, 
     maintenance, and operation of State public school systems 
     that are separate and not educationally adequate.
       (7) In 1970, the Presidential Commission on School Finance 
     found that significant disparities in the distribution of 
     educational resources existed among school districts within 
     States because the States relied too significantly on local 
     district financing for educational revenues, and that reforms 
     in systems of school financing would increase the Nation's 
     ability to serve the educational needs of all children.
       (8) In 1999, the National Research Council of the National 
     Academy of Sciences published a report entitled ``Making 
     Money Matter, Financing America's Schools'', which found that 
     the concept of funding adequacy, which moves beyond the more 
     traditional concepts of finance equity to focus attention on 
     the sufficiency of funding for desired educational outcomes, 
     is an important step in developing a fair and productive 
     educational system.
       (9) In 2001, the Executive Order establishing the 
     President's Commission on Educational Resource Equity 
     declared, ``A quality education is essential to the success 
     of every child in the 21st century and to the continued 
     strength and prosperity of our Nation. . . . [L]ong-standing 
     gaps in access to educational resources exist, including 
     disparities based on race and ethnicity.'' (Exec. Order No. 
     13190, 66 Fed. Reg. 5424 (2001)).
       (10) According to the Secretary of Education, as stated in 
     a letter (with enclosures) from the Secretary to States dated 
     January 19, 2001--
       (A) racial and ethnic minorities continue to suffer from 
     lack of access to educational resources, including 
     ``experienced and qualified teachers, adequate facilities, 
     and instructional programs and support, including technology, 
     as well as . . . the funding necessary to secure these 
     resources''; and
       (B) these inadequacies are ``particularly acute in high-
     poverty schools, including urban schools, where many students 
     of color are isolated and where the effect of the resource 
     gaps may be cumulative. In other words, students who need the 
     most may often receive the least, and these students often 
     are students of color.''.
       (11) In the amendments made by the No Child Left Behind Act 
     of 2001, Congress--
       (A)(i) required each State to establish standards and 
     assessments in mathematics, reading or language arts, and 
     science; and
       (ii) required schools to ensure that all students are 
     proficient in mathematics, reading or language arts, and 
     science not later than 12 years after the end of the 2001-
     2002 school year, and held schools accountable for the 
     students' progress; and
       (B) required each State to describe how the State will help 
     local educational agencies and schools to develop the 
     capacity to improve student academic achievement.
       (12) The standards and accountability movement will succeed 
     only if, in addition to standards and accountability, all 
     schools have access to the educational resources necessary to 
     enable students to achieve.
       (13) Raising standards without ensuring access to 
     educational resources may in fact exacerbate achievement gaps 
     and set children up for failure.
       (14) According to the World Economic Forum's Global 
     Competitiveness Report 2001-2002, the United States ranks 
     last among developed countries in the difference in the 
     quality of schools available to rich and poor children.
       (15) The persistence of pervasive inadequacies in the 
     quality of education provided by State public school systems 
     effectively deprives millions of children throughout the 
     United States of the opportunity for an education adequate to 
     enable the children to--
       (A) acquire the knowledge and skills necessary for 
     responsible citizenship in a diverse democracy, including the 
     ability to participate fully in the political process through 
     informed electoral choice;
       (B) meet challenging student academic achievement 
     standards; and
       (C) be able to compete and succeed in a global economy.
       (16) Each State government has ultimate authority to 
     determine every important aspect and priority of the public 
     school system that provides elementary and secondary 
     education to children in the State, including whether 
     students throughout the State have access to the fundamentals 
     of educational opportunity described in section 102.
       (17) Because a well educated populace is critical to the 
     Nation's political and economic well-being and national 
     security, the Federal Government has a substantial interest 
     in ensuring that States provide a high-quality education by 
     ensuring that all students have access to the fundamentals of 
     educational opportunity described in section 102 to enable 
     the students to succeed academically and in life.
       (b) Purposes.--The purposes of this Act are the following:
       (1) To further the goals of the Elementary and Secondary 
     Education Act of 1965 (as amended by the No Child Left Behind 
     Act of 2001), by holding States accountable for providing all 
     students with access to the fundamentals of educational 
     opportunity described in section 102.
       (2) To ensure that all students in public elementary 
     schools and secondary schools receive educational 
     opportunities that enable such students to--
       (A) acquire the knowledge and skills necessary for 
     responsible citizenship in a diverse democracy, including the 
     ability to participate fully in the political process through 
     informed electoral choice;
       (B) meet challenging student academic achievement 
     standards; and
       (C) be able to compete and succeed in a global economy.
       (3) To end the pervasive pattern of States maintaining 
     public school systems that do not meet the requirements of 
     section 101(a).

               TITLE I--ACCESS TO EDUCATIONAL OPPORTUNITY

     SEC. 101. STATE PUBLIC SCHOOL SYSTEMS.

       (a) Requirements.--Each State receiving Federal financial 
     assistance for elementary or secondary education shall ensure 
     that the State's public school system provides all students 
     within the State with an education that enables the students 
     to acquire the knowledge and skills necessary for responsible 
     citizenship in a diverse democracy, including the ability to 
     participate fully in the political process through informed 
     electoral choice, to meet challenging student academic 
     achievement standards, and to be able to compete and succeed 
     in a global economy, through--
       (1) the provision of fundamentals of educational 
     opportunity described in section 102, at adequate or ideal 
     levels as defined by the State under section 201(a)(1)(A) to 
     students at each public elementary school and secondary 
     school in the State;
       (2) the provision of educational services in school 
     districts that receive funds under part A of title I of the 
     Elementary and Secondary Education Act of 1965 (20 U.S.C. 
     6311 et seq.) that are, taken as a whole, at least comparable 
     to educational services provided in school districts not 
     receiving such funds; and
       (3) compliance with any final Federal or State court order 
     in any matter concerning the adequacy or equitableness of the 
     State's public school system.
       (b) Determinations Concerning State Public School 
     Systems.--Not later than October 1 of each year, the 
     Secretary shall determine whether each State maintains a 
     public school system that meets the requirements of 
     subsection (a). The Secretary may make a determination that a 
     State public school system does not meet such requirements 
     only after providing notice and an opportunity for a hearing.
       (c) Publication.--The Secretary shall publish and make 
     available to the general public (including by means of the 
     Internet) the determinations made under subsection (b).

     SEC. 102. FUNDAMENTALS OF EDUCATIONAL OPPORTUNITY.

       The fundamentals of educational opportunity are the 
     following:
       (1) Highly qualified teachers, principals, and academic 
     support personnel.--
       (A) Highly qualified teachers.--Instruction from highly 
     qualified teachers in core academic subjects.
       (B) Highly qualified principals.--Leadership, management, 
     and guidance from principals who meet State certification 
     standards.
       (C) Highly qualified academic support personnel.--Necessary 
     additional academic support in reading or language arts, 
     mathematics, and other core academic subjects from personnel 
     who meet applicable State standards.
       (2) Rigorous academic standards, curricula, and methods of 
     instruction.--Rigorous academic standards, curricula, and 
     methods of instruction, as measured by the extent to which 
     each school district succeeds in providing high-quality 
     academic standards, curricula, and methods of instruction to 
     students in each public elementary school and secondary 
     school within the district.
       (3) Small class sizes.--Small class sizes, as measured by--
       (A) the average class size and the range of class sizes; 
     and
       (B) the percentage of elementary school classes with 17 or 
     fewer students.
       (4) Textbooks, instructional materials, and supplies.--
     Textbooks, instructional materials, and supplies, as measured 
     by--
       (A) the average age and quality of textbooks, instructional 
     materials, and supplies used in core academic subjects; and
       (B) the percentage of students who begin the school year 
     with school-issued textbooks, instructional materials, and 
     supplies.
       (5) Library resources.--Library resources, as measured by--
       (A) the size and qualifications of the library's staff, 
     including whether the library is staffed by a full-time 
     librarian certified under applicable State standards;
       (B) the size (relative to the number of students) and 
     quality (including age) of the library's collection of books 
     and periodicals; and
       (C) the library's hours of operation.
       (6) School facilities and computer technology.--
       (A) Quality school facilities.--Quality school facilities, 
     as measured by--

[[Page 27428]]

       (i) the physical condition of school buildings and major 
     school building features;
       (ii) environmental conditions in school buildings; and
       (iii) the quality of instructional space.
       (B) Computer technology.--Computer technology, as measured 
     by--
       (i) the ratio of computers to students;
       (ii) the quality of computers and software available to 
     students;
       (iii) Internet access;
       (iv) the quality of system maintenance and technical 
     assistance for the computers; and
       (v) the number of computer laboratory courses taught by 
     qualified computer instructors.
       (7) Quality guidance counseling.--Qualified guidance 
     counselors, as measured by the ratio of students to qualified 
     guidance counselors who have been certified under an 
     applicable State or national program.

                     TITLE II--STATE ACCOUNTABILITY

     SEC. 201. STATE ACCOUNTABILITY PLAN.

       (a) General Plan.--
       (1) Contents.--Each State receiving Federal financial 
     assistance for elementary and secondary education shall 
     annually submit to the Secretary a plan, developed by the 
     State educational agency, in consultation with local 
     educational agencies, teachers, principals, pupil services 
     personnel, administrators, other staff, and parents, that 
     contains the following:
       (A) A description of 2 levels of high access (adequate and 
     ideal) to each of the fundamentals of educational opportunity 
     described in section 102 that measure how well the State, 
     through school districts, public elementary schools, and 
     public secondary schools, is achieving the purposes of this 
     Act by providing children with the resources they need to 
     succeed academically and in life.
       (B) A description of a third level of access (basic) to 
     each of the fundamentals of educational opportunity described 
     in section 102 that measures how well the State, through 
     school districts, public elementary schools, and public 
     secondary schools, is achieving the purposes of this Act by 
     providing children with the resources they need to succeed 
     academically and in life.
       (C) A description of the level of access of each school 
     district, public elementary school, and public secondary 
     school in the State to each of the fundamentals of 
     educational opportunity described in section 102, including 
     identification of any such schools that lack high access (as 
     described in subparagraph (A)) to any of the fundamentals.
       (D) An estimate of the additional cost, if any, of ensuring 
     that the system meets the requirements of section 101(a).
       (E) Information stating the percentage of students in each 
     school district, public elementary school, and public 
     secondary school in the State that are proficient in 
     mathematics, reading or language arts, and science, as 
     measured through assessments administered as described in 
     section 1111(b)(3)(C)(v) of the Elementary and Secondary 
     Education Act of 1965 (20 U.S.C. 6311(b)(3)(C)(v)).
       (F) Information stating whether each school district, 
     public elementary school, and public secondary school in the 
     State is making adequate yearly progress, as defined under 
     section 1111(b)(2) of the Elementary and Secondary Education 
     Act of 1965 (20 U.S.C. 6311(b)(2)).
       (G)(i) For each school district, public elementary school, 
     and public secondary school in the State, information 
     stating--
       (I) the number and percentage of children counted under 
     section 1124(c) of the Elementary and Secondary Education Act 
     of 1965 (20 U.S.C. 6333(c)); and
       (II) the number and percentage of students described in 
     section 1111(b)(3)(C)(xiii) of the Elementary and Secondary 
     Education Act of 1965 (20 U.S.C. 6311(b)(3)(C)(xiii)).
       (ii) For each such school district, information stating 
     whether the district is an urban, mixed, or rural district 
     (as defined by the National Center for Education Statistics).
       (2) Levels of access.--For purposes of the plan submitted 
     under paragraph (1)--
       (A) in defining basic, adequate, and ideal levels of access 
     to each of the fundamentals of educational opportunity, each 
     State shall consider, in addition to the factors described in 
     section 102, the access available to students in the highest-
     achieving decile of public elementary schools and secondary 
     schools, the unique needs of low-income, urban and rural, and 
     minority students, and other educationally appropriate 
     factors; and
       (B) the levels of access described in subparagraphs (A) and 
     (B) of paragraph (1) shall be aligned with the challenging 
     academic content standards, challenging student academic 
     achievement standards, and high-quality academic assessments 
     required under the Elementary and Secondary Education Act of 
     1965 (20 U.S.C. 6301 et seq.).
       (3) Information.--The State shall annually disseminate to 
     parents, in an understandable and uniform format, the 
     descriptions, estimate, and information described in 
     paragraph (1).
       (b) Accountability and Remediation.--
       (1) Accountability.--If the Secretary determines under 
     section 101(b) that a State maintains a public school system 
     that fails to meet the requirements of section 101(a)(1), the 
     plan submitted under subsection (a)(1) shall--
       (A) demonstrate that the State has developed and is 
     implementing a single, statewide State accountability system 
     that will be effective in ensuring that the State makes 
     adequate yearly progress under this Act (as defined by the 
     State in a manner that annually reduces the number of public 
     elementary schools and secondary schools in the State without 
     high access (as described in subsection (a)(1)(A)) to each of 
     fundamentals of educational opportunity described in section 
     102);
       (B) demonstrate, based on the levels of access described in 
     paragraph (1) what constitutes adequate yearly progress of 
     the State under this Act toward providing all students with 
     high access to the fundamentals of educational opportunity 
     described in section 102; and
       (C) ensure--
       (i) the establishment of a timeline for that adequate 
     yearly progress that includes interim yearly goals for the 
     reduction of the number of public elementary schools and 
     secondary schools in the State without high access to each of 
     the fundamentals of educational opportunity described in 
     section 102; and
       (ii) that not later than 12 years after the end of the 
     2005-2006 school year, each public elementary school in the 
     State shall have access to each of the fundamentals of 
     educational opportunity described in section 102.
       (2) Remediation.--If the Secretary determines under section 
     101(b) that a State maintains a public school system that 
     fails to meet the requirements of section 101(a)(2), not 
     later than 1 year after the Secretary makes the 
     determination, the State shall include in the plan submitted 
     under subsection (a)(1) a strategy to remediate the 
     conditions that caused the Secretary to make such 
     determination, not later than the end of the second school 
     year beginning after submission of the plan.
       (c) Amendments.--A State may amend the plan submitted under 
     subsection (a)(1) to improve the plan or to take into account 
     significantly changed circumstances.
       (d) Disapproval.--The Secretary may disapprove the plan 
     submitted under subsection (a)(1) (or an amendment to such a 
     plan) if the Secretary determines, after notice and 
     opportunity for hearing, that the plan (or amendment) is 
     inadequate to meet the requirements described in subsections 
     (a) and (b).
       (e) Waiver.--
       (1) In general.--A State may request, and the Secretary may 
     grant, a waiver of the requirements of subsections (a) and 
     (b) for 1 year for exceptional circumstances, such as a 
     precipitous decrease in State revenues, or another 
     circumstance that the Secretary determines to be exceptional, 
     that prevents a State from complying with the requirements of 
     subsections (a) and (b).
       (2) Contents of waiver request.--A State that requests a 
     waiver under paragraph (1) shall include in the request--
       (A) a description of the exceptional circumstance that 
     prevents the State from complying with the requirements of 
     subsections (a) and (b); and
       (B) a plan that details the manner in which the State will 
     comply with such requirements by the end of the waiver 
     period.

     SEC. 202. CONSEQUENCES OF FAILURE TO MEET REQUIREMENTS.

       (a) Interim Yearly Goals.--
       (1) In general.--For a fiscal year and a State described in 
     section 201(b)(1), the Secretary shall withhold from the 
     State 2.75 percent of funds otherwise available to the State 
     for the administration of Federal elementary and secondary 
     education programs, for each covered goal that the Secretary 
     determines the State is not meeting during that year.
       (2) Definition.--In this subsection, the term ``covered 
     goal'', used with respect to a fiscal year, means an interim 
     yearly goal described in section 201(b)(1)(C)(i) that is 
     applicable to that year or a prior fiscal year.
       (b) Consequences of Nonremediation.--Notwithstanding any 
     other provision of law, if the Secretary determines that a 
     State required to include a strategy under section 201(b)(2) 
     continues to maintain a public school system that does not 
     meet the requirements of section 101(a)(2) at the end of the 
     second school year described in section 201(b)(2), the 
     Secretary shall withhold from the State not more than 33\1/3\ 
     percent of funds otherwise available to the State for the 
     administration of programs authorized under the Elementary 
     and Secondary Education Act of 1965 (20 U.S.C. 6301 et seq.) 
     until the Secretary determines that the State maintains a 
     public school system that meets the requirements of section 
     101(a)(2).
       (c) Consequences of Noncompliance With Court Orders.--If 
     the Secretary determines under section 101(b) that a State 
     maintains a public school system that fails to meet the 
     requirements of section 101(a)(3), the Secretary shall 
     withhold from the State not more than 33\1/3\ percent of 
     funds otherwise available to the State for the administration 
     of programs authorized under the Elementary and Secondary 
     Education Act of 1965 (20 U.S.C. 6301 et seq.).
       (d) Disposition of Funds Withheld.--
       (1) Determination.--Not later than 1 year after the 
     Secretary withholds funds from a

[[Page 27429]]

     State under this section, the Secretary shall determine 
     whether the State has corrected the condition that led to the 
     withholding.
       (2) Disposition.--
       (A) Correction.--If the Secretary determines under 
     paragraph (1), that the State has corrected the condition 
     that led to the withholding, the Secretary shall make the 
     withheld funds available to the State to use for the original 
     purpose of the funds during 1 or more fiscal years specified 
     by the Secretary.
       (B) Noncorrection.--If the Secretary determines under 
     paragraph (1), that the State has not corrected the condition 
     that led to the withholding, the Secretary shall allocate the 
     withheld funds to public school districts, public elementary 
     schools, or public secondary schools in the State that are 
     most adversely affected by the condition that led to the 
     withholding, to enable the districts or schools to correct 
     the condition during 1 or more fiscal years specified by the 
     Secretary.
       (3) Availability.--Amounts made available or allocated 
     under subparagraph (A) or (B) of paragraph (2) shall remain 
     available during the fiscal years specified by the Secretary 
     under that subparagraph.

              TITLE III--REPORT TO CONGRESS AND THE PUBLIC

     SEC. 301. ANNUAL REPORT ON STATE PUBLIC SCHOOL SYSTEMS.

       (a) Annual Report to Congress.--Not later than October 1 of 
     each year, beginning the year after completion of the first 
     full school year after the date of enactment of this Act, the 
     Secretary shall submit to Congress a report that includes a 
     full and complete analysis of the public school system of 
     each State.
       (b) Contents of Report.--The analysis conducted under 
     subsection (a) shall include the following:
       (1) Public school system information.--The following 
     information related to the public school system of each 
     State:
       (A) The number of school districts, public elementary 
     schools, public secondary schools, and students in the 
     system.
       (B)(i) For each such school district and school--
       (I) information stating the number and percentage of 
     children counted under section 1124(c) of the Elementary and 
     Secondary Education Act of 1965 (20 U.S.C. 6333(c)); and
       (II) the number and percentage of students, disaggregated 
     by groups described in section 1111(b)(3)(C)(xiii) of the 
     Elementary and Secondary Education Act of 1965 (20 U.S.C. 
     6311(b)(3)(C)(xiii)).
       (ii) For each such district, information stating whether 
     the district is an urban, mixed, or rural district (as 
     defined by the National Center for Education Statistics).
       (C) The average per-pupil expenditure (both in actual 
     dollars and adjusted for cost and need) for the State and for 
     each school district in the State.
       (D) Each school district's decile ranking as measured by 
     achievement in mathematics, reading or language arts, and 
     science on State academic assessments required under section 
     1111(b)(3) of the Elementary and Secondary Education Act of 
     1965 (20 U.S.C. 6311(b)(3)) and on the National Assessment of 
     Educational Progress.
       (E) For each school district, public elementary school, and 
     public secondary school--
       (i) the level of access (as described in section 201(a)(1)) 
     to each of the fundamentals of educational opportunity 
     described in section 102;
       (ii) the percentage of students that are proficient in 
     mathematics, reading or language arts, and science, as 
     measured through assessments administered as described in 
     section 1111(b)(3)(C)(v) of the Elementary and Secondary 
     Education Act of 1965 (20 U.S.C. 6311(b)(3)(C)(v)); and
       (iii) whether the school district or school is making 
     adequate yearly progress--

       (I) as defined under section 1111(b)(2) of the Elementary 
     and Secondary Education Act of 1965 (20 U.S.C. 6311(b)(2)); 
     and
       (II) as defined by the State under section 201(b)(1)(A).

       (F) For each State, the number of public elementary schools 
     and secondary schools that lack, and names of each such 
     school that lacks, high access (as described in section 
     201(a)(1)(A)) to any of the fundamentals of educational 
     opportunity described in section 102.
       (G) For the year covered by the report, a summary of any 
     changes in the data required in subparagraphs (A) through (F) 
     for each of the preceding 3 years (which may be based on such 
     data as are available, for the first 3 reports submitted 
     under subsection (a)).
       (H) Such other information as the Secretary considers 
     useful and appropriate.
       (2) State actions.--For each State that the Secretary 
     determines under section 101(b) maintains a public school 
     system that fails to meet the requirements of section 101(a), 
     a detailed description and evaluation of the success of any 
     actions taken by the State, and measures proposed to be taken 
     by the State, to meet the requirements.
       (3) State plans.--A copy of each State's most recent plan 
     submitted under section 201(a)(1).
       (4) Relationship between compliance and achievement.--An 
     analysis of the relationship between meeting the requirements 
     of section 101(a) and improving student academic achievement, 
     as measured on State academic assessments required under 
     section 1111(b)(3) of the Elementary and Secondary Education 
     Act of 1965 (20 U.S.C. 6311(b)(3)).
       (c) Scope of Report.--The report required under subsection 
     (a) shall cover the school year ending in the calendar year 
     in which the report is required to be submitted.
       (d) Submission of Data to Secretary.--Each State receiving 
     Federal financial assistance for elementary and secondary 
     education shall submit to the Secretary, at such time and in 
     such manner as the Secretary may reasonably require, such 
     data as the Secretary determines to be necessary to make a 
     determination under section 101(b) and to submit the report 
     under this section. Such data shall include the information 
     used to measure the State's success in providing the 
     fundamentals of educational opportunity described in section 
     102.
       (e) Failure To Submit Data.--If a State fails to submit the 
     data that the Secretary determines to be necessary to make a 
     determination under section 101(b) regarding whether the 
     State maintains a public school system that meets the 
     requirements of section 101(a)--
       (1) such State's public school system shall be deemed not 
     to have met the applicable requirements until the State 
     submits such data and the Secretary is able to make such 
     determination under section 101(b); and
       (2) the Secretary shall provide, to the extent practicable, 
     the analysis required in subsection (a) for the State based 
     on the best data available to the Secretary.
       (f) Publication.--The Secretary shall publish and make 
     available to the general public (including by means of the 
     Internet) the report required under subsection (a).

                            TITLE IV--REMEDY

     SEC. 401. CIVIL ACTION FOR ENFORCEMENT.

       A student or parent of a student aggrieved by a violation 
     of this Act may bring a civil action against the appropriate 
     official in an appropriate Federal district court seeking 
     declaratory or injunctive relief to enforce the requirements 
     of this Act, together with reasonable attorney's fees and the 
     costs of the action.

                      TITLE V--GENERAL PROVISIONS

     SEC. 501. DEFINITIONS.

       In this Act:
       (1) Referenced terms.--The terms ``elementary school'', 
     ``secondary school'', ``local educational agency'', ``highly 
     qualified'', ``core academic subjects'', ``parent'', and 
     ``average per-pupil expenditure'' have the meanings given 
     those terms in section 9101 of the Elementary and Secondary 
     Education Act of 1965 (20 U.S.C. 7801).
       (2) Federal elementary and secondary education programs.--
     The term ``Federal elementary and secondary education 
     programs'' means programs providing Federal financial 
     assistance for elementary or secondary education, other than 
     programs under the following provisions of law:
       (A) The Individuals with Disabilities Education Act (20 
     U.S.C. 1400 et seq.).
       (B) Title III of the Elementary and Secondary Education Act 
     of 1965 (20 U.S.C. 6801 et seq.).
       (C) The Richard B. Russell National School Lunch Act (42 
     U.S.C. 1751 et seq.).
       (D) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et 
     seq.).
       (3) Public school system.--The term ``public school 
     system'' means a State's system of public elementary and 
     secondary education.
       (4) State.--The term ``State'' means each of the several 
     States, the District of Columbia, and the Commonwealth of 
     Puerto Rico.

     SEC. 502. RULEMAKING.

       The Secretary may prescribe regulations to carry out this 
     Act.

     SEC. 503. CONSTRUCTION.

       Nothing in this Act shall be construed to require a 
     jurisdiction to increase its property tax or other tax rates 
     or to redistribute revenues from such taxes.
                                 ______
                                 
      Mr. ROCKEFELLER:
  S. 2190. A bill to amend title XVIII of the Social Security Act to 
provide for the inclusion of barbiturates and bezodiazepines as covered 
part D drugs beginning in 2008; to the Committee on Finance.
  Mr. ROCKEFELLER. Mr. President, today I rise to introduce the 
Medicare Mental Health Prescription Drug Access Act of 2007--
legislation to provide our Nation's seniors and individuals with 
disabilities access to the mental health drugs that best meet their 
needs.
  As many of my colleagues are aware, nearly one out of four Americans, 
58 million people, will experience a mental illness during any given 
year, and a large number of them will be senior citizens and 
individuals with disabilities.
  For far too long, mental illness has been shrouded in fear, 
misunderstanding and stigma. I believe it is long past time for us to 
address the inequitable treatment of mental illness in

[[Page 27430]]

our broader health care system. Mental health parity is a critical part 
of the solution. We must fulfill the intent of the 1996 mental health 
parity law and expand the definition of parity to include deductibles, 
co-payments, coinsurance, out-of-pocket expenses, as well as scope and 
duration of treatment.
  However, parity alone is not a panacea to the problem of treating 
mental illness in this country. We must improve the range of mental 
health illnesses and treatment options covered by health plans, 
particularly for children and seniors.
  This year in the Senate, we have taken a major step toward improving 
access to mental health services for children by passing the Children's 
Health Insurance Program, CHIP, Reauthorization Act, H.R. 976, not 
once, but twice. Among the many important provisions included in this 
legislation, which I co-authored, is a provision that requires the 
private health insurance plans that administer CHIP to provide mental 
health services for children that are equivalent to the coverage 
provided for physical illnesses. In other words, we require full mental 
health parity for children enrolled in CHIP.
  I still believe that we must do more to ensure that all children have 
the broadest health care coverage possible for mental health screening 
and treatment, along the lines of what is provided to children enrolled 
in Medicaid through the Early Periodic Screening Diagnosis and 
Treatment, EPSDT, program. However, we have taken a significant step in 
the right direction toward addressing the mental health needs of our 
nation's children by passing the CHIP reauthorization bill.
  Unfortunately, the same is not true for our nation's seniors and 
individuals with disabilities. We haven't done nearly enough to address 
their mental health needs. In fact, we have taken a step backwards in 
the mental health coverage provided to Medicare participants, 
particularly those that are dually eligible for Medicare and Medicaid.
  Many of my colleagues will recall that the Medicare Prescription 
Drug, Improvement and Modernization Act of 2003 excluded certain 
classes of medications from the newly-created Medicare prescription 
drug program. Among the prescription drugs excluded were two important 
classes of mental health drugs, benzodiepines and barbiturates, central 
nervous system depressants which have multiple clinical benefits.
  Benzodiazepines and barbiturates are used to help seniors and 
individuals with disabilities who are dealing with a variety of 
conditions including anxiety, depression, insomnia, panic disorders, 
muscle spasms and seizures. Despite being some of the oldest and most 
effective medications for the treatment of mental illness, 
benzodiazepines and barbiturates are currently unavailable to most 
seniors and individuals with disabilities enrolled in Medicare. That is 
just wrong.
  Patients who have found success with benzodiazepines and barbiturates 
are reluctant to change prescriptions because of the potential side 
effects or the understandable fear that their conditions might return. 
Often, there is also an increased cost associated with alternative 
medications, but the efficacy of these ``replacement'' drugs may 
actually be less than benzodiazepines and barbiturates. So, why should 
we require MediCare participants to use prescription drugs that could 
cost more without offering any greater clinical benefit? I don't 
believe we should. Medicare participants deserve affordable access to 
the prescription medications that are best suited to treat their 
conditions.
  Many of my colleagues may be wondering why these two classes of 
prescription drugs were excluded from the Medicare prescription drug 
program in the first place. They were excluded because of an 
inappropriate application of existing Medicaid law to the Medicare 
prescription drug program. The 1990 law that established the Medicaid 
prescription drug rebate program gave state Medicaid agencies the 
OPTION to exclude barbiturates and benzodiazepines from their drug 
formularies. Even though no states have excluded these medications from 
their Medicaid formularies, the Medicare law makes this exclusion 
MANDATORY for seniors and individuals with disabilities.
  It is unfair to restrict access to prescribed medications that have 
been proven to be safe and effective in the treatment of mental 
illnesses and other conditions that commonly affect seniors and the 
disabled. That is why I am introducing this important piece of 
legislation today, and I urge my colleagues to support it.
  We know that mental illness is treatable, and treatment can help 
people to live healthy, productive lives. Yet, our Nation's focus on 
mental health has continued to take a backseat to our focus on physical 
health even though the two are interrelated. We must act now to bring 
an end to the silent epidemic of mental illness in our country.
  Mr. President, 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. 2190

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Mental Health 
     Prescription Drug Access Act of 2007''.

     SEC. 2. INCLUSION OF BARBITURATES AND BENZODIAZEPINES AS 
                   COVERED PART D DRUGS BEGINNING IN 2008.

       Section 1860D-2(e)(2)(A) of the Social Security Act (42 
     U.S.C. 1395w-102(e)(2)(A)) is amended by inserting ``and, 
     beginning in 2008, other than subparagraphs (I) (relating to 
     barbiturates) and (J) (relating to benzodiazepines) of such 
     section'' after ``agents)''.

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