I

103D CONGRESS

1ST SESSION H. R. 3075

To promote greater equity in the delivery of health care services to American

women through expanded research on women’s health issues and through

improved access to health care services, including preventive health services.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 14, 1993

Mrs. SCHROEDER (for herself, Ms. SNOWE, Ms. SLAUGHTER, Ms. BROWN of

Florida, Ms. BYRNE, Mrs. CLAYTON, Mrs. COLLINS of Illinois, Ms.

DELAURO, Ms. ESHOO, Mrs. JOHNSON of Connecticut, Mrs. LLOYD, Mrs.

LOWEY, Mrs. KENNELLY, Ms. MCKINNEY, Mrs. MALONEY, Mrs. MEEK,

Mrs. MINK, Ms. MOLINARI, Mrs. MORELLA, Ms. PELOSI, Ms. ROYBALALLARD, Ms. SCHENK, Mr. THURMAN, Mrs. UNSOELD, Ms. VELA ́ZQUEZ,

Ms. WATERS, Ms. WOOLSEY, Mr. ABERCROMBIE, Mr. BERMAN, Mr.

BROWN of California, Mr. EVANS, Mr. FRANK of Massachusetts, Mr.

HOCHBRUECKNER, Mr. LANTOS, Mr. MARTINEZ, Mr. MCDERMOTT, Mr.

NADLER, Mr. SANDERS, Mr. WHEAT, and Mr. YATES) introduced the following bill; which was referred jointly to the Committees on Energy and

Commerce, Ways and Means, Armed Services, Education and Labor,

Foreign Affairs, the Judiciary, and Veterans’ Affairs

A BILL

To promote greater equity in the delivery of health care

services to American women through expanded research

on women’s health issues and through improved access

to health care services, including preventive health services.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Women’s Health

3 Equity Act of 1993’’.

4 SEC. 2. TABLE OF CONTENTS.

5 The table of contents for this Act is as follows:

Sec. 1. Short title.

Sec. 2. Table of contents.

TITLE I—RESEARCH ON WOMEN’S HEALTH

Subtitle A—NIH Women Scientists Employment Opportunities Act

Sec. 101. Short title.

Sec. 102. Women’s scientific employment.

Subtitle B—Women and AIDS Research Initiative Amendments of 1993

Sec. 106. Short title.

Sec. 107. Establishment of general program of research regarding women and

Acquired Immune Deficiency Syndrome.

Subtitle C—Women and Alcohol Research Equity Act of 1993

Sec. 111. Short title.

Sec. 112. Findings.

Sec. 113. Provisions regarding increase in amount of funds expended for research on alcohol abuse and alcoholism among women.

Subtitle D—National Breast Cancer Strategy Act of 1993

Sec. 116. Short title.

PART I—ESTABLISHMENT OF OFFICE OF BREAST CANCER AND NATIONAL

BREAST CANCER COMMISSION

Sec. 117. Office of breast cancer.

Sec. 118. Establishment of national breast cancer commission.

PART II—DUTIES OF DIRECTOR OF THE NATIONAL CANCER INSTITUTE

RELATING TO BREAST CANCER

Sec. 119. Provisions for full funding for National Cancer Institute with respect

to research on breast cancer.

Sec. 120. Duties of Director.

Sec. 121. Specialized programs of research excellence with respect to breast,

lung, and prostate cancer.

Subtitle E—Lupus Research Amendments of 1993

Sec. 126. Short title.

Sec. 127. Findings.

Sec. 128. Expansion and intensification of activities regarding lupus.
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Subtitle F—Women’s Midlife Health Research Act

Sec. 131. Short title.

Sec. 132. Establishment of program for research centers on women’s midlife

health care, including menopause and menopausal health conditions.

Subtitle G—Osteoporosis and Related Bone Disorders Research Education,

and Health Services Act of 1993

Sec. 136. Short title.

Sec. 137. Findings.

Sec. 138. Osteoporosis research.

Subtitle H—Ovarian Cancer Research and Information Amendments of 1993

Sec. 141. Short title.

Sec. 142. Funding for research on ovarian cancer.

Sec. 143. Public information and education on ovarian cancer.

Subtitle I—Antiprogestin Testing Act of 1993

Sec. 146. Short title.

Sec. 147. Research.

Sec. 148. Report.

Subtitle J—Women’s Health Environmental Factors Research Act of 1993

Sec. 151. Short title.

Sec. 152. Research on effect of environmental factors on women’s health.

Subtitle K—Federal Risk Assessment in Women’s Health Act of 1993

Sec. 156. Short title.

Sec. 157. Interagency review.

Sec. 158. Study of research needs.

Subtitle L—Pharmaceutical Interactions Safety Act

Sec. 161. Short title.

Sec. 162. Clinical investigations.

Sec. 163. Biological products clinical investigations.

Subtitle M—Pharmaceutical Testing Fairness Act

Sec. 166. Short title.

Sec. 167. New drug clinical investigations.

Sec. 168. Device clinical investigations.

Sec. 169. Biological products clinical investigations.

Subtitle N—Tobacco Advertising and Promotion Studies Act of 1993

Sec. 171. Short title.

Sec. 172. Findings.

Sec. 173. Tobacco advertising studies.

TITLE II—SERVICES REGARDING WOMEN’S HEALTH

Subtitle A—Equity in Health Professions Education Act
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Sec. 201. Short title.

Sec. 202. Study regarding curricula of health professions schools and women’s

health conditions.

Subtitle B—Women’s Health Office Act of 1993

Sec. 206. Short title.

Sec. 207. Public Health Service Office of Women’s Health.

Sec. 208. Centers for Disease Control and Prevention Office of Women’s

Health.

Sec. 209. Agency for Health Care Policy and Research Office of Women’s

Health.

Sec. 210. Health Resources and Services Administration Office of Women’s

Health.

Sec. 210A. Food and Drug Administration Office of Women’s Health.

Subtitle C—Women’s Health Information Act of 1993

Sec. 211. Short title.

Sec. 212. Findings.

Sec. 213. Interagency Committee on Health Communications.

Sec. 214. Dissemination efforts of women’s health information within public

health service.

Sec. 215. Study on effectiveness of health communications.

Subtitle D—Breast and Cervical Cancer Amendments of 1993

Sec. 216. Short title.

Sec. 217. Revisions in program of State grants regarding breast and cervical

cancer.

Sec. 218. Funding.

Subtitle E—Women’s Preventive Health Amendments of 1993

Sec. 221. Short title.

Sec. 222. Establishment of demonstration program of grants for additional preventive health services for women.

Sec. 223. Funding.

Subtitle F—Postreproductive Health Care Act

Sec. 226. Short title.

Sec. 227. Establishment of program for postreproductive health care.

Subtitle G—Medicare Bone Mass Measurement Coverage Act of 1993

Sec. 231. Short title.

Sec. 232. Medicare coverage of bone mass measurements.

Subtitle H—Mickey Leland Adolescent Pregnancy Prevention and Parenthood

Act of 1993

Sec. 236. Short title.

Sec. 237. Adolescent pregnancy prevention, care, and research grants.

Subtitle I—Adolescent Health Demonstrations Projects Act of 1993

Sec. 241. Short title.

Sec. 242. Establishment or support of demonstration projects.
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Sec. 243. Project requirements.

Sec. 244. Areas to be served.

Sec. 245. Abortion restriction.

Sec. 245A. Report.

Subtitle J—Eating Disorders Information and Education Act of 1993

Sec. 246. Short title.

Sec. 247. Findings.

Sec. 248. Public information and education on eating disorders.

Subtitle K—Women and HIV Outreach and Prevention Act

Sec. 251. Short title.

Sec. 252. Preventive health programs regarding women and human

immunodeficiency virus.

Sec. 253. Treatment of women for substance abuse.

Sec. 254. Early intervention services for women.

Subtitle L—Standby Guardianship Act

Sec. 256. Short title.

Sec. 257. States required to have standby guardianship law as a condition of

eligibility for Federal funds for foster care and adoption assistance.

Subtitle M—Federal Prohibition of Female Genital Mutilation Act of 1993

Sec. 261. Short title.

Sec. 262. Title 18 amendment.

Sec. 263. Education and outreach.

Sec. 264. Effective dates.

Subtitle N—Smoking Prevention and Cessation in WIC Clinics Act

Sec. 266. Short title.

Sec. 267. Smoking cessation demonstration programs for WIC participants.

Subtitle O—Family and Medical Leave Health Care Reform Resolution of

1993

Sec. 271. Short title.

Sec. 272. Findings.

Sec. 273. Sense of Congress.

Subtitle P—Veteran Women’s Health Improvement Act of 1993

Sec. 276. Short title.

Sec. 277. Women’s health services.

Sec. 278. Expansion of research relating to women veterans.

Sec. 279. Mammography quality standards.

Subtitle Q—Defense Women’s Health Improvement Act of 1993

Sec. 281. Short title.

PART I—WOMEN’S HEALTH CARE

Sec. 282. Primary and preventive health-care services for women.
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Sec. 283. Report on the provision of health-care services to women.

PART II—WOMEN’S HEALTH RESEARCH

Sec. 284. Defense women’s health research center.

Sec. 285. Continuation of Army breast cancer research program.

Sec. 286. Inclusion of women and minorities in clinical research projects.

Sec. 287. Report on research relating to female members of the uniformed services and female covered beneficiaries.

PART III—WOMEN’S HEALTH EDUCATION

Sec. 288. Women’s health curriculum advisory committee.

Subtitle R—International Population Stabilization and Reproductive Health

Act

Sec. 291. Short title.

Sec. 292. Authorities relating to United States population assistance.

Sec. 293. Authorizations of appropriations.

Sec. 294. Economic and social development initiatives to stabilize world population.

Sec. 295. AIDS prevention and control fund.

Sec. 296. Oversight of multilateral development banks.

Sec. 297. Commission on world population stabilization and reproductive

health.

Sec. 298. Support for United Nations forward looking strategies for the advancement of women.

Sec. 299. Support for the Convention on the Elimination of All Forms of Discrimination Against Women.

1 TITLE I—RESEARCH ON

2 WOMEN’S HEALTH

3 Subtitle A—NIH Women Scientists

4 Employment Opportunites Act

5 SEC. 101. SHORT TITLE.

6 This subtitle may be cited as the ‘‘NIH Women Sci7 entists Employment Opportunity Act’’.

8 SEC. 102. WOMEN’S SCIENTIFIC EMPLOYMENT.

9 Subpart A of title IV of the Public Health Service

10 Act (42 U.S.C. 281 et seq.), as amended by section 209

11 of Public Law 103–43 (107 Stat. 149), is amended by

12 adding at the end the following section:
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1 ‘‘WOMEN’S SCIENTIFIC EMPLOYMENT

2 ‘‘SEC. 404F. (a) IN GENERAL.—The Director of

3 NIH shall—

4 ‘‘(1) establish policies for the National Insti5 tutes of Health on matters relating to the employ6 ment by the National Institutes of Health of women

7 as scientists; and

8 ‘‘(2) monitor the extent of compliance with such

9 policies and take appropriate action in cases in

10 which the Director determines that the policies have

11 been violated.

12 ‘‘(b) CERTAIN FUNCTIONS.—In carrying out sub13 section (a), the Director of NIH shall provide for the fol14 lowing:

15 ‘‘(1) Implementing the recommendations of the

16 group known as the Task Force on the Status of

17 NIH Intramural Women Scientists.

18 ‘‘(2) Determining the concerns of intramural

19 women scientists.

20 ‘‘(3) Developing a policy defining the standard

21 tenure process for employment at the National Insti22 tutes of Health.

23 ‘‘(4) Determining the reason for departure from

24 such Institutes by interviewing women and men sci25 entists as they leave.
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1 ‘‘(5) Distributing yearly to all employees of

2 such Institutes the policy of such Institutes on flexi3 ble family leave.

4 ‘‘(6) Monitoring the number of women, includ5 ing minority women, included on the committees,

6 panels, and other working groups (and in meetings)

7 of such Institutes.

8 ‘‘(7) Making efforts to recruit minority women,

9 based on the small numbers of tenured minority

10 women scientists.

11 ‘‘(8) Developing additional goals related to

12 women and minority women scientists at such Insti13 tutes.

14 ‘‘(c) INCLUSION OF WOMEN ON INTRAMURAL AND

15 EXTRAMURAL CONFERENCES AND OTHER GROUPS.—

16 ‘‘(1) IN GENERAL.—The Director of NIH shall

17 establish a policy at the National Institutes of

18 Health of requiring inclusion of women scientists in

19 greater numbers on or in intramural and extramural

20 conferences, workshops, meetings, international con21 gresses, and other groups funded or sponsored by

22 such Institutes. Such policy shall provide for the in23 clusion of not less than one woman scientist in each

24 such group, except as provided in paragraph (2).
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1 ‘‘(2) EXCLUSION; WRITTEN EXPLANATION.—

2 The policy established in paragraph (1) may provide

3 that no woman scientist will be included in a group

4 for purposes of such paragraph if the Director of

5 NIH provides a waiver of the requirement. The Di6 rector may grant such a waiver only if—

7 ‘‘(A) the individual with the chief respon8 sibility for the group involved submits to the

9 Director a written request for the waiver and

10 the request provides an explanation of the rea11 sons underlying the need for the waiver; and

12 ‘‘(B) the Director makes a determination

13 that extraordinary circumstances justify provid14 ing the waiver.

15 ‘‘(d) STUDY ON PAY EQUITY.—

16 ‘‘(1) IN GENERAL.—The Director of NIH shall

17 provide for study to identify any pay differences

18 among men and women scientists employed by the

19 National Institutes of Health, both tenured and

20 untenured. The study shall include recommendations

21 on measures to adjust any disparities or inequities,

22 and shall identify a program to communicate infor23 mation on salary ranges to all employees.

24 ‘‘(2) REPORT.—Not later than 240 days after

25 the date of the enactment of the NIH Women Sci-
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1 entist Employment Opportunity Act, the Director of

2 NIH shall complete the study required in paragraph

3 (1) and submit to the Committee on Energy and

4 Commerce of the House of Representatives, and to

5 the Committee on Labor and Human Resources of

6 the Senate, a report describing the findings made as

7 a result of the study.

8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the

9 purpose of carrying out this section, there are authorized

10 to be appropriated such sums as may be necessary for

11 each of the fiscal years 1994 through 1996.’’.

12 Subtitle B—Women and AIDS Re13 search Initiative Amendments

14 of 1993

15 SEC. 106. SHORT TITLE.

16 This subtitle may be cited as the ‘‘Women and AIDS

17 Research Initiative Amendments of 1993’’.

18 SEC. 107. ESTABLISHMENT OF GENERAL PROGRAM OF RE19 SEARCH REGARDING WOMEN AND ACQUIRED

20 IMMUNE DEFICIENCY SYNDROME.

21 Part B of title XXIII of the Public Health Service

22 Act (42 U.S.C. 300cc–11 et seq.) is amended by adding

23 at the end the following section:
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1 ‘‘SEC. 2321. RESEARCH REGARDING WOMEN.

2 ‘‘(a) IN GENERAL.—With respect to cases of infec3 tion with the human immunodeficiency virus, the Sec4 retary shall establish a program for the purpose of con5 ducting biomedical and behavioral research on such cases

6 in women, including research on the prevention of such

7 cases. The Secretary may conduct such research directly,

8 and may make grants to public and nonprofit private enti9 ties for the conduct of the research.

10 ‘‘(b) CERTAIN FORMS OF RESEARCH.—In carrying

11 out subsection (a), the Secretary shall provide for research

12 on—

13 ‘‘(1) the manner in which the human

14 immunodeficiency virus is transmitted to women, in15 cluding the relationship between cases of infection

16 with such virus and other cases of sexually transmit17 ted diseases, including clinical trials which examine

18 the question of how much human immunodeficiency

19 virus infection can be prevented by finding and

20 treating sexually transmitted diseases in women;

21 ‘‘(2) measures for the prevention of exposure to

22 and the transmission of such virus, including re23 search on—

24 ‘‘(A) the prevention of any sexually trans25 mitted disease that may facilitate the trans26 mission of the virus;
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1 ‘‘(B) rapid, inexpensive, easy-to-use sexu2 ally transmitted disease diagnostic tests for

3 women;

4 ‘‘(C) inexpensive single dose therapy for

5 treatable sexually transmitted diseases;

6 ‘‘(D) the development of methods of pre7 vention for use by women; and

8 ‘‘(E) the development and dissemination of

9 prevention programs and materials whose pur10 pose is to reduce the incidence of substance

11 abuse among women;

12 ‘‘(3) the development and progression of symp13 toms resulting from infection with such virus, in14 cluding research regarding gynecological infections

15 as well as breast changes, hormonal changes, and

16 menses and menopause changes, whose occurrence

17 becomes probable as a result of the deterioration of

18 the immune system;

19 ‘‘(4) the treatment of cases of such infection,

20 including clinical research; and

21 ‘‘(5) behavioral research on the prevention of

22 such cases and research on model educational pro23 grams for such prevention.

24 ‘‘(c) CLINICAL TRIALS.—
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1 ‘‘(1) GYNECOLOGICAL EVALUATIONS.—In clini2 cal trials regarding the human immunodeficiency

3 virus in which women participate as subjects, the

4 Secretary shall ensure that—

5 ‘‘(A) each female subject who is infected

6 with the human immunodeficiency virus—

7 ‘‘(i) undergoes a gynecological exam8 ination as part of the evaluation of the

9 medical status of the woman prior to par10 ticipation in the trial; and

11 ‘‘(ii) receives appropriate follow-up

12 services regarding such examination; and

13 ‘‘(B) the results of the gynecological ex14 aminations are analyzed to determine the rela15 tionship between gynecological conditions and

16 the infection with such virus.

17 ‘‘(2) STANDARD TREATMENTS FOR GYNECO18 LOGICAL CONDITIONS.—The Secretary shall conduct

19 or support clinical trials under subsection (a) to de20 termine whether standard methods of treating gyne21 cological conditions are effective in the case of such

22 conditions that arise as a result of infection with the

23 human immunodeficiency virus.

24 ‘‘(3) EFFECTIVENESS OF CERTAIN TREATMENT

25 PROTOCOLS.—With respect to cases of infection with
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1 the human immunodeficiency virus, the Secretary

2 shall conduct or support clinical trials under sub3 section (a) to determine whether treatment protocols

4 approved for men with such cases are effective for

5 women with such cases.

6 ‘‘(4) SUPPORT SERVICES.—

7 ‘‘(A) In conducting or supporting clinical

8 trials regarding the human immunodeficiency

9 virus in which women participate as subjects,

10 the Secretary shall provide the women with

11 such transportation, child care, and other sup12 port services (including medical and mental

13 health services, treatment for drug abuse, and

14 social services, including services addressing do15 mestic violence) as may be necessary to enable

16 the women to participate as such subjects.

17 ‘‘(B) Services under subparagraph (A)

18 shall include services designed to respond to the

19 particular needs of women with respect to par20 ticipation in the clinical trials involved, includ21 ing, as appropriate, training of the individuals

22 who conduct the trials.

23 ‘‘(d) PREVENTION PROGRAMS.—

24 ‘‘(1) SEXUAL TRANSMISSION.—
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1 ‘‘(A) With respect to preventing the sexual

2 transmission of the human immunodeficiency

3 virus, the Secretary shall conduct or support re4 search under subsection (a) on barrier methods

5 for prevention of sexually transmitted diseases,

6 including human immunodeficiency virus dis7 ease, that women can use without their sexual

8 partner’s cooperation or knowledge.

9 ‘‘(B) In carrying out subparagraph (A),

10 the Secretary shall give priority to identified re11 search needs and opportunities identified at the

12 National Institutes of Health sponsored meet13 ing on Development of Topical Microbicides

14 held in May 1993, including research on—

15 ‘‘(i) the early steps in infectious proc16 esses;

17 ‘‘(ii) identification, formulation, and

18 preclinical evaluation of new preparations;

19 ‘‘(iii) clinical testing for safety and ef20 ficacy; and

21 ‘‘(iv) studies on acceptability and com22 pliance of safe, effective microbicides.

23 ‘‘(2) EPIDEMIOLOGICAL RESEARCH.—The Sec24 retary shall conduct or support epidemiological re25 search under subsection (a) to determine the factors
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1 of risk regarding infection with the human

2 immunodeficiency virus that are particular to

3 women, including research regarding—

4 ‘‘(A) the use of various contraceptive meth5 ods;

6 ‘‘(B) the use of tampons;

7 ‘‘(C) the relationship between such infec8 tion and other sexually transmitted diseases;

9 ‘‘(D) the relationship between such infec10 tion and various forms of substance abuse (in11 cluding use of the form of cocaine commonly

12 known as crack); and

13 ‘‘(E) the relationship between such infec14 tion and noncoital forms of sexual activity.

15 ‘‘(e) INTERAGENCY STUDY.—With respect to the

16 study (known as the Women’s Interagency HIV Study)

17 that, as of June 1993, is being carried out by the Sec18 retary through various agencies of the Public Health Serv19 ice for the purpose of monitoring the progression in

20 women of infection with the human immunodeficiency

21 virus, and determining whether such progression is dif22 ferent in women than in men, the following applies:

23 ‘‘(1) The Secretary shall ensure that not less

24 than 5,000 women with such infection are included

25 in the study.
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1 ‘‘(2) The Secretary shall provide for an increase

2 in the number of sites at which the study is to be

3 conducted.

4 ‘‘(3) The Secretary shall ensure that the study

5 period is for a minimum of 8 years.

6 ‘‘(4) With respect to markers of human

7 immunodeficiency virus disease progression and viral

8 activity, including the cells commonly known as CD4

9 cells, the Secretary shall ensure that the study ade10 quately addresses the relationship between such

11 markers and the development of serious illnesses in

12 such women, including the relationship between the

13 number of such cells and the development of such

14 illnesses. For purposes of the preceding sentence,

15 the study shall address gynecological conditions, and

16 other conditions particular to women, that are not

17 currently included in the list of conditions arising

18 from such infection that, for surveillance purposes,

19 is maintained by the Director of the Centers for Dis20 ease Control and Prevention.

21 ‘‘(f) DEFINITIONS.—For purposes of this section, the

22 term ‘human immunodeficiency virus’ means the etiologic

23 agent for acquired immune deficiency syndrome.

24 ‘‘(g) AUTHORIZATIONS OF APPROPRIATIONS.—

25 ‘‘(1) CLINICAL TRIALS.—
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1 ‘‘(A) For the purpose of carrying out sub2 section (c)(1), there are authorized to be appro3 priated $20,000,000 for fiscal year 1994, and

4 such sums as may be necessary for each of the

5 fiscal years 1995 through 1996.

6 ‘‘(B) For the purpose of carrying out sub7 section (c)(2), there are authorized to be appro8 priated $10,000,000 for fiscal year 1994, and

9 such sums as may be necessary for each of the

10 fiscal years 1995 through 1996.

11 ‘‘(C) For the purpose of carrying out sub12 section (c)(3), there are authorized to be appro13 priated $10,000,000 for fiscal year 1994, and

14 such sums as may be necessary for each of the

15 fiscal years 1995 through 1996.

16 ‘‘(D) For the purpose of carrying out sub17 section (c)(4), there are authorized to be appro18 priated $15,000,000 for fiscal year 1994, and

19 such sums as may be necessary for each of the

20 fiscal years 1995 and 1996.

21 ‘‘(2) PREVENTION PROGRAMS.—

22 ‘‘(A) For the purpose of carrying out sub23 section (d)(1), there are authorized to be appro24 priated $30,000,000 for fiscal year 1994, and
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1 such sums as may be necessary for each of the

2 fiscal years 1995 through 1996.

3 ‘‘(B) For the purpose of carrying out sub4 section (d)(2), there are authorized to be appro5 priated $10,000,000 for fiscal year 1994, and

6 such sums as may be necessary for each of the

7 fiscal years 1995 through 1996.

8 ‘‘(3) INTERAGENCY STUDY.—For the purpose

9 of carrying out subsection (e), there are authorized

10 to be appropriated $15,000,000 for fiscal year 1994,

11 and such sums as may be necessary for each of the

12 fiscal years 1995 through 1996.’’.

13 Subtitle C—Women and Alcohol

14 Research Equity Act of 1993

15 SEC. 111. SHORT TITLE.

16 This subtitle may be cited as the ‘‘Women and Alco17 hol Research Equity Act of 1993’’.

18 SEC. 112. FINDINGS.

19 The Congress finds as follows with respect to the

20 United States:

21 (1) One of every 3 alcoholics receiving treat22 ment is a woman.

23 (2) In fiscal year 1992, the National Institute

24 on Alcohol Abuse and Alcoholism had a total re25 search budget of $169,000,000, and only
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1 $14,200,000 of the budget (approximately 8 per2 cent) was available for research on alcohol abuse and

3 alcoholism among women. Research on this topic is

4 critical because alcoholism has long been known to

5 be a gender-specific disease.

6 (3) Women continue to be underrepresented in

7 treatment programs. Women make up less than 25

8 percent of all publicly funded alcohol treatment ad9 missions and about 30 percent of treatment admis10 sions for other drug dependencies although women

11 make up an estimated 50 percent of the total alcohol

12 and drug dependent population.

13 (4) Alcohol use by pregnant women is the lead14 ing known cause of mental retardation in newborns.

15 Fetal alcohol syndrome, which is marked by dysfunc16 tion of the central nervous system and by prenatal

17 and postnatal growth deficiency and facial mal18 formations, strikes 1 to 3 out of every 1,000

19 newborns, or 3,600 to 10,000 babies a year. The in20 cidence of less severe fetal alcohol effects is at least

21 3 times that of fetal alcohol syndrome. Research is

22 also needed on the male contribution to birth abnor23 malities related to alcohol and other drug use.
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1 (5) Most treatment programs do not provide

2 child care or adequate alternatives for women enter3 ing treatment.

4 (6) The death rate of female alcoholics is 50 to

5 100 percent higher than for male alcoholics.

6 (7) More alcoholic women die of cirrhosis of the

7 liver than do alcoholic men.

8 (8) Combined effects of estrogen and alcohol

9 augment liver damage.

10 (9) Women experience greater physiological

11 damage from consumption of alcohol than do their

12 male counterparts. The interval between the onset of

13 drinking and entry into treatment appears to be

14 shorter for women than men.

15 (10) Negative effects of drinking show up ear16 lier in women than men, even when they consume

17 less alcohol than men. This disease process is ‘‘tele18 scoped’’ or accelerated in women.

19 (11) Women become intoxicated faster than

20 men. This is due to a different enzyme activity than

21 men and hormonal fluctuations in women.

22 (12) Chronic, heavy drinking contributes to

23 menstrual disorders, fertility problems, and pre24 mature menopause.
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1 (13) Alcohol use may be associated with an in2 creased risk of breast cancer. Research indicates

3 that the incidence of breast cancer increases when a

4 woman consumes 1 ounce or more of absolute alco5 hol daily.

6 (14) The National Institute on Alcohol Abuse

7 and Alcoholism has identified areas for future re8 search on alcohol abuse and alcoholism among

9 women. These areas were identified by the Institute

10 more than a decade ago, yet a sufficient number of

11 research projects regarding such areas has yet to be

12 conducted.

13 SEC. 113. PROVISIONS REGARDING INCREASE IN AMOUNT

14 OF FUNDS EXPENDED FOR RESEARCH ON AL15 COHOL ABUSE AND ALCOHOLISM AMONG

16 WOMEN.

17 Section 464H(d)(1) of the Public Health Service Act

18 (42 U.S.C. 285n(d)(1)), as added by section 122 of Public

19 Law 102–321 (106 Stat. 358), is amended by adding at

20 the end the following new sentence: ‘‘For fiscal year 1994,

21 of the first $131,606,000 appropriated under the preced22 ing sentence, the Director of the Institute shall obligate

23 not less than $14,200,000 for the purpose of carrying out

24 under this subpart projects of research on alcohol abuse

25 and alcoholism among women, and of the amounts appro-
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1 priated under such sentence in excess of $131,606,000,

2 the Director shall obligate for such purpose not less than

3 $23,250,000.’’.

4 Subtitle D—National Breast Cancer

5 Strategy Act of 1993

6 SEC. 116. SHORT TITLE.

7 This subtitle may be cited as the ‘‘National Breast

8 Cancer Strategy Act of 1993’’.

9 PART I—ESTABLISHMENT OF OFFICE OF BREAST

10 CANCER AND NATIONAL BREAST CANCER

11 COMMISSION

12 SEC. 117. OFFICE OF BREAST CANCER.

13 Title XVII of the Public Health Service Act (42

14 U.S.C. 300uu et seq.) is amended by adding at the end

15 the following new section:

16 ‘‘SEC. 1709. ESTABLISHMENT OF OFFICE OF BREAST CAN17 CER.

18 ‘‘(a) IN GENERAL.—There is established an Office of

19 Breast Cancer within the Office of the Assistant Secretary

20 for Health. The Office shall have a Director who shall be

21 appointed by the Secretary. The Secretary, acting through

22 the Director, shall carry out this section.

23 ‘‘(b) DUTIES.—The Secretary shall coordinate, in

24 conjunction with the Director of the National Cancer In25 stitute, the activities of the Institute relating to breast
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1 cancer with similar activities of other agencies of the Fed2 eral Government, including the other agencies of the Na3 tional Institutes of Health, and with similar activities of

4 other public entities and of private entities.’’.

5 SEC. 118. ESTABLISHMENT OF NATIONAL BREAST CANCER

6 COMMISSION.

7 Title XVII of the Public Health Service Act (42

8 U.S.C. 300uu et seq.), as amended by section 117, is

9 amended by adding at the end the following new section:

10 ‘‘SEC. 1710. NATIONAL BREAST CANCER COMMISSION.

11 ‘‘(a) ESTABLISHMENT.—There is established a com12 mission to be known as the ‘National Breast Cancer Com13 mission’ (in this section referred to as the ‘Commission’).

14 ‘‘(b) STUDY.—The Commission shall conduct a study

15 on current efforts in both the public and private sectors

16 relating to the prevention, early detection, treatment, edu17 cation, and research relating to breast cancer.

18 ‘‘(c) REPORT.—Not later than 1 year after the date

19 on which the initial appointments of the members have

20 been completed under subsection (d), the Commission

21 shall submit to the President and the Congress a report

22 containing—

23 ‘‘(1) the results of the study conducted under

24 subsection (b); and

25 ‘‘(2) recommendations relating to such study.
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1 ‘‘(d) NUMBER AND APPOINTMENT.—

2 ‘‘(1) APPOINTMENT.—The Commission shall be

3 composed of 15 members as follows:

4 ‘‘(A) 5 members shall be appointed by the

5 President—

6 ‘‘(i) 3 of whom shall be—

7 ‘‘(I) the Secretary of Health and

8 Human Services;

9 ‘‘(II) the Secretary of Veterans

10 Affairs; and

11 ‘‘(III) the Secretary of Defense;

12 who shall be nonvoting members, except

13 that, in the case of a tie vote by the Com14 mission, the Secretary of Health and

15 Human Services shall be a voting member;

16 and

17 ‘‘(ii) 2 of whom shall be selected from

18 the general public on the basis of such in19 dividuals being specially qualified to serve

20 on the Commission by reason of their edu21 cation, training, or experience.

22 ‘‘(B) 5 members shall be appointed by the

23 Speaker of the House of Representatives on the

24 joint recommendation of the Majority and Mi25 nority Leaders of the House of Representatives.
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1 ‘‘(C) 5 members shall be appointed by the

2 President pro tempore of the Senate on the

3 joint recommendation of the Majority and Mi4 nority Leaders of the Senate.

5 ‘‘(2) CONGRESSIONAL COMMITTEE REC6 OMMENDATIONS.—In making appointments under

7 subparagraphs (B) and (C) of paragraph (1), the

8 Majority and Minority leaders of the House of Rep9 resentatives and the Senate shall duly consider the

10 recommendations of the Chairmen and Ranking Mi11 nority Members of committees with jurisdiction over

12 laws contained in chapter 17 of title 38, United

13 States Code (relating to veterans’ health care), title

14 XIX of the Social Security Act (42 U.S.C. 1901 et

15 seq.) (relating to Medicaid), and the Public Health

16 Service Act (42 U.S.C. 201 et seq.) (relating to the

17 Public Health Service).

18 ‘‘(3) REQUIREMENTS OF APPOINTMENTS.—The

19 Majority and Minority leaders of the Senate and the

20 House of Representatives shall—

21 ‘‘(A) select individuals who are specially

22 qualified to serve on the Commission by reason

23 of their education, training, or experience; and

24 ‘‘(B) engage in consultations for the pur25 pose of ensuring that the expertise of the 10
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1 members appointed by the Speaker of the

2 House of Representatives and the President pro

3 tempore of the Senate shall provide as much of

4 a balance as possible and, to the greatest extent

5 possible, cover the fields of medicine, science,

6 law, ethics, health-care and social services.

7 ‘‘(4) TERM OF MEMBERS.—Members of the

8 Commission (other than members appointed under

9 paragraph (1)(A)(i)) shall serve for the life of the

10 Commission.

11 ‘‘(5) VACANCY.—A vacancy on the Commission

12 shall be filled in the manner in which the original

13 appointment was made.

14 ‘‘(e) CHAIRMAN.—Not later than 15 days after the

15 members of the Commission are appointed, such members

16 shall select a Chairman from among the members of the

17 Commission.

18 ‘‘(f) QUORUM.—7 members of the Commission shall

19 constitute a quorum, but a lesser number may be author20 ized by the Commission to conduct hearings.

21 ‘‘(g) MEETINGS.—The Commission shall hold its 1st

22 meeting on a date specified by the Chairman. After the

23 initial meeting, the Commission shall meet at the call of

24 the Chairman or a majority of its members, but shall meet
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1 at least 3 times each year during the life of the Commis2 sion.

3 ‘‘(h) PAY.—Members of the Commission who are offi4 cers or employees or elected officials of a government en5 tity shall receive no additional compensation by reason of

6 their service on the Commission.

7 ‘‘(i) PER DIEM.—While away from their homes or

8 regular places of business in the performance of duties for

9 the Commission, members of the Commission shall be al10 lowed travel expenses, including per diem in lieu of sub11 sistence, at rates authorized for employees of agencies

12 under sections 5702 and 5703 of title 5, United States

13 Code.

14 ‘‘(j) DEADLINE FOR APPOINTMENT.—The members

15 of the Commission shall be appointed not later than 60

16 days after the date of the enactment of this section.

17 ‘‘(k) TERMINATION.—The Commission shall cease to

18 exist 60 days after the date on which its final report is

19 submitted under subsection (c).’’.
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1 PART II—DUTIES OF DIRECTOR OF THE NA2 TIONAL CANCER INSTITUTE RELATING TO

3 BREAST CANCER

4 SEC. 119. PROVISIONS FOR FULL FUNDING FOR NATIONAL

5 CANCER INSTITUTE WITH RESPECT TO RE6 SEARCH ON BREAST CANCER.

7 Section 408(a)(1) of the Public Health Service Act

8 (42 U.S.C. 284c(a)(1)) is amended by adding at the end

9 the following subparagraph:

10 ‘‘(C) For the purpose of conducting and sup11 porting research on breast cancer through the Na12 tional Cancer Institute, there is authorized to be ap13 propriated for fiscal year 1994 an amount equal to

14 the sum of $300,000,000 and the amount obligated

15 by such Institute for such research for fiscal year

16 1993. For such purpose, there are authorized to be

17 appropriated such sums as may be necessary for

18 each of the fiscal years 1995 and 1996.’’.

19 SEC. 120. DUTIES OF DIRECTOR.

20 Subpart 1 of part C of title IV of the Public Health

21 Service Act (42 U.S.C. 285 et seq.) is amended by adding

22 at the end the following new section:

23 ‘‘SEC. 417. DUTIES OF DIRECTOR OF THE INSTITUTE RELAT24 ING TO BREAST CANCER RESEARCH.

25 ‘‘(a) The Director of the Institute shall conduct and

26 support biomedical and behavioral research and research
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1 training, the dissemination of health information, and

2 other programs with respect to breast cancer.

3 ‘‘(b) In carrying out subsection (a), the Director of

4 the Institute shall conduct or support multidisciplinary

5 clinical research on breast cancer, including research on

6 assisting individuals with such cancers (and the families

7 of such individuals) and with responding to psychological

8 and social problems that arise as the result of the cancer.

9 ‘‘(c)(1) The Director of the Institute shall establish

10 the Rose Kushner Scholarship Program for the purpose

11 of entering into contracts with individuals under which—

12 ‘‘(A) the Director of the Institute agrees to pro13 vide to the individuals scholarships for attendance at

14 accredited health professions schools; and

15 ‘‘(B) the individuals agree—

16 ‘‘(i) to complete the programs of education

17 for which the scholarships are provided;

18 ‘‘(ii) to complete a program of post19 graduate clinical training in oncology; and

20 ‘‘(iii) after completing a program of such

21 training, to serve as employees of the National

22 Institutes of Health, for the period described in

23 paragraph (2), in positions that are needed by

24 such Institutes in carrying out programs with

25 respect to breast cancer.
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1 ‘‘(2)(A) For purposes of paragraph (1)(B)(iii), the

2 period of service for which an individual is obligated to

3 serve as an employee of the National Institutes of Health

4 is 12 months for each academic year for which the scholar5 ship under such subsection is provided.

6 ‘‘(B) The Director of the Institute may defer the obli7 gation of an individual to provide a period of service under

8 paragraph (1)(B)(iii), if the Director determines that such

9 a deferral is appropriate.

10 ‘‘(C) For any period in which an individual provides

11 service as an employee of the National Institutes of Health

12 in satisfaction of the obligation of the individual under

13 paragraph (1)(B)(iii), the individual may be appointed as

14 such an employee without regard to the provisions of title

15 5, United States Code, relating to appointment and com16 pensation.

17 ‘‘(3)(A) The Director of the Institute may not provide

18 a scholarship under paragraph (1) for an academic year

19 unless—

20 ‘‘(i) the individual applying for the scholarship

21 has submitted to the Director a proposed academic

22 program for the year and the Director has approved

23 the program; and

24 ‘‘(ii) the individual agrees that the program will

25 not be altered without the approval of the Director.
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1 ‘‘(B) The Director of the Institute may not provide

2 a scholarship under paragraph (1) for an academic year

3 unless the individual applying for the scholarship agrees

4 to maintain an acceptable level of academic standing, as

5 determined by the educational institution involved in ac6 cordance with regulations issued by the Secretary.

7 ‘‘(4)(A) The Director of the Institute may not provide

8 a scholarship under paragraph (1) for an academic year

9 in an amount exceeding $10,000.

10 ‘‘(B) A scholarship provided under paragraph (1)

11 may be expended only for tuition expenses, other reason12 able educational expenses, and reasonable living expenses

13 incurred while attending the health professions school in14 volved.

15 ‘‘(C) In the case of a health professions school with

16 respect to which a scholarship under paragraph (1) is pro17 vided, the Director of the Institute may enter into a con18 tract with the school under which the amounts provided

19 in the scholarship for tuition and other educational ex20 penses are paid directly to the school. Payments to the

21 school under the contract may be made without regard

22 to section 3324 of title 31, United States Code.

23 ‘‘(5) The provisions of section 338E shall apply to

24 the program established in paragraph (1) to the same ex25 tent and in the same manner as such provisions apply to
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1 the National Health Service Corps Loan Repayment Pro2 gram established in section 338B.

3 ‘‘(6) The Director of the Institute may not provide

4 a scholarship under paragraph (1) unless an application

5 for the scholarship is submitted to the Director and the

6 application is in such form, is made in such manner, and

7 contains such agreements, assurances, and information as

8 the Director determines to be necessary to carry out this

9 section.

10 ‘‘(d)(1) The Director of the Institute shall, subject

11 to paragraph (2), carry out a program of entering into

12 contracts with appropriately qualified health professionals

13 under which the professionals agree to carry out activities

14 with respect to breast cancer as employees of the National

15 Institutes of Health in consideration of the Federal Gov16 ernment agreeing to pay, for each year of such service,

17 not more than $20,000 of the principal and interest of

18 the educational loans of the professionals.

19 ‘‘(2) The Director of the Institute may not enter into

20 a contract with a health professional pursuant to para21 graph (1) unless the professional has a substantial amount

22 of educational loans relative to income.

23 ‘‘(3) Except to the extent inconsistent with this sec24 tion, 338E shall apply to the program established in para25 graph (1) to the same extent and in the same manner as
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1 such section applies to the National Health Service Corps

2 Loan Repayment Program established in section 338B.’’.

3 SEC. 121. SPECIALIZED PROGRAMS OF RESEARCH EXCEL4 LENCE WITH RESPECT TO BREAST, LUNG,

5 AND PROSTATE CANCER.

6 Section 408(a)(1) of the Public Health Service Act,

7 as amended by section 119, is amended by adding at the

8 end the following subparagraph:

9 ‘‘(D)(i) For the purpose of carrying out not less

10 than 10 programs for research on breast cancer,

11 lung cancer, or prostate cancer under the programs

12 designated by the Director of the National Cancer

13 Institute as the Specialized Programs of Research

14 Excellence, there is authorized to be appropriated

15 such sums as may be necessary for each of the fiscal

16 years 1994 through 1996.

17 ‘‘(ii) With respect to the purpose described in

18 clause (i), the authorizations of appropriations es19 tablished in such clause may not be construed as

20 terminating the availability for such purpose of any

21 other authorization of appropriations (including the

22 authorization established in subparagraph (A).’’.
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1 Subtitle E—Lupus Research

2 Amendments of 1993

3 SEC. 126. SHORT TITLE.

4 This subtitle may be cited as the ‘‘Lupus Research

5 Amendments of 1993’’.

6 SEC. 127. FINDINGS.

7 The Congress finds that—

8 (1) lupus is a serious, complex, inflammatory,

9 autoimmune disease of particular concern to women;

10 (2) lupus affects women 9 times more often

11 than men;

12 (3) there are 3 main types of lupus: systemic

13 lupus, a serious form of the disease that affects

14 many parts of the body; discoid lupus, a form of the

15 disease that affects mainly the skin; and drug-in16 duced lupus caused by certain medications;

17 (4) lupus can be fatal if not detected and

18 treated early;

19 (5) the disease can simultaneously affect var20 ious areas of the body, such as the skin, joints, kid21 neys, and brain, and can be difficult to diagnose be22 cause the symptoms of lupus are similar to those of

23 many other diseases;

24 (6) lupus disproportionately affects African25 American women, as the prevalence of the disease
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1 among such women is 3 times the prevalence among

2 white women, and an estimated 1 in 250 African3 American women between the ages of 15 and 65 de4 velops the disease;

5 (7) it has been estimated that over 500,000

6 Americans have been diagnosed with the disease,

7 and that many more have undiagnosed cases;

8 (8) current treatments for the disease can be

9 effective, but may lead to damaging side effects; and

10 (9) many victims of the disease suffer debilitat11 ing pain and fatigue, making it difficult to maintain

12 employment and lead normal lives.

13 SEC. 128. EXPANSION AND INTENSIFICATION OF ACTIVI14 TIES REGARDING LUPUS.

15 Subpart 4 of part C of title IV of the Public Health

16 Service Act (42 U.S.C. 285d et seq.) is amended by insert17 ing after section 441 the following section:

18 ‘‘LUPUS

19 ‘‘SEC. 441A. (a) IN GENERAL.—The Director of the

20 Institute shall expand and intensify research and related

21 activities of the Institute with respect to lupus.

22 ‘‘(b) COORDINATION WITH OTHER INSTITUTES.—

23 The Director of the Institute shall coordinate the activities

24 of the Director under subsection (a) with similar activities

25 conducted by the other national research institutes and

26 agencies of the National Institutes of Health to the extent
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1 that such Institutes and agencies have responsibilities that

2 are related to lupus.

3 ‘‘(c) PROGRAMS FOR LUPUS.—In carrying out sub4 section (a), the Director of the Institute shall conduct or

5 support research to expand the understanding of the

6 causes of, and to find a cure for, lupus. Activities under

7 such subsection shall include research to determine the

8 reasons underlying the elevated prevalence of the disease

9 among African-American and other women. Activities

10 under such subsection shall provide for an expansion and

11 intensification of the conduct and support of—

12 ‘‘(1) basic research concerning the etiology and

13 causes of lupus;

14 ‘‘(2) epidemiological studies to address the fre15 quency and natural history of the disease and the

16 differences among the sexes and among racial and

17 ethnic groups with respect to the disease;

18 ‘‘(3) the development of improved screening

19 techniques;

20 ‘‘(4) clinical research for the development and

21 evaluation of new treatments, including new biologi22 cal agents; and

23 ‘‘(5) information and education programs for

24 health care professionals and the public.
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1 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the

2 purpose of carrying out this section, there are authorized

3 to be appropriated $20,000,000 for fiscal year 1994, and

4 such sums as may be necessary for each of the fiscal years

5 1994 through 1996. The authorization of appropriations

6 established in the preceding sentence is in addition to any

7 other authorization of appropriations that is available for

8 such purpose.’’.

9 Subtitle F—Women’s Midlife Health

10 Research Act

11 SEC. 131. SHORT TITLE.

12 This subtitle may be cited as the ‘‘Women’s Midlife

13 Health Research Act’’.

14 SEC. 132. ESTABLISHMENT OF PROGRAM FOR RESEARCH

15 CENTERS ON WOMEN’S MIDLIFE HEALTH

16 CARE, INCLUDING MENOPAUSE AND MENO17 PAUSAL HEALTH CONDITIONS.

18 Subpart 5 of part C of title IV of the Public Health

19 Service Act (42 U.S.C. 285e et seq.) is amended by adding

20 at the end the following section:

21 ‘‘RESEARCH CENTERS ON MENOPAUSE AND MENOPAUSAL

22 HEALTH CONDITIONS

23 ‘‘SEC. 445G. (a) The Director of the Institute, after

24 consultation with the advisory council for the Institute,

25 shall provide for the development or expansion of not less

26 than 5 centers for research on—
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1 ‘‘(1) the process by which the functioning of the

2 ovaries diminishes or ceases completely (in this sec3 tion referred to as ‘menopause’); and

4 ‘‘(2) conditions arising from the diminished or

5 complete cessation of the functioning of the ovaries,

6 whether occurring naturally or otherwise (in this

7 section referred to as ‘menopausal health condi8 tions’).

9 ‘‘(b) Each center assisted under this section shall—

10 ‘‘(1)(A) use the facilities of a single institution

11 or a consortium of cooperating institutions; and

12 ‘‘(B) meet such qualifications as may be pre13 scribed by the Secretary;

14 ‘‘(2) conduct basic and clinical research into the

15 natural history of menopause in order to improve

16 the state of medical knowledge or methods regarding

17 the cause, diagnosis, early detection, prevention, con18 trol, and treatment of menopausal health conditions;

19 ‘‘(3) develop multidisciplinary models of health

20 care regarding menopause and menopausal health

21 conditions;

22 ‘‘(4) conduct educational and training programs

23 on menopause and menopausal health conditions for

24 physicians, scientists, and other health and allied

25 health professionals;
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1 ‘‘(5) conduct information and continuing edu2 cation programs for physicians and other health and

3 allied health professionals who provide care for pa4 tients with such conditions; and

5 ‘‘(6) conduct programs for the dissemination to

6 the general public of information on menopause and

7 menopausal health conditions.

8 ‘‘(c) In carrying out subsection (b)(2), the Director

9 of the Institute shall ensure that centers assisted under

10 this section—

11 ‘‘(1) conduct research on hormonal treatments

12 for menopausal health conditions, research on

13 nonhormonal treatments of symptoms arising from

14 such conditions, and research on the relationship be15 tween such conditions and cardiovascular disease,

16 osteoporosis, bone fractures, bladder conditions,

17 breast and uterine cancers, and other conditions that

18 research indicates may be relevant; and

19 ‘‘(2) conduct research to determine whether and

20 to what extent differences may exist, with respect to

21 menopause and menopausal health conditions,

22 among various socioeconomic groups, ethnic groups,

23 and racial groups.

24 ‘‘(d) In carrying out subsection (a), the Director of

25 the Institute, in consultation with the Director of NIH
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1 and the Administrator for Health Care Policy and Re2 search, shall establish a program to develop protocols for

3 the prevention and treatment of menopausal health condi4 tions and other conditions regarding women’s midlife

5 health.

6 ‘‘(e) A center may use funds provided under sub7 section (a) to provide stipends for health professionals en8 rolled in educational or training programs described in

9 subsection (b)(4).

10 ‘‘(f) The Director shall ensure that the activities of

11 centers assisted under this section are coordinated among

12 the centers.

13 ‘‘(g) The Director of the Institute shall, to the extent

14 practicable, provide for an equitable geographical distribu15 tion of centers assisted under this section.

16 ‘‘(h) Support of a center under this section may be

17 for a period of not to exceed five years. Such period may

18 be extended by the Director of the Institute for one or

19 more additional periods of not more than five years if the

20 operations of such center have been reviewed by an appro21 priate technical and scientific peer review group estab22 lished by the Director and if such group has recommended

23 to the Director that such period should be extended.’’.
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1 Subtitle G—Osteoporosis and Re2 lated Bone Disorders Research

3 Education, and Health Services

4 Act of 1993

5 SEC. 136. SHORT TITLE.

6 This subtitle may be cited as the ‘‘Osteoporosis and

7 Related Bone Disorders Research, Education, and Health

8 Services Act of 1993’’.

9 SEC. 137. FINDINGS.

10 The Congress finds that—

11 (1) osteoporosis, or porous bone, is a condition

12 characterized by an excessive loss of bone tissue and

13 an increased susceptibility to fractures of the hip,

14 spine, and wrist;

15 (2) an estimated 25,000,000 Americans have

16 osteoporosis, with many cases undiagnosed because

17 the condition develops without symptoms until a

18 strain, bump, or fall causes a fracture;

19 (3) between 3 and 4 million Americans have

20 Paget’s disease, Osteogenesis Imperfecta, and other

21 related metabolic bone disorders;

22 (4) osteoporosis is responsible for 1,300,000

23 bone fractures annually, including more than

24 250,000 hip fractures, 500,000 vertebral fractures,
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1 200,000 fractures of the wrist, and the remaining

2 fractures at other limb sites;

3 (5) osteoporosis affects one-third to one-half of

4 all postmenopausal women and nearly half of all

5 people over age 75;

6 (6) direct medical costs of osteoporosis reached

7 an estimated $10,000,000,000 in 1988 for the Unit8 ed States, not including the costs of family care and

9 lost work for caregivers;

10 (7) direct medical costs of osteoporosis are ex11 pected to increase precipitously because the propor12 tion of the population comprised of older persons is

13 expanding and each generation of older persons

14 tends to have a higher incidence of osteoporosis than

15 preceding generations;

16 (8) technology now exists, and new technology

17 is developing, that will permit early diagnosis and

18 prevention of osteoporosis as well as management of

19 the condition once it has developed;

20 (9) funding for research on osteoporosis and re21 lated bone disorders is severely constrained at key

22 research institutes, including the National Institute

23 of Arthritis and Musculoskeletal and Skin Diseases,

24 the National Institute on Aging, and the National
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1 Institute of Diabetes and Digestive and Kidney Dis2 eases;

3 (10) further research is needed to improve med4 ical knowledge concerning—

5 (A) cellular mechanisms related to the

6 processes of bone resorption and bone forma7 tion, and the effect of different agents on bone

8 remodeling;

9 (B) risk factors for osteoporosis, including

10 newly discovered risk factors, risk factors relat11 ed to groups not ordinarily studied, such as

12 men and minorities, and the relationship of

13 aging processes to the development of

14 osteoporosis;

15 (C) bone mass measurement technology,

16 including techniques for making faster and

17 more precise measurements and for interpreting

18 measurements;

19 (D) calcium, including bioavailability, in20 take requirements, and the role of calcium in

21 building heavier and denser skeletons;

22 (E) prevention and treatment, including

23 the efficacy of current therapies, alternative

24 drug therapies for prevention and treatment,

25 and the role of exercise; and
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1 (F) rehabilitation; and

2 (11) further educational efforts are needed to

3 increase public and professional knowledge of the

4 causes of, methods for avoiding, and treatment of

5 osteoporosis.

6 SEC. 138. OSTEOPOROSIS RESEARCH.

7 Subpart 4 of part C of title IV of the Public Health

8 Service Act (42 U.S.C. 285d et seq.) is amended—

9 (1) by inserting after the subpart designation

10 and heading the following:

11 ‘‘DIVISION A—ARTHRITIS’’;

12 and

13 (2) by adding at the end the following:

14 ‘‘DIVISION B—OSTEOPOROSIS

15 ‘‘SEC. 442A. DEFINITIONS.

16 ‘‘As used in this division:

17 ‘‘(1) ADVISORY PANEL.—The term ‘Advisory

18 Panel’ means the Advisory Panel on Osteoporosis

19 and Related Disorders, established in section 442D.

20 ‘‘(2) COUNCIL.—The term ‘Council’ means the

21 Interagency Council on Osteoporosis and Related

22 Disorders, established in section 442C.

23 ‘‘(3) DEPARTMENT.—The term ‘Department’

24 means the Department of Health and Human Serv25 ices.
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1 ‘‘(4) RELATED DISORDERS.—The term ‘related

2 bone disorders’ includes—

3 ‘‘(A) Paget’s disease, a bone disease char4 acterized by enlargement and loss of density

5 with bowing and deformity of the bones;

6 ‘‘(B) Osteogenesis Imperfecta, a familial

7 disease marked by extreme brittleness of the

8 long bones;

9 ‘‘(C) hyperparathyroidism, a condition

10 characterized by the presence of excess para11 thormone in the body resulting in disturbance

12 of calcium metabolism with loss of calcium from

13 bone and renal damage;

14 ‘‘(D) hypoparathyroidism, a condition

15 characterized by the absence of parathormone

16 resulting in disturbances of calcium metabolism;

17 ‘‘(E) renal bone disease, a disease charac18 terized by metabolic disturbances from dialysis,

19 renal transplants, or other renal disturbances;

20 ‘‘(F) primary or postmenopausal

21 osteoporosis and secondary osteoporosis, such

22 as that induced by corticosteroids; and

23 ‘‘(G) other general disorders of bone and

24 mineral metabolism including abnormalities of

25 vitamin D.
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1 ‘‘(5) RESOURCE CENTER.—The term ‘Resource

2 Center’ means the Resource Center on Osteoporosis

3 and Related Disorders, established in section 442E.

4 ‘‘SEC. 442B. EXPANSION OF RESEARCH ON OSTEOPOROSIS

5 AND RELATED BONE DISORDERS.

6 ‘‘(a) RESEARCH.—The Director of the National Insti7 tute of Arthritis and Musculoskeletal and Skin Diseases,

8 the Director of the National Institute on Aging, and the

9 Director of the National Institute of Diabetes and Diges10 tive and Kidney Diseases shall expand and intensify re11 search on osteoporosis and related bone disorders. The re12 search shall be in addition to research that is authorized

13 under any other provision of law.

14 ‘‘(b) RESEARCH CENTERS.—The Director of the Na15 tional Institute of Arthritis and Musculoskeletal and Skin

16 Diseases shall increase the number of Specialized Centers

17 of Research devoted to research on osteoporosis and relat18 ed bone disorders. The Director of the National Institute

19 on Aging shall increase the number of program project

20 grants devoted to creating centers of excellence in

21 osteoporosis and related bone disorders. The Director of

22 the National Institute of Diabetes and Digestive and Kid23 ney Diseases shall increase the number of program

24 projects grants in osteoporosis.
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1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

2 are authorized to be appropriated to carry out this section

3 $36,000,000 for the National Institute of Arthritis and

4 Musculoskeletal and Skin Diseases, $24,000,000 for the

5 National Institute on Aging, and $2,000,000 for the Na6 tional Institute of Diabetes and Digestive and Kidney Dis7 eases for each of the fiscal years 1994 through 1996, and

8 such sums as may be necessary for subsequent fiscal

9 years. These funds are in addition to amounts authorized

10 to be appropriated for biomedical research relating to

11 osteoporosis and related bone disorders under any other

12 provision of law.

13 ‘‘SEC. 442C. INTERAGENCY COUNCIL ON OSTEOPOROSIS

14 AND RELATED BONE DISORDERS.

15 ‘‘(a) ESTABLISHMENT.—There is established in the

16 Department an Interagency Council on Osteoporosis and

17 Related Disorders. The Council shall be composed of—

18 ‘‘(1) the Assistant Secretary for Health;

19 ‘‘(2) the Surgeon General of the United States;

20 ‘‘(3) the Assistant Secretary for Planning and

21 Evaluation of the Department;

22 ‘‘(4) the Director of the National Institute of

23 Arthritis and Musculoskeletal and Skin Diseases;

24 ‘‘(5) the Director of the National Institute on

25 Aging;
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1 ‘‘(6) the Director of the National Institute of

2 Diabetes, Digestive, and Kidney Diseases;

3 ‘‘(7) the Director of the National Institute of

4 Mental Health;

5 ‘‘(8) the Director of the National Institute of

6 Child Health and Human Development;

7 ‘‘(9) the Administrator of the Health Care Fi8 nancing Administration;

9 ‘‘(10) the Administrator for Health Care Policy

10 and Research;

11 ‘‘(11) the Director of the Bureau of Child and

12 Maternal Health;

13 ‘‘(12) the Commissioner of Food and Drugs;

14 ‘‘(13) the Director of the National Institute of

15 Dental Research;

16 ‘‘(14) the Commissioner on Aging;

17 ‘‘(15) the Director of the Office of Disease Pre18 vention and Health Promotion; and

19 ‘‘(16) such additional members as the Secretary

20 considers appropriate.

21 ‘‘(b) FUNCTIONS.—The Council shall—

22 ‘‘(1) coordinate research conducted by or

23 through the Department on osteoporosis and related

24 bone disorders;
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1 ‘‘(2) establish a mechanism for sharing infor2 mation on osteoporosis and related bone disorders

3 among all officers and employees of the Department

4 involved in carrying out programs serving older per5 sons, midlife women, and young persons, in order to

6 provide for full communication and exchange of in7 formation;

8 ‘‘(3) review and coordinate the most promising

9 areas of research concerning osteoporosis and relat10 ed bone disorders;

11 ‘‘(4) assist the National Institute of Arthritis

12 and Musculoskeletal and Skin Diseases, the National

13 Institute on Aging, the National Institute of Diabe14 tes, Digestive and Kidney Disease, the National In15 stitute on Dental Research, and other institutes in

16 developing and coordinating plans for research on

17 osteoporosis and related bone disorders;

18 ‘‘(5) assist the Office of Disease Prevention and

19 Health Promotion and the Administration on Aging

20 and other offices in developing and coordinating

21 plans for education and health promotion on

22 osteoporosis and related bone disorders; and

23 ‘‘(6) establish mechanisms to use the results of

24 research concerning osteoporosis and related bone

25 disorders in the development of policies, programs,
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1 and other measures to improve the quality of life for

2 older Americans.

3 ‘‘(c) CHAIRPERSON.—The Secretary shall select a

4 Chairperson or co-Chairpersons for the Council from

5 among its members.

6 ‘‘(d) QUORUM.—A majority of the members of the

7 Council shall constitute a quorum, but a lesser number

8 may hold hearings.

9 ‘‘(e) MEETINGS.—The Council shall meet periodically

10 at the call of the Chairperson, but not less often than twice

11 each year.

12 ‘‘(f) EXECUTIVE SECRETARY.—The Secretary shall

13 appoint an Executive Secretary for the Council.

14 ‘‘(g) ADMINISTRATIVE STAFF AND SUPPORT.—The

15 Secretary shall provide the Council with such additional

16 administrative staff and support as may be necessary to

17 enable the Council to carry out its functions.

18 ‘‘(h) REPORTS.—

19 ‘‘(1) INITIAL REPORT.—

20 ‘‘(A) PREPARATION.—Not later than 9

21 months after the date of enactment of this divi22 sion, the Executive Secretary of the Council

23 shall prepare a report detailing the research

24 plans referred to in paragraphs (4) and (5) of

25 subsection (b). The report shall describe the ac-
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1 tivities to be carried out under the research

2 plans during each of the fiscal years 1994

3 through 1996.

4 ‘‘(B) OTHER FEDERAL PROGRAMS.—To

5 the maximum extent feasible, the report shall

6 ensure that activities carried out under the re7 search plans are coordinated with, and use the

8 resources of, other Federal programs concern9 ing osteoporosis and related bone disorders, in10 cluding—

11 ‘‘(i) centers supported by the National

12 Institute of Arthritis and Musculoskeletal

13 and Skin Diseases, the National Institute

14 on Aging, and the National Institute of Di15 abetes, Digestive and Kidney Disease;

16 ‘‘(ii) other centers supported by Fed17 eral funds involved in research on

18 osteoporosis and related bone disorders;

19 and

20 ‘‘(iii) other programs concerning

21 osteoporosis and related bone disorders

22 that are planned or conducted by Federal

23 agencies such as the Administration on

24 Aging and the Office of Disease Prevention

25 and Health Promotion, Federal agencies
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1 outside the Department, State or local

2 agencies, community organizations, or pri3 vate foundations.

4 ‘‘(C) DISTRIBUTION.—The Executive Sec5 retary of the Council shall—

6 ‘‘(i) transmit the report to Congress;

7 and

8 ‘‘(ii) make the report available to the

9 public and to the Advisory Panel.

10 ‘‘(2) SUBSEQUENT REPORTS.—Not later than

11 12 months after the date on which the report re12 quired by paragraph (1) is transmitted to Congress,

13 and annually thereafter, the Executive Secretary of

14 the Council shall—

15 ‘‘(A) prepare a report that—

16 ‘‘(i) describes research and edu17 cational initiatives sponsored by the Fed18 eral Government on osteoporosis and relat19 ed bone disorders; and

20 ‘‘(ii) makes recommendations for new

21 research and educational initiatives on

22 osteoporosis and related bone disorders;

23 and

24 ‘‘(B) transmit the report to Congress and

25 make the report available to the public.
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1 ‘‘SEC. 442D. ADVISORY PANEL ON OSTEOPOROSIS AND RE2 LATED DISORDERS.

3 ‘‘(a) ESTABLISHMENT.—There is established in the

4 Department an Advisory Panel on Osteoporosis and Relat5 ed Disorders. The Advisory Panel shall be composed of

6 the following 15 voting members and additional nonvoting,

7 ex officio members:

8 ‘‘(1) VOTING MEMBERS.—The Director of the

9 Office of Technology Assessment shall appoint to the

10 Advisory Panel—

11 ‘‘(A) 5 members who are biomedical re12 search scientists with demonstrated achieve13 ment in biomedical research on osteoporosis and

14 related bone disorders, including at least 1 re15 searcher at a specialized center for research in

16 osteoporosis;

17 ‘‘(B) 2 members with demonstrated

18 achievements in research on community-based

19 and family services covering osteoporosis and

20 related bone disorders;

21 ‘‘(C) 1 member who is knowledgeable in

22 health promotion and disease prevention pro23 grams concerning osteoporosis and related bone

24 disorders;
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1 ‘‘(D) 2 members who are associated with

2 specialized bone programs affiliated with aca3 demic health centers;

4 ‘‘(E) 2 members who are experts in private

5 health care insurance and long-term care fi6 nancing; and

7 ‘‘(F) 3 members who are representatives of

8 national voluntary organizations that are con9 cerned with the problems of individuals with

10 osteoporosis and related bone disorders and

11 their families.

12 ‘‘(2) NONVOTING, EX OFFICIO MEMBERS.—The

13 Advisory Panel shall include as nonvoting, ex officio

14 members—

15 ‘‘(A) the Chairperson of the Council;

16 ‘‘(B) the Director of National Institute of

17 Arthritis and Musculoskeletal and Skin Dis18 eases;

19 ‘‘(C) the Director of the National Institute

20 on Aging;

21 ‘‘(D) the Director of the National Institute

22 of Diabetes and Digestive and Kidney Diseases;

23 and

24 ‘‘(E) such other members as the Secretary

25 may appoint.
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1 ‘‘(3) APPOINTMENT.—The Director of the Of2 fice of Technology Assessment shall appoint mem3 bers to the Advisory Panel within 90 days after the

4 date of enactment of this division. The Director shall

5 not appoint to the Advisory Panel individuals who

6 are officers or employees of the Federal Government.

7 ‘‘(b) FUNCTIONS.—The Advisory Panel shall advise

8 the Secretary and Council with respect to the identifica9 tion of—

10 ‘‘(1) research priorities for projects on

11 osteoporosis, related bone disorders, and the care of

12 individuals with osteoporosis or related bone dis13 orders;

14 ‘‘(2) emerging issues in and promising areas of

15 biomedical, clinical, and behavioral research on

16 osteoporosis and related bone disorders;

17 ‘‘(3) emerging issues in research on health serv18 ices for individuals, and the families of individuals,

19 with osteoporosis or related bone disorders;

20 ‘‘(4) emerging issues in home-based and com21 munity-based services and systems of services for in22 dividuals, and the families of individuals, with

23 osteoporosis or related bone disorders;

24 ‘‘(5) emerging issues in financing health care

25 services and social services for individuals, and the
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•HR 3075 IH

1 families of individuals, with osteoporosis and related

2 bone disorders;

3 ‘‘(6) emerging issues in health promotion pro4 grams concerning osteoporosis; and

5 ‘‘(7) emerging issues in professional and public

6 education concerning osteoporosis.

7 ‘‘(c) CHAIRPERSON.—The Secretary shall appoint a

8 Chairperson of the Advisory Panel from among the mem9 bers appointed.

10 ‘‘(d) TERM OF OFFICE.—The term of a member of

11 the Advisory Panel shall be for the life of the Advisory

12 Panel. A vacancy on the Advisory Panel shall be filled in

13 the same manner as the original appointment was made.

14 A vacancy on the Advisory Panel shall not affect its

15 powers.

16 ‘‘(e) QUORUM.—A majority of the members of the

17 Advisory Panel appointed shall constitute a quorum, but

18 a lesser number may hold hearings. The Advisory Panel

19 may establish such subcommittees as the Advisory Panel

20 considers appropriate.

21 ‘‘(f) MEETINGS.—The Advisory Panel shall meet at

22 the call of the Chairperson, but not less often than twice

23 per year.
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1 ‘‘(g) EXECUTIVE SECRETARY.—The Executive Sec2 retary of the Council shall serve as Executive Secretary

3 of the Advisory Panel.

4 ‘‘(h) STAFF AND SUPPORT.—The Secretary shall pro5 vide the Advisory Panel with such additional administra6 tive staff and support as may be necessary to enable the

7 Advisory Panel to carry out its functions.

8 ‘‘(i) COMPENSATION AND TRAVEL EXPENSES.—

9 ‘‘(1) COMPENSATION.—Subject to paragraph

10 (2), no member of the Advisory Panel shall receive

11 compensation for service on the Advisory Panel.

12 ‘‘(2) TRAVEL EXPENSES.—Each member of the

13 Advisory Panel shall receive reimbursement for trav14 el, subsistence, and other necessary expenses in15 curred in the performance of duties of the Advisory

16 Panel.

17 ‘‘(j) REPORT.—The Advisory Panel shall—

18 ‘‘(1) prepare an annual report, which shall con19 tain recommendations for administrative and legisla20 tive actions to—

21 ‘‘(A) improve services, education, and in22 formation for individuals, and families of indi23 viduals, with osteoporosis and related bone dis24 orders;

25 ‘‘(B) improve professional education; and
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•HR 3075 IH

1 ‘‘(C) provide for promising biomedical re2 search related to osteoporosis and related bone

3 disorders; and

4 ‘‘(2) transmit the annual report to the Con5 gress, the Secretary, and the Council and make it

6 available to the public.

7 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There

8 are authorized to be appropriated to carry out this section

9 $200,000 for each of fiscal years 1994 through 1996.

10 ‘‘SEC. 442E. RESOURCE CENTER ON OSTEOPOROSIS AND

11 RELATED DISORDERS.

12 ‘‘(a) ESTABLISHMENT.—The Director of the Na13 tional Institute of Arthritis and Musculoskeletal and Skin

14 Diseases shall make grants or enter into contracts with

15 eligible organizations to establish a Resource Center on

16 Osteoporosis and Related Disorders.

17 ‘‘(b) PURPOSE.—The purpose of the Resource Center

18 shall be to facilitate and enhance knowledge and under19 standing of osteoporosis and related bone disorders by dis20 seminating information about research results, services

21 and educational materials, to health professionals, pa22 tients, and the public.

23 ‘‘(c) FUNCTIONS.—An organization receiving a grant

24 or contract under this section shall—
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1 ‘‘(1) compile, archive, and disseminate informa2 tion concerning research, demonstration, evaluation,

3 and training programs and projects concerning

4 osteoporosis and related bone disorders;

5 ‘‘(2) annually publish a summary of the infor6 mation compiled under paragraph (1) during the

7 preceding 12-month period, and make the informa8 tion available on request to appropriate individuals

9 and entities, including educational institutions, re10 search entities, and Federal and public agencies;

11 ‘‘(3) provide information and assistance in

12 accessing community services to patients and the

13 public;

14 ‘‘(4) coordinate regional training programs for

15 the development of health professional resource net16 works on osteoporosis and related bone disorders;

17 and

18 ‘‘(5) maintain a resource library on osteoporosis

19 and related bone disorders.

20 ‘‘(d) INFORMATION SYSTEM AND TELEPHONE

21 LINE.—

22 ‘‘(1) INFORMATION SYSTEM.—An organization

23 receiving a grant or contract under this section shall

24 establish a central computerized information system

25 to—
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1 ‘‘(A) compile and disseminate information

2 concerning initiatives by State and local govern3 ments and private entities to provide programs

4 and services for individuals with osteoporosis;

5 and

6 ‘‘(B) translate scientific and technical in7 formation concerning the initiatives into infor8 mation readily understandable by the general

9 public, and make the information available on

10 request.

11 ‘‘(2) TELEPHONE LINE.—An organization re12 ceiving a grant or contract under this section shall

13 establish a national toll-free telephone line to make

14 available the information described in paragraph (1)

15 and information concerning Federal programs, serv16 ices, and benefits for individuals with osteoporosis

17 and their families.

18 ‘‘(e) FEES.—In accordance with regulations issued by

19 the Secretary, the organization receiving a grant or con20 tract under this section shall charge appropriate fees for

21 providing information through the Research Center as

22 specified in subsections (c) or (d). The organization may

23 make exceptions to the fees for individuals and organiza24 tions who are not financially able to pay the fees. The or25 ganization shall transfer the sums obtained from payment
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•HR 3075 IH

1 of the fees to the Secretary, who shall use the sums to

2 carry out this section.

3 ‘‘(f) APPLICATION OR PROPOSAL.—In order to re4 ceive a grant or enter into a contract under this section,

5 an organization shall submit an application or proposal

6 to the Director of the National Institute of Arthritis and

7 Musculoskeletal and Skin Diseases. The application or

8 proposal shall contain—

9 ‘‘(1) information demonstrating that the organi10 zation has a network of contacts that will enable the

11 organization to receive information necessary to op12 erate the central computerized information system

13 described in subsection (d)(1); and

14 ‘‘(2) such other information as the Director

15 may prescribe.

16 ‘‘(g) ELIGIBLE ORGANIZATIONS.—Organizations eli17 gible to receive grants under this section shall include pub18 lic and private nonprofit organizations that are knowledge19 able about osteoporosis and related bone disorders. The

20 Secretary shall establish additional eligibility criteria for

21 organizations to receive grants or enter into contracts

22 under this section.

23 ‘‘(h) RESEARCH SUMMARIES.—The Director of the

24 National Institute of Arthritis and Musculoskeletal and

25 Skin Diseases, the National Institute on Aging, the Na-
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•HR 3075 IH

1 tional Institute of Diabetes, Digestive, and Kidney Dis2 eases, the National Institute on Dental Research, and

3 other agencies specified by the Secretary shall provide to

4 the Resource Center summaries of the findings of research

5 conducted on osteoporosis, related bone disorders, or rel6 evant treatments for osteoporosis or related bone dis7 orders.

8 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There

9 are authorized to be appropriated to carry out this section

10 $500,000 for fiscal year 1994, and such sums as may be

11 necessary for fiscal years 1995 and 1996.’’.

12 Subtitle H—Ovarian Cancer Re13 search and Information Amend14 ments of 1993

15 SEC. 141. SHORT TITLE.

16 This subtitle may be cited as the ‘‘Ovarian Cancer

17 Research and Information Amendments of 1993’’.

18 SEC. 142. FUNDING FOR RESEARCH ON OVARIAN CANCER.

19 Section 417B(b)(2) of the Public Health Service Act,

20 as added by section 403 of Public Law 103–43, is amend21 ed—

22 (1) by striking ‘‘CANCERS.—For the purpose

23 of’’ and all that follows through ‘‘417,’’ and insert24 ing the following: ‘‘CANCERS.—
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1 ‘‘(A) For the purpose of carrying out sec2 tion 417(d),’’; and

3 (2) by adding at the end the following subpara4 graph:

5 ‘‘(B)(i) For the purpose of carrying out re6 search under section 417(d) on ovarian cancer,

7 there are authorized to be appropriated

8 $90,000,000 for fiscal year 1994, and such

9 sums as may be necessary for each of the fiscal

10 years 1995 and 1996. With respect to such pur11 pose, such authorizations of appropriations are

12 in addition to the authorizations of appropria13 tions established in subparagraph (A) and in

14 subsection (a).

15 ‘‘(ii) Of the amounts appropriated under

16 clause (i), the Director of the Institute shall re17 serve 50 percent for research described in such

18 clause that does not involve treatment or clini19 cal trials, and 50 percent for research described

20 in such clause that does involve treatment and

21 clinical trials.

22 ‘‘(iii) In expending the amounts reserved

23 under clause (ii), the Director of the Institute

24 shall ensure that 1 or more programs of re25 search on ovarian cancer are carried out under
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1 the programs designated by the Director as the

2 Specialized Programs of Research Excellence.’’.

3 SEC. 143. PUBLIC INFORMATION AND EDUCATION ON

4 OVARIAN CANCER.

5 Section 417(d)(4) of the Public Health Service Act,

6 as added by section 401 of Public Law 103–43, is amend7 ed by striking ‘‘section 413; and’’ and inserting the follow8 ing: ‘‘section 413, which programs shall include programs

9 on ovarian cancer that (subject to changes in the applica10 ble facts) provide information and education regarding—

11 ‘‘(A) screening procedures for such cancer,

12 including the fact that there is not a procedure

13 that reliably provides for the early detection of

14 such cancer;

15 ‘‘(B) the fact that there may be a genetic

16 basis to such cancer;

17 ‘‘(C) factors indicating a substantial risk

18 of such cancer; and

19 ‘‘(D) the various treatments for such can20 cer and the extent to which the treatments are

21 effective; and’’.
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1 Subtitle I—Antiprogestin Testing

2 Act of 1993

3 SEC. 146. SHORT TITLE.

4 This subtitle may be cited as the ‘‘Antiprogestin

5 Testing Act of 1993’’.

6 SEC. 147. RESEARCH.

7 (a) IN GENERAL.—The Secretary of Health and

8 Human Services, acting through the Director of the Na9 tional Institutes of Health, may conduct and support re10 search (including clinical trials) on antiprogestin drugs for

11 their safety and efficacy for any potential use, including

12 termination of pregnancy and contraception, and when

13 used therapeutically for cancer, endocrine disorders, and

14 endometriosis.

15 (b) INSTITUTIONAL REVIEW BOARDS AND PEER RE16 VIEW.—Research conducted or supported under sub17 section (a) shall be subject to sections 491 and 492 of

18 the Public Health Service Act (42 U.S.C. 289, 289a).

19 (c) PRIORITIES.—In determining priorities for re20 search under subsection (a), the Secretary shall consider

21 data from previous research.

22 SEC. 148. REPORT.

23 The Secretary of Health and Human Services shall

24 report to Congress the results of research conducted or
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1 supported under section 2(a) on January 1, 1994, and

2 annually thereafter.

3 Subtitle J—Women’s Health Envi4 ronmental Factors Research Act

5 of 1993

6 SEC. 151. SHORT TITLE.

7 This subtitle may be cited as the ‘‘Women’s Health

8 Environmental Factors Research Act of 1993’’.

9 SEC. 152. RESEARCH ON EFFECT OF ENVIRONMENTAL FAC10 TORS ON WOMEN’S HEALTH.

11 Subpart 12 of part C of title IV of the Public Health

12 Service Act (42 U.S.C. 285), as amended by section 1301

13 of Public Law 103–43 (107 Stat. 169), is amended by

14 adding at the end the following section:

15 ‘‘EFFECT OF ENVIRONMENTAL FACTORS ON WOMEN’S

16 HEALTH

17 ‘‘SEC. 463B. (a) The Director of the Institute shall

18 carry out research on the effects that environmental fac19 tors have on women’s health conditions (as defined in sec20 tion 486), including the effect of such factors on breast

21 cancer, immune disfunction, and estrogen-like compounds

22 (and related compounds).

23 ‘‘(b) For the purpose of carrying out subsection (a),

24 there are authorized to be appropriated $30,000,000 for

25 fiscal year 1994, and such sums as may be necessary for

26 each of the fiscal years 1995 and 1996. Such authoriza-
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1 tion is in addition to any other authorization of appropria2 tions that is established with respect to such purpose.’’.

3 Subtitle K—Federal Risk Assess4 ment in Women’s Health Act of

5 1993

6 SEC. 156. SHORT TITLE.

7 This subtitle may be cited as the ‘‘Federal Risk As8 sessment in Women’s Health Act of 1993’’.

9 SEC. 157. INTERAGENCY REVIEW.

10 The Office of Science and Technology Policy, through

11 the Federal Coordinating Council for Science, Engineer12 ing, and Technology, and in consultation with the Office

13 of Research on Women’s Health of the National Institutes

14 of Health, shall conduct a review of all Federal programs

15 that assess or mitigate the risks to women’s health from

16 environmental exposures, including programs setting

17 standards for exposure to various pollutants, toxic sub18 stances, pesticide use, and pesticide residues. The results

19 of such review, including recommendations for ensuring

20 that women’s health needs are addressed by Federal pro21 grams and policies, shall be transmitted to the Congress

22 within 6 months after the date of enactment of this Act.

23 SEC. 158. STUDY OF RESEARCH NEEDS.

24 The National Institute of Environmental Health

25 Sciences shall enter into a contract with the National Re-
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1 search Council of the National Academy of Sciences for

2 the carrying out by such Council, in consultation with the

3 Office of Research on Women’s Health of the National

4 Institutes of Health, for a study to determine the status

5 of the science base and needs of the Federal Government

6 for research relating to the risks to women’s health from

7 environmental exposures, for the purpose of assessing and

8 mitigating such risks. The results of such study shall be

9 transmitted to the Congress within one year after the date

10 of enactment of this Act.

11 Subtitle L—Pharmaceutical

12 Interactions Safety Act

13 SEC. 161. SHORT TITLE.

14 This subtitle may be cited as the ‘‘Pharmaceutical

15 Interactions Safety Act’’.

16 SEC. 162. CLINICAL INVESTIGATIONS.

17 Section 505(b) of the Federal Food, Drug, and Cos18 metic Act is amended by adding at the end the following:

19 ‘‘(4) Clinical investigations to be submitted as part

20 of an application in accordance with paragraph (1)(A)

21 shall include investigations of the possible interaction of

22 the drug with relevant female or male hormones or related

23 substances unless there is substantial evidence that there

24 are no significant interactions between the drug under in25 vestigation and such substances or the inclusion of such
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1 investigations is otherwise inappropriate under guidelines

2 established by the Secretary by rule.’’.

3 SEC. 163. BIOLOGICAL PRODUCTS CLINICAL INVESTIGA4 TIONS.

5 Section 351(c) of the Public Health Service Act (42

6 U.S.C. 262(c)) is amended by adding at the end the fol7 lowing:

8 ‘‘(3) Clinical investigations submitted as part of an

9 application for a biological product in accordance with

10 paragraph (1) shall include investigations of the possible

11 interaction of the biological product with relevant female

12 or male hormones or related substances unless there is

13 substantial evidence that there are no significant inter14 actions between the biological product under investigation

15 and such substances or the inclusion of such investigations

16 is otherwise inappropriate under guidelines established by

17 the Secretary by rule.’’.

18 Subtitle M—Pharmaceutical

19 Testing Fairness Act

20 SEC. 166. SHORT TITLE.

21 This subtitle may be cited as the ‘‘Pharmaceutical

22 Testing Fairness Act’’.

23 SEC. 167. NEW DRUG CLINICAL INVESTIGATIONS.

24 Section 505(b) of the Federal Food, Drug, and Cos25 metic Act is amended by adding at the end the following:
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1 ‘‘(4)(A) Clinical investigations submitted as part of

2 an application in accordance with paragraph (1)(A) shall

3 include women and members of minority groups as sub4 jects of such investigations unless the inclusion of women

5 and minority groups is inappropriate with respect to the

6 drug under investigation or is otherwise inappropriate

7 under such guidelines as the Secretary shall by rule estab8 lish in accordance with subparagraph (B).

9 ‘‘(B) The guidelines of the Secretary respecting the

10 inclusion of women and members of minority groups in

11 clinical investigations—

12 ‘‘(i) shall provide that the costs of such inclu13 sion is not a permissible consideration in determin14 ing whether such inclusion is inappropriate,

15 ‘‘(ii) shall provide that women or minority

16 groups are not required to be included if women or

17 minority groups will not be using the drug under in18 vestigation, and

19 ‘‘(iii) may provide that such inclusion is not re20 quired if there is substantial scientific data dem21 onstrating that there is no significant difference be22 tween the effects that the variables to be studied in

23 the investigation have on women or members of mi24 nority groups, respectively, and on the other individ25 uals who would serve as subjects in the investigation
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1 in the event that the inclusion of women and mem2 bers of minority groups was not required.

3 ‘‘(C) Phase three clinical investigations which are

4 submitted as part of an application in accordance with

5 paragraph (1)(A) shall be designed so that there is a valid

6 analysis of whether the drug under investigation affects

7 women or members of minority groups differently than

8 other users of the drug. If the Secretary determines that

9 it would be appropriate for other phases of such investiga10 tions to be so designed, such other phases shall be so de11 signed.’’.

12 SEC. 168. DEVICE CLINICAL INVESTIGATIONS.

13 Section 515(c) of the Federal Food, Drug, and Cos14 metic Act (21 U.S.C. 360e(c)) is amended by adding at

15 the end the following:

16 ‘‘(3)(A) Clinical investigations submitted as part of

17 an application in accordance with paragraph (1) shall in18 clude women and members of minority groups as subjects

19 of such investigations unless the inclusion of women and

20 minority groups is inappropriate with respect to the device

21 under investigation or is otherwise inappropriate under

22 such guidelines as the Secretary shall by rule establish in

23 accordance with subparagraph (B).
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1 ‘‘(B) The guidelines of the Secretary respecting the

2 inclusion of women and members of minority groups in

3 clinical investigations—

4 ‘‘(i) shall provide that the costs of such inclu5 sion is not a permissible consideration in determin6 ing whether such inclusion is inappropriate,

7 ‘‘(ii) shall provide that women or minority

8 groups are not required to be included if women or

9 minority groups will not be using the device under

10 investigation, and

11 ‘‘(iii) may provide that such inclusion is not re12 quired if there is substantial scientific data dem13 onstrating that there is no significant difference be14 tween the effects that the variables to be studied in

15 the investigation have on women or members of mi16 nority groups, respectively, and on the other individ17 uals who would serve as subjects in the investigation

18 in the event that the inclusion of women and mem19 bers of minority groups was not required.

20 ‘‘(C)(i) Clinical investigations designated by the Sec21 retary under clause (ii) which are submitted as part of

22 an application in accordance with paragraph (1) shall be

23 designed so that there is a valid analysis of whether the

24 device under investigation affects women or members of

25 minority groups differently than other users of the device.
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1 ‘‘(ii) The Secretary shall designate which of the clini2 cal investigations submitted as part of an application

3 under paragraph (1) shall be subject to the requirement

4 of clause (i).’’.

5 SEC. 169. BIOLOGICAL PRODUCTS CLINICAL INVESTIGA6 TIONS.

7 Section 351(c) of the Public Health Service Act (42

8 U.S.C. 262(c)) is amended by adding at the end the fol9 lowing:

10 ‘‘(3)(A) Clinical investigations submitted as part of

11 an application in accordance with paragraph (1) shall in12 clude women and members of minority groups as subjects

13 of such investigations unless the inclusion of women and

14 minority groups is inappropriate with respect to the bio15 logical product under investigation or is otherwise inap16 propriate under such guidelines as the Secretary shall by

17 rule establish in accordance with subparagraph (B).

18 ‘‘(B) The guidelines of the Secretary respecting the

19 inclusion of women and members of minority groups in

20 clinical investigations—

21 ‘‘(i) shall provide that the costs of such inclu22 sion is not a permissible consideration in determin23 ing whether such inclusion is inappropriate,

24 ‘‘(ii) shall provide that women or minority

25 groups are not required to be included if women or
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1 minority groups will not be using the biological prod2 uct under investigation, and

3 ‘‘(iii) may provide that such inclusion is not re4 quired if there is substantial scientific data dem5 onstrating that there is no significant difference be6 tween the effects that the variables to be studied in

7 the investigation have on women or members of mi8 nority groups, respectively, and on the other individ9 uals who would serve as subjects in the investigation

10 in the event that the inclusion of women and mem11 bers of minority groups was not required.

12 ‘‘(C)(i) Clinical investigations designated by the Sec13 retary under clause (ii) which are submitted as part of

14 an application in accordance with paragraph (1) shall be

15 designed so that there is a valid analysis of whether the

16 device under investigation affects women or members of

17 minority groups differently than other users of the device.

18 ‘‘(ii) The Secretary shall designate which of the clini19 cal investigations submitted as part of an application

20 under paragraph (1) shall be subject to the requirement

21 of clause (i).’’.
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1 Subtitle N—Tobacco Advertising

2 and Promotion Studies Act of 1993

3 SEC. 171. SHORT TITLE.

4 This subtitle may be cited as the ‘‘Tobacco Advertis5 ing and Promotion Studies Act of 1993’’.

6 SEC. 172. FINDINGS.

7 (a) WOMEN.—The Congress makes the following

8 findings respecting women and tobacco:

9 (1) The fastest growing sector of smokers in

10 the United States are women under the age of 23.

11 Approximately 2,000 women smoke their first ciga12 rette every day.

13 (2) It is expected that between the years 2005

14 and 2010, the number of women dying from smok15 ing related diseases will exceed the number of men

16 so dying.

17 (3) Each year tobacco kills more than 147,000

18 women in the United States, mostly through ciga19 rette smoking induced heart disease, lung cancer,

20 and other lung diseases.

21 (4) As smoking by women has increased, lung

22 cancer in women has skyrocketed. In 1987 lung can23 cer surpassed breast cancer as the leading cancer

24 killer of women.
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1 (5) Women who smoke as little as one to 4

2 cigarettes each day increase their risk of heart at3 tack by 2 to 3 times.

4 (6) Once women start to smoke they find it

5 more difficult to quit than do men.

6 (7) Women who smoke cigarettes during preg7 nancy increase the risk for low birth weight and pre8 mature infants, miscarriage, stillbirths, sudden in9 fant death syndrome, and infant mortality.

10 (8) Pregnant women who smoke deliver babies

11 an average of one-half inch shorter and 7 ounces

12 lighter than the babies of nonsmoking mothers.

13 There is a 25 to 50 percent higher rate of fetal and

14 infant death among women who smoke during preg15 nancy compared with those who do not smoke. It is

16 estimated that 4,000 infants die each year because

17 of their mother’s smoking.

18 (9) Approximately 44 percent of all women who

19 currently smoke have attempted to quit smoking in

20 the past year.

21 (10) Cigarette smoking increases women’s risk

22 of contracting cervical cancer.

23 (b) MINORITIES.—The Congress makes the following

24 findings respecting minorities and tobacco:
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1 (1) Tobacco use by African-Americans is re2 sponsible for nearly 48,000 deaths each year in the

3 United States.

4 (2) Tobacco companies aggressively target

5 members of the African-American community and

6 the growing Hispanic population, particularly in the

7 urban, inner-city environment.

8 (3) As of 1991, 29.2 percent of African-Amer9 ican adults (aged 18 and older) smoked cigarettes,

10 including 35.1 percent of African-American men and

11 24.4 percent of African-American women.

12 (4) As of 1991, 16 percent of Asian/Pacific Is13 lander adults (aged 18 and older) smoke cigarettes,

14 including 24.2 percent of Asian/Pacific Islander men

15 and 7.5 percent of Asian/Pacific Islander women.

16 (5) As of 1991, 31.4 percent of American In17 dian/Alaskan Natives adults (aged 18 and older)

18 smoked cigarettes, including 27.9 percent of Amer19 ican Indian/Alaskan Natives men and 35.2 percent

20 of American Indian/Alaskan Natives women.

21 (6) As of 1991, 20.2 percent of Hispanic adults

22 (aged 18 and older) smoked cigarettes, including

23 25.2 percent of Hispanic men and 15.5 percent His24 panic women.
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1 (7) African Americans suffer from tobacco-re2 lated disease at a higher rate than whites, including

3 a higher incidence of respiratory system, esophagus,

4 and oral cavity cancers.

5 (8) Lung cancer is increasing among Hispanic

6 men.

7 SEC. 173. TOBACCO ADVERTISING STUDIES.

8 (a) STUDIES.—The Federal Trade Commission shall

9 conduct the following studies which should be based on

10 existing studies and on significant original market re11 search:

12 (1) WOMEN AND MINORITIES.—A study of cur13 rent tobacco advertising to determine—

14 (A) if and in what forms such advertising

15 is designed and disseminated in such a way as

16 to appeal specifically to (i) girls and women and

17 (ii) minorities to promote their use of tobacco,

18 and

19 (B) whether targeting girls, women, and

20 minorities increases tobacco use.

21 In connection with such study, advertising of alco22 holic beverages shall be reviewed to determine the

23 extent to which such advertising targets girls and

24 women and minorities.

25 (2) WEIGHT LOSS AND MAINTENANCE.—
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1 (A) IN GENERAL.—A study of current cig2 arette advertising to investigate the targeting of

3 girls and women in cigarette advertising and to4 bacco companies’ use of messages in their ad5 vertising concerning weight loss and weight

6 maintenance, the wording and overall imagery

7 used in such advertising and its impact on girls

8 and women, and the perception of girls and

9 women, including smokers and non-smokers, of

10 the relation between the use of tobacco and

11 weight control and maintenance.

12 (B) TERMS AND IMAGERY.—In conducting

13 the study under subparagraph (A), the Federal

14 Trade Commission shall examine—

15 (i) whether women interpret the use

16 of the terms ‘‘slim’’, ‘‘light’’, ‘‘thin’’,

17 ‘‘superslim’’, and related terms and the

18 shape of cigarettes employing such terms

19 as implying that cigarette smoking results

20 in weight loss or weight maintenance,

21 (ii) whether girl’s and women’s inter22 pretation of such terms and imagery accu23 rately reflects the actual effect of cigarette

24 smoking on weight,
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1 (iii) the relative impact of cigarette

2 smoking on the health of girls and women,

3 and

4 (iv) what action should be taken by

5 the Federal Trade Commission with re6 spect to advertising using such terms and

7 imagery.

8 (3) DEMOGRAPHICS.—A study of the demo9 graphics of cigarette advertising and promotions

10 which are targeted at girls, women, and minorities,

11 including the age, gender, race, ethnicity, and socio12 economic groups of the girls, women, and minorities

13 and, in the case of minorities, the demographics of

14 such advertising and promotions for smokeless to15 bacco products. Such study shall include an exam16 ination of the expenditures for advertising and pro17 motions for each of the aspects of girls, women, and

18 minorities referred to in the preceding sentence.

19 (b) REPORT.—The Federal Trade Commission shall

20 complete each of the studies identified in subsection (a)

21 not later than 9 months after the date of the enactment

22 of this Act and shall, not later than 12 months after such

23 date, report to the Congress—

24 (1) the results of such studies, and
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1 (2) any actions the Commission proposes to

2 take on the basis of such findings.

3 TITLE II—SERVICES REGARDING

4 WOMEN’S HEALTH

5 Subtitle A—Equity in Health

6 Professions Education Act

7 SEC. 201. SHORT TITLE.

8 This subtitle may be cited as the ‘‘Equity in Health

9 Professions Education Act’’.

10 SEC. 202. STUDY REGARDING CURRICULA OF HEALTH PRO11 FESSIONS SCHOOLS AND WOMEN’S HEALTH

12 CONDITIONS.

13 (a) IN GENERAL.—The Secretary of Health and

14 Human Services, acting through the Administrator of the

15 Health Resources and Services Administration, shall con16 duct a study for the purpose of determining the extent

17 to which health professions schools provide adequate edu18 cation to students on women’s health conditions. The Sec19 retary shall give priority in the study to schools of medi20 cine and osteopathic medicine.

21 (b) CONSULTATIONS.—The Secretary shall carry out

22 subsection (a) in consultation with the Director of the Of23 fice of Research on Women’s Health and the Director of

24 the Office of Women’s Health.
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1 (c) CERTAIN ELEMENTS OF STUDY.—In conducting

2 the study under subsection (a), the Secretary—

3 (1) shall assess the content of the educational

4 programs of health professions schools with respect

5 to women’s health conditions, including the content

6 of programs providing clinical training; and

7 (2) shall, if the Secretary determines that the

8 extent of education on such conditions is inadequate,

9 determine the extent to which such inadequacy is af10 fecting the health of women.

11 (d) COMMENTS AND RECOMMENDATIONS OF PUBLIC

12 AND PRIVATE ENTITIES.—In carrying out subsection (a),

13 the Secretary shall consider the comments and rec14 ommendations of public and private entities regarding the

15 study under such subsection, including representatives of

16 health professions schools and representatives of organiza17 tions concerned with women’s health conditions.

18 (e) REPORT.—Not later than April 1, 1995, the Sec19 retary shall complete the study required in subsection (a)

20 and submit to the Committee on Energy and Commerce

21 and the Committee on Appropriations of the House of

22 Representatives, and to the Committee on Labor and

23 Human Resources and the Committee on Appropriations

24 of the Senate, a report describing the findings made as

25 a result of the study and containing any recommendations
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1 of the Secretary regarding such findings, including rec2 ommendations regarding the accreditation of health pro3 fessions schools and the licensure of health professionals.

4 (f) DEFINITIONS.—For purposes of this section:

5 (1) The term ‘‘health professions schools’’

6 means—

7 (A) the schools and programs defined in

8 section 799(1) of the Public Health Service Act

9 (other than schools of veterinary medicine); and

10 (B) schools of nursing, as defined in sec11 tion 853 of such Act.

12 (2) The term ‘‘Office of Research on Women’s

13 Health’’ means the Office of Research on Women’s

14 Health established within the Office of the Director

15 of the National Institutes of Health.

16 (3) The term ‘‘Office of Women’s Health’’

17 means the Office of Women’s Health established

18 within the Office of the Assistant Secretary for

19 Health.

20 (4) The term ‘‘Secretary’’ means the Secretary

21 of Health and Human Services.

22 (5) The term ‘‘women’s health conditions’’ has

23 the meaning given such term in section 486 of the

24 Public Health Service Act.
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1 Subtitle B—Women’s Health Office

2 Act of 1993

3 SEC. 206. SHORT TITLE.

4 This subtitle may be cited as the ‘‘Women’s Health

5 Office Act of 1993’’.

6 SEC. 207. PUBLIC HEALTH SERVICE OFFICE OF WOMEN’S

7 HEALTH.

8 Part A of title III of the Public Health Service Act

9 (42 U.S.C. 241 et seq.) is amended by adding at the end

10 thereof the following new section:

11 ‘‘PUBLIC HEALTH SERVICE OFFICE OF WOMEN’S HEALTH

12 ‘‘SEC. 310A. (a) ESTABLISHMENT OF OFFICE.—

13 There is established an Office of Women’s Health (here14 after referred to in this section as the ‘Office’) within the

15 Office of the Assistant Secretary for Health.

16 ‘‘(b) ASSISTANT SECRETARY.—There shall be in the

17 Department of Health and Human Services a Deputy As18 sistant Secretary for Women’s Health, who shall be the

19 head of the Office. The Secretary, acting through such

20 Deputy Assistant Secretary, shall carry out this section.

21 ‘‘(c) DUTIES.—The Secretary, acting through the Of22 fice, shall, with respect to the health concerns of women—

23 ‘‘(1) establish short-range and long-range goals

24 and objectives and coordinate all other activities

25 within the Department of Health and Human Serv-
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1 ices that relate to disease prevention, health pro2 motion, service delivery, and research concerning

3 women;

4 ‘‘(2) advise the Assistant Secretary for Health

5 concerning scientific, legal, ethical, and policy issues

6 relating to women’s health;

7 ‘‘(3) monitor Public Health Service agency and

8 regional activities regarding women’s health, and co9 ordinate activities of such agency Offices of Wom10 en’s Health;

11 ‘‘(4) establish a women’s health resource center

12 to facilitate the exchange of information regarding

13 matters relating to health information and health

14 promotion, preventive health services, and education

15 in the appropriate use of health care, to facilitate ac16 cess to such information, to assist in the analysis of

17 issues and problems relating to such matters, and to

18 provide technical assistance with respect to the ex19 change of such information (including facilitating

20 the development of materials for such technical as21 sistance); and

22 ‘‘(5) coordinate efforts to promote women’s

23 health programs and policies in the voluntary and

24 corporate sectors.
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1 ‘‘(d) REPORTS.—Not later than January 31, 1995,

2 and January 31 of each second year thereafter, the Sec3 retary shall prepare and submit to the appropriate com4 mittees of Congress a report describing the activities car5 ried out under this section during the preceding 2 fiscal

6 years.

7 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the

8 purpose of carrying out this section, there are authorized

9 to be appropriated such sums as may be necessary for

10 each of the fiscal years 1994 through 1996.’’.

11 SEC. 208. CENTERS FOR DISEASE CONTROL AND PREVEN12 TION OFFICE OF WOMEN’S HEALTH.

13 Part A of title III of the Public Health Service Act

14 (42 U.S.C. 241 et seq.) (as amended by section 2) is fur15 ther amended by adding at the end thereof the following

16 new section:

17 ‘‘CENTERS FOR DISEASE CONTROL AND PREVENTION

18 OFFICE OF WOMEN’S HEALTH

19 ‘‘SEC. 310B. (a) ESTABLISHMENT.—There is estab20 lished within the Office of the Director of the Centers for

21 Disease Control and Prevention an office to be known as

22 the Office of Women’s Health (hereafter referred to in this

23 section as the ‘Office’). The Office shall be headed by a

24 director who shall be appointed by the Director of the Cen25 ters.

26 ‘‘(b) PURPOSE.—The Director of the Office shall—
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1 ‘‘(1) determine the current level of the Centers

2 activity regarding women’s health conditions, across

3 age, biological, and sociocultural contexts, in all as4 pects of the Centers work, including prevention pro5 grams, public and professional education, services,

6 and treatment;

7 ‘‘(2) establish short-range and long-range goals

8 and objectives for women’s health and coordinate all

9 other activities within the Centers that relate to pre10 vention, research, education and training, service de11 livery, and policy development;

12 ‘‘(3) identify projects in women’s health that

13 should be conducted or supported by the National

14 Centers;

15 ‘‘(4) consult with health professionals, non-gov16 ernmental organizations, consumer organizations,

17 women’s health professionals, and other individuals

18 and groups, as appropriate, on the policy of the Cen19 ters with regard to women; and

20 ‘‘(5) coordinate agency activities on women’s

21 health with the Public Health Service Office of

22 Women’s Health established under section 310A.

23 ‘‘(c) COORDINATING COMMITTEE.—

24 ‘‘(1) ESTABLISHMENT.—In carrying out sub25 section (b), the Director of the Office shall establish
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1 a committee to be known as the Coordinating Com2 mittee on Research on Women’s Health (hereafter

3 referred to in this subsection as the ‘Coordinating

4 Committee’).

5 ‘‘(2) COMPOSITION.—The Coordinating Com6 mittee shall be composed of the Directors of the Na7 tional Centers.

8 ‘‘(3) CHAIRPERSON.—The Director of the Of9 fice shall serve as the chairperson of the Coordinat10 ing Committee.

11 ‘‘(4) DUTIES.—With respect to women’s health,

12 the Coordinating Committee shall assist the Director

13 of the Office in—

14 ‘‘(A) identifying the need for programs and

15 activities that focus on women’s health;

16 ‘‘(B) identifying needs regarding the co17 ordination of activities, including intramural

18 and extramural multidisciplinary activities; and

19 ‘‘(C) making recommendations to the Di20 rector of the Centers for Disease Control and

21 Prevention concerning findings made under

22 subparagraphs (A) and (B).

23 ‘‘(d) REPORTS.—Not later than January 31, 1995,

24 and January 31 of each second year thereafter, the Direc25 tor shall prepare and submit to the Director of the Public
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1 Health Service Office of Women’s Health, a report de2 scribing the activities carried out under this section during

3 the preceding 2 fiscal years.

4 ‘‘(e) DEFINITION.—As used in this section the term

5 ‘women’s health conditions’, with respect to women of all

6 age, ethnic, and racial groups, means all diseases, dis7 orders, and conditions—

8 ‘‘(1) unique to, more serious, or more prevalent

9 in women; and

10 ‘‘(2) for which the factors of medical risk or

11 type of medical intervention are different for women,

12 or for which it is unknown whether such factors or

13 types are different for women.’’.

14 SEC. 209. AGENCY FOR HEALTH CARE POLICY AND RE15 SEARCH OFFICE OF WOMEN’S HEALTH.

16 Part C of title IX of the Public Health Service Act

17 (42 U.S.C. 299c et seq.) is amended—

18 (1) by redesignating section 927 as section 928;

19 and

20 (2) by inserting after section 926, the following

21 new section:

22 ‘‘SEC. 927. OFFICE OF WOMEN’S HEALTH.

23 ‘‘(a) ESTABLISHMENT.—There is established within

24 the Office of the Director of the Agency for Health Care

25 Policy and Research an office to be known as the Office
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1 of Women’s Health (hereafter referred to in this section

2 as the ‘Office’). The Office shall be headed by a Director

3 who shall be appointed by the Director of the Agency.

4 ‘‘(b) PURPOSE.—The Director of the Office shall—

5 ‘‘(1) determine the current Agency level of ac6 tivity regarding women’s health, across age, biologi7 cal, and sociocultural contexts, in all aspects of

8 Agency work, including drafting clinical practice

9 guidelines, and conducting research into patient out10 comes, delivery of health care services, and access to

11 health care;

12 ‘‘(2) establish short-range and long-range goals

13 and objectives for research important to women’s

14 health and coordinate all other activities within the

15 Agency that relate to health services and medical ef16 fectiveness research;

17 ‘‘(3) identify projects in women’s health that

18 should be conducted or supported by the Agency;

19 ‘‘(4) consult with health professionals, non-gov20 ernmental organizations, consumer organizations,

21 women’s health professionals, and other individuals

22 and groups, as appropriate, on Agency policy with

23 regard to women; and
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1 ‘‘(5) coordinate agency activities on women’s

2 health with the Public Health Service Office of

3 Women’s Health established under section 310A.

4 ‘‘(c) COORDINATING COMMITTEE.—

5 ‘‘(1) ESTABLISHMENT.—In carrying out sub6 section (b), the Director of the Office shall establish

7 a committee to be known as the Coordinating Com8 mittee on Research on Women’s Health (hereafter

9 referred to in this subsection as the ‘Coordinating

10 Committee’).

11 ‘‘(2) COMPOSITION.—The Coordinating Com12 mittee shall be composed of the Directors of the Of13 fices.

14 ‘‘(3) CHAIRPERSON.—The Director of the Of15 fice shall serve as the chairperson of the Coordinat16 ing Committee.

17 ‘‘(4) DUTIES.—With respect to research on

18 women’s health, the Coordinating Committee shall

19 assist the Director of the Office in—

20 ‘‘(A) identifying the need for such re21 search, and making an estimate each fiscal year

22 of the funds needed to adequately support the

23 research;

24 ‘‘(B) identifying needs regarding the co25 ordination of research activities, including in-
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1 tramural and extramural multidisciplinary ac2 tivities; and

3 ‘‘(C) making recommendations to the Di4 rector of the Agency for Health Care Policy and

5 Research concerning findings made under sub6 paragraphs (A) and (B).

7 ‘‘(d) REPORTS.—Not later than January 31, 1995,

8 and January 31 of each second year thereafter, the Direc9 tor shall prepare and submit to the Director of the Public

10 Health Service Office of Women’s Health, a report de11 scribing the activities carried out under this section during

12 the preceding 2 fiscal years.’’.

13 SEC. 210. HEALTH RESOURCES AND SERVICES ADMINIS14 TRATION OFFICE OF WOMEN’S HEALTH.

15 Title VII of the Social Security Act (42 U.S.C. 901

16 et seq.) is amended by adding at the end thereof the fol17 lowing new section:

18 ‘‘OFFICE OF WOMEN’S HEALTH

19 ‘‘SEC. 712. (a) ESTABLISHMENT.—There is estab20 lished within the Office of the Administrator of the Health

21 Resources and Services Administration an office to be

22 known as the Office of Women’s Health (hereafter re23 ferred to in this section as the ‘Office’). The Office shall

24 be headed by a director who shall be appointed by the Di25 rector of the Administration.

26 ‘‘(b) PURPOSE.—The Director of the Office shall—
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1 ‘‘(1) determine the current agency level of activ2 ity regarding women’s health across age, biological,

3 and sociocultural contexts;

4 ‘‘(2) establish short-range and long-range goals

5 and objectives for women’s health and coordinate all

6 other activities within the agency that relate to

7 health care provider training, health service delivery,

8 research, and demonstration projects;

9 ‘‘(3) identify projects in women’s health that

10 should be conducted or supported by the Bureaus;

11 ‘‘(4) consult with health professionals, non-gov12 ernmental organizations, consumer organizations,

13 women’s health professionals, and other individuals

14 and groups, as appropriate, on agency policy with

15 regard to women; and

16 ‘‘(5) coordinate agency activities on women’s

17 health with the Public Health Service Office of

18 Women’s Health established under section 310A of

19 the Public Health Service Act.

20 ‘‘(c) COORDINATING COMMITTEE.—

21 ‘‘(1) ESTABLISHMENT.—In carrying out sub22 section (b), the Director of the Office shall establish

23 a committee to be known as the Coordinating Com24 mittee on Research on Women’s Health (hereafter
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1 referred to in this subsection as the ‘Coordinating

2 Committee’).

3 ‘‘(2) COMPOSITION.—The Coordinating Com4 mittee shall be composed of the Directors of the Bu5 reaus.

6 ‘‘(3) CHAIRPERSON.—The Director of the Of7 fice shall serve as the Chairperson of the Coordinat8 ing Committee.

9 ‘‘(4) DUTIES.—With respect to research on

10 women’s health, the Coordinating Committee shall

11 assist the Director of the Office in—

12 ‘‘(A) identifying the need for programs and

13 activities that focus on women’s health;

14 ‘‘(B) identifying needs regarding the co15 ordination of activities, including intramural

16 and extramural multidisciplinary activities; and

17 ‘‘(C) making recommendations to the Di18 rector of the Centers for Disease Control and

19 Prevention concerning findings made under

20 subparagraphs (A) and (B).

21 ‘‘(d) REPORTS.—Not later than January 31, 1995,

22 and January 31 of each second year thereafter, the Direc23 tor of the Office shall prepare and submit to the Director

24 of the Public Health Service Office of Women’s Health,
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1 a report describing the activities carried out under this

2 section during the preceding 2 fiscal years.’’.

3 SEC. 210A. FOOD AND DRUG ADMINISTRATION OFFICE OF

4 WOMEN’S HEALTH.

5 Chapter IX of the Federal Food, Drug, and Cosmetic

6 Act (21 U.S.C. 391 et seq.) is amended by adding at the

7 end thereof the following new section:

8 ‘‘SEC. 906. OFFICE OF WOMEN’S HEALTH.

9 ‘‘(a) ESTABLISHMENT.—There is established within

10 the Office of the Commissioner of the Food and Drug Ad11 ministration an office to be known as the Office of Wom12 en’s Health (hereafter referred to in this section as the

13 ‘Office’). The Office shall be headed by a Director who

14 shall be appointed by the Commissioner of the Administra15 tion.

16 ‘‘(b) PURPOSE.—The Director of the Office shall—

17 ‘‘(1) determine current Commission levels of ac18 tivity regarding women’s participation in clinical

19 trials the study of gender differences in the testing

20 of drugs, medical devices, and biological products,

21 across, age, sociocultural, and, where deemed appro22 priate, biological contexts.

23 ‘‘(2) establish short-range and long-range goals

24 and objectives for adequate inclusion of women in all

25 Commission protocols and policies;
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1 ‘‘(3) provide guidance or criteria for drug and

2 device manufacturers to use in determining the ex3 tent and sufficiency of female representation in clini4 cal trials;

5 ‘‘(4) consult with pharmaceutical manufactur6 ers, health professionals with expertise in women’s

7 issues, consumer organizations, and women’s health

8 professionals on Commission policy with regard to

9 women;

10 ‘‘(5) make annual estimates of funds needed to

11 monitor clinical trials in accordance with needs that

12 are identified; and

13 ‘‘(6) coordinate Commission activities on wom14 en’s health with the Public Health Service Office of

15 Women’s Health established under section 310A of

16 the Public Health Service Act.

17 ‘‘(c) COORDINATING COMMITTEE.—

18 ‘‘(1) ESTABLISHMENT.—In carrying out sub19 section (b), the Director of the Office shall establish

20 a committee to be known as the Coordinating Com21 mittee on Women’s Health (hereafter referred to in

22 this subsection as the ‘Coordinating Committee’).

23 ‘‘(2) COMPOSITION.—The Coordinating Com24 mittee shall be composed of the Directors of the

25 Food and Drug Administration Centers.
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1 ‘‘(3) CHAIRPERSON.—The Director of the Of2 fice shall serve as the Chairperson of the Coordinat3 ing Committee.

4 ‘‘(4) DUTIES.—With respect to studies on wom5 en’s health, the Coordinating Committee shall assist

6 the Director of the Office in—

7 ‘‘(A) identifying the need for further stud8 ies in specific areas of women’s health that fall

9 within the mission of the Commission, and de10 veloping strategies to foster such studies;

11 ‘‘(B) identifying needs regarding the co12 ordination of Commission activities, including

13 intramural and extramural studies;

14 ‘‘(C) maintaining the Commission’s focus

15 in areas of importance to women;

16 ‘‘(D) supporting the development of meth17 odologies to determine the circumstances in

18 which obtaining data specific to women (includ19 ing data relating to the age of women and the

20 membership of women in ethnic or racial

21 groups) is an appropriate function of clinical

22 trials of treatments and therapies;

23 ‘‘(E) supporting the development and ex24 pansion of clinical trials of treatments and

25 therapies for which obtaining such data has
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1 been determined to be an appropriate function;

2 and

3 ‘‘(F) encouraging the Food and Drug Ad4 ministration Centers to conduct and support

5 such studies, including such clinical trials.

6 ‘‘(d) REPORTS.—Not later than January 31, 1995,

7 and January 31 of each second year thereafter, the Direc8 tor shall prepare and submit to the Director of the Public

9 Health Service Office of Women’s Health, a report de10 scribing the activities carried out under this section during

11 the preceding 2 fiscal years.’’.

12 Subtitle C—Women’s Health

13 Information Act of 1993

14 SEC. 211. SHORT TITLE.

15 This subtitle may be cited as the ‘‘Women’s Health

16 Information Act of 1993’’.

17 SEC. 212. FINDINGS.

18 The Congress finds as follows:

19 (1) A report by the General Accounting Office

20 indicates that the Department of Health and

21 Human Services, which is responsible for providing

22 health information to the public, lacks an overall

23 strategy for providing such information to women.
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1 (2) Such Department has no overall strategy to

2 ensure that the most needed and useful health infor3 mation is distributed to the public.

4 (3) Health information activities of the Depart5 ment are left to the discretion of the agencies of the

6 Public Health Service, each of which largely plans

7 the production and dissemination of information

8 independently of the other agencies of the Service.

9 (4) Even when health information for the public

10 is produced and disseminated by the Department, it

11 is not always easily accessible to the public.

12 (5) With respect to health information, the

13 agencies of such Department cannot determine

14 whether the efforts of the agencies are appropriately

15 targeted to raise women’s awareness and increase

16 their knowledge about conditions that confront them.

17 SEC. 213. INTERAGENCY COMMITTEE ON HEALTH COMMU18 NICATIONS.

19 (a) IN GENERAL.—The Secretary of Health and

20 Human Services shall establish an Interagency Committee

21 on Health Communications (in this section referred to as

22 the ‘‘Committee’’).

23 (b) DUTIES.—

24 (1) IN GENERAL.—The Committee shall provide

25 advice to the Secretary of Health of Human Services
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1 on developing, overseeing, and coordinating Federal

2 promotion and education activities, including such

3 activities within the Public Health Service.

4 (2) WOMEN’S HEALTH.—In carrying out para5 graph (1), the Committee shall give priority to car6 rying activities regarding women’s health.

7 (c) CHAIR.—The Committee shall be chaired by the

8 Assistant Secretary for Health.

9 (d) COMPOSITION.—

10 (1) IN GENERAL.—Subject to paragraph (2),

11 the Committee shall be composed of one representa12 tive from each agency with authority to speak for

13 the agency, in order to address activities and goal14 setting with regard to communications specific to

15 women’s health. Decisions shall be implemented ei16 ther individually or collectively as required.

17 (2) WOMEN’S HEALTH.—The Director of the

18 Office of Women’s Health at the Public Health

19 Service shall serve as a member of the Committee to

20 ensure that the efforts of the Committee and the

21 Public Health Service reflect pertinent recommenda22 tions and objectives to improve women’s health.

23 (e) MEETINGS.—

24 (1) IN GENERAL.—The Committee shall, as ap25 propriate, meet not fewer than 4 times a year in
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1 order to promote collaboration, enhance cooperation,

2 and develop effective strategies in this effort.

3 (2) ANNUAL FORUM.—The Assistant Secretary

4 for Health shall convene a forum once a year to hear

5 testimony by interested public and private individ6 uals and organizations regarding priorities for areas

7 of women’s health, and shall respond to the testi8 mony and make recommendations regarding the tes9 timony.

10 (f) REPORT.—The Assistant Secretary of Health

11 shall issue a yearly report on the progress of the Commit12 tee’s efforts to establish a coordinated strategy of health

13 promotion and disease prevention activities at the Public

14 Health Service.

15 SEC. 214. DISSEMINATION EFFORTS OF WOMEN’S HEALTH

16 INFORMATION WITHIN PUBLIC HEALTH

17 SERVICE.

18 (a) CLEARINGHOUSE ON WOMEN’S HEALTH.—The

19 Assistant Secretary for Health shall establish the Clear20 inghouse on Women’s Health to compile, archive, and dis21 seminate information concerning women’s health and to

22 publish a yearly summary of such materials to be made

23 available upon request.

24 (b) OTHER ACTIVITIES.—
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1 (1) IN GENERAL.—The Secretary of Health and

2 Human Services may make a grant, or enter into a

3 contract with one or more organizations representing

4 women—

5 (A) to make available information concern6 ing Federal programs, services, informational

7 resources, and benefits related to women’s

8 health;

9 (B) establish a toll-free hotline; and

10 (C) assess demand for publications and

11 costs on an annual basis, and develop publica12 tions as needed.

13 (2) FEES REGARDING TOLL-FREE HOTLINE.—

14 The Clearinghouse may, as necessary, charge an ap15 propriate fee for information provided by the toll16 free hotline. Exceptions shall be made for individuals

17 or organizations that are financially unable to pay

18 such fees.

19 (c) ADVERTISING CAMPAIGN.—The Secretary of

20 Health and Human Services shall conduct an outreach

21 and advertising campaign to women and health profes22 sionals regarding the existence of the clearinghouse and

23 the toll-free number.

24 (d) AUTHORIZATION OF APPROPRIATIONS.—For the

25 purpose of carrying out this section, there are authorized
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1 to be appropriated such sums as may be necessary for

2 each of the fiscal years 1994 through 1999.

3 SEC. 215. STUDY ON EFFECTIVENESS OF HEALTH COMMU4 NICATIONS.

5 The Secretary of Health and Human Services shall

6 convene a study of the Agency for Health Care Policy and

7 Research to evaluate the overall effectiveness of health

8 communications, including the efficacy of existing policies

9 and techniques utilized by the Public Health Service to

10 develop and disseminate such information. The study shall

11 involve evaluation of effort, mode, use of toll-free numbers,

12 and assessment of organization and competency. The

13 study shall also include an analysis of efforts regarding

14 reaching underserved populations. The Agency for Health

15 Care Policy and Research shall make recommendations to

16 the Assistant Secretary for Health on the most effective

17 strategy for reaching the public and presenting health

18 communications.

19 Subtitle D—Breast and Cervical

20 Cancer Amendments of 1993

21 SEC. 216. SHORT TITLE.

22 This subtitle may be cited as the ‘‘Breast and Cer23 vical Cancer Amendments of 1993’’.
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1 SEC. 217. REVISIONS IN PROGRAM OF STATE GRANTS RE2 GARDING BREAST AND CERVICAL CANCER.

3 (a) LIMITED AUTHORITY REGARDING FOR-PROFIT

4 ENTITIES.—

5 (1) IN GENERAL.—Section 1501(b) of the Pub6 lic Health Service Act (42 U.S.C. 300k(b)) is

7 amended—

8 (A) by striking ‘‘STATES.—A State’’ and

9 all that follows through ‘‘may expend’’ and in10 serting the following: ‘‘STATES.—

11 ‘‘(1) IN GENERAL.—A State receiving a grant

12 under subsection (a) may, subject to paragraph (2),

13 expend’’; and

14 (B) by adding at the end the following

15 paragraph:

16 ‘‘(2) LIMITED AUTHORITY REGARDING OTHER

17 ENTITIES.—In addition to the authority established

18 in paragraph (1) for a State with respect to grants

19 and contracts, the State may provide for screenings

20 under subsection (a)(1) through entering into con21 tracts with private entities. The amount paid by a

22 State to a private entity under the preceding sen23 tence for a screening procedure may not exceed the

24 amount that would be paid under part B of title

25 XVIII of the Social Security Act if payment were
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1 made under such part for furnishing the procedure

2 to a woman enrolled under such part.’’.

3 (2) CONFORMING AMENDMENT.—Section

4 1505(3) of the Public Health Service Act (42 U.S.C.

5 300n–1(3)) is amended by inserting before the semi6 colon the following: ‘‘(and additionally, in the case of

7 services and activities under section 1501(a)(1), with

8 any similar services or activities of private entities)’’.

9 (b) QUALITY ASSURANCE REGARDING SCREENING

10 PROCEDURES.—

11 (1) IN GENERAL.—Section 1503 of the Public

12 Health Service Act (42 U.S.C. 300m) is amended by

13 striking subsections (c) through (e) and inserting

14 the following:

15 ‘‘(c) QUALITY ASSURANCE REGARDING SCREENING

16 PROCEDURES.—The Secretary may not make a grant

17 under section 1501 unless the State involved agrees that

18 the State will, in accordance with applicable law, assure

19 the quality of screening procedures conducted pursuant to

20 such section.’’.

21 (2) TRANSITION RULE REGARDING

22 MAMMOGRAPHIES.—With respect to the screening

23 procedure for breast cancer known as a mammog24 raphy, the requirements in effect on the day before

25 the date of the enactment of this subtitle under sec-
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1 tion 1503(c) of the Public Health Service Act re2 main in effect (for an individual or facility conduct3 ing such procedures pursuant to a grant to a State

4 under section 1501 of such Act) until there is in ef5 fect for the facility a certificate (or provisional cer6 tificate) issued under section 354 of such Act.

7 (c) STATEWIDE PROVISION OF SERVICES.—Section

8 1504(c) of the Public Health Service Act (42 U.S.C.

9 300n(c)) is amended by adding at the end the following

10 paragraph:

11 ‘‘(3) GRANTS TO TRIBES AND TRIBAL ORGANI12 ZATIONS.—

13 ‘‘(A) The Secretary, acting through the Di14 rector of the Centers for Disease Control and

15 Prevention, may make grants to tribes and trib16 al organizations (as such terms are used in

17 paragraph (1)) for the purpose of carrying out

18 programs described in section 1501(a). This

19 title (other than section 1501(c)) applies to

20 such a grant (in relation to the jurisdiction of

21 the tribe or organization) to the same extent

22 and in the same manner as such title applies to

23 grants to States under section 1501 (in relation

24 to the jurisdiction of the States).
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1 ‘‘(B) If a tribe or tribal organization is re2 ceiving a grant under subparagraph (A) and the

3 State in which the tribe or organization is lo4 cated is receiving a grant under section 1501,

5 the requirement established in paragraph (1)

6 for the State regarding the tribe or organiza7 tion is deemed to have been waived under para8 graph (2).’’.

9 (d) EVALUATIONS AND REPORTS.—Section 1508 of

10 the Public Health Service Act (42 U.S.C. 300n–4) is

11 amended—

12 (1) in subsection (a), by adding at the end the

13 following sentence: ‘‘Such evaluations shall include

14 evaluations of the extent to which States carrying

15 out such programs are in compliance with section

16 1501(a)(2) and with section 1504(c).’’; and

17 (2) in subsection (b), by inserting before the pe18 riod the following: ‘‘, including recommendations re19 garding compliance by the States with section

20 1501(a)(2) and with section 1504(c)’’.

21 (e) ESTABLISHMENT OF COORDINATING COMMIT22 TEE.—Section 1501 of the Public Health Service Act (42

23 U.S.C. 300k) is amended by adding at the end the follow24 ing subsection:
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1 ‘‘(c) COORDINATING COMMITTEE REGARDING YEAR

2 2000 HEALTH OBJECTIVES.—The Secretary, acting

3 through the Director of the Centers for Disease Control

4 and Prevention, shall establish a committee to coordinate

5 the activities of the agencies of the Public Health Service

6 (and other appropriate Federal agencies) that are carried

7 out toward achieving the objectives established by the Sec8 retary for reductions in the incidence of breast and cer9 vical cancer in the United States by the year 2000. Such

10 committee shall be comprised of Federal officers or em11 ployees designated by the heads of the agencies involved

12 to serve on the committee as representatives of the agen13 cies, and such representatives from other public or private

14 entities as the Secretary determines to be appropriate.’’.

15 (f) TECHNICAL CORRECTIONS.—Title XV of the Pub16 lic Health Service Act (42 U.S.C. 300k et seq.) is amend17 ed—

18 (1) in section 1501(a), in the matter preceding

19 paragraph (1), by striking ‘‘Control,’’ and inserting

20 ‘‘Control and Prevention,’’; and

21 (2) in section 1505(4), by inserting ‘‘will’’ be22 fore ‘‘be used’’.

23 SEC. 218. FUNDING.

24 Section 1509(a) of the Public Health Service Act (42

25 U.S.C. 300n–5(a)) is amended—
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1 (1) by striking ‘‘and’’ after ‘‘1991,’’; and

2 (2) by inserting before the period the following:

3 ‘‘, $100,000,000 for fiscal year 1994, and such sums

4 as may be necessary for each of the fiscal years

5 1995 through 1998’’.

6 Subtitle E—Women’s Preventive

7 Health Amendments of 1993

8 SEC. 221. SHORT TITLE.

9 This subtitle may be cited as the ‘‘Women’s Preven10 tive Health Amendments of 1993’’.

11 SEC. 222. ESTABLISHMENT OF DEMONSTRATION PROGRAM

12 OF GRANTS FOR ADDITIONAL PREVENTIVE

13 HEALTH SERVICES FOR WOMEN.

14 Title XV of the Public Health Service Act (42 U.S.C.

15 300k et seq.) is amended—

16 (1) by redesignating section 1509 as section

17 1510; and

18 (2) by inserting after section 1508 the following

19 section:

20 ‘‘SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL

21 PREVENTIVE HEALTH SERVICES.

22 ‘‘(a) DEMONSTRATION PROJECTS.—In the case of

23 States receiving grants under section 1501, the Secretary,

24 acting through the Director of the Centers for Disease

25 Control and Prevention, may make grants to not more
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1 than 3 such States to carry out demonstration projects

2 for the purpose of—

3 ‘‘(1) providing to women preventive health serv4 ices, and health promotion services, in addition to

5 the services authorized in such section;

6 ‘‘(2) providing appropriate referrals for medical

7 treatment of women receiving services pursuant to

8 paragraph (1) and ensuring, to the extent prac9 ticable, the provision of appropriate follow-up serv10 ices; and

11 ‘‘(3) evaluating activities conducted under para12 graphs (1) and (2) through appropriate surveillance

13 or program-monitoring activities.

14 ‘‘(b) STATUS AS PARTICIPANT IN PROGRAM REGARD15 ING BREAST AND CERVICAL CANCER.—The Secretary

16 may not make a grant under subsection (a) unless the

17 State involved agrees that services under the grant will

18 be provided only through entities that are screening

19 women for breast or cervical cancer pursuant to a grant

20 under section 1501.

21 ‘‘(c) REQUIREMENTS REGARDING MATCHING FUNDS,

22 FEES FOR SERVICES, AND CERTAIN OTHER MATTERS.—

23 The Secretary may not make a grant under subsection (a)

24 unless the State involved agrees that section 1502, and

25 sections 1504 through 1506, apply to a grant under sub-
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1 section (a) to the same extent and in the same manner

2 as such sections apply to a grant under section 1501.

3 ‘‘(d) TECHNICAL ASSISTANCE; SUPPLIES AND SERV4 ICES IN LIEU OF GRANT FUNDS.—Section 1507 applies

5 to a grant under subsection (a) to the same extent and

6 in the same manner as such section applies to a grant

7 under section 1501.

8 ‘‘(e) EVALUATIONS AND REPORTS.—Section 1508

9 applies to a grant under subsection (a) to the same extent

10 and in the same manner as such section applies to a grant

11 under section 1501.’’.

12 SEC. 223. FUNDING.

13 Section 1510 of the Public Health Service Act, as re14 designated by section 222 of this Act, is amended to read

15 as follows:

16 ‘‘SEC. 1510. FUNDING.

17 ‘‘(a) PROGRAM REGARDING BREAST AND CERVICAL

18 CANCER.—

19 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

20 For the purpose of carrying out this title other than

21 section 1509, there are authorized to be appro22 priated such sums as may be necessary for fiscal

23 year 1994.

24 ‘‘(2) SET-ASIDE FOR TECHNICAL ASSISTANCE

25 AND PROVISION OF SUPPLIES AND SERVICES.—Of
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1 the amounts appropriated under paragraph (1) for

2 a fiscal year, the Secretary shall reserve not more

3 than 20 percent for carrying out section 1507.

4 ‘‘(b) PROGRAM REGARDING ADDITIONAL PREVEN5 TIVE HEALTH SERVICES.—

6 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

7 Subject to paragraph (2), for the purpose of carry8 ing out section 1509, there are authorized to be ap9 propriated such sums as may be necessary for each

10 of the fiscal years 1994 through 1996.

11 ‘‘(2) LIMITATION REGARDING FUNDING WITH

12 RESPECT TO BREAST AND CERVICAL CANCER.—The

13 authorization of appropriations established in para14 graph (1) is not effective for a fiscal year unless the

15 amount appropriated under subsection (a)(1) for the

16 fiscal year equals or exceeds the amount appro17 priated under such subsection for the preceding fis18 cal year.’’.

19 Subtitle F—Postreproductive

20 Health Care Act

21 SEC. 226. SHORT TITLE.

22 This subtitle may be cited as the ‘‘Postreproductive

23 Health Care Act’’.
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1 SEC. 227. ESTABLISHMENT OF PROGRAM FOR

2 POSTREPRODUCTIVE HEALTH CARE.

3 Part D of title III of the Public Health Service Act

4 (42 U.S.C. 254b et seq.) is amended by adding at the end

5 the following new subpart:

6 ‘‘Subpart IX—Postreproductive Health Care

7 ‘‘POSTREPRODUCTIVE HEALTH CARE

8 ‘‘SEC. 340D. (a) IN GENERAL.—The Secretary shall

9 make grants for the purpose of providing the services de10 scribed in subsection (b) to women who are of menopausal

11 age or older. Such grants may be made only to public or

12 nonprofit private entities that provide health services to

13 a significant number of low-income women.

14 ‘‘(b) AUTHORIZED SERVICES.—The services referred

15 to in subsection (a) are as follows:

16 ‘‘(1) The prevention and outpatient treatment

17 of health conditions—

18 ‘‘(A) unique to, more serious, or more

19 prevalent for eligible women; or

20 ‘‘(B) for which, in the case of such women,

21 the factors of medical risk or types of medical

22 intervention are different.

23 ‘‘(2) Counseling on the conditions described in

24 paragraph (1).

25 ‘‘(3) The education and training of health pro26 fessionals (including allied health professionals) on
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1 the prevention and treatment of such conditions and

2 on the provision of such counseling.

3 ‘‘(c) PRIORITY IN PROVISION OF SERVICES.—The

4 Secretary may make a grant under subsection (a) only if

5 the applicant involved agrees that, in expending the grant

6 to provide authorized services to eligible women, the appli7 cant will give priority to providing the services for meno8 pausal health conditions.

9 ‘‘(d) OUTREACH.—The Secretary may make a grant

10 under subsection (a) only if the applicant involved

11 agrees—

12 ‘‘(1) to conduct outreach services to inform

13 women in the community involved of the fact that

14 authorized services are available from the applicant;

15 and

16 ‘‘(2) to give priority to providing the outreach

17 services to low-income women.

18 ‘‘(e) LIMITATION ON IMPOSITION OF FEES FOR

19 SERVICES.—The Secretary may make a grant under sub20 section (a) only if the applicant involved agrees that, if

21 a charge is imposed for the provision of services or activi22 ties under the grant, such charge—

23 ‘‘(1) will be made according to a schedule of

24 charges that is made available to the public;
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1 ‘‘(2) will be adjusted to reflect the income of

2 the woman involved; and

3 ‘‘(3) will not be imposed on any woman with an

4 income equal to or less than 100 percent of the offi5 cial poverty line, as established by the Director of

6 the Office of Management and Budget and revised

7 by the Secretary in accordance with section 673(2)

8 of the Omnibus Budget Reconciliation Act of 1981.

9 ‘‘(f) REPORTS TO SECRETARY.—The Secretary may

10 make a grant under subsection (a) only if the applicant

11 involved agrees to submit to the Secretary, for each fiscal

12 year for which such a grant is made to the applicant, a

13 report describing the purposes for which the grant has

14 been expended.

15 ‘‘(g) REQUIREMENT OF APPLICATION.—The Sec16 retary may make a grant under subsection (a) only if the

17 applicant involved makes an agreement that the grant will

18 not be expended for any purpose other than the purpose

19 described in such subsection and for compliance with any

20 other agreements required in this section. Such a grant

21 may be made only if an application for the grant is sub22 mitted to the Secretary containing such agreements, and

23 the application is in such form, is made in such manner,

24 and contains such other agreements, and such assurances
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1 and information, as the Secretary determines to be nec2 essary to carry out this section.

3 ‘‘(h) DEFINITIONS.—For purposes of this section:

4 ‘‘(1) The term ‘authorized services’ means the

5 services described in subsection (b).

6 ‘‘(2) The term ‘eligible women’ means women

7 described in subsection (a).

8 ‘‘(3) The term ‘health conditions’ includes dis9 eases and disorders.

10 ‘‘(4) The term ‘health’ includes mental health.

11 ‘‘(5) The term ‘menopausal age’, with respect

12 to a woman, includes the age at which the woman

13 is nearing menopause and includes any age at which

14 the woman experiences menopausal health condi15 tions.

16 ‘‘(6) The term ‘menopausal health conditions’

17 means conditions arising from the diminished or

18 complete cessation of the functioning of the ovaries,

19 whether occurring naturally or otherwise.

20 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the

21 purpose of carrying out this section, there are authorized

22 to be appropriated $25,000,000 for fiscal year 1994, and

23 such sums as may be necessary for each of the fiscal years

24 1995 and 1996.’’.
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1 Subtitle G—Medicare Bone Mass

2 Measurement Coverage Act of 1993

3 SEC. 231. SHORT TITLE.

4 This subtitle may be cited as the ‘‘Medicare Bone

5 Mass Measurement Coverage Act of 1993’’.

6 SEC. 232. MEDICARE COVERAGE OF BONE MASS MEASURE7 MENTS.

8 (a) IN GENERAL.—Section 1861 of the Social Secu9 rity Act (42 U.S.C. 1395x) is amended—

10 (1) in subsection (s)—

11 (A) in paragraph (12)(C), by striking

12 ‘‘and’’ at the end,

13 (B) by striking the period at the end of

14 paragraph (14) and inserting ‘‘; and’’,

15 (C) by redesignating paragraphs (15) and

16 (16) as paragraphs (16) and (17), and

17 (D) by inserting after paragraph (14) the

18 following new paragraph:

19 ‘‘(15) bone mass measurement (as defined in

20 subsection (oo));’’; and

21 (2) by inserting after subsection (nn) the fol22 lowing new subsection:

23 ‘‘Bone Mass Measurement

24 ‘‘(oo)(1) The term ‘bone mass measurement’ means

25 a radiologic or radioisotopic procedure performed on a
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1 qualified individual (as defined in paragraph (2)) for the

2 purpose of detecting bone loss through the use of single

3 and dual photon absorptiometry, dual energy X-ray

4 absorptiometry or similar dual energy techniques, or quan5 titative computed tomography, and includes a physician’s

6 interpretation of the results of the procedure.

7 ‘‘(2) For purposes of paragraph (1), the term ‘quali8 fied individual’ means (in accordance with regulations pre9 scribed by the Secretary)—

10 ‘‘(A) an estrogen-deficient woman at clinical

11 risk for osteoporosis;

12 ‘‘(B) an individual with vertebral abnormalities;

13 ‘‘(C) an individual receiving long-term

14 glucocorticoid steroid therapy; or

15 ‘‘(D) an individual with primary

16 hyperparathyroidism.’’.

17 (b) CONFORMING AMENDMENTS.—The Social Secu18 rity Act is amended by striking ‘‘paragraphs (15) and

19 (16)’’ each place it appears in sections 1864(a), 1865(a),

20 1902(a)(9)(C), and 1915(a)(1)(B)(ii)(I) and inserting

21 ‘‘paragraphs (16) and (17)’’.

22 (c) EFFECTIVE DATE.—The amendments made by

23 this section shall apply to bone mass measurements per24 formed on or after January 1, 1994.
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1 Subtitle H—Mickey Leland Adoles2 cent Pregnancy Prevention and

3 Parenthood Act of 1993

4 SEC. 236. SHORT TITLE.

5 This subtitle may be cited as the ‘‘Mickey Leland Ad6 olescent Pregnancy Prevention and Parenthood Act of

7 1993’’.

8 SEC. 237. ADOLESCENT PREGNANCY PREVENTION, CARE,

9 AND RESEARCH GRANTS.

10 Title XX of the Public Health Service Act (42 U.S.C.

11 300z et seq.) is amended to read as follows:

12 ‘‘TITLE XX—ADOLESCENT PREG13 NANCY PREVENTION, CARE,

14 AND RESEARCH GRANTS

15 ‘‘SEC. 2001. FINDINGS AND PURPOSES.

16 ‘‘(a) FINDINGS.— The Congress finds that—

17 ‘‘(1) adolescents are at a high risk of unwanted

18 pregnancy;

19 ‘‘(2) in 1988, more than 1,000,000 teenagers

20 became pregnant, and nearly 500,000 teenagers car21 ried their pregnancies to term, of which more than

22 6 out of 10 births were out of wedlock;

23 ‘‘(3) the birthrate for adolescents between the

24 ages of 15 and 17 increased 23 percent between

25 1986 and 1989;
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1 ‘‘(4) in a high proportion of cases, the pregnant

2 adolescent is herself the product of an unmarried

3 parenthood during adolescence and is continuing the

4 pattern in her own lifestyle;

5 ‘‘(5) pregnancy and childbirth among unmar6 ried adolescents, particularly young adolescents,

7 often results in severe adverse health, social, and

8 economic consequences, including—

9 ‘‘(A) higher percentage of pregnancy and

10 childbirth complications;

11 ‘‘(B) higher incidence of low birth weight

12 babies;

13 ‘‘(C) higher infant mortality and morbid14 ity;

15 ‘‘(D) greater likelihood that an adolescent

16 marriage will end in divorce;

17 ‘‘(E) decreased likelihood of completing

18 schooling; and

19 ‘‘(F) higher risks of unemployment and

20 welfare dependency; and

21 therefore, education, training, and job research serv22 ices are important for adolescent parents; and

23 ‘‘(6) an adolescent who becomes pregnant once

24 is likely to experience rapid repeat pregnancies and

25 childbearing, with increased risks;
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1 ‘‘(7) research has shown that in cases in which

2 there is a family involvement in comprehensive val3 ues-based projects and services—

4 ‘‘(A) low birth weight is significantly re5 duced;

6 ‘‘(B) delays in initiating sexual activity

7 occur;

8 ‘‘(C) there are significant reductions in re9 peat pregnancy, welfare costs, and child abuse;

10 and

11 ‘‘(D) teens are more likely to return and

12 complete their high school education; and

13 therefore, the family should become a partner in the

14 development of curriculum and programs that reflect

15 the values of the community;

16 ‘‘(8) the problems of adolescent pregnancy and

17 parenthood are multiple and complex and are best

18 approached through a variety of integrated and es19 sential services, particularly those that allow the

20 pregnant adolescent and adolescent parent to stay in

21 school;

22 ‘‘(9) such services, including a wide array of

23 educational and supportive services, often are not

24 available to the adolescents who need them, or are

25 available but fragmented and thus of limited effec-
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1 tiveness in preventing pregnancies and future wel2 fare dependency; and

3 ‘‘(10) Federal policy therefore should encourage

4 the development of appropriate health, educational,

5 and social services where they are now lacking or in6 adequate, and the better coordination of existing

7 services where they are available in order to prevent

8 unwanted early and repeat pregnancies and to help

9 adolescents become productive, independent contrib10 utors to family and community life.

11 ‘‘(b) PURPOSES.—It is the purpose of this title—

12 ‘‘(1) to establish better coordination, integra13 tion, and linkages among existing programs in order

14 to expand and improve the availability of, and access

15 to, needed comprehensive community services that

16 assist in preventing unwanted initial and repeat

17 pregnancies among adolescents, enable pregnant

18 adolescents to obtain proper care and assist preg19 nant adolescents, their male partners, and adoles20 cent parents to become productive independent con21 tributors to family and community life, with primary

22 emphasis on services to adolescents who are 17 years

23 of age and under;

24 ‘‘(2) to expand the availability of such services

25 that are essential to that objective;
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1 ‘‘(3) to promote innovative, comprehensive, and

2 integrated approaches to the delivery of such serv3 ices;

4 ‘‘(4) to encourage and support research pro5 grams concerning the societal causes and con6 sequences of pregnancy, childbearing, and child

7 rearing for adolescent females and males;

8 ‘‘(5) to support evaluative research to identify

9 effective services that reduce adolescent pregnancy

10 rates and that improve the outcome of adolescent

11 childbearing for the parents, the child, and their

12 families; and

13 ‘‘(6) to encourage and provide for the dissemi14 nation of results, findings, and information from

15 programs and research projects relating to adoles16 cent pregnancy and parenthood.

17 ‘‘SEC. 2002. DEFINITIONS.

18 ‘‘For the purposes of this title:

19 ‘‘(1) ADOLESCENT.—The term ‘adolescent’

20 means an individual under the age of 21.

21 ‘‘(2) CARE SERVICES.—The term ‘care services’

22 means all services for the provision of care to adoles23 cents, both male and female, pregnant adolescents

24 and their male partners, and adolescent parents.

25 Such term shall include all core services and may in-
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1 clude supplementary services, in accordance with

2 regulations prescribed by the Secretary.

3 ‘‘(3) CORE SERVICES.—The term ‘core services’

4 means those services that shall be provided by a

5 grantee, as determined by the Secretary by regula6 tion, which shall include—

7 ‘‘(A) pregnancy testing and maternity

8 counseling, or referral for such services;

9 ‘‘(B) family planning services, except that

10 such services for adolescents who are not al11 ready parents may be limited to counseling and

12 referral unless suitable and appropriate family

13 planning services are not otherwise available in

14 the community;

15 ‘‘(C) counseling on all options regarding

16 pregnancy, or referral for such services;

17 ‘‘(D) primary and preventive health serv18 ices, including prenatal and postnatal care for

19 mother and children and arrangements for de20 livery;

21 ‘‘(E) well-baby care;

22 ‘‘(F) nutrition information and counseling;

23 ‘‘(G) screening, counseling and treatment

24 or referral for treatment and prevention of sex-
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1 ually transmitted diseases, including acquired

2 immunodeficiency syndrome;

3 ‘‘(H) referral to appropriate pediatric care;

4 ‘‘(I) educational services relating to sexual5 ity and family life, including—

6 ‘‘(i) education on responsible decision7 making regarding sexual activity;

8 ‘‘(ii) education on the responsibilities

9 of parenting;

10 ‘‘(iii) education on a full range of

11 means for delaying becoming pregnant, in12 cluding abstinence, natural family plan13 ning, and contraception;

14 ‘‘(iv) education on the prevention of

15 sexually transmitted diseases, including ac16 quired immunodeficiency syndrome; and

17 ‘‘(v) assistance to parents, schools,

18 youth agencies, and health care providers

19 to educate adolescents and pre-adolescents

20 concerning self-discipline and responsibility

21 in human sexuality;

22 ‘‘(J) referral to appropriate educational,

23 employment, employment training, and voca24 tional services;
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1 ‘‘(K) mental health services and referral to

2 mental health services and to other appropriate

3 physical health and social services; and

4 ‘‘(L) encouragement of parent and family

5 involvement in each of the core services de6 scribed in subparagraphs (A) through (K).

7 ‘‘(4) ELIGIBLE GRANT RECIPIENT.—The term

8 ‘eligible grant recipient’ means a public or nonprofit

9 private organization or agency that demonstrates, to

10 the satisfaction of the Secretary—

11 ‘‘(A) in the case of an organization that

12 will provide care services, the capability of pro13 viding all care services in a single setting or the

14 capability of creating a network through which

15 all care services would be provided; or

16 ‘‘(B) in the case of an organization that

17 will provide prevention services, the capability

18 of providing such services.

19 ‘‘(5) ELIGIBLE PERSON.—The term ‘eligible

20 person’ means—

21 ‘‘(A) with regard to the provision of pre22 vention services and referral to such other serv23 ices as may be appropriate, any adolescent; or
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1 ‘‘(B) with regard to the provision of care

2 services, adolescent parents and (when appro3 priate) adolescents who are not parents.

4 ‘‘(6) PREVENTION SERVICES.—The term ‘pre5 vention services’ means services described in sub6 paragraphs (B) and (I) of paragraph (3) and refer7 rals to such other services as may be appropriate, in8 cluding services to be offered in schools at local dis9 cretion.

10 ‘‘(7) SECRETARY.—The term ‘Secretary’ means

11 the Secretary of Health and Human Services.

12 ‘‘(8) SUPPLEMENTAL SERVICES.—The term

13 ‘supplemental services’ means those services that

14 may be provided by a grantee, as determined by the

15 Secretary by regulation, which may include—

16 ‘‘(A) child care sufficient to enable the ad17 olescent parent to continue education or to

18 enter into employment, including services to be

19 provided within secondary schools at local dis20 cretion;

21 ‘‘(B) consumer education and home22 making;

23 ‘‘(C) counseling for the immediate and ex24 tended family members of the eligible person;

25 ‘‘(D) transportation;
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1 ‘‘(E) referral to licensed residential care or

2 maternity home services;

3 ‘‘(F) referral to licensed adoption agencies

4 for adoption placement services;

5 ‘‘(G) employability training and counseling;

6 and

7 ‘‘(H) such other services as are consistent

8 with this title as the Secretary may approve in

9 accordance with regulations promulgated by the

10 Secretary.

11 ‘‘SEC. 2003. AUTHORITY TO MAKE GRANTS FOR SERVICES.

12 ‘‘The Secretary may make grants to provide preven13 tion and care services to pregnant adolescents and their

14 male partners, adolescent parents, and nonpregnant ado15 lescents. Grants shall be used to provide, supplement, or

16 improve the quality of such services.

17 ‘‘SEC. 2004. USE OF GRANTS FOR SERVICES.

18 ‘‘(a) USES.—A grant made under this title may be

19 used to—

20 ‘‘(1) provide eligible persons—

21 ‘‘(A) prevention services;

22 ‘‘(B) care services; or

23 ‘‘(C) any combination of prevention and

24 care services;
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1 ‘‘(2) coordinate, integrate, and provide linkages

2 among providers of prevention, care, and other serv3 ices for eligible persons in furtherance of the pur4 poses of this title;

5 ‘‘(3) provide supplemental services where such

6 services are not adequate or not available to eligible

7 persons in the community and that are essential to

8 the care of eligible persons and to the prevention of

9 adolescent pregnancy;

10 ‘‘(4) plan, for a period of not more than 1 year,

11 for the administration and coordination of preg12 nancy prevention services and programs of care for

13 eligible persons that will further the objectives of

14 this title; and

15 ‘‘(5) fulfill assurances required for grant ap16 proval by section 2006.

17 ‘‘(b) FEES.—Grantees shall charge fees for services

18 only pursuant to a fee schedule, approved by the Secretary

19 as a part of the application described in section 2006, that

20 bases fees charged by the grantee on the income of the

21 eligible person and takes into account the difficulty adoles22 cents face in obtaining resources to pay for services. In

23 no case may a grantee discriminate with regard to the pro24 vision of services to any individual because of that individ25 ual’s inability to provide payment for such services.
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1 ‘‘SEC. 2005. PRIORITIES, AMOUNTS, AND DURATION OF

2 GRANTS FOR SERVICES.

3 ‘‘(a) PRIORITIES.—In approving applications for

4 grants for services under this title, the Secretary shall give

5 priority to applicants who—

6 ‘‘(1) serve an area where there is a high inci7 dence of adolescent pregnancy;

8 ‘‘(2) serve an area with a high proportion of

9 low-income families and where the availability of

10 programs of prevention and care for eligible persons

11 is low;

12 ‘‘(3) show evidence—

13 ‘‘(A) in the case of an applicant who will

14 provide prevention services, of having the ability

15 to provide prevention services for adolescents

16 and their families that are appropriate for the

17 target population and the geographic area to be

18 served, including the special needs of rural

19 areas; or

20 ‘‘(B) in the case of an applicant who will

21 provide care services, of having the ability to

22 bring together a wide range of needed core serv23 ices and, as appropriate, supplemental services

24 in comprehensive single-site programs, or to es25 tablish a well-integrated network of such serv26 ices (appropriate for the target population and
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1 geographic area to be served including the spe2 cial needs of rural areas) for eligible persons;

3 ‘‘(4) will utilize to the maximum extent feasible

4 existing available programs and facilities such as

5 community health centers, child welfare agencies,

6 children and youth centers, maternal and infant

7 health centers, regional rural health facilities, li8 censed adoption agencies, maternity homes, school

9 and other educational programs, family planning

10 clinics, mental health programs, nutrition programs,

11 recreation programs, and other ongoing pregnancy

12 prevention and pregnancy-related services;

13 ‘‘(5) make use, to the maximum extent feasible,

14 of other Federal, State, and local funds, programs,

15 contributions, and other third-party reimbursements;

16 ‘‘(6) can demonstrate a community commitment

17 to the program by making available to the program

18 non-Federal funds, personnel, and facilities;

19 ‘‘(7) have involved the community to be served,

20 including public and nonprofit private agencies, ado21 lescents, and families, in the planning and imple22 mentation of the program; and

23 ‘‘(8) will demonstrate innovative and effective

24 approaches in addressing the problems of adolescent

25 pregnancy or parenthood, including outreach to ado-
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1 lescent males and approaches for providing pregnant

2 adolescents with adequate information about adop3 tion.

4 ‘‘(b) AMOUNTS.—

5 ‘‘(1) IN GENERAL.—The amount of a grant for

6 a program for services under this title shall be deter7 mined by the Secretary, based on factors such as the

8 incidence of adolescent pregnancy in the geographic

9 area to be served, and the adequacy of pregnancy

10 prevention services and programs of care for eligible

11 persons in such area.

12 ‘‘(2) RURAL AREAS.—In making grants for

13 services under this title, the Secretary shall consider

14 the special needs of rural areas and, to the maxi15 mum extent practicable, shall distribute funds taking

16 into consideration the relative number of adolescents

17 in such areas in need of such services.

18 ‘‘(c) FEDERAL SHARE.—

19 ‘‘(1) IN GENERAL.—Subject to paragraph (3), a

20 grant for services under this title may not exceed 75

21 percent of the costs of the program for any year.

22 ‘‘(2) FORM OF NON-FEDERAL CONTRIBU23 TIONS.—Non-Federal contributions required by

24 paragraph (1) may be in cash or in kind, fairly eval25 uated, including plant, equipment, or services.
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1 ‘‘(3) WAIVER.—The Secretary may waive the

2 limitation specified in paragraph (1) for any year in

3 accordance with criteria established by regulation.

4 ‘‘SEC. 2006. REQUIREMENTS FOR APPLICATIONS FOR

5 GRANTS FOR SERVICES.

6 ‘‘(a) IN GENERAL.—An application for a grant for

7 services under this title shall be in such form and contain

8 such information as the Secretary may require, and shall

9 include—

10 ‘‘(1) an identification of the incidence of adoles11 cent pregnancy and related problems;

12 ‘‘(2) a description of the economic conditions

13 and income levels in the geographic area to be

14 served;

15 ‘‘(3) a description of existing pregnancy preven16 tion services and programs of care for eligible per17 sons (including adoption services), and including

18 where, how, by whom, and to which population

19 groups such services are provided, and the extent to

20 which they are coordinated in the geographic area to

21 be served;

22 ‘‘(4) a description of the major unmet needs for

23 services for adolescents at risk of initial or recurrent

24 pregnancies and an estimate of the number of ado25 lescents not being served in the area;
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1 ‘‘(5)(A) in the case of an applicant who will

2 provide prevention services, a description of the nec3 essary services to be provided and how the applicant

4 will provide such services; or

5 ‘‘(B) in the case of an applicant who will pro6 vide care services, a description of how all core serv7 ices will be provided in the program using funds

8 under this title or will otherwise be provided by the

9 grantee in the area to be served, the population to

10 which such services will be provided, how such serv11 ices will be coordinated, integrated, and linked with

12 other related programs and services and the source

13 or sources of funding of such core services in the

14 public and private sectors; or

15 ‘‘(6) a description of the manner in which ado16 lescents needing services other than the services pro17 vided directly by the applicant will be identified and

18 how access and appropriate referral to such other

19 services (such as but not limited to medicaid; li20 censed adoption agencies; maternity home services;

21 public assistance; employment services; child care

22 services for adolescent parents; and other city, coun23 ty, and State programs related to adolescent preg24 nancy) will be provided, including a description of a
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1 plan to coordinate such other services with the serv2 ices supported under this title;

3 ‘‘(7) a description of the results expected from

4 the provision of services, and the procedures to be

5 used for evaluating those results;

6 ‘‘(8) assurances that the applicant will have an

7 ongoing quality assurance program;

8 ‘‘(9) assurances that the applicant shall have a

9 system for maintaining the confidentiality of patient

10 records in accordance with regulations prescribed by

11 the Secretary;

12 ‘‘(10) assurances that the applicant will dem13 onstrate its financial responsibility by the use of

14 such accounting procedures and other requirements

15 as may be prescribed by the Secretary;

16 ‘‘(11) assurances that the applicant will make

17 maximum use of other sources of Federal and State

18 funding;

19 ‘‘(12)(A) a description of—

20 ‘‘(i) the schedule of fees to be used in the

21 provision of services, which shall comply with

22 section 2004(c); and

23 ‘‘(ii) a corresponding schedule of discounts

24 to be applied to the payment of such fees, which

25 shall—
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1 ‘‘(I) comply with section 2004(b);

2 ‘‘(II) be adjusted on the basis of the

3 ability of the eligible person to pay; and

4 ‘‘(III) provide that no fee will be im5 posed on any eligible individual with an in6 come of less than 100 percent of the offi7 cial poverty line;

8 ‘‘(B) assurances that the applicant has made

9 and will continue to make every reasonable effort—

10 ‘‘(i) to secure from eligible persons pay11 ment for services in accordance with such

12 schedules;

13 ‘‘(ii) to collect reimbursement for health or

14 other services provided to persons who are enti15 tled to have payment made on their behalf for

16 such services under any Federal or other gov17 ernment program or private insurance program;

18 and

19 ‘‘(iii) to seek such reimbursement on the

20 basis of the full amount of fees for services

21 without application of any discount; and

22 ‘‘(C) assurances that the applicant has submit23 ted or will submit to the Secretary such reports as

24 the Secretary may require to determine compliance

25 with this paragraph;
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1 ‘‘(13) assurances that the applicant will make

2 maximum use of funds available under title X;

3 ‘‘(14) assurances that the acceptance by any in4 dividual of family planning services or family plan5 ning information (including educational materials)

6 provided through financial assistance under this title

7 shall be voluntary and shall not be a prerequisite to

8 eligibility for or receipt of any other service fur9 nished by the applicant;

10 ‘‘(15) assurances that fees collected by the ap11 plicant for services rendered in accordance with this

12 title shall be used by the applicant to further the

13 purposes of this title;

14 ‘‘(16) assurances that the applicant, if provid15 ing both prevention and care services, will not ex16 clude or discriminate against any adolescent who re17 ceives prevention services and subsequently requires

18 care services as a pregnant adolescent;

19 ‘‘(17) a description of how the applicant will as20 certain whether services for which adolescents have

21 been referred have actually been obtained and de22 velop a plan to ensure that needed services actually

23 are received;

24 ‘‘(18) assurances that unemancipated minors

25 requesting services from the applicant will be en-
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•HR 3075 IH

1 couraged to consult with their parents with respect

2 to such services and that services shall not be denied

3 to unemancipated minors who decide not to consult

4 their parents;

5 ‘‘(19) assurances that all pregnant adolescents

6 receiving services will be informed of the availability

7 of counseling (either by the entity providing core

8 services or through a referral agreement with such

9 other entity that provides such counseling) on all op10 tions, regarding the pregnancy;

11 ‘‘(20) assurances that primary emphasis for

12 services supported under this title shall be given to

13 adolescents 17 and under who are not able to obtain

14 needed assistance through other means;

15 ‘‘(21) assurances that funds received under this

16 title shall not supplant funds received from any

17 other Federal, State, or local program or any private

18 sources of funds; and

19 ‘‘(22) a plan for the conduct of, and assurances

20 that the applicant will conduct, evaluations of the ef21 fectiveness of the services supported under this title

22 in accordance with subsection (b).

23 ‘‘(b) EVALUATIONS.—

24 ‘‘(1) IN GENERAL.—Each grantee that receives

25 funds for a grant for services under this title shall
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1 expend at least 3 percent but not in excess of 10

2 percent of the amounts received under this title for

3 the conduct of evaluations of the services supported

4 under this title. The Secretary may, for a particular

5 grantee on good cause shown, waive the preceding

6 sentence with respect to the amounts to be expended

7 on evaluations, but may not waive the requirement

8 that such evaluations be conducted.

9 ‘‘(2) INDEPENDENT EVALUATION.—Evaluations

10 required by paragraph (1) shall be conducted by an

11 organization or entity that is independent of the

12 grantee providing services supported under this title.

13 ‘‘(c) REPORTS.—

14 ‘‘(1) IN GENERAL.—Each grantee that partici15 pates in the program established by this title shall

16 make such reports concerning its use of Federal

17 funds as the Secretary may require, including re18 ports on prevention programs and care programs.

19 ‘‘(2) CONTENTS OF REPORTS ON PREVENTION

20 PROGRAMS.—Reports on prevention programs shall

21 be in a standard format as prescribed by the Sec22 retary and shall include a description of—

23 ‘‘(A) the characteristics, educational at24 tainments, and economic status of clients;
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1 ‘‘(B) the clients’ previous exposure in

2 home, school, or other locations to educational

3 efforts regarding sexuality and family life;

4 ‘‘(C) the types of interventions employed in

5 the prevention program;

6 ‘‘(D) the before and after outcome meas7 urements on variables appropriate to the inter8 vention;

9 ‘‘(E) to the extent possible and where ap10 propriate to program goals, the pregnancy and

11 sexually transmitted disease rates subsequent to

12 intervention; and

13 ‘‘(F) the extent of parent or family involve14 ment in the program.

15 ‘‘(3) CONTENTS OF REPORTS ON CARE PRO16 GRAMS.—Reports on care programs shall be in

17 standard format as prescribed by the Secretary and

18 shall include a description of—

19 ‘‘(A) the characteristics, health history,

20 educational attainments, and economic status of

21 clients at the time of entry;

22 ‘‘(B) the client prenatal care and preg23 nancy outcome, complications of pregnancy and

24 delivery, and infant birth outcomes;
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1 ‘‘(C) the characteristics, educational at2 tainments, and economic status of clients at

3 time of follow-up and infant follow-up informa4 tion;

5 ‘‘(D) the types of services provided to cli6 ents; and

7 ‘‘(E) the extent of parent or family involve8 ment in the services provided.

9 ‘‘(4) COMPARISON DATA.—Reports on preven10 tion programs and care programs shall include con11 trol group data or other appropriate comparison

12 data to provide comparisons with project data and to

13 indicate program impact or effectiveness.

14 ‘‘(5) FOLLOW-UP DATA.—Reports on prevention

15 programs and care programs shall include, to the ex16 tent possible, follow-up data on a random sample of

17 program graduates and dropouts.

18 ‘‘(d) TIMING OF SERVICES.—No application submit19 ted for a grant for a program for care services under this

20 title may be approved unless the Secretary is satisfied that

21 core services shall be available through the applicant with22 in a reasonable time after such grant is received.
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1 ‘‘SEC. 2007. COORDINATION OF FEDERAL AND STATE PRO2 GRAMS.

3 ‘‘(a) FEDERAL PROGRAMS.—The Secretary shall co4 ordinate Federal policies and programs providing services

5 relating to the prevention of initial and recurrent adoles6 cent pregnancies and providing care services for eligible

7 persons. In achieving such coordination, the Secretary

8 shall—

9 ‘‘(1) require grantees who receive grants for

10 services under this title to report periodically to the

11 Secretary concerning Federal, State, and local poli12 cies and programs that interfere with the delivery of

13 and coordination of pregnancy prevention services

14 and other programs of care for pregnant adolescents

15 and adolescent parents;

16 ‘‘(2) provide technical assistance to facilitate

17 coordination by State and local recipients of Federal

18 assistance;

19 ‘‘(3) give priority in the provision of funds,

20 where appropriate, to applicants using single or co21 ordinated grant applications for multiple programs;

22 and

23 ‘‘(4) give priority, where appropriate, to the

24 provision of funds under Federal programs adminis25 tered by the Secretary (other than the program es26 tablished by this title) to programs providing com-
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1 prehensive prevention services and comprehensive

2 programs of care for eligible persons.

3 ‘‘(b) OTHER RECIPIENTS.—Any recipient of a grant

4 for services under this title shall coordinate its activities

5 with any other recipient of such a grant that is located

6 in the same locality.

7 ‘‘SEC. 2008. GRANTS FOR RESEARCH.

8 ‘‘(a) IN GENERAL.—

9 ‘‘(1) AUTHORIZATION.—The Secretary may

10 make grants to public agencies or nonprofit private

11 organizations or institutions of higher education to

12 support the research and dissemination activities de13 scribed in paragraphs (4), (5), and (6) of section

14 2001(b).

15 ‘‘(2) DURATION.—The Secretary may make

16 grants or enter into contracts under this section for

17 a period of 1 year. A grant or contract under this

18 section for a program may be renewed for 4 addi19 tional 1-year periods, which need not be consecutive.

20 ‘‘(3) AMOUNT LIMITATION.—A grant or con21 tract for any 1-year period under this section may

22 not exceed $100,000 for the direct costs of conduct23 ing research or dissemination activities under this

24 section and may include such additional amounts for

25 the indirect costs of conducting such activities as the
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1 Secretary determines appropriate. The Secretary

2 may waive the preceding sentence with respect to a

3 specific program if the Secretary determines that—

4 ‘‘(A) exceptional circumstances warrant

5 such waiver and that the program will have na6 tional impact;

7 ‘‘(B) additional amounts are necessary for

8 the direct costs of conducting limited programs

9 for the provision of necessary services in order

10 to provide data for research carried out under

11 this title; or

12 ‘‘(C) several grantees together require

13 more than $100,000 to evaluate the effective14 ness of different combinations of services, and

15 if such grantees demonstrate evidence of rea16 sonable progress in the first year, such

17 multisite evaluation studies shall receive pref18 erence for funding renewal.

19 ‘‘(4) CARRYOVER FOR REPORT.—The amount

20 of any grant or contract made under this section

21 may remain available for obligation or expenditure

22 after the close of the 1-year period for which such

23 grant or contract is made in order to assist the re24 cipient in preparing the report required by sub25 section (f)(1).
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1 ‘‘(b) USE OF FUNDS.—

2 ‘‘(1) IN GENERAL.—Funds provided for re3 search under this section may be used for descriptive

4 or explanatory surveys, evaluation studies, longitu5 dinal studies, or limited programs for services that

6 are for the purpose of increasing knowledge and un7 derstanding of the matters described in paragraphs

8 (4) and (5) of section 2001(b).

9 ‘‘(2) LIMITATIONS.—Funds provided under this

10 section may not be used for the purchase or im11 provement of land, or the purchase, construction, or

12 permanent improvement (other than minor remodel13 ing) of any building or facility.

14 ‘‘(c) PREREQUISITES.—The Secretary may not make

15 any grant or enter into any contract to support research

16 or dissemination activities under this section unless—

17 ‘‘(1) the Secretary has received an application

18 for such grant or contract that is in such form and

19 that contains such information as the Secretary may

20 by regulation require;

21 ‘‘(2) the applicant has demonstrated that the

22 applicant is capable of conducting one or more of

23 the types of research or dissemination activities de24 scribed in paragraph (4), (5), or (6) of section

25 2001(b); and
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1 ‘‘(3) in the case of an application for a research

2 program, the panel established by subsection (e)(2)

3 has determined that the program is of scientific

4 merit.

5 ‘‘(d) COORDINATION.—The Secretary shall coordi6 nate research and dissemination activities carried out

7 under this section with research and dissemination activi8 ties carried out by the National Institutes of Health.

9 ‘‘(e) REVIEW OF APPLICATIONS.—

10 ‘‘(1) SYSTEM.—The Secretary shall establish a

11 system for the review of applications for grants and

12 contracts under this section. Such system shall be

13 substantially similar to the system for scientific peer

14 review of the National Institutes of Health and shall

15 meet the requirements of paragraphs (2) and (3).

16 ‘‘(2) PANEL.—

17 ‘‘(A) ESTABLISHMENT.—In establishing

18 the system required by paragraph (1), the Sec19 retary shall establish a panel to review applica20 tions under this section.

21 ‘‘(B) EXPERTISE.—Panel members should

22 have expertise in research and evaluation and

23 should represent disciplines relevant to the

24 study of adolescent pregnancy and parenting.
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1 ‘‘(C) LIMIT ON PHYSICIANS.—Not more

2 than 25 percent of the members of the panel

3 shall be physicians.

4 ‘‘(D) MEETINGS.—The panel shall meet as

5 often as may be necessary to facilitate the expe6 ditious review of applications under this section,

7 but not less than once each year.

8 ‘‘(E) REVIEW.—The panel shall review

9 each program for which an application is made

10 under this section, evaluate the scientific merit

11 of the program, determine whether the program

12 is of scientific merit, and make recommenda13 tions to the Secretary concerning whether the

14 application for the program should be approved.

15 ‘‘(3) GRANT DETERMINATION.—The Secretary

16 shall make grants under this section from among the

17 programs that the panel established by paragraph

18 (2) has determined to be of scientific merit and may

19 only approve an application for a program if the

20 panel has made such determination with respect to

21 such a program. The Secretary shall make a deter22 mination with respect to an application within 1

23 month after receiving the determinations and rec24 ommendations of such panel with respect to the ap25 plication.
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1 ‘‘(f) REPORTS.—

2 ‘‘(1) RESEARCH REPORTS.—

3 ‘‘(A) IN GENERAL.—The recipient of a

4 grant or contract for a research program under

5 this section shall prepare and transmit to the

6 Secretary a report describing the results and

7 conclusions of such research. Except as pro8 vided in subparagraph (B), such report shall be

9 transmitted to the Secretary not later than 12

10 months after the end of the year for which

11 funds are provided under this section. The re12 cipient may utilize reprints of articles published

13 or accepted for publication in professional jour14 nals to supplement or replace such report if the

15 research contained in such articles was sup16 ported under this section during the year for

17 which the report is required.

18 ‘‘(B) MULTIYEAR PROGRAMS.—In the case

19 of any research program for which assistance is

20 provided under this section for 2 or more con21 secutive 1-year periods, the recipient of such as22 sistance shall prepare and transmit the report

23 required by subparagraph (A) to the Secretary

24 not later than 12 months after the end of each
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1 1-year period for which such funding is pro2 vided.

3 ‘‘(2) OTHER REPORTS.—Recipients of grants

4 and contracts for dissemination under this section

5 shall submit to the Secretary such reports as the

6 Secretary determines appropriate.

7 ‘‘SEC. 2009. EVALUATION.

8 ‘‘Of the funds appropriated under this title, the Sec9 retary shall reserve not less than 1 percent and not more

10 than 3 percent for the evaluation of activities carried out

11 under this title. The Secretary shall submit to the appro12 priate committees of Congress a summary of each evalua13 tion conducted under this section and a summary of the

14 data reported by grantees under section 2006(c).

15 ‘‘SEC. 2010. AUTHORIZATION OF APPROPRIATIONS.

16 ‘‘(a) IN GENERAL.—For the purpose of carrying out

17 this title, there are authorized to be appropriated

18 $60,000,000 for each of the fiscal years 1995 through

19 1997.

20 ‘‘(b) GRANTS FOR SERVICES.—At least two-thirds of

21 the amounts appropriated to carry out this title shall be

22 used to make grants for services.

23 ‘‘(c) PREVENTION SERVICES.—Two-thirds of the

24 amounts specified under subsection (b) for use for grants
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1 for services shall be used for grants for prevention serv2 ices.

3 ‘‘SEC. 2011. FUND RESTRICTION.

4 ‘‘No funds for grants made under this title may be

5 used for payment for the performance of an abortion.’’.

6 Subtitle I—Adolescent Health Dem7 onstrations Projects Act of 1993

8 SEC. 241. SHORT TITLE.

9 This subtitle may be cited as the ‘‘Adolescent Health

10 Demonstrations Projects Act of 1993’’.

11 SEC. 242. ESTABLISHMENT OR SUPPORT OF DEMONSTRA12 TION PROJECTS.

13 The Secretary of Health and Human Services (here14 inafter in this subtitle referred to as the ‘‘Secretary’’) shall

15 make grants in fiscal years 1994 through 1998 to public

16 and nonprofit private entities to establish or support ado17 lescent health demonstration projects in secondary schools

18 or entities associated with secondary schools for the pur19 pose of demonstrating how such projects may be estab20 lished throughout the United States.

21 SEC. 243. PROJECT REQUIREMENTS.

22 An adolescent health demonstration project estab23 lished or supported under section 242 shall (1) provide

24 nutrition and hygiene counseling, health care related to

25 sports, family planning information and services, prenatal
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1 and postpartum care, family life and parenting counseling,

2 and alcohol and drug abuse education and treatment, (2)

3 serve adolescents before their graduation from high school,

4 (3) encourage family participation, to the extent practical,

5 (4) obtain the approval of the school board in the locality

6 to be served by the project before the project is imple7 mented, (5) furnish such reports and data as the Sec8 retary may require, including, at a minimum, the number

9 and characteristics of individuals served, the services pro10 vided, and the results achieved, and (6) establish a com11 munity advisory committee to oversee the establishment

12 and implementation of such project. Such community ad13 visory committee shall include students, parents, school

14 personnel, physicians, religious and business leaders, and

15 other community representatives and shall establish poli16 cies for the project with respect to the services to be pro17 vided under the project, the populations to be served, the

18 personnel who will provide services, fees to be charged, and

19 other policy issues.

20 SEC. 244. AREAS TO BE SERVED.

21 In making grants under section 242, the Secretary

22 shall give priority to applications for projects which will

23 serve areas with low-income residents or minority popu24 lations.
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1 SEC. 245. ABORTION RESTRICTION.

2 None of the funds provided under a grant under sec3 tion 242 may be used to perform or pay for abortions.

4 SEC. 245A. REPORT.

5 The Secretary shall, in each fiscal year, set aside not

6 more than 5 percent of the amount appropriated for

7 grants under section 242 to evaluate the operations of the

8 projects for which grants were made under such section.

9 Not later than December 1, 1999, the Secretary shall re10 port to the Congress the result of such evaluation together

11 with such recommendations as the Secretary may have re12 specting the extension of the grant authority under section

13 242 or the establishment of a continuing service program.

14 Subtitle J—Eating Disorders Infor15 mation and Education Act of

16 1993

17 SEC. 246. SHORT TITLE.

18 This subtitle may be cited as the ‘‘Eating Disorders

19 Information and Education Act of 1993’’.

20 SEC. 247. FINDINGS.

21 The Congress finds the following:

22 (1) Eating disorders include anorexia nervosa

23 and bulimia nervosa, as well as eating disorders not

24 otherwise defined.

25 (2) Anorexia nervosa and bulimia each can re26 sult in death, cardiac impairments, depression, sub-
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1 stance abuse, osteoporosis, infertility, amenorrhea,

2 anemia, and other medical conditions.

3 (3) Medical authorities are uncertain to what

4 extent eating disorders are caused by physiological

5 factors, by psychosocial factors, or by both.

6 (4) Such disorders primarily affect women. As

7 many as 6 percent of women may be experiencing

8 eating disorders, and the rate of new cases is in9 creasing. As many as 30 percent of women in insti10 tutions of higher education may be displaying symp11 toms of eating disorders.

12 (5) There are effective treatments for some eat13 ing disorders.

14 SEC. 248. PUBLIC INFORMATION AND EDUCATION ON EAT15 ING DISORDERS.

16 Subpart 3 of part B of title V of the Public Health

17 Service Act (42 U.S.C. 290bb-31 et seq.), as added by sec18 tion 115 of Public Law 102–321 (106 Stat. 346), is

19 amended by adding at the end the following section:

20 ‘‘EATING DISORDERS

21 ‘‘SEC. 520C. (a) INFORMATION AND EDUCATION.—

22 The Secretary, acting through the Director of the Center

23 for Mental Health Services, shall carry out a program to

24 provide information and education to the public on the

25 prevention and treatment of eating disorders.
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1 ‘‘(b) TOLL-FREE TELEPHONE COMMUNICATIONS.—

2 In carrying out subsection (a), the Secretary shall provide

3 for the operation of toll-free telephone communications to

4 provide information to the public on eating disorders, in5 cluding referrals for services for the prevention and treat6 ment of such disorders. Such communications shall be

7 available on a 24-hour, 7-day basis.

8 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

9 purpose of carrying out this section, there are authorized

10 to be appropriated $2,000,000 for fiscal year 1994, and

11 such sums as may be necessary for each of the fiscal years

12 1994 through 1996.’’.

13 Subtitle K—Women and HIV

14 Outreach and Prevention Act

15 SEC. 251. SHORT TITLE.

16 This subtitle may be cited as the ‘‘Women and HIV

17 Outreach and Prevention Act’’.

18 SEC. 252. PREVENTIVE HEALTH PROGRAMS REGARDING

19 WOMEN AND HUMAN IMMUNODEFICIENCY

20 VIRUS.

21 Title XXV of the Public Health Service Act (42

22 U.S.C. 300ee et seq.) is amended by adding at the end

23 the following part:
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1 ‘‘PART C—PROGRAMS FOR WOMEN

2 ‘‘SEC. 2531. PREVENTIVE HEALTH SERVICES.

3 ‘‘(a) IN GENERAL.—The Secretary may make grants

4 for the following purposes:

5 ‘‘(1) Providing to women preventive health serv6 ices that are related to acquired immune deficiency

7 syndrome, including—

8 ‘‘(A) counseling on the prevention of infec9 tion with, and the transmission of, the etiologic

10 agent for such syndrome; and

11 ‘‘(B) screening women for infection with

12 such agent.

13 ‘‘(2) Providing appropriate referrals regarding

14 the provision of other services to women who are re15 ceiving services pursuant to paragraph (1), includ16 ing, as appropriate, referrals for treatment for such

17 infection, referrals for treatment for substance

18 abuse, referrals for mental health services, referrals

19 regarding pregnancy, childbirth, and pediatric care,

20 and referrals for housing services.

21 ‘‘(3) Providing follow-up services regarding

22 such referrals, to the extent practicable.

23 ‘‘(4) Improving referral arrangements for pur24 poses of paragraph (2).
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1 ‘‘(5) In the case of a woman receiving services

2 pursuant to any of paragraphs (1) through (3), pro3 viding to the partner of the woman the services de4 scribed in such paragraphs, as appropriate.

5 ‘‘(6) With respect to the services specified in

6 paragraphs (1) through (5)—

7 ‘‘(A) providing outreach services to inform

8 women of the availability of such services; and

9 ‘‘(B) providing training regarding the ef10 fective provision of such services.

11 ‘‘(b) MINIMUM QUALIFICATIONS OF GRANTEES.—

12 The Secretary may make a grant under subsection (a)

13 only if the applicant for the grant is a grantee under sec14 tion 329, section 330, or section 1001, or is another public

15 or nonprofit private entity that provides health or vol16 untary family planning services to a significant number

17 of low-income women in a culturally sensitive and lan18 guage-appropriate manner.

19 ‘‘(c) CONFIDENTIALITY.—The Secretary may make a

20 grant under subsection (a) only if the applicant for the

21 grant agrees to maintain the confidentiality of information

22 on individuals regarding screenings pursuant to subsection

23 (a), subject to complying with applicable law.

24 ‘‘(d) APPLICATION FOR GRANT.—The Secretary may

25 make a grant under subsection (a) only if an application
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1 for the grant is submitted to the Secretary and the appli2 cation is in such form, is made in such manner, and con3 tains such agreements, assurances, and information as the

4 Secretary determines to be necessary to carry out such

5 subsection.

6 ‘‘(e) EVALUATIONS AND REPORTS.—

7 ‘‘(1) EVALUATIONS.—The Secretary shall, di8 rectly or through contracts with public or private en9 tities, provide for evaluations of projects carried out

10 pursuant to subsection (a).

11 ‘‘(2) REPORTS.—Not later than 1 year after the

12 date on which amounts are first appropriated under

13 subsection (f), and annually thereafter, the Sec14 retary shall submit to the Congress a report summa15 rizing evaluations carried out under paragraph (1)

16 during the preceding fiscal year.

17 ‘‘(f) AUTHORIZATIONS OF APPROPRIATIONS.—

18 ‘‘(1) TITLE X CLINICS.—For the purpose of

19 making grants under subsection (a) to entities that

20 are grantees under section 1001, and for the pur21 pose of otherwise carrying out this section with re22 spect to such grants, there are authorized to be ap23 propriated $30,000,000 for fiscal year 1994, and

24 such sums as may be necessary for each of the fiscal

25 years 1995 and 1996.
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1 ‘‘(2) COMMUNITY AND MIGRANT HEALTH CEN2 TERS; OTHER PROVIDERS.—For the purpose of mak3 ing grants under subsection (a) to entities that are

4 grantees under section 329 or 330, and to other en5 tities described in subsection (b) that are not grant6 ees under section 1001, and for the purpose of oth7 erwise carrying out this section with respect to such

8 grants, there are authorized to be appropriated

9 $20,000,000 for fiscal year 1994, and such sums as

10 may be necessary for each of the fiscal years 1995

11 and 1996.

12 ‘‘SEC. 2532. PUBLIC EDUCATION.

13 ‘‘(a) IN GENERAL.—The Secretary may make grants

14 for the purpose of developing and carrying out programs

15 to educate women on the prevention of infection with, and

16 the transmission of, the etiologic agent for acquired im17 mune deficiency syndrome.

18 ‘‘(b) MINIMUM QUALIFICATIONS OF GRANTEES.—

19 The Secretary may make a grant under subsection (a)

20 only if the applicant involved is a public or nonprofit pri21 vate entity that is experienced in carrying out health-relat22 ed activities for women, with a priority given to such enti23 ties that have successfully targeted women of color.

24 ‘‘(c) APPLICATION FOR GRANT.—The Secretary may

25 make a grant under subsection (a) only if an application
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1 for the grant is submitted to the Secretary and the appli2 cation is in such form, is made in such manner, and con3 tains such agreements, assurances, and information as the

4 Secretary determines to be necessary to carry out such

5 subsection.

6 ‘‘(d) EVALUATIONS AND REPORTS.—

7 ‘‘(1) EVALUATIONS.—The Secretary shall, di8 rectly or through contracts with public or private en9 tities, provide for evaluations of projects carried out

10 pursuant to subsection (a).

11 ‘‘(2) REPORTS.—Not later than 1 year after the

12 date on which amounts are first appropriated under

13 subsection (e), and annually thereafter, the Sec14 retary shall submit to the Congress a report summa15 rizing evaluations carried out under paragraph (1)

16 during the preceding fiscal year.

17 ‘‘(e) AUTHORIZATIONS OF APPROPRIATIONS.—For

18 the purpose of carrying out this section, there are author19 ized to be appropriated $30,000,000 for fiscal year 1994,

20 and such sums as may be necessary for each of the fiscal

21 years 1995 and 1996.’’.

22 SEC. 253. TREATMENT OF WOMEN FOR SUBSTANCE ABUSE.

23 Subpart 1 of part B of title V of the Public Health

24 Service Act (42 U.S.C. 290bb et seq.), as amended by sec25 tion 108 of Public Law 102–321 (106 Stat. 336), is
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1 amended by inserting after section 509 the following sec2 tion:

3 ‘‘TREATMENT OF WOMEN FOR SUBSTANCE ABUSE

4 ‘‘SEC. 509A. (a) IN GENERAL.—The Director of the

5 Center for Substance Abuse Treatment may make awards

6 of grants, cooperative agreements, and contracts for the

7 purpose of carrying out programs—

8 ‘‘(1) to provide treatment for substance abuse

9 to women, including but not limited to, women with

10 dependent children;

11 ‘‘(2) to provide to women who engage in such

12 abuse counseling on the prevention of infection with,

13 and the transmission of, the etiologic agent for ac14 quired immune deficiency syndrome; and

15 ‘‘(3) to provide such counseling to women who

16 are the partners of individuals who engage in such

17 abuse.

18 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—For the

19 purpose of carrying out subsection (a), there are author20 ized to be appropriated $20,000,000 for fiscal year 1994,

21 and such sums as may be necessary for each of the fiscal

22 years 1995 and 1996.’’.

23 SEC. 254. EARLY INTERVENTION SERVICES FOR WOMEN.

24 Section 2655 of the Public Health Service Act (42

25 U.S.C. 300ff–55) is amended—
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1 (1) by striking ‘‘For the purpose of’’ and insert2 ing ‘‘(a) IN GENERAL.—For the purpose of’’; and

3 (2) by adding at the end the following sub4 section:

5 ‘‘(b) PROGRAMS FOR WOMEN.—For the purpose of

6 making grants under section 2651 to provide to women

7 early intervention services described in such section, and

8 for the purpose of providing technical assistance under

9 section 2654(b) with respect to such grants, there are au10 thorized to be appropriated $20,000,000 for fiscal year

11 1994, and such sums as may be necessary for each of the

12 fiscal years 1995 and 1996.’’.

13 Subtitle L—Standby Guardianship

14 Act

15 SEC. 256. SHORT TITLE.

16 This subtitle may be cited as the ‘‘Standby Guardian17 ship Act’’.

18 SEC. 257. STATES REQUIRED TO HAVE STANDBY GUARD19 IANSHIP LAW AS A CONDITION OF ELIGI20 BILITY FOR FEDERAL FUNDS FOR FOSTER

21 CARE AND ADOPTION ASSISTANCE.

22 (a) IN GENERAL.—Part E of title IV of the Social

23 Security Act (42 U.S.C. 670–679) is amended by inserting

24 after section 477 the following:
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1 ‘‘SEC. 478. STANDBY GUARDIANSHIP LAWS AND PROCE2 DURES.

3 ‘‘To be eligible for payments under this part, a State

4 must have in effect laws and procedures that permit any

5 parent who is chronically ill or near death, without surren6 dering parental rights, to designate a standby guardian

7 for the parent’s minor children, whose authority would

8 take effect upon—

9 ‘‘(1) the death of the parent;

10 ‘‘(2) the mental incapacity of the parent; or

11 ‘‘(3) the physical debilitation and consent of the

12 parent.’’.

13 (b) EFFECTIVE DATE.—The amendment made by

14 subsection (a) shall take effect at the end of the first cal15 endar quarter that begins 60 or more months after the

16 date of the enactment of this Act, and shall apply to pay17 ments under part E of title IV of the Social Security Act

18 for the quarter and payments made under such part for

19 any succeeding quarter.

20 Subtitle M—Federal Prohibition of

21 Female Genital Mutilation Act

22 of 1993

23 SEC. 261. SHORT TITLE.

24 This subtitle may be cited as the ‘‘Federal Prohibi25 tion of Female Genital Mutilation Act of 1993’’.
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1 SEC. 262. TITLE 18 AMENDMENT.

2 (a) IN GENERAL.—Chapter 7 of title 18, United

3 States Code, is amended by adding at the end the follow4 ing new section:

5 ‘‘§ 116. Female genital mutilation

6 ‘‘(a) Except as provided in subsection (b), whoever

7 knowingly circumcises, excises, or infibulates the whole or

8 any part of the labia majora or labia minora or clitoris

9 of another person who has not attained the age of 18 years

10 shall be fined under this title or imprisoned not more than

11 5 years, or both.

12 ‘‘(b) A surgical operation is not a violation of this

13 section if the operation is—

14 ‘‘(1) necessary to the health of the person on

15 whom it is performed, and is performed by a person

16 licensed in the place of its performance as a medical

17 practitioner; or

18 ‘‘(2) performed on a person in labor or who has

19 just given birth and is performed for medical pur20 poses connected with that labor or birth by a person

21 licensed in the place it is performed as a medical

22 practitioner, midwife, or person in training to be23 come such a practitioner or midwife.

24 ‘‘(c) In applying subsection (b)(1), no account shall

25 be taken of the effect on the person on whom the operation

26 is to be performed of any belief on the part of that or
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1 any other person that the operation is required as a mat2 ter of custom or ritual.

3 ‘‘(d) Whoever knowingly denies to any person medical

4 care or services or otherwise discriminates against any

5 person in the provision of medical care or services, be6 cause—

7 ‘‘(1) that person has undergone female cir8 cumcision, excision, or infibulation; or

9 ‘‘(2) that person has requested that female cir10 cumcision, excision, or infibuation be performed on

11 any person;

12 shall be fined under this title or imprisoned not more than

13 one year, or both.’’.

14 (b) CLERICAL AMENDMENT.—The table of sections

15 at the beginning of chapter 7 of title 18, United States

16 Code, is amended by adding at the end the following new

17 item:

‘‘116. Female genital mutilation.’’.

18 SEC. 263. EDUCATION AND OUTREACH.

19 The Secretary of Health and Human Services shall

20 carry our appropriate education, preventive, and outreach

21 activities in communities that traditionally practice female

22 circumcision, excision, or infibulation, to inform people in

23 those communities about the health risks and emotional

24 trauma inflicted by those practices, and to inform them
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1 and the medical community about the provisions of section

2 262.

3 SEC. 264. EFFECTIVE DATES.

4 Section 263 shall take effect immediately, and the

5 Secretary of Health and Human Services shall commence

6 carrying it out not later than 90 days after the date of

7 the enactment of this Act. Section 262 shall take effect

8 180 days after the date of the enactment of this Act.

9 Subtitle N—Smoking Prevention

10 and Cessation in WIC Clinics Act

11 SEC. 266. SHORT TITLE.

12 This subtitle may be cited as the ‘‘Smoking Preven13 tion and Cessation in WIC Clinics Act’’.

14 SEC. 267. SMOKING CESSATION DEMONSTRATION PRO15 GRAMS FOR WIC PARTICIPANTS.

16 Section 17(e) of the Child Nutrition Act of 1966 (42

17 U.S.C. 1786(e)) is amended—

18 (1) by redesignating paragraphs (3) (the second

19 place it appears), (4), and (5) as paragraphs (4)

20 through (6), respectively; and

21 (2) by adding at the end the following new

22 paragraph:

23 ‘‘(7)(A) The State agency shall ensure that each local

24 agency operating the program under this section—
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1 ‘‘(i) establishes and carries out an on-site smok2 ing cessation demonstration program for pregnant

3 participants on a voluntary basis; and

4 ‘‘(ii) educates all participants about the adverse

5 health effects of cigarette smoking.

6 ‘‘(B) The program described in subparagraph (A)(i)

7 shall—

8 ‘‘(i) be provided to participants during regular

9 visits to the clinic;

10 ‘‘(ii) be incorporated into the program under

11 this section;

12 ‘‘(iii) include a public information and edu13 cation component, which shall include the dissemina14 tion of risk information and materials relating to the

15 adverse health effects of cigarette smoking during

16 pregnancy; and

17 ‘‘(iv) include a self-monitoring component,

18 which shall include—

19 ‘‘(I) one-on-one counseling designed to help

20 participants quit smoking; and

21 ‘‘(II) the utilization of a process whereby

22 the participant develops and signs, and a rep23 resentative from the local agency and an indi24 vidual chosen by the participant also sign, a

25 written statement containing a promise by the
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1 participant to quit smoking beginning on a cer2 tain date.

3 ‘‘(C)(i) The State agency shall ensure that each local

4 agency operating the program under this section submits

5 to such State agency an annual report containing a de6 scription and evaluation of the program established and

7 carried out by such local agency, including a description

8 of the total number of participants receiving services

9 under such program and the success rate of such partici10 pants in quitting smoking. The State agency shall compile

11 such reports into 1 annual report and submit such report

12 to the Secretary.

13 ‘‘(ii) The Secretary shall submit to the Congress an

14 annual report containing—

15 ‘‘(I) a compilation of the information contained

16 in the reports received by the Secretary from each

17 State agency under clause (i); and

18 ‘‘(II) an evaluation of the effectiveness of the

19 smoking cessation demonstration programs.’’.

20 Subtitle O—Family and Medical

21 Leave Health Care Reform Res22 olution of 1993

23 SEC. 271. SHORT TITLE.

24 This subtitle may be cited as the ‘‘Family and Medi25 cal Leave Health Care Reform Resolution of 1993’’.
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1 SEC. 272. FINDINGS.

2 The Congress finds that—

3 (1) the number of single-parent and 2-parent house4 holds in which the single parent or both parents work is

5 increasing significantly;

6 (2) it is important for the development of chil7 dren and the family unit that fathers and mothers

8 be able to participate in early childrearing and the

9 care of family members who have serious health con10 ditions;

11 (3) the lack of employment policies to accom12 modate working parents can force individuals to

13 choose between job security and parenting;

14 (4) there is inadequate job security for employ15 ees who have serious health conditions that prevent

16 them from working for temporary periods;

17 (5) due to the nature of the roles of men and

18 women in the society of the United States, the pri19 mary responsibility for family caretaking often falls

20 on women, and such responsibility affects the work21 ing lives of women more than it affects the working

22 lives of men;

23 (6) more than 70 percent of women with school24 aged children and 56 percent of women with pre25 school-aged children work outside the home;
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1 (7) employment standards that apply only to 1

2 gender have serious potential for encouraging em3 ployers to discriminate against employees and appli4 cants for employment who are of the gender;

5 (8) numerous bills to reform the health insur6 ance system in the United States have been intro7 duced in the Senate and the House of Representa8 tives;

9 (9) several of the bills, if they were enacted,

10 would significantly alter the existing health insur11 ance system; and

12 (10) granting employees family and temporary

13 medical leave as part of a reform of the health in14 surance system promises to improve both the preven15 tion and cure of serious health conditions by avert16 ing undue stress on the part of employees and per17 mitting them personally to attend to family members

18 who have such conditions.

19 SEC. 273. SENSE OF CONGRESS.

20 It is the sense of the Congress that any bill to address

21 the ongoing and unmet health insurance needs of the peo22 ple of the United States that is enacted should require

23 that paid or unpaid leave, as detailed in the Family and

24 Medical Leave Act of 1993, be incorporated as a basic or
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1 elective option for plan participants for 1 or more of the

2 following:

3 (1) Because of the birth of a son or daughter

4 of an employee and in order to care for the son or

5 daughter.

6 (2) Because of the placement of a son or

7 daughter with an employee for adoption or foster

8 care.

9 (3) In order to care for the spouse, or a son,

10 daughter, or parent, of an employee, if the spouse,

11 son, daughter, or parent has a serious health condi12 tion.

13 (4) Because of a serious health condition that

14 makes an employee unable to perform the functions

15 of the position of the employee.

16 Subtitle P—Veteran Women’s

17 Health Improvement Act of 1993

18 SEC. 276. SHORT TITLE.

19 This subtitle may be cited as the ‘‘Veteran Women’s

20 Health Improvement Act of 1993’’.

21 SEC. 277. WOMEN’S HEALTH SERVICES.

22 (a) WOMEN’S HEALTH SERVICES.—Section 1701 of

23 title 38, United States Code, is amended—
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1 (1) in paragraph (6)(A)(i), by inserting ‘‘wom2 en’s health services,’’ after ‘‘preventive health serv3 ices,’’; and

4 (2) by adding at the end the following:

5 ‘‘(10) The term ‘women’s health services’ means

6 health care services provided to women, including counsel7 ing and services relating to the following:

8 ‘‘(A) Papanicolaou tests (pap smear).

9 ‘‘(B) Breast examinations and mammography.

10 ‘‘(C) Comprehensive reproductive health care,

11 including pregnancy-related care.

12 ‘‘(D) The management of infertility.

13 ‘‘(E) The management and prevention of sexu14 ally-transmitted diseases.

15 ‘‘(F) Menopause, osteoporosis, and other condi16 tions relating to aging.

17 ‘‘(G) Physical or psychological conditions aris18 ing out of acts of sexual violence.’’.

19 (b) CONTRACTS FOR WOMEN’S HEALTH SERVICES.—

20 Section 1703(a) of such title is amended by adding at the

21 end the following:

22 ‘‘(9) Women’s health services for veterans on

23 an ambulatory or outpatient basis.’’.
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1 (c) REPEAL OF SUPERSEDED AUTHORITY.—Section

2 106 of the Veterans Health Care Act of 1992 (Public Law

3 102–585; 38 U.S.C. 1710 note) is amended—

4 (1) by striking out subsection (a); and

5 (2) by striking out ‘‘(b) RESPONSIBILITIES OF

6 DIRECTORS OF FACILITIES.—’’ before ‘‘The Sec7 retary’’.

8 (d) REPORT ON HEALTH CARE AND RESEARCH.—

9 Section 107(b) of such Act (38 U.S.C. 1710 note) is

10 amended—

11 (1) in paragraph (1), by inserting ‘‘and wom12 en’s health services (as such term is defined in sec13 tion 1701(10) of title 38, United States Code)’’ after

14 ‘‘section 106 of this Act’’;

15 (2) in paragraph (2), by striking out ‘‘and (B)’’

16 and inserting in lieu thereof ‘‘(B) the type and

17 amount of services provided by such personnel, in18 cluding information on the numbers of inpatient

19 stays and the number of outpatient visits through

20 which such services were provided, and (C)’’;

21 (3) by redesignating paragraph (4) as para22 graph (7);

23 (4) by adding after paragraph (3) the following

24 new paragraphs:
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1 ‘‘(4) A description of the personnel of the De2 partment who provided such services to women vet3 erans, including the number of employees (including

4 both the number of individual employees and the

5 number of full-time employee equivalents) and the

6 professional qualifications or specialty training of

7 such employees and the Department facilities to

8 which such personnel were assigned.

9 ‘‘(5) A description of any actions taken by the

10 Secretary to ensure the retention of the personnel

11 described in paragraph (4) and any actions under12 taken to recruit additional such personnel or person13 nel to replace such personnel.

14 ‘‘(6) An assessment by the Secretary of any dif15 ficulties experienced by the Secretary in the furnish16 ing of such services and the actions taken by the

17 Secretary to resolve such difficulties.’’; and

18 (5) by adding after paragraph (7), as redesig19 nated by paragraph (3) of this subsection, the fol20 lowing:

21 ‘‘(8) A description of the actions taken by the

22 Secretary to foster and encourage the expansion of

23 such research.’’.
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1 SEC. 278. EXPANSION OF RESEARCH RELATING TO WOMEN

2 VETERANS.

3 (a) HEALTH RESEARCH.—Section 109(a) of the Vet4 erans Health Care Act of 1992 (Public Law 102–585; 38

5 U.S.C. 7303 note) is amended—

6 (1) by inserting ‘‘(1)’’ before ‘‘The Secretary’’;

7 (2) in paragraph (1), as so designated, by strik8 ing out ‘‘veterans who are women’’ and inserting in

9 lieu thereof ‘‘women veterans’’; and

10 (3) by adding at the end the following:

11 ‘‘(2) In carrying out this section, the Secretary shall

12 consult with the following:

13 ‘‘(A) The Director of the Nursing Service.

14 ‘‘(B) Officials of the Central Office assigned re15 sponsibility for women’s health programs and sexual

16 trauma services.

17 ‘‘(C) The members of the Advisory Committee

18 on Women Veterans established under section 542 of

19 title 38, United States Code.

20 ‘‘(D) Members of appropriate task forces and

21 working groups within the Department of Veterans

22 Affairs (including the Women Veterans Working

23 Group and the Task Force on Treatment of Women

24 Who Suffer Sexual Abuse).
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1 ‘‘(3) The Secretary shall foster and encourage re2 search under this section on the following matters as they

3 relate to women:

4 ‘‘(A) Breast cancer.

5 ‘‘(B) Gynecological and reproductive health, in6 cluding gynecological cancer, infertility, sexually7 transmitted diseases, and pregnancy.

8 ‘‘(C) Human Immunodeficiency Virus and Ac9 quired Immune Deficiency Syndrome.

10 ‘‘(D) Mental health, including post-traumatic

11 stress disorder, depression, combat related stress,

12 and trauma.

13 ‘‘(E) Diseases related to aging, including meno14 pause, osteoporosis, and Alzheimer’s Disease.

15 ‘‘(F) Substance abuse.

16 ‘‘(G) Sexual violence and related trauma.

17 ‘‘(H) Exposure to toxic chemicals and other en18 vironmental hazards.

19 ‘‘(4) The Secretary shall, to the maximum extent

20 practicable, ensure that personnel of the Department of

21 Veterans Affairs engaged in the research referred to in

22 paragraph (1) include the following:

23 ‘‘(A) Personnel of the geriatric research, edu24 cation, and clinical centers designated pursuant to

25 section 7314 of title 38, United States Code.
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1 ‘‘(B) Personnel of the National Center for Post2 Traumatic Stress Disorder established pursuant to

3 section 110(c) of the Veterans Health Care Act of

4 1984 (Public Law 98–528; 98 Stat. 2692).

5 ‘‘(5) The Secretary shall ensure that personnel of the

6 Department engaged in research relating to the health of

7 women veterans are advised and informed of such research

8 engaged in by other personnel of the Department.’’.

9 (b) INCLUSION OF WOMEN AND MINORITIES IN

10 CLINICAL RESEARCH PROJECTS.—(1) In conducting or

11 supporting clinical research, the Secretary of Veterans Af12 fairs shall ensure that—

13 (A) women who are veterans are included as

14 subjects in each project of such research; and

15 (B) members of minority groups who are veter16 ans are included as subjects of such research.

17 (2) The requirement in paragraph (1) regarding

18 women and members of minority groups who are veterans

19 may be waived by the Secretary of Veterans Affairs with

20 respect to a project of clinical research if the Secretary

21 determines that the inclusion, as subjects in the project,

22 of women and members of minority groups, respectively—

23 (A) is inappropriate with respect to the health

24 of the subjects;
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1 (B) is inappropriate with respect to the purpose

2 of the research; or

3 (C) is inappropriate under such other cir4 cumstances as the Secretary of Veterans Affairs may

5 designate.

6 (3) In the case of a project of clinical research in

7 which women or members of minority groups will under

8 paragraph (1) be included as subjects of the research, the

9 Secretary of Veterans Affairs shall ensure that the project

10 is designed and carried out so as to provide for a valid

11 analysis of whether the variables being tested in the re12 search affect women or members of minority groups, as

13 the case may be, differently than other persons who are

14 subjects of the research.

15 (c) POPULATION STUDY.—Section 110(a) of such Act

16 (38 U.S.C. 1710 note) is amended—

17 (1) in paragraph (1), by striking out the second

18 sentence; and

19 (2) by amending paragraph (3) to read as fol20 lows:

21 ‘‘(3)(A) Subject to subparagraph (B), the study shall

22 be based on—

23 ‘‘(i) an appropriate sample of veterans who are

24 women; and
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1 ‘‘(ii) an examination of the medical and demo2 graphic histories of the women comprising such sam3 ple.

4 ‘‘(B) The sample referred to in subparagraph (A)

5 shall constitute a representative sampling (as determined

6 by the Secretary) of the ages, the ethnic, social and eco7 nomic backgrounds, the enlisted and officer grades, and

8 the branches of service of all veterans who are women.

9 ‘‘(C) In carrying out the examination referred to in

10 subparagraph (A)(ii), the Secretary shall determine the

11 number of women of the sample who have used medical

12 facilities of the Department, nursing home facilities of or

13 under the jurisdiction of the Department, and outpatient

14 care facilities of or under the jurisdiction of the Depart15 ment.’’.

16 SEC. 279. MAMMOGRAPHY QUALITY STANDARDS.

17 (a) APPLICABILITY TO DEPARTMENT OF VETERANS

18 AFFAIRS OF MAMMOGRAPHY QUALITY STANDARDS ACT

19 OF 1992.—Subsections (a) through (k) of section 354 of

20 the Public Health Service Act (42 U.S.C. 263b) shall

21 apply with respect to facilities of the Department of Veter22 ans Affairs without regard to the last sentence of subpara23 graph (A) of subsection (a)(3) of such section.

24 (b) EXTENSION OF DEADLINES.—Any deadline for

25 the completion of any action prescribed under any provi-
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1 sion referred to in subsection (a) shall be applied with re2 spect to facilities of the Department of Veterans Affairs

3 by extending such deadline so as to be two years after

4 the date of the enactment of this Act or two years after

5 the date which would otherwise be applicable under such

6 provision, whichever is later.

7 (c) INTERAGENCY COOPERATION.—The Secretary of

8 Veterans Affairs shall take appropriate steps to cooperate

9 with the Secretary of Health and Human Services in the

10 implementation of this section.

11 Subtitle Q—Defense Women’s

12 Health Improvement Act of 1993

13 SEC. 281. SHORT TITLE.

14 This subtitle may be cited as the ‘‘Defense Women’s

15 Health Improvement Act of 1993’’.

16 PART I—WOMEN’S HEALTH CARE

17 SEC. 282. PRIMARY AND PREVENTIVE HEALTH-CARE SERV18 ICES FOR WOMEN.

19 (a) FEMALE MEMBERS AND RETIREES OF THE UNI20 FORMED SERVICES.—(1) Chapter 55 of title 10, United

21 States Code, is amended by inserting after section 1074c

22 the following new section:
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1 ‘‘§ 1074d. Primary and preventive health-care serv2 ices for women

3 ‘‘Female members and former members of the uni4 formed services who are entitled to medical care under sec5 tion 1074 or 1074a of this part shall be furnished with

6 primary and preventive health-care services for women as

7 part of such medical care.’’.

8 (2) The table of sections at the beginning of such

9 chapter is amended by inserting after the item relating

10 to section 1074c the following new item:

‘‘1074d. Primary and preventive health-care services for women.’’.

11 (b) FEMALE DEPENDENTS.—Section 1077(a) of such

12 title is amended by adding at the end the following new

13 paragraph:

14 ‘‘(13) Primary and preventive health-care serv15 ices for women.’’.

16 (c) DEFINITION.—Section 1072 of such title is

17 amended by adding at the end the following new para18 graph:

19 ‘‘(6) The term ‘primary and preventive health20 care services for women’ means health-care services

21 provided to women, including counseling, relating to

22 the following:

23 ‘‘(A) Papanicolaou tests (pap smear).

24 ‘‘(B) Breast examinations and mammog25 raphy.
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1 ‘‘(C) Comprehensive reproductive health

2 care, including care related to pregnancy.

3 ‘‘(D) Infertility and sexually transmitted

4 diseases, including prevention.

5 ‘‘(E) Menopause.

6 ‘‘(F) Physical or psychological conditions

7 arising out of acts of sexual violence.’’.

8 SEC. 283. REPORT ON THE PROVISION OF HEALTH-CARE

9 SERVICES TO WOMEN.

10 (a) REPORT REQUIRED.—The Secretary of Defense

11 shall prepare a report evaluating the provision of health12 care services through military medical treatment facilities

13 and the Civilian Health and Medical Program of the Uni14 formed Services to female members of the uniformed serv15 ices and female covered beneficiaries eligible for health

16 care under chapter 55 of title 10, United States Code.

17 (b) CONTENTS.—The report required by subsection

18 (a) shall contain the following:

19 (1) A description of the medical personnel of

20 the Department of Defense who provided health-care

21 services during fiscal year 1993 to female members

22 and covered beneficiaries, including—

23 (A) the number of such personnel (includ24 ing both the number of individual employees
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1 and the number of full-time employee equiva2 lents);

3 (B) the professional qualifications or spe4 cialty training of such personnel; and

5 (C) the medical facilities to which such

6 personnel were assigned.

7 (2) A description of any actions, including the

8 use of special pays and incentives, taken by the Sec9 retary during fiscal year 1993—

10 (A) to ensure the retention of the medical

11 personnel described in paragraph (1);

12 (B) to recruit additional personnel to pro13 vide health-care services to female members and

14 female covered beneficiaries; and

15 (C) to replace departing personnel who

16 provided such services.

17 (3) A description of any existing or proposed

18 programs to encourage specialization of health care

19 professionals in fields related to primary and preven20 tive health-care services for women.

21 (4) An assessment of any difficulties experi22 enced by military medical treatment facilities or the

23 Civilian Health and Medical Program of the Uni24 formed Services in furnishing primary and preven25 tive health-care services for women and a description
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1 of those actions taken by the Secretary to resolve

2 such difficulties.

3 (5) An assessment of the extent to which gen4 der-related factors impede or complicate diagnoses

5 (such as inappropriate psychiatric referrals and ad6 missions) made by medical personnel described in

7 paragraph (1).

8 (6) A description of the actions taken by the

9 Secretary to foster and encourage the expansion of

10 research relating to health care issues of concern to

11 female members of the uniformed services and fe12 male covered beneficiaries.

13 (c) POPULATION STUDY OF THE NEED OF FEMALE

14 MEMBERS AND FEMALE COVERED BENEFICIARIES FOR

15 HEALTH-CARE SERVICES.—(1) As part of the report re16 quired by subsection (a), the Secretary shall conduct a

17 study to determine the needs of female members of the

18 uniformed services and female covered beneficiaries for

19 health-care services, including primary and preventive

20 health-care services for women.

21 (2) The study shall examine the health needs of cur22 rent members and covered beneficiaries and future mem23 bers and covered beneficiaries based upon the anticipated

24 size and composition of the Armed Forces in the year
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1 2000 and should be based on the demographics of society

2 as a whole.

3 (d) SUBMISSION AND REVISION.—The Secretary of

4 Defense shall submit the report required by subsection (a)

5 to Congress not later than April 1, 1994. The Secretary

6 shall revise and resubmit the report to Congress not later

7 than April 1, 1999.

8 (e) DEFINITIONS.—For purposes of this section:

9 (1) The term ‘‘primary and preventive health

10 care services for women’’ has the meaning given

11 such term in paragraph (6) of section 1072 of title

12 10, United States Code, as added by section 101(c)).

13 (2) The term ‘‘covered beneficiary’’ has the

14 meaning given such term in paragraph (5) of such

15 section.

16 PART II—WOMEN’S HEALTH RESEARCH

17 SEC. 284. DEFENSE WOMEN’S HEALTH RESEARCH CENTER.

18 (a) ESTABLISHMENT OF THE CENTER.—The Sec19 retary of Defense shall establish a Defense Women’s

20 Health Research Center (hereinafter in this section re21 ferred to as the ‘‘Center’’) in the Department of the Army.

22 The Center shall be under the authority of the Army

23 Health Services Command.

24 (b) PURPOSES.—(1) The Center shall be the coordi25 nating agent for multidisciplinary and multiinstitutional
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1 research within the Department of Defense on women’s

2 health issues related to service in the Armed Forces. The

3 Center shall be dedicated to development and application

4 of new knowledge, procedures, techniques, training, and

5 equipment for the improvement of the health of women

6 in the Armed Forces.

7 (2) In carrying out or sponsoring research studies,

8 the Center shall provide that the cohort of women in the

9 Armed Forces shall be considered as a control group.

10 (3) The Center shall support the goals and objectives

11 recognized by the Department of Defense under the plan

12 of the Department of Health and Human Services des13 ignated as ‘‘Healthy People 2000’’.

14 (4) The Center shall support initiation and expansion

15 of research into matters relating to women’s health in the

16 military, including the following matters as they relate to

17 women in the military:

18 (A) Combat stress and trauma.

19 (B) Exposure to toxins and other environmental

20 hazards associated with military hardware.

21 (C) Psychology related stresses in warfare situ22 ations.

23 (D) Breast cancer.

24 (E) Reproductive health, including pregnancy.

25 (F) Gynecological cancers.
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1 (G) Infertility and sexually transmitted dis2 eases.

3 (H) HIV and AIDS.

4 (I) Mental health, including post-traumatic

5 stress disorder and depression.

6 (J) Menopause, osteoporosis, Alzheimer’s dis7 ease, and other conditions and diseases related to

8 aging.

9 (K) Substance abuse.

10 (L) Sexual violence and related trauma.

11 (M) Human factor studies related to women in

12 combat.

13 (c) PREPARATION OF A PLAN.—The Secretary of De14 fense, acting through the Secretary of the Army and in

15 coordination with the other military departments, shall

16 prepare a plan for the implementation of this section. The

17 plan shall be submitted to the Committees on Armed Serv18 ices of the Senate and House of Representatives before

19 May 1, 1994.

20 (d) REQUIREMENTS RELATING TO ESTABLISHMENT

21 OF CENTER.—(1) The Secretary shall provide for the es22 tablishment of the Center at an existing Army facility.

23 (2) The Center may be established only at a facility

24 having the following characteristics:
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1 (A) A physical plant immediately available to

2 serve as headquarters for the medical activities to be

3 carried out by the Center.

4 (B) Ongoing fellowship and residency programs

5 colocated with ongoing collaborative health-related

6 and interdisciplinary research of (i) a facility of the

7 Department of Veterans Affairs, (ii) an accredited

8 university with specialties in medical research and

9 clinical diagnostics, and (iii) a hospital owned and

10 operated by a municipality.

11 (C) A technologically modern laboratory capa12 bility at the site and at the affiliated sites referred

13 to in subparagraph (B), with the capability to in14 clude state-of-the-art clinical diagnostic instrumenta15 tion, data processing, telecommunication, and data

16 storage systems.

17 (D) Compatibility with and capability to effec18 tively expand its existing mission in accordance with

19 the mission of the Center under this section.

20 (E) Maximum multi-State geographic jurisdic21 tion to permit regional health-related issues to be re22 searched and integrated into national military

23 databases.
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1 (F) An existing relationship for the provision of

2 services to Native Americans through the Indian

3 Health Service.

4 (e) ACTIVITIES FOR FISCAL YEAR 1994.—During fis5 cal year 1994, the Center shall address the following:

6 (1) Program planning, infrastructure develop7 ment, baseline information gathering, technology in8 fusion, and connectivity.

9 (2) Management and technical staffing.

10 (3) Data base development of health issues re11 lated to service on active duty as compared to serv12 ice in the National Guard or Reserves.

13 (4) Research protocols, cohort development,

14 health surveillance and epidemiologic studies.

15 SEC. 285. CONTINUATION OF ARMY BREAST CANCER RE16 SEARCH PROGRAM.

17 During fiscal year 1994, the Secretary of the Army

18 shall continue the breast cancer research program estab19 lished in the second and third provisos in the paragraph

20 in title IV of the Department of Defense Appropriations

21 Act, 1993 (Public Law 102–396; 106 Stat. 1890) under

22 the heading ‘‘RESEARCH, DEVELOPMENT, TEST, AND

23 EVALUATION, ARMY’’ .
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1 SEC. 286. INCLUSION OF WOMEN AND MINORITIES IN CLIN2 ICAL RESEARCH PROJECTS.

3 (a) GENERAL RULE.—In conducting or supporting

4 clinical research, the Secretary of Defense shall ensure

5 that—

6 (1) women who are members of the Armed

7 Forces are included as subjects in each project of

8 such research; and

9 (2) members of minority groups who are mem10 bers of the Armed Forces are included as subjects

11 of such research.

12 (b) WAIVER AUTHORITY.—The requirement in sub13 section (a) regarding women and members of minority

14 groups who are members of the Armed Forces may be

15 waived by the Secretary of Defense with respect to a

16 project of clinical research if the Secretary determines that

17 the inclusion, as subjects in the project, of women and

18 members of minority groups, respectively—

19 (1) is inappropriate with respect to the health

20 of the subjects;

21 (2) is inappropriate with respect to the purpose

22 of the research; or

23 (3) is inappropriate under such other cir24 cumstances as the Secretary of Defense may des25 ignate.
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1 (c) REQUIREMENT FOR ANALYSIS OF RESEARCH.—

2 In the case of a project of clinical research in which women

3 or members of minority groups will under subsection (a)

4 be included as subjects of the research, the Secretary of

5 Defense shall ensure that the project is designed and car6 ried out so as to provide for a valid analysis of whether

7 the variables being tested in the research affect women

8 or members of minority groups, as the case may be, dif9 ferently than other persons who are subjects of the re10 search.

11 SEC. 287. REPORT ON RESEARCH RELATING TO FEMALE

12 MEMBERS OF THE UNIFORMED SERVICES

13 AND FEMALE COVERED BENEFICIARIES.

14 Not later than July 1 of each of 1995, 1996, and

15 1997, the Secretary of Defense shall submit to Congress

16 a report containing—

17 (1) a description (as of May 31 of the year in

18 which the report is submitted) of the status of any

19 health research that is being carried out by or under

20 the jurisdiction of the Secretary relating to female

21 members of the uniformed services and female cov22 ered beneficiaries under chapter 55 of title 10, Unit23 ed States Code; and

24 (2) recommendations of the Secretary as to fu25 ture health research (including a proposal for any
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1 legislation relating to such research) relating to such

2 female members and covered beneficiaries.

3 PART III—WOMEN’S HEALTH EDUCATION

4 SEC. 288. WOMEN’S HEALTH CURRICULUM ADVISORY COM5 MITTEE.

6 The Secretary of Defense shall establish at the F.

7 Edward Hebert School of Medicine of the Uniformed Serv8 ices University of the Health Sciences a women’s health

9 curriculum advisory committee to promote the comprehen10 sive integration of women’s health issues into the curricu11 lum at the University. The committee shall include the

12 surgeon general of each of the military departments and

13 the dean of the School of Medicine. The committee shall

14 be established by April 1, 1994.

15 Subtitle R—International Popu16 lation Stabilization and Repro17 ductive Health Act

18 SEC. 291. SHORT TITLE.

19 This subtitle may be cited as the ‘‘International Pop20 ulation Stabilization and Reproductive Health Act’’.

21 SEC. 292. AUTHORITIES RELATING TO UNITED STATES POP22 ULATION ASSISTANCE.

23 Part I of the Foreign Assistance Act of 1961 is

24 amended—
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1 (1) in section 104(b), by striking ‘‘on such

2 terms and conditions as he may determine’’ and in3 serting ‘‘in accordance with the provisions of chapter

4 12’’; and

5 (2) by adding at the end the following new

6 chapter:

7 ‘‘CHAPTER 12—UNITED STATES

8 POPULATION ASSISTANCE

9 ‘‘SEC. 499. DEFINITION.

10 ‘‘For purposes of this chapter, the term ‘United

11 States population assistance’ means assistance provided

12 under section 104(b) of this Act.

13 ‘‘SEC. 499A. CONGRESSIONAL FINDINGS.

14 ‘‘The Congress makes the following findings:

15 ‘‘(1) Throughout much of the world, the lack of

16 access of women, particularly poor women, to basic

17 reproductive health services and information under18 mines women’s struggle for self-determination, con19 tributes to death and suffering among women and

20 their children, puts pressure on the land, forests,

21 and other natural resources on which many poor

22 families depend for their survival, and in other ways

23 vitiates the efforts of families to lift themselves out

24 of the poverty in which over 1,000,000,000 of the

25 world’s more than 5,000,000,000 people live.
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1 ‘‘(2) During the 1980s, nearly 800,000,000

2 people, a number three times greater than the popu3 lation of the United States, were added to the

4 world’s population.

5 ‘‘(3) Birthrates in many developing countries

6 are declining too slowly to prevent a near tripling of

7 the world’s population before stabilization can occur,

8 and although birthrates in some countries have de9 clined faster in recent years than anticipated, world

10 progress toward stabilization was noticeably slower

11 in the 1980s than in the 1970s.

12 ‘‘(4) After more than a quarter century of expe13 rience and research, the actions needed to bring

14 about a rapid decline in birthrates are well docu15 mented. The ability to exercise reproductive choice

16 must be expanded, and such expansion should occur

17 through broader dissemination and choice of contra18 ceptive services that involve the community and are

19 sufficient to meet the needs and values of those who

20 use them.

21 ‘‘(5) Although a number of religious and cul22 tural barriers to family planning remain, attitudes

23 toward modern contraception have changed over the

24 last decade, and in many countries a large and

25 growing unmet desire exists for deferring or prevent-
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1 ing pregnancy among women and men who are too

2 poor to pay the full cost of services.

3 ‘‘(6) Although many social and economic factors

4 affect desired family size, organized, accessible, and

5 affordable family planning programs have the most

6 rapid and strongest effect on birthrate because they

7 enable women and their families to determine the

8 timing and number of their children. Widespread

9 voluntary adoption of modern family planning meth10 ods and their successful long-term use depend on the

11 quality of reproductive health care services offered

12 and their responsiveness to individual and commu13 nity needs and values.

14 ‘‘(7) Millions of women, most of them mothers,

15 are killed or injured each year as a result of unsafe

16 abortions. The availability of safe and effective fam17 ily planning methods and services can help prevent

18 many of these tragedies.

19 ‘‘(8) The impact of human population growth,

20 combined with widespread poverty and unsustainable

21 patterns of natural resource consumption, is evident

22 in mounting signs of stress on the world’s environ23 ment, particularly in tropical deforestation, erosion

24 of arable land and watersheds, extinction of plant
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1 and animal species, global climate change, waste

2 management, and air and water pollution.

3 ‘‘(9) Traditionally, United States population as4 sistance has not focused on achieving specific goals

5 with respect to international population stabilization

6 or the expansion of reproductive choice. The absence

7 of clear goals in those areas has led to a lack of cri8 teria for allocating funds and evaluating program

9 success.

10 ‘‘SEC. 499B. DECLARATION OF POLICY.

11 ‘‘(a) IN GENERAL.—The Congress declares that to

12 reduce population growth and stabilize world population

13 at the lowest level feasible and thereby protect the global

14 environment, to provide greater self-determination for

15 women, and to improve the health and well-being of the

16 world’s families, a principal objective of the foreign policy

17 of the United States shall be to assist the international

18 community to—

19 ‘‘(1) achieve universal availability of high qual20 ity family planning services through a wide choice of

21 safe and effective means of contraception, including

22 programs of public education and other health and

23 development efforts that enable individuals to choose

24 smaller families;
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1 ‘‘(2) ensure that all individuals and couples, re2 gardless of age or marital status, are able to exercise

3 their right to decide whether and how many children

4 to have and their right to reproductive health by im5 proving the quality and accessibility of accountable

6 family planning and reproductive health programs;

7 ‘‘(3) improve reproductive health, especially of

8 women and young people, through maternal and

9 child health and nutrition services, and through sex10 uality and gender education services, especially for

11 young people; and

12 ‘‘(4) achieve population stabilization at a level

13 consistent with the maintenance of the natural re14 source base and with investment in human re15 sources, within a broad strategy to adjust consump16 tion levels and patterns in all countries.

17 ‘‘(b) FINANCIAL TARGETS.—The Congress estab18 lishes a target for global expenditures in developing coun19 tries from all domestic and international sources by the

20 year 2000 of at least $11,000,000,000 for population pro21 grams described in section 499C, and establishes a goal

22 for United States population assistance by the year 2000

23 of $1,400,000,000 in constant 1990 dollars, not including

24 funds available for other reproductive health programs.
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1 ‘‘SEC. 499C. AUTHORIZED ACTIVITIES.

2 ‘‘United States population assistance is authorized to

3 provide—

4 ‘‘(1) support for the expansion of quality, af5 fordable, voluntary family planning services, which

6 emphasize informed choice among a variety of safe

7 and effective family planning methods and closely re8 lated reproductive health care services, including the

9 prevention and control of sexually transmitted dis10 eases and reproductive tract infections;

11 ‘‘(2) support for adequate and regular supplies

12 of quality contraceptive and other commodities, com13 prehensive counseling, appropriate followup, and

14 support for programs that emphasize the use of the

15 mass media to improve public knowledge of contra16 ceptive methods and related disease prevention

17 methods and where they may be obtained and to

18 promote the benefits of family planning and repro19 ductive health to individuals, families, and commu20 nities;

21 ‘‘(3) support to United States and foreign re22 search institutions and other appropriate entities for

23 biomedical research to develop and evaluate im24 proved methods of safe and effective contraception

25 and related disease control, with particular emphasis

26 on methods which—
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1 ‘‘(A) are likely to be safer, easier to use,

2 easier to make available in developing country

3 settings, and less expensive than current

4 methods;

5 ‘‘(B) are controlled by women, including

6 barrier methods and vaginal microbicides;

7 ‘‘(C) are likely to prevent the spread of

8 sexually transmitted diseases; and

9 ‘‘(D) encourage and enable men to take

10 greater responsibility for their own fertility;

11 ‘‘(4) support for field research on the character12 istics of programs most likely to result in sustained

13 use of effective family planning in meeting each indi14 vidual’s lifetime reproductive goals, with particular

15 emphasis on the perspectives of family planning

16 users, including support for relevant social and be17 havioral research focusing on such factors as the

18 use, non-use, and unsafe or ineffective use of various

19 contraceptive and related-disease control methods;

20 ‘‘(5) support for the development of new evalua21 tion techniques and performance criteria for family

22 planning programs, emphasizing the family planning

23 user’s perspective and reproductive goals;

24 ‘‘(6) support for research and research dissemi25 nation related to population policy development, in-
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1 cluding demographic and health surveys to assess

2 population trends, measure unmet needs, and evalu3 ate program impact, and support for policy-relevant

4 research on the relationships between population

5 trends, poverty, and environmental management, in6 cluding implications for sustainable agriculture,

7 agroforestry, biodiversity, water resources, energy

8 use, and local and global climate change;

9 ‘‘(7) support for research and public informa10 tion dissemination on the health and welfare con11 sequences of unsafe abortions and for the equipment

12 and training necessary for the medical treatment of

13 the complications of unsafe abortions;

14 ‘‘(8) support for special programs to reach ado15 lescents and young adults, regardless of marital sta16 tus, before they begin childbearing, including health

17 education programs which stress responsible parent18 hood and the health risks of unprotected sexual

19 intercourse, as well as service programs designed to

20 meet the information and contraception needs of

21 adolescents and young adults; and

22 ‘‘(9) support for a broad array of governmental

23 and nongovernmental communication strategies de24 signed—

25 ‘‘(A) to create public awareness worldwide;
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1 ‘‘(B) to generate a consensus on the need

2 to address reproductive health issues and the

3 problems associated with continued world popu4 lation growth;

5 ‘‘(C) to emphasize the need to educate men

6 as well as women and mobilize their support for

7 reproductive rights and responsibilities; and

8 ‘‘(D) to make family planning an estab9 lished community norm.

10 ‘‘SEC. 499D. TERMS AND CONDITIONS.

11 ‘‘United States population assistance is authorized to

12 be provided subject to the following conditions:

13 ‘‘(1) Such assistance may only support, directly

14 or through referral, those activities which provide a

15 broad range of contraceptive methods permitted by

16 individual country policy and a broad choice of pub17 lic and private family planning services, including

18 networks for community-based and subsidized com19 mercial distribution of contraceptives.

20 ‘‘(2) No program supported by United States

21 population assistance may deny an individual family

22 planning services because of such individual’s inabil23 ity to pay all or part of the cost of such services.

24 ‘‘(3) Family planning services and related re25 productive health care services supported by United
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1 States population assistance shall maintain the high2 est medical standards possible under local conditions

3 and shall ensure regular oversight of the quality of

4 medical care and other services offered.

5 ‘‘(4) United States-supported reproductive

6 health programs shall in each recipient country sup7 port to the extent possible an integrated approach,

8 consistent with respect for the rights of women as

9 decisionmakers in matters of reproduction and sexu10 ality, for the provision of public and private repro11 ductive health services.

12 ‘‘(5) United States population assistance pro13 grams shall furnish only those contraceptive drugs

14 and devices which have received approval for mar15 keting in the United States by the Food and Drug

16 Administration or which have been tested and deter17 mined to be safe and effective under research proto18 cols comparable to those required by the Food and

19 Drug Administration or have been determined to be

20 safe by an appropriate international organization or

21 the relevant health authority in the country to which

22 they are provided.

23 ‘‘(6) Reproductive health services supported by

24 the United States shall be designed to take into ac25 count the needs of individuals and couples, including
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1 the constraints on women’s time, by involving com2 munities, particularly representatives of women,

3 through appropriate training and recruitment ef4 forts, in the design, management, and ongoing eval5 uation of services. The design of such services shall

6 stress easy accessibility, by locating services as close

7 as possible to potential users, by keeping hours of

8 service convenient, and by improving communica9 tions between users and providers through commu10 nity outreach and involvement. The evaluation of re11 productive health services also shall not use as a

12 measure of program success the degree of longevity

13 or permanency of any contraceptive method.

14 ‘‘(7) United States population assistance to ad15 olescent fertility programs shall be provided in the

16 context of prevailing norms and customs in the re17 cipient country.

18 ‘‘(8) None of the funds made available by the

19 United States Government to foreign governments,

20 international organizations, or nongovernmental or21 ganizations may be used to coerce any person to un22 dergo contraceptive sterilization or involuntary abor23 tion or to accept any other method of fertility

24 control.
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1 ‘‘SEC. 499E. ELIGIBILITY FOR POPULATION ASSISTANCE.

2 ‘‘(a) ELIGIBLE COUNTRIES.—Notwithstanding any

3 other provision of law, United States population assistance

4 shall be available, directly or through intermediary organi5 zations, to any country which the President determines

6 has met one or more of the following criteria:

7 ‘‘(1) The country accounts for a significant pro8 portion of the world’s annual population increment.

9 ‘‘(2) The country has significant unmet needs

10 for methods of contraception, prevention and treat11 ment of sexually transmitted diseases and acquired

12 immune deficiency syndrome (AIDS), and obstetric

13 and gynecological care, and requires foreign assist14 ance to directly implement, expand, or sustain qual15 ity reproductive health services for all its people.

16 ‘‘(3) The country demonstrates a strong com17 mitment to population stabilization and to com18 prehensive reproductive health care strategies

19 through policies, programs and the commitment of

20 domestic funds to improve service and make services

21 more widely available.

22 ‘‘(b) ELIGIBILITY OF NONGOVERNMENTAL AND MUL23 TILATERAL ORGANIZATIONS.—In determining eligibility

24 for United States population assistance, the President

25 shall not subject nongovernmental and multilateral organi26 zations to requirements which are more restrictive than
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1 requirements applicable to foreign governments for such

2 assistance.

3 ‘‘SEC. 499F. PARTICIPATION IN MULTILATERAL ORGANIZA4 TIONS.

5 ‘‘(a) FINDING.—The Congress recognizes that the re6 cent attention in government policies toward population

7 stabilization owes much to the efforts of the United Na8 tions and its specialized agencies and organizations, par9 ticularly the United Nations Population Fund.

10 ‘‘(b) AVAILABILITY OF FUNDS.—United States popu11 lation assistance shall be available for contributions to the

12 United Nations Population Fund in such amounts as the

13 President determines would be commensurate with United

14 States contributions to other multilateral organizations

15 and with the contributions of other donor countries.

16 ‘‘(c) PROHIBITIONS.—(1) The prohibitions contained

17 in section 104(f) of this Act shall apply to the funds made

18 available for the United Nations Population Fund.

19 ‘‘(2) No United States population assistance may be

20 available to the United Nations Population Fund unless

21 such assistance is held in a separate account and not com22 mingled with any other funds.

23 ‘‘(3) No funds may be available for the United Na24 tions Population Fund unless the Fund agrees to prohibit

25 the use of those funds to carry out any program, project,
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1 or activity that involves the use of coerced abortion or in2 voluntary sterilization.

3 ‘‘(d) ALLOCATION OF FUNDS.—Of the funds made

4 available for United States population assistance, the

5 President shall make available for the Special Programme

6 of Research, Development and Research Training in

7 Human Reproduction for each of the fiscal years 1994 and

8 1995 an amount commensurate with the contributions of

9 the other donor countries for the purpose of furthering

10 international cooperation in the development and evalua11 tion of contraceptive technology.

12 ‘‘SEC. 499G. SUPPORT FOR NONGOVERNMENTAL ORGANIZA13 TIONS.

14 ‘‘(a) FINDINGS.—The Congress finds that—

15 ‘‘(1) in many developing countries, nongovern16 mental entities, including private and voluntary or17 ganizations and private sector entities, such as the

18 International Planned Parenthood Federation and

19 the Planned Parenthood Federation of America, are

20 the most appropriate and effective providers of Unit21 ed States assistance to population and family plan22 ning activities; and

23 ‘‘(2) in particular, organizations and groups

24 founded by women or in which women have signifi25 cant and meaningful participation, and which are
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1 committed to promoting women’s reproductive health

2 rights through client-oriented programs and activi3 ties, have proven the most effective of all.

4 ‘‘(b) PROCEDURES.—The President shall establish

5 simplified procedures for the development and approval of

6 programs to be carried out by nongovernmental organiza7 tions that have demonstrated—

8 ‘‘(1) a capacity to undertake quality, effective,

9 client-oriented reproductive health and population

10 activities which encourage significant involvement by

11 private health practitioners, employer-based health

12 services, unions, and cooperative health organiza13 tions; and

14 ‘‘(2) a commitment to quality, client-oriented

15 reproductive health care for women.

16 ‘‘(c) PRIORITY FOR NONGOVERNMENTAL ORGANIZA17 TIONS.—The largest share of United States population as18 sistance made available for any fiscal year shall be made

19 available through United States and foreign nongovern20 mental organizations.

21 ‘‘SEC. 499H. REPORTS TO CONGRESS.

22 ‘‘The President shall prepare and submit to the Con23 gress, as part of the annual presentation materials on for24 eign assistance, a report on world progress toward popu-
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1 lation stabilization and universal reproductive choice. The

2 report shall include—

3 ‘‘(1) estimates of expenditures on the popu4 lation activities described in section 499C by na5 tional governments, donor agencies, and private sec6 tor entities;

7 ‘‘(2) an assessment by country of the availabil8 ity and use of all methods of contraception and

9 abortion, whether lawful or unlawful in that country;

10 ‘‘(3) an analysis by country and region of the

11 impact of population trends on a set of key social,

12 economic, political, and environmental indicators,

13 which shall be identified by the President in the first

14 report submitted pursuant to this section and ana15 lyzed in that report and each subsequent report; and

16 ‘‘(4) a detailed statement of prior year and pro17 posed direct and indirect allocations of population

18 assistance, by country, which describes how each

19 country allocation meets the criteria set forth in this

20 section.’’.

21 SEC. 293. AUTHORIZATIONS OF APPROPRIATIONS.

22 Section 104(g)(1) of the Foreign Assistance Act of

23 1961 (22 U.S.C. 2151b(g)(1) is amended by amending

24 subparagraph (A) to read as follows:
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1 ‘‘(A) $725,000,000 for fiscal year 1994 and

2 $800,000,000 for fiscal year 1995 to carry out sub3 section (b) of this section; and’’.

4 SEC. 294. ECONOMIC AND SOCIAL DEVELOPMENT INITIA5 TIVES TO STABILIZE WORLD POPULATION.

6 (a) CONGRESSIONAL FINDINGS.—The Congress

7 makes the following findings:

8 (1) Women represent 50 percent of the world’s

9 human resource potential. Therefore, improving the

10 health, social, and economic status of women and in11 creasing their productivity are essential for economic

12 progress in all countries.

13 (2) Throughout the world, women who partici14 pate in the social, economic, and political affairs of

15 their communities are more likely to exercise their

16 choice about childbearing than women who do not

17 participate in such activities.

18 (3) Effective economic development strategies

19 address issues such as infant and child survival

20 rates, educational opportunities, especially literacy

21 programs, for girls and women, and gender equality

22 in development.

23 (4) Comprehensive population stabilization ef24 forts which include both family planning services

25 and economic development activities achieve lower
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1 birth rates and stimulate more development than

2 those which pursue these objectives independently.

3 (5) The most powerful, long-term influence on

4 birthrates is education, especially educational attain5 ment among women. The education of women also

6 has a strong influence on other aspects of family

7 welfare, including child survival. World-wide statis8 tics, however, indicate that the number of school-age

9 children, especially girls, not attending school is

10 growing annually.

11 (6) Each year, nearly 15,000,000 children

12 under the age of 5 die, most from preventable

13 causes. Wider availability of vaccines, simple treat14 ments for diarrheal disease and respiratory infec15 tions, and improved nutrition could prevent many of

16 these deaths.

17 (7) Each year, 500,000 or more women world18 wide die from complications related to pregnancy,

19 childbirth, or illegal abortion. Another 10 million

20 women annually suffer long-term illness or perma21 nent physical impairment from such causes.

22 (8) In many countries, high levels of mortality

23 and morbidity among women of childbearing age are

24 directly related to inadequate or inaccessible repro25 ductive health care services.
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1 (9) Many women are their family’s principal

2 caregiver and chief source of economic support. The

3 death of a mother substantially increases the risk of

4 neglect, abandonment, or death for her young

5 children.

6 (10) Malnutrition and anemia are widespread

7 among poor women in their childbearing years, yet

8 the worldwide campaign to encourage breastfeeding

9 has devoted little attention to the nutritional needs

10 of nursing mothers, or in the improvement of nutri11 tional and health levels of women in general.

12 (11) During the 1990s, women, especially in

13 Africa, face substantially increased risks of death or

14 disability from sexually transmitted diseases. During

15 the 1990s, more than 3,000,000 women in Africa

16 will die of the acquired immune deficiency syndrome

17 (AIDS), leaving more than 5,000,000 orphans.

18 (b) DECLARATION OF POLICY.—Congress declares

19 that, in order to further the United States foreign policy

20 objective of assisting the international community in

21 achieving universal availability of quality family planning

22 services and stabilizing world population, additional objec23 tives of the foreign policy of the United States shall be—

24 (1) to expand basic education opportunities for

25 girls and women;
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1 (2) to reduce the gap between male and female

2 levels of literacy and between male and female levels

3 of primary and secondary school enrollment;

4 (3) to help ensure that women worldwide have

5 the opportunity to become equal partners with men

6 in the development of their societies;

7 (4) to reduce global maternal and infant mor8 tality rates; and

9 (5) to improve worldwide overall reproductive

10 health, maternal and child health status, and quality

11 of life.

12 (c) AUTHORIZED ACTIVITIES.—United States devel13 opment assistance shall be available, on a priority basis,

14 for—

15 (1) countries which either have adopted and im16 plemented, or have agreed to adopt and implement,

17 strategies to help ensure, by the year 2000—

18 (A) the completion of primary school edu19 cation by no less than 80 percent of the coun20 try’s primary school-age children;

21 (B) the reduction of adult illiteracy by at

22 least one-half the country’s 1990 level; and

23 (C) the elimination of the gap between

24 male and female levels of literacy and between
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1 male and female levels of primary and second2 ary school enrollment;

3 (2) governmental and nongovernmental pro4 grams which, with respect to a targeted country, are

5 intended—

6 (A) to reduce significantly malnutrition

7 among the country’s children under 5 years of

8 age;

9 (B) to maintain immunizations against

10 childhood diseases for significant segments of

11 the country’s children; and

12 (C) to reduce the number of childhood

13 deaths in the country which result from diar14 rheal disease and acute respiratory infections;

15 (3) governmental and nongovernmental pro16 grams which are intended to increase women’s pro17 ductivity through improved access to appropriate

18 labor-saving technology, vocational training, and ex19 tension services and access to credit and child care;

20 and

21 (4) governmental and nongovernmental pro22 grams which are intended to increase the access of

23 girls and women to comprehensive reproductive

24 health care services pursuant to subsection (d).
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1 (d) SAFE MOTHERHOOD INITIATIVE.—(1)(A) The

2 President is authorized to establish a grant program, to

3 be known as the Safe Motherhood Initiative, to help im4 prove the access of girls and women worldwide to com5 prehensive reproductive health care services.

6 (B) Such program shall be carried out in accordance

7 with this section and shall be subject to the same terms,

8 conditions, prohibitions, and restrictions as are applicable

9 to assistance made available under sections 499D, 499E,

10 and 499F of the Foreign Assistance Act of 1961.

11 (2) Eligible for assistance under this section are com12 prehensive reproductive health programs which empha13 size—

14 (A) contraceptive services;

15 (B) prenatal care and screening for high risk

16 pregnancies, and improved access to safe delivery

17 services for women with high risk pregnancies;

18 (C) supplemental food programs for pregnant

19 and nursing women;

20 (D) expanded and coordinated programs to pre21 vent, detect, and treat sexually transmitted diseases,

22 including acquired immune deficiency syndrome

23 (AIDS), reproductive tract infections, and other

24 chronic reproductive health problems;
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1 (E) programs to eliminate traditional practices

2 injurious to women’s health, including female genital

3 mutilation; and

4 (F) improvements in the practice of midwifery,

5 including outreach to traditional birth attendants.

6 (e) REPORTS TO CONGRESS.—(1) Not later than De7 cember 31, 1994, the President shall prepare and submit

8 to the Congress a report which includes—

9 (A) estimates of the total financial resources

10 needed to achieve, by the year 2000, the specific ob11 jectives set forth in subsection (c) with respect to

12 education, rates of illiteracy, malnutrition, immuni13 zation, maternal and child mortality and morbidity,

14 and improvements in the economic productivity of

15 women;

16 (B) an analysis of such estimates which sepa17 rately lists the total financial resources needed from

18 the United States, other donor nations, and non-gov19 ernmental organizations;

20 (C) an analysis, by country, which—

21 (i) identifies the legal, social, economic,

22 and cultural barriers to women’s self-determina23 tion and to improvements in the economic pro24 ductivity of women in traditional and modern

25 labor sectors; and
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1 (ii) describes initiatives needed to develop

2 appropriate technologies for use by women,

3 credit programs for low-income women, ex4 panded child care, vocational training, and ex5 tension services for women; and

6 (D) a comprehensive description of—

7 (i) new and expanded initiatives to ensure

8 safe motherhood worldwide;

9 (ii) findings on the major causes of mortal10 ity and morbidity among women of childbearing

11 age in various regions of the world;

12 (iii) actions needed to reduce, by the year

13 2000, world maternal mortality by one-half of

14 the worldwide 1990 level; and

15 (iv) the financial resources needed to meet

16 this goal from the United States, other donor

17 nations, and nongovernmental organizations.

18 (2) In each annual country human rights report, the

19 Secretary of State shall include—

20 (A) information on any patterns within the

21 country of discrimination against women in in22 heritance laws, property rights, family law, ac23 cess to credit and technology, hiring practices,

24 formal education, and vocational training; and
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1 (B) an assessment which makes reference

2 to all significant forms of violence against

3 women, including rape, domestic violence, and

4 female genital mutilation, the extent of involun5 tary marriage and childbearing, and the preva6 lence of marriage among women under the age

7 of 18 years.

8 (f) AUTHORIZATION OF APPROPRIATIONS.—(1) Of

9 the aggregate amounts available for United States devel10 opment and economic assistance programs for education

11 activities, $350,000,000 for fiscal year 1994 and

12 $350,000,000 for fiscal year 1995 shall be available only

13 for programs in support of equalizing male and female lev14 els of primary and secondary school enrollment.

15 (2) There are authorized to be appropriated

16 $405,000,000 for fiscal year 1994 and $490,000,000 for

17 fiscal year 1995 to the Child Survival Fund under section

18 104(c)(2) of the Foreign Assistance Act of 1961, which

19 amounts shall be available for child survival activities only,

20 including the Children’s Vaccine Initiative, the worldwide

21 immunization effort, and oral rehydration programs.

22 (3) There are authorized to be appropriated

23 $100,000,000 for the Safe Motherhood Initiative for each

24 of fiscal years 1994 and 1995.

25 (g) DEFINITIONS.—For purposes of this section—
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1 (1) the term ‘‘annual country human rights re2 port’’ refers to the report required to be submitted

3 pursuant to section 502B(b) of the Foreign Assist4 ance Act of 1961 (22 U.S.C. 2304(b)); and

5 (2) the term ‘‘United States development and

6 economic assistance’’ means assistance made avail7 able under chapter 1 of part I and chapter 4 of part

8 II of the Foreign Assistance Act of 1961.

9 SEC. 295. AIDS PREVENTION AND CONTROL FUND.

10 (a) IN GENERAL.—Section 104(c) of the Foreign As11 sistance Act of 1961 (22 U.S.C. 2151b(c)) is amended by

12 adding at the end the following new paragraph:

13 ‘‘(4)(A)(i) The President is authorized to provide as14 sistance, under such terms and conditions as he may de15 termine, with respect to activities relating to research on,

16 and the treatment and control of, acquired immune defi17 ciency syndrome (AIDS) in developing countries.

18 ‘‘(ii) Assistance provided under clause (i) shall in19 clude—

20 ‘‘(I) funds made available directly to the World

21 Health Organization for its use in financing the

22 Global Program on AIDS (including activities imple23 mented by the Pan American Health Organization);

24 and
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1 ‘‘(II) funds made available to the United Na2 tions Children’s Fund (UNICEF) for AIDS-related

3 activities.

4 ‘‘(B) Appropriations pursuant to subparagraph (A)

5 may be referred to as the ‘AIDS Prevention and Control

6 Fund’.’’.

7 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

8 104(g)(1) of the Foreign Assistance Act of 1961 (22

9 U.S.C. 2151b(g)) is amended—

10 (1) by striking ‘‘and’’ at the end of subpara11 graph (A);

12 (2) in subparagraph (B), by striking ‘‘sub13 section (c) of this section.’’ and inserting ‘‘sub14 section (c) of this section (other than paragraph (4)

15 thereof); and’’; and

16 (3) by adding at the end thereof the following

17 new subparagraph:

18 ‘‘(C) $100,000,000 for fiscal year 1994

19 and $165,000,000 for fiscal year 1995 to carry

20 out subsection (c)(4) of this section.’’.

21 (c) EFFECTIVE DATE.—The amendments made by

22 this section shall take effect October 1, 1993.
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1 SEC. 296. OVERSIGHT OF MULTILATERAL DEVELOPMENT

2 BANKS.

3 (a) FINDING.—The Congress considers insufficient

4 the role currently played in global population efforts by

5 the International Bank for Reconstruction and Develop6 ment, the Asian Development Bank, the Inter-American

7 Development Bank and the African Development Bank.

8 Although these multilateral development banks are sin9 gularly important sources of support for development ac10 tivities, together they provided less than $200,000,000 in

11 1990 in assistance for core population programs. Nor have

12 these institutions consistently encouraged appropriate

13 population and reproductive health care policies.

14 (b) REPORT REQUIRED.—(1) The Congress believes

15 that the multilateral development banks should together

16 increase their support for the population activities de17 scribed in section 499C of the Foreign Assistance Act of

18 1961 to no less than $1,000,000,000 by the end of 1999.

19 (2) Not later than July 31 of each year, the United

20 States Executive Directors of the International Bank for

21 Reconstruction and Development, the Asian Development

22 Bank, the Inter-American Development Bank and the Af23 rican Development Bank shall prepare and transmit to

24 Congress a report which sets forth information on alloca25 tions by each of these institutions to the population activi26 ties described in section 499C of the Foreign Assistance
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1 Act of 1961 and, if such allocations total less than

2 $1,000,000,000, set forth any specific actions taken by the

3 Executive Directors to encourage increases in such alloca4 tions and in policy level discussions with donor and devel5 oping country governments.

6 SEC. 297. COMMISSION ON WORLD POPULATION STABILIZA7 TION AND REPRODUCTIVE HEALTH.

8 (a) ESTABLISHMENT OF COMMISSION.—There is es9 tablished the Commission on World Population Stabiliza10 tion and Reproductive Health for the purpose of coordi11 nating United States preparation for, and participation in,

12 the 1994 International Conference on Population and De13 velopment and for other purposes.

14 (b) COMPOSITION OF COMMISSION.—The Commis15 sion shall be composed of—

16 (1) the Under Secretary of State for Global

17 Population, Environment and National Resources;

18 (2) the Administrator of the Agency for Inter19 national Development;

20 (3) the Deputy Assistant Secretary for Popu21 lation Affairs of the Department of Health and

22 Human Services;

23 (4) the Assistant Administrator for Inter24 national Activities of the Environmental Protection

25 Agency;
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1 (5) the Director of the Congressional Office of

2 Technology Assessment; and

3 (6) three individuals appointed by the Presi4 dent, by and with the advice and consent of the Sen5 ate, one of whom the President shall designate as

6 Chairman.

7 (c) PERIOD OF APPOINTMENT; VACANCIES.—Mem8 bers shall be appointed for the life of the Commission. Any

9 vacancy in the Commission shall not affect its powers, but

10 shall be filled in the same manner as the original appoint11 ment.

12 (d) QUORUM.—A majority of the members of the

13 Commission shall constitute a quorum, but a lesser num14 ber of members may hold hearings.

15 (e) HEARINGS.—The Commission may hold such

16 hearings, sit and act at such times and places, take such

17 testimony, and receive such evidence as the Commission

18 considers advisable to carry out the purposes of this sec19 tion.

20 (f) INFORMATION FROM FEDERAL AGENCIES.—The

21 Commission may secure directly from any Federal depart22 ment or agency such information as the Commission con23 siders necessary to carry out the provisions of this subtitle.

24 Upon request of the Chairman of the Commission, the
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1 head of such department or agency shall furnish such in2 formation to the Commission.

3 (g) POSTAL SERVICES.—The Commission may use

4 the United States mails in the same manner and under

5 the same conditions as other departments and agencies of

6 the Federal Government.

7 (h) GIFTS.—The Commission may accept, use, and

8 dispose of gifts or donations of services or property.

9 (i) COMPENSATION OF MEMBERS.—Each member of

10 the Commission who is not an officer or employee of the

11 Federal Government shall be compensated at a rate equal

12 to the daily equivalent of the annual rate of basic pay pre13 scribed for level IV of the Executive Schedule under sec14 tion 5315 of title 5, United States Code, for each day (in15 cluding travel time) during which such member is engaged

16 in the performance of the duties of the Commission. All

17 members of the Commission who are officers or employees

18 of the United States shall serve without compensation in

19 addition to that received for their services as officers or

20 employees of the United States.

21 (j) TRAVEL EXPENSES.—The members of the Com22 mission shall be allowed travel expenses, including per

23 diem in lieu of subsistence, at rates authorized for employ24 ees of agencies under subchapter I of chapter 57 of title

25 5, United States Code, while away from their homes or
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1 regular places of business in the performance of services

2 for the Commission.

3 (k) STAFF COMPENSATION.—The Chairman of the

4 Commission may fix the compensation of personnel with5 out regard to the provisions of chapter 51 and subchapter

6 III of chapter 53 of title 5, United States Code, relating

7 to classification of positions and General Schedule pay

8 rates, except that the rate of pay for the executive director

9 and other personnel may not exceed the rate payable for

10 level V of the Executive Schedule under section 5316 of

11 such title.

12 (l) DETAIL OF GOVERNMENT EMPLOYEES.—Any

13 Federal Government employee may be detailed to the

14 Commission without reimbursement, and such detail shall

15 be without interruption or loss of civil service status or

16 privilege.

17 (m) PROCUREMENT OF TEMPORARY AND INTERMIT18 TENT SERVICES.—The Chairman of the Commission may

19 procure temporary and intermittent services under section

20 3109(b) of title 5, United States Code, at rates for individ21 uals which do not exceed the daily equivalent of the annual

22 rate of basic pay prescribed for level V of the Executive

23 Schedule under section 5316 of such title.

24 (n) REPORT.—Not later than June 30, 1994, the

25 Commission shall submit to the President a public report
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1 on national and international population trends and the

2 probable impact of such trends on efforts to alleviate pov3 erty and protect the environment. The report, which

4 should be made available for consideration at the 1994

5 International Conference on Population and Development,

6 shall specify, among other things, modifications in policy

7 and financial commitments required by foreign govern8 ments to achieve universal reproductive choice and early

9 population stabilization.

10 (o) TERMINATION OF THE COMMISSION.—The Com11 mission shall terminate 90 days after the date on which

12 the Commission submits its report under subsection (n).

13 (p) AUTHORIZATION OF APPROPRIATIONS.—To carry

14 out this section, there are authorized to be appropriated

15 to the Commission $1,000,000 for fiscal year 1994.

16 SEC. 298. SUPPORT FOR UNITED NATIONS FORWARD LOOK17 ING STRATEGIES FOR THE ADVANCEMENT OF

18 WOMEN.

19 (a) IN GENERAL.—The President shall direct the

20 United States representatives to the United Nations Com21 mission on the Status of Women to take all actions nec22 essary to ensure the rapid implementation of the United

23 Nations Forward Looking Strategies for the Advancement

24 of Women, as adopted in 1985 at the United Nations Con25 ference ending the Decade for Women.
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1 (b) REVIEW AND ANNUAL REPORTS.—Not later than

2 December 31, 1993, the Secretary of State shall submit

3 the 5-year review of the status of United States women,

4 as called for at the conference, and shall submit such an5 nual reports as are requested by the United Nations Com6 mission on the Status of Women.

7 SEC. 299. SUPPORT FOR THE CONVENTION ON THE ELIMI8 NATION OF ALL FORMS OF DISCRIMINATION

9 AGAINST WOMEN.

10 The President shall promptly complete the review of

11 the United Nations Convention on the Elimination of All

12 Forms of Discrimination Against Women, which was

13 signed by the United States on July 17, 1980, and submit

14 to the Senate any reservations, understandings, or dec15 larations that the President considers necessary in order

16 that the Senate may give its advice and consent to ratifica17 tion, or report to the Congress why he is unable or unwill18 ing to do so.

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