```

[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3075 Introduced in House (IH)]

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. Roybal-Allard, Ms. Schenk, 
Mr. Thurman, Mrs. Unsoeld, Ms. Velazquez, 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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Women's Health Equity Act of 1993''.

SEC. 2. TABLE OF CONTENTS.

    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.
            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

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.
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.
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.

                  TITLE I--RESEARCH ON WOMEN'S HEALTH

      Subtitle A--NIH Women Scientists Employment Opportunites Act

SEC. 101. SHORT TITLE.

    This subtitle may be cited as the ``NIH Women Scientists Employment 
Opportunity Act''.

SEC. 102. WOMEN'S SCIENTIFIC EMPLOYMENT.

    Subpart A of title IV of the Public Health Service Act (42 U.S.C. 
281 et seq.), as amended by section 209 of Public Law 103-43 (107 Stat. 
149), is amended by adding at the end the following section:

                    ``women's scientific employment

    ``Sec. 404F. (a) In General.--The Director of NIH shall--
            ``(1) establish policies for the National Institutes of 
        Health on matters relating to the employment by the National 
        Institutes of Health of women as scientists; and
            ``(2) monitor the extent of compliance with such policies 
        and take appropriate action in cases in which the Director 
        determines that the policies have been violated.
    ``(b) Certain Functions.--In carrying out subsection (a), the 
Director of NIH shall provide for the following:
            ``(1) Implementing the recommendations of the group known 
        as the Task Force on the Status of NIH Intramural Women 
        Scientists.
            ``(2) Determining the concerns of intramural women 
        scientists.
            ``(3) Developing a policy defining the standard tenure 
        process for employment at the National Institutes of Health.
            ``(4) Determining the reason for departure from such 
        Institutes by interviewing women and men scientists as they 
        leave.
            ``(5) Distributing yearly to all employees of such 
        Institutes the policy of such Institutes on flexible family 
        leave.
            ``(6) Monitoring the number of women, including minority 
        women, included on the committees, panels, and other working 
        groups (and in meetings) of such Institutes.
            ``(7) Making efforts to recruit minority women, based on 
        the small numbers of tenured minority women scientists.
            ``(8) Developing additional goals related to women and 
        minority women scientists at such Institutes.
    ``(c) Inclusion of Women on Intramural and Extramural Conferences 
and Other Groups.--
            ``(1) In general.--The Director of NIH shall establish a 
        policy at the National Institutes of Health of requiring 
        inclusion of women scientists in greater numbers on or in 
        intramural and extramural conferences, workshops, meetings, 
        international congresses, and other groups funded or sponsored 
        by such Institutes. Such policy shall provide for the inclusion 
        of not less than one woman scientist in each such group, except 
        as provided in paragraph (2).
            ``(2) Exclusion; written explanation.--The policy 
        established in paragraph (1) may provide that no woman 
        scientist will be included in a group for purposes of such 
        paragraph if the Director of NIH provides a waiver of the 
        requirement. The Director may grant such a waiver only if--
                    ``(A) the individual with the chief responsibility 
                for the group involved submits to the Director a 
                written request for the waiver and the request provides 
                an explanation of the reasons underlying the need for 
                the waiver; and
                    ``(B) the Director makes a determination that 
                extraordinary circumstances justify providing the 
                waiver.
    ``(d) Study on Pay Equity.--
            ``(1) In general.--The Director of NIH shall provide for 
        study to identify any pay differences among men and women 
        scientists employed by the National Institutes of Health, both 
        tenured and untenured. The study shall include recommendations 
        on measures to adjust any disparities or inequities, and shall 
        identify a program to communicate information on salary ranges 
        to all employees.
            ``(2) Report.--Not later than 240 days after the date of 
        the enactment of the NIH Women Scientist Employment Opportunity 
        Act, the Director of NIH shall complete the study required in 
        paragraph (1) and submit to the Committee on Energy and 
        Commerce of the House of Representatives, and to the Committee 
        on Labor and Human Resources of the Senate, a report describing 
        the findings made as a result of the study.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 1994 through 1996.''.

   Subtitle B--Women and AIDS Research Initiative Amendments of 1993

SEC. 106. SHORT TITLE.

    This subtitle may be cited as the ``Women and AIDS Research 
Initiative Amendments of 1993''.

SEC. 107. ESTABLISHMENT OF GENERAL PROGRAM OF RESEARCH REGARDING WOMEN 
              AND ACQUIRED IMMUNE DEFICIENCY SYNDROME.

    Part B of title XXIII of the Public Health Service Act (42 U.S.C. 
300cc-11 et seq.) is amended by adding at the end the following 
section:

``SEC. 2321. RESEARCH REGARDING WOMEN.

    ``(a) In General.--With respect to cases of infection with the 
human immunodeficiency virus, the Secretary shall establish a program 
for the purpose of conducting biomedical and behavioral research on 
such cases in women, including research on the prevention of such 
cases. The Secretary may conduct such research directly, and may make 
grants to public and nonprofit private entities for the conduct of the 
research.
    ``(b) Certain Forms of Research.--In carrying out subsection (a), 
the Secretary shall provide for research on--
            ``(1) the manner in which the human immunodeficiency virus 
        is transmitted to women, including the relationship between 
        cases of infection with such virus and other cases of sexually 
        transmitted diseases, including clinical trials which examine 
        the question of how much human immunodeficiency virus infection 
        can be prevented by finding and treating sexually transmitted 
        diseases in women;
            ``(2) measures for the prevention of exposure to and the 
        transmission of such virus, including research on--
                    ``(A) the prevention of any sexually transmitted 
                disease that may facilitate the transmission of the 
                virus;
                    ``(B) rapid, inexpensive, easy-to-use sexually 
                transmitted disease diagnostic tests for women;
                    ``(C) inexpensive single dose therapy for treatable 
                sexually transmitted diseases;
                    ``(D) the development of methods of prevention for 
                use by women; and
                    ``(E) the development and dissemination of 
                prevention programs and materials whose purpose is to 
                reduce the incidence of substance abuse among women;
            ``(3) the development and progression of symptoms resulting 
        from infection with such virus, including research regarding 
        gynecological infections as well as breast changes, hormonal 
        changes, and menses and menopause changes, whose occurrence 
        becomes probable as a result of the deterioration of the immune 
        system;
            ``(4) the treatment of cases of such infection, including 
        clinical research; and
            ``(5) behavioral research on the prevention of such cases 
        and research on model educational programs for such prevention.
    ``(c) Clinical Trials.--
            ``(1) Gynecological evaluations.--In clinical trials 
        regarding the human immunodeficiency virus in which women 
        participate as subjects, the Secretary shall ensure that--
                    ``(A) each female subject who is infected with the 
                human immunodeficiency virus--
                            ``(i) undergoes a gynecological examination 
                        as part of the evaluation of the medical status 
                        of the woman prior to participation in the 
                        trial; and
                            ``(ii) receives appropriate follow-up 
                        services regarding such examination; and
                    ``(B) the results of the gynecological examinations 
                are analyzed to determine the relationship between 
                gynecological conditions and the infection with such 
                virus.
            ``(2) Standard treatments for gynecological conditions.--
        The Secretary shall conduct or support clinical trials under 
        subsection (a) to determine whether standard methods of 
        treating gynecological conditions are effective in the case of 
        such conditions that arise as a result of infection with the 
        human immunodeficiency virus.
            ``(3) Effectiveness of certain treatment protocols.--With 
        respect to cases of infection with the human immunodeficiency 
        virus, the Secretary shall conduct or support clinical trials 
        under subsection (a) to determine whether treatment protocols 
        approved for men with such cases are effective for women with 
        such cases.
            ``(4) Support services.--
                    ``(A) In conducting or supporting clinical trials 
                regarding the human immunodeficiency virus in which 
                women participate as subjects, the Secretary shall 
                provide the women with such transportation, child care, 
                and other support services (including medical and 
                mental health services, treatment for drug abuse, and 
                social services, including services addressing domestic 
                violence) as may be necessary to enable the women to 
                participate as such subjects.
                    ``(B) Services under subparagraph (A) shall include 
                services designed to respond to the particular needs of 
                women with respect to participation in the clinical 
                trials involved, including, as appropriate, training of 
                the individuals who conduct the trials.
    ``(d) Prevention Programs.--
            ``(1) Sexual transmission.--
                    ``(A) With respect to preventing the sexual 
                transmission of the human immunodeficiency virus, the 
                Secretary shall conduct or support research under 
                subsection (a) on barrier methods for prevention of 
                sexually transmitted diseases, including human 
                immunodeficiency virus disease, that women can use 
                without their sexual partner's cooperation or 
                knowledge.
                    ``(B) In carrying out subparagraph (A), the 
                Secretary shall give priority to identified research 
                needs and opportunities identified at the National 
                Institutes of Health sponsored meeting on Development 
                of Topical Microbicides held in May 1993, including 
                research on--
                            ``(i) the early steps in infectious 
                        processes;
                            ``(ii) identification, formulation, and 
                        preclinical evaluation of new preparations;
                            ``(iii) clinical testing for safety and 
                        efficacy; and
                            ``(iv) studies on acceptability and 
                        compliance of safe, effective microbicides.
            ``(2) Epidemiological research.--The Secretary shall 
        conduct or support epidemiological research under subsection 
        (a) to determine the factors of risk regarding infection with 
        the human immunodeficiency virus that are particular to women, 
        including research regarding--
                    ``(A) the use of various contraceptive methods;
                    ``(B) the use of tampons;
                    ``(C) the relationship between such infection and 
                other sexually transmitted diseases;
                    ``(D) the relationship between such infection and 
                various forms of substance abuse (including use of the 
                form of cocaine commonly known as crack); and
                    ``(E) the relationship between such infection and 
                noncoital forms of sexual activity.
    ``(e) Interagency Study.--With respect to the study (known as the 
Women's Interagency HIV Study) that, as of June 1993, is being carried 
out by the Secretary through various agencies of the Public Health 
Service for the purpose of monitoring the progression in women of 
infection with the human immunodeficiency virus, and determining 
whether such progression is different in women than in men, the 
following applies:
            ``(1) The Secretary shall ensure that not less than 5,000 
        women with such infection are included in the study.
            ``(2) The Secretary shall provide for an increase in the 
        number of sites at which the study is to be conducted.
            ``(3) The Secretary shall ensure that the study period is 
        for a minimum of 8 years.
            ``(4) With respect to markers of human immunodeficiency 
        virus disease progression and viral activity, including the 
        cells commonly known as CD4 cells, the Secretary shall ensure 
        that the study adequately addresses the relationship between 
        such markers and the development of serious illnesses in such 
        women, including the relationship between the number of such 
        cells and the development of such illnesses. For purposes of 
        the preceding sentence, the study shall address gynecological 
        conditions, and other conditions particular to women, that are 
        not currently included in the list of conditions arising from 
        such infection that, for surveillance purposes, is maintained 
        by the Director of the Centers for Disease Control and 
        Prevention.
    ``(f) Definitions.--For purposes of this section, the term `human 
immunodeficiency virus' means the etiologic agent for acquired immune 
deficiency syndrome.
    ``(g) Authorizations of Appropriations.--
            ``(1) Clinical trials.--
                    ``(A) For the purpose of carrying out subsection 
                (c)(1), there are authorized to be appropriated 
                $20,000,000 for fiscal year 1994, and such sums as may 
                be necessary for each of the fiscal years 1995 through 
                1996.
                    ``(B) For the purpose of carrying out subsection 
                (c)(2), there are authorized to be appropriated 
                $10,000,000 for fiscal year 1994, and such sums as may 
                be necessary for each of the fiscal years 1995 through 
                1996.
                    ``(C) For the purpose of carrying out subsection 
                (c)(3), there are authorized to be appropriated 
                $10,000,000 for fiscal year 1994, and such sums as may 
                be necessary for each of the fiscal years 1995 through 
                1996.
                    ``(D) For the purpose of carrying out subsection 
                (c)(4), there are authorized to be appropriated 
                $15,000,000 for fiscal year 1994, and such sums as may 
                be necessary for each of the fiscal years 1995 and 
                1996.
            ``(2) Prevention programs.--
                    ``(A) For the purpose of carrying out subsection 
                (d)(1), there are authorized to be appropriated 
                $30,000,000 for fiscal year 1994, and such sums as may 
                be necessary for each of the fiscal years 1995 through 
                1996.
                    ``(B) For the purpose of carrying out subsection 
                (d)(2), there are authorized to be appropriated 
                $10,000,000 for fiscal year 1994, and such sums as may 
                be necessary for each of the fiscal years 1995 through 
                1996.
            ``(3) Interagency study.--For the purpose of carrying out 
        subsection (e), there are authorized to be appropriated 
        $15,000,000 for fiscal year 1994, and such sums as may be 
        necessary for each of the fiscal years 1995 through 1996.''.

       Subtitle C--Women and Alcohol Research Equity Act of 1993

SEC. 111. SHORT TITLE.

    This subtitle may be cited as the ``Women and Alcohol Research 
Equity Act of 1993''.

SEC. 112. FINDINGS.

    The Congress finds as follows with respect to the United States:
            (1) One of every 3 alcoholics receiving treatment is a 
        woman.
            (2) In fiscal year 1992, the National Institute on Alcohol 
        Abuse and Alcoholism had a total research budget of 
        $169,000,000, and only $14,200,000 of the budget (approximately 
        8 percent) was available for research on alcohol abuse and 
        alcoholism among women. Research on this topic is critical 
        because alcoholism has long been known to be a gender-specific 
        disease.
            (3) Women continue to be underrepresented in treatment 
        programs. Women make up less than 25 percent of all publicly 
        funded alcohol treatment admissions and about 30 percent of 
        treatment admissions for other drug dependencies although women 
        make up an estimated 50 percent of the total alcohol and drug 
        dependent population.
            (4) Alcohol use by pregnant women is the leading known 
        cause of mental retardation in newborns. Fetal alcohol 
        syndrome, which is marked by dysfunction of the central nervous 
        system and by prenatal and postnatal growth deficiency and 
        facial malformations, strikes 1 to 3 out of every 1,000 
        newborns, or 3,600 to 10,000 babies a year. The incidence of 
        less severe fetal alcohol effects is at least 3 times that of 
        fetal alcohol syndrome. Research is also needed on the male 
        contribution to birth abnormalities related to alcohol and 
        other drug use.
            (5) Most treatment programs do not provide child care or 
        adequate alternatives for women entering treatment.
            (6) The death rate of female alcoholics is 50 to 100 
        percent higher than for male alcoholics.
            (7) More alcoholic women die of cirrhosis of the liver than 
        do alcoholic men.
            (8) Combined effects of estrogen and alcohol augment liver 
        damage.
            (9) Women experience greater physiological damage from 
        consumption of alcohol than do their male counterparts. The 
        interval between the onset of drinking and entry into treatment 
        appears to be shorter for women than men.
            (10) Negative effects of drinking show up earlier in women 
        than men, even when they consume less alcohol than men. This 
        disease process is ``telescoped'' or accelerated in women.
            (11) Women become intoxicated faster than men. This is due 
        to a different enzyme activity than men and hormonal 
        fluctuations in women.
            (12) Chronic, heavy drinking contributes to menstrual 
        disorders, fertility problems, and premature menopause.
            (13) Alcohol use may be associated with an increased risk 
        of breast cancer. Research indicates that the incidence of 
        breast cancer increases when a woman consumes 1 ounce or more 
        of absolute alcohol daily.
            (14) The National Institute on Alcohol Abuse and Alcoholism 
        has identified areas for future research on alcohol abuse and 
        alcoholism among women. These areas were identified by the 
        Institute more than a decade ago, yet a sufficient number of 
        research projects regarding such areas has yet to be conducted.

SEC. 113. PROVISIONS REGARDING INCREASE IN AMOUNT OF FUNDS EXPENDED FOR 
              RESEARCH ON ALCOHOL ABUSE AND ALCOHOLISM AMONG WOMEN.

    Section 464H(d)(1) of the Public Health Service Act (42 U.S.C. 
285n(d)(1)), as added by section 122 of Public Law 102-321 (106 Stat. 
358), is amended by adding at the end the following new sentence: ``For 
fiscal year 1994, of the first $131,606,000 appropriated under the 
preceding sentence, the Director of the Institute shall obligate not 
less than $14,200,000 for the purpose of carrying out under this 
subpart projects of research on alcohol abuse and alcoholism among 
women, and of the amounts appropriated under such sentence in excess of 
$131,606,000, the Director shall obligate for such purpose not less 
than $23,250,000.''.

        Subtitle D--National Breast Cancer Strategy Act of 1993

SEC. 116. SHORT TITLE.

    This subtitle may be cited as the ``National Breast Cancer Strategy 
Act of 1993''.

 PART I--ESTABLISHMENT OF OFFICE OF BREAST CANCER AND NATIONAL BREAST 
                           CANCER COMMISSION

SEC. 117. OFFICE OF BREAST CANCER.

    Title XVII of the Public Health Service Act (42 U.S.C. 300uu et 
seq.) is amended by adding at the end the following new section:

``SEC. 1709. ESTABLISHMENT OF OFFICE OF BREAST CANCER.

    ``(a) In General.--There is established an Office of Breast Cancer 
within the Office of the Assistant Secretary for Health. The Office 
shall have a Director who shall be appointed by the Secretary. The 
Secretary, acting through the Director, shall carry out this section.
    ``(b) Duties.--The Secretary shall coordinate, in conjunction with 
the Director of the National Cancer Institute, the activities of the 
Institute relating to breast cancer with similar activities of other 
agencies of the Federal Government, including the other agencies of the 
National Institutes of Health, and with similar activities of other 
public entities and of private entities.''.

SEC. 118. ESTABLISHMENT OF NATIONAL BREAST CANCER COMMISSION.

    Title XVII of the Public Health Service Act (42 U.S.C. 300uu et 
seq.), as amended by section 117, is amended by adding at the end the 
following new section:

``SEC. 1710. NATIONAL BREAST CANCER COMMISSION.

    ``(a) Establishment.--There is established a commission to be known 
as the `National Breast Cancer Commission' (in this section referred to 
as the `Commission').
    ``(b) Study.--The Commission shall conduct a study on current 
efforts in both the public and private sectors relating to the 
prevention, early detection, treatment, education, and research 
relating to breast cancer.
    ``(c) Report.--Not later than 1 year after the date on which the 
initial appointments of the members have been completed under 
subsection (d), the Commission shall submit to the President and the 
Congress a report containing--
            ``(1) the results of the study conducted under subsection 
        (b); and
            ``(2) recommendations relating to such study.
    ``(d) Number and Appointment.--
            ``(1) Appointment.--The Commission shall be composed of 15 
        members as follows:
                    ``(A) 5 members shall be appointed by the 
                President--
                            ``(i) 3 of whom shall be--
                                    ``(I) the Secretary of Health and 
                                Human Services;
                                    ``(II) the Secretary of Veterans 
                                Affairs; and
                                    ``(III) the Secretary of Defense;
                        who shall be nonvoting members, except that, in 
                        the case of a tie vote by the Commission, the 
                        Secretary of Health and Human Services shall be 
                        a voting member; and
                            ``(ii) 2 of whom shall be selected from the 
                        general public on the basis of such individuals 
                        being specially qualified to serve on the 
                        Commission by reason of their education, 
                        training, or experience.
                    ``(B) 5 members shall be appointed by the Speaker 
                of the House of Representatives on the joint 
                recommendation of the Majority and Minority Leaders of 
                the House of Representatives.
                    ``(C) 5 members shall be appointed by the President 
                pro tempore of the Senate on the joint recommendation 
                of the Majority and Minority Leaders of the Senate.
            ``(2) Congressional committee recommendations.--In making 
        appointments under subparagraphs (B) and (C) of paragraph (1), 
        the Majority and Minority leaders of the House of 
        Representatives and the Senate shall duly consider the 
        recommendations of the Chairmen and Ranking Minority Members of 
        committees with jurisdiction over laws contained in chapter 17 
        of title 38, United States Code (relating to veterans' health 
        care), title XIX of the Social Security Act (42 U.S.C. 1901 et 
        seq.) (relating to Medicaid), and the Public Health Service Act 
        (42 U.S.C. 201 et seq.) (relating to the Public Health 
        Service).
            ``(3) Requirements of appointments.--The Majority and 
        Minority leaders of the Senate and the House of Representatives 
        shall--
                    ``(A) select individuals who are specially 
                qualified to serve on the Commission by reason of their 
                education, training, or experience; and
                    ``(B) engage in consultations for the purpose of 
                ensuring that the expertise of the 10 members appointed 
                by the Speaker of the House of Representatives and the 
                President pro tempore of the Senate shall provide as 
                much of a balance as possible and, to the greatest 
                extent possible, cover the fields of medicine, science, 
                law, ethics, health-care and social services.
            ``(4) Term of members.--Members of the Commission (other 
        than members appointed under paragraph (1)(A)(i)) shall serve 
        for the life of the Commission.
            ``(5) Vacancy.--A vacancy on the Commission shall be filled 
        in the manner in which the original appointment was made.
    ``(e) Chairman.--Not later than 15 days after the members of the 
Commission are appointed, such members shall select a Chairman from 
among the members of the Commission.
    ``(f) Quorum.--7 members of the Commission shall constitute a 
quorum, but a lesser number may be authorized by the Commission to 
conduct hearings.
    ``(g) Meetings.--The Commission shall hold its 1st meeting on a 
date specified by the Chairman. After the initial meeting, the 
Commission shall meet at the call of the Chairman or a majority of its 
members, but shall meet at least 3 times each year during the life of 
the Commission.
    ``(h) Pay.--Members of the Commission who are officers or employees 
or elected officials of a government entity shall receive no additional 
compensation by reason of their service on the Commission.
    ``(i) Per Diem.--While away from their homes or regular places of 
business in the performance of duties for the Commission, members of 
the Commission shall be allowed travel expenses, including per diem in 
lieu of subsistence, at rates authorized for employees of agencies 
under sections 5702 and 5703 of title 5, United States Code.
    ``(j) Deadline for Appointment.--The members of the Commission 
shall be appointed not later than 60 days after the date of the 
enactment of this section.
    ``(k) Termination.--The Commission shall cease to exist 60 days 
after the date on which its final report is submitted under subsection 
(c).''.

 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.

    Section 408(a)(1) of the Public Health Service Act (42 U.S.C. 
284c(a)(1)) is amended by adding at the end the following subparagraph:
            ``(C) For the purpose of conducting and supporting research 
        on breast cancer through the National Cancer Institute, there 
        is authorized to be appropriated for fiscal year 1994 an amount 
        equal to the sum of $300,000,000 and the amount obligated by 
        such Institute for such research for fiscal year 1993. For such 
        purpose, there are authorized to be appropriated such sums as 
        may be necessary for each of the fiscal years 1995 and 1996.''.

SEC. 120. DUTIES OF DIRECTOR.

    Subpart 1 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285 et seq.) is amended by adding at the end the following 
new section:

``SEC. 417. DUTIES OF DIRECTOR OF THE INSTITUTE RELATING TO BREAST 
              CANCER RESEARCH.

    ``(a) The Director of the Institute shall conduct and support 
biomedical and behavioral research and research training, the 
dissemination of health information, and other programs with respect to 
breast cancer.
    ``(b) In carrying out subsection (a), the Director of the Institute 
shall conduct or support multidisciplinary clinical research on breast 
cancer, including research on assisting individuals with such cancers 
(and the families of such individuals) and with responding to 
psychological and social problems that arise as the result of the 
cancer.
    ``(c)(1) The Director of the Institute shall establish the Rose 
Kushner Scholarship Program for the purpose of entering into contracts 
with individuals under which--
            ``(A) the Director of the Institute agrees to provide to 
        the individuals scholarships for attendance at accredited 
        health professions schools; and
            ``(B) the individuals agree--
                    ``(i) to complete the programs of education for 
                which the scholarships are provided;
                    ``(ii) to complete a program of postgraduate 
                clinical training in oncology; and
                    ``(iii) after completing a program of such 
                training, to serve as employees of the National 
                Institutes of Health, for the period described in 
                paragraph (2), in positions that are needed by such 
                Institutes in carrying out programs with respect to 
                breast cancer.
    ``(2)(A) For purposes of paragraph (1)(B)(iii), the period of 
service for which an individual is obligated to serve as an employee of 
the National Institutes of Health is 12 months for each academic year 
for which the scholarship under such subsection is provided.
    ``(B) The Director of the Institute may defer the obligation of an 
individual to provide a period of service under paragraph (1)(B)(iii), 
if the Director determines that such a deferral is appropriate.
    ``(C) For any period in which an individual provides service as an 
employee of the National Institutes of Health in satisfaction of the 
obligation of the individual under paragraph (1)(B)(iii), the 
individual may be appointed as such an employee without regard to the 
provisions of title 5, United States Code, relating to appointment and 
compensation.
    ``(3)(A) The Director of the Institute may not provide a 
scholarship under paragraph (1) for an academic year unless--
            ``(i) the individual applying for the scholarship has 
        submitted to the Director a proposed academic program for the 
        year and the Director has approved the program; and
            ``(ii) the individual agrees that the program will not be 
        altered without the approval of the Director.
    ``(B) The Director of the Institute may not provide a scholarship 
under paragraph (1) for an academic year unless the individual applying 
for the scholarship agrees to maintain an acceptable level of academic 
standing, as determined by the educational institution involved in 
accordance with regulations issued by the Secretary.
    ``(4)(A) The Director of the Institute may not provide a 
scholarship under paragraph (1) for an academic year in an amount 
exceeding $10,000.
    ``(B) A scholarship provided under paragraph (1) may be expended 
only for tuition expenses, other reasonable educational expenses, and 
reasonable living expenses incurred while attending the health 
professions school involved.
    ``(C) In the case of a health professions school with respect to 
which a scholarship under paragraph (1) is provided, the Director of 
the Institute may enter into a contract with the school under which the 
amounts provided in the scholarship for tuition and other educational 
expenses are paid directly to the school. Payments to the school under 
the contract may be made without regard to section 3324 of title 31, 
United States Code.
    ``(5) The provisions of section 338E shall apply to the program 
established in paragraph (1) to the same extent and in the same manner 
as such provisions apply to the National Health Service Corps Loan 
Repayment Program established in section 338B.
    ``(6) The Director of the Institute may not provide a scholarship 
under paragraph (1) unless an application for the scholarship is 
submitted to the Director and the application is in such form, is made 
in such manner, and contains such agreements, assurances, and 
information as the Director determines to be necessary to carry out 
this section.
    ``(d)(1) The Director of the Institute shall, subject to paragraph 
(2), carry out a program of entering into contracts with appropriately 
qualified health professionals under which the professionals agree to 
carry out activities with respect to breast cancer as employees of the 
National Institutes of Health in consideration of the Federal 
Government agreeing to pay, for each year of such service, not more 
than $20,000 of the principal and interest of the educational loans of 
the professionals.
    ``(2) The Director of the Institute may not enter into a contract 
with a health professional pursuant to paragraph (1) unless the 
professional has a substantial amount of educational loans relative to 
income.
    ``(3) Except to the extent inconsistent with this section, 338E 
shall apply to the program established in paragraph (1) to the same 
extent and in the same manner as such section applies to the National 
Health Service Corps Loan Repayment Program established in section 
338B.''.

SEC. 121. SPECIALIZED PROGRAMS OF RESEARCH EXCELLENCE WITH RESPECT TO 
              BREAST, LUNG, AND PROSTATE CANCER.

    Section 408(a)(1) of the Public Health Service Act, as amended by 
section 119, is amended by adding at the end the following 
subparagraph:
            ``(D)(i) For the purpose of carrying out not less than 10 
        programs for research on breast cancer, lung cancer, or 
        prostate cancer under the programs designated by the Director 
        of the National Cancer Institute as the Specialized Programs of 
        Research Excellence, there is authorized to be appropriated 
        such sums as may be necessary for each of the fiscal years 1994 
        through 1996.
            ``(ii) With respect to the purpose described in clause (i), 
        the authorizations of appropriations established in such clause 
        may not be construed as terminating the availability for such 
        purpose of any other authorization of appropriations (including 
        the authorization established in subparagraph (A).''.

             Subtitle E--Lupus Research Amendments of 1993

SEC. 126. SHORT TITLE.

    This subtitle may be cited as the ``Lupus Research Amendments of 
1993''.

SEC. 127. FINDINGS.

    The Congress finds that--
            (1) lupus is a serious, complex, inflammatory, autoimmune 
        disease of particular concern to women;
            (2) lupus affects women 9 times more often than men;
            (3) there are 3 main types of lupus: systemic lupus, a 
        serious form of the disease that affects many parts of the 
        body; discoid lupus, a form of the disease that affects mainly 
        the skin; and drug-induced lupus caused by certain medications;
            (4) lupus can be fatal if not detected and treated early;
            (5) the disease can simultaneously affect various areas of 
        the body, such as the skin, joints, kidneys, and brain, and can 
        be difficult to diagnose because the symptoms of lupus are 
        similar to those of many other diseases;
            (6) lupus disproportionately affects African-American 
        women, as the prevalence of the disease among such women is 3 
        times the prevalence among white women, and an estimated 1 in 
        250 African-American women between the ages of 15 and 65 
        develops the disease;
            (7) it has been estimated that over 500,000 Americans have 
        been diagnosed with the disease, and that many more have 
        undiagnosed cases;
            (8) current treatments for the disease can be effective, 
        but may lead to damaging side effects; and
            (9) many victims of the disease suffer debilitating pain 
        and fatigue, making it difficult to maintain employment and 
        lead normal lives.

SEC. 128. EXPANSION AND INTENSIFICATION OF ACTIVITIES REGARDING LUPUS.

    Subpart 4 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285d et seq.) is amended by inserting after section 441 the 
following section:

                                ``lupus

    ``Sec. 441A. (a) In General.--The Director of the Institute shall 
expand and intensify research and related activities of the Institute 
with respect to lupus.
    ``(b) Coordination With Other Institutes.--The Director of the 
Institute shall coordinate the activities of the Director under 
subsection (a) with similar activities conducted by the other national 
research institutes and agencies of the National Institutes of Health 
to the extent that such Institutes and agencies have responsibilities 
that are related to lupus.
    ``(c) Programs for Lupus.--In carrying out subsection (a), the 
Director of the Institute shall conduct or support research to expand 
the understanding of the causes of, and to find a cure for, lupus. 
Activities under such subsection shall include research to determine 
the reasons underlying the elevated prevalence of the disease among 
African-American and other women. Activities under such subsection 
shall provide for an expansion and intensification of the conduct and 
support of--
            ``(1) basic research concerning the etiology and causes of 
        lupus;
            ``(2) epidemiological studies to address the frequency and 
        natural history of the disease and the differences among the 
        sexes and among racial and ethnic groups with respect to the 
        disease;
            ``(3) the development of improved screening techniques;
            ``(4) clinical research for the development and evaluation 
        of new treatments, including new biological agents; and
            ``(5) information and education programs for health care 
        professionals and the public.
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $20,000,000 
for fiscal year 1994, and such sums as may be necessary for each of the 
fiscal years 1994 through 1996. The authorization of appropriations 
established in the preceding sentence is in addition to any other 
authorization of appropriations that is available for such purpose.''.

            Subtitle F--Women's Midlife Health Research Act

SEC. 131. SHORT TITLE.

    This subtitle may be cited as the ``Women's Midlife Health Research 
Act''.

SEC. 132. ESTABLISHMENT OF PROGRAM FOR RESEARCH CENTERS ON WOMEN'S 
              MIDLIFE HEALTH CARE, INCLUDING MENOPAUSE AND MENOPAUSAL 
              HEALTH CONDITIONS.

    Subpart 5 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285e et seq.) is amended by adding at the end the following 
section:

    ``research centers on menopause and menopausal health conditions

    ``Sec. 445G. (a) The Director of the Institute, after consultation 
with the advisory council for the Institute, shall provide for the 
development or expansion of not less than 5 centers for research on--
            ``(1) the process by which the functioning of the ovaries 
        diminishes or ceases completely (in this section referred to as 
        `menopause'); and
            ``(2) conditions arising from the diminished or complete 
        cessation of the functioning of the ovaries, whether occurring 
        naturally or otherwise (in this section referred to as 
        `menopausal health conditions').
    ``(b) Each center assisted under this section shall--
            ``(1)(A) use the facilities of a single institution or a 
        consortium of cooperating institutions; and
            ``(B) meet such qualifications as may be prescribed by the 
        Secretary;
            ``(2) conduct basic and clinical research into the natural 
        history of menopause in order to improve the state of medical 
        knowledge or methods regarding the cause, diagnosis, early 
        detection, prevention, control, and treatment of menopausal 
        health conditions;
            ``(3) develop multidisciplinary models of health care 
        regarding menopause and menopausal health conditions;
            ``(4) conduct educational and training programs on 
        menopause and menopausal health conditions for physicians, 
        scientists, and other health and allied health professionals;
            ``(5) conduct information and continuing education programs 
        for physicians and other health and allied health professionals 
        who provide care for patients with such conditions; and
            ``(6) conduct programs for the dissemination to the general 
        public of information on menopause and menopausal health 
        conditions.
    ``(c) In carrying out subsection (b)(2), the Director of the 
Institute shall ensure that centers assisted under this section--
            ``(1) conduct research on hormonal treatments for 
        menopausal health conditions, research on nonhormonal 
        treatments of symptoms arising from such conditions, and 
        research on the relationship between such conditions and 
        cardiovascular disease, osteoporosis, bone fractures, bladder 
        conditions, breast and uterine cancers, and other conditions 
        that research indicates may be relevant; and
            ``(2) conduct research to determine whether and to what 
        extent differences may exist, with respect to menopause and 
        menopausal health conditions, among various socioeconomic 
        groups, ethnic groups, and racial groups.
    ``(d) In carrying out subsection (a), the Director of the 
Institute, in consultation with the Director of NIH and the 
Administrator for Health Care Policy and Research, shall establish a 
program to develop protocols for the prevention and treatment of 
menopausal health conditions and other conditions regarding women's 
midlife health.
    ``(e) A center may use funds provided under subsection (a) to 
provide stipends for health professionals enrolled in educational or 
training programs described in subsection (b)(4).
    ``(f) The Director shall ensure that the activities of centers 
assisted under this section are coordinated among the centers.
    ``(g) The Director of the Institute shall, to the extent 
practicable, provide for an equitable geographical distribution of 
centers assisted under this section.
    ``(h) Support of a center under this section may be for a period of 
not to exceed five years. Such period may be extended by the Director 
of the Institute for one or more additional periods of not more than 
five years if the operations of such center have been reviewed by an 
appropriate technical and scientific peer review group established by 
the Director and if such group has recommended to the Director that 
such period should be extended.''.

Subtitle G--Osteoporosis and Related Bone Disorders Research Education, 
                    and Health Services Act of 1993

SEC. 136. SHORT TITLE.

    This subtitle may be cited as the ``Osteoporosis and Related Bone 
Disorders Research, Education, and Health Services Act of 1993''.

SEC. 137. FINDINGS.

    The Congress finds that--
            (1) osteoporosis, or porous bone, is a condition 
        characterized by an excessive loss of bone tissue and an 
        increased susceptibility to fractures of the hip, spine, and 
        wrist;
            (2) an estimated 25,000,000 Americans have osteoporosis, 
        with many cases undiagnosed because the condition develops 
        without symptoms until a strain, bump, or fall causes a 
        fracture;
            (3) between 3 and 4 million Americans have Paget's disease, 
        Osteogenesis Imperfecta, and other related metabolic bone 
        disorders;
            (4) osteoporosis is responsible for 1,300,000 bone 
        fractures annually, including more than 250,000 hip fractures, 
        500,000 vertebral fractures, 200,000 fractures of the wrist, 
        and the remaining fractures at other limb sites;
            (5) osteoporosis affects one-third to one-half of all 
        postmenopausal women and nearly half of all people over age 75;
            (6) direct medical costs of osteoporosis reached an 
        estimated $10,000,000,000 in 1988 for the United States, not 
        including the costs of family care and lost work for 
        caregivers;
            (7) direct medical costs of osteoporosis are expected to 
        increase precipitously because the proportion of the population 
        comprised of older persons is expanding and each generation of 
        older persons tends to have a higher incidence of osteoporosis 
        than preceding generations;
            (8) technology now exists, and new technology is 
        developing, that will permit early diagnosis and prevention of 
        osteoporosis as well as management of the condition once it has 
        developed;
            (9) funding for research on osteoporosis and related bone 
        disorders is severely constrained at key research institutes, 
        including the National Institute of Arthritis and 
        Musculoskeletal and Skin Diseases, the National Institute on 
        Aging, and the National Institute of Diabetes and Digestive and 
        Kidney Diseases;
            (10) further research is needed to improve medical 
        knowledge concerning--
                    (A) cellular mechanisms related to the processes of 
                bone resorption and bone formation, and the effect of 
                different agents on bone remodeling;
                    (B) risk factors for osteoporosis, including newly 
                discovered risk factors, risk factors related to groups 
                not ordinarily studied, such as men and minorities, and 
                the relationship of aging processes to the development 
                of osteoporosis;
                    (C) bone mass measurement technology, including 
                techniques for making faster and more precise 
                measurements and for interpreting measurements;
                    (D) calcium, including bioavailability, intake 
                requirements, and the role of calcium in building 
                heavier and denser skeletons;
                    (E) prevention and treatment, including the 
                efficacy of current therapies, alternative drug 
                therapies for prevention and treatment, and the role of 
                exercise; and
                    (F) rehabilitation; and
            (11) further educational efforts are needed to increase 
        public and professional knowledge of the causes of, methods for 
        avoiding, and treatment of osteoporosis.

SEC. 138. OSTEOPOROSIS RESEARCH.

    Subpart 4 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285d et seq.) is amended--
            (1) by inserting after the subpart designation and heading 
        the following:

                       ``DIVISION A--ARTHRITIS'';

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

                       ``DIVISION B--OSTEOPOROSIS

``SEC. 442A. DEFINITIONS.

    ``As used in this division:
            ``(1) Advisory panel.--The term `Advisory Panel' means the 
        Advisory Panel on Osteoporosis and Related Disorders, 
        established in section 442D.
            ``(2) Council.--The term `Council' means the Interagency 
        Council on Osteoporosis and Related Disorders, established in 
        section 442C.
            ``(3) Department.--The term `Department' means the 
        Department of Health and Human Services.
            ``(4) Related disorders.--The term `related bone disorders' 
        includes--
                    ``(A) Paget's disease, a bone disease characterized 
                by enlargement and loss of density with bowing and 
                deformity of the bones;
                    ``(B) Osteogenesis Imperfecta, a familial disease 
                marked by extreme brittleness of the long bones;
                    ``(C) hyperparathyroidism, a condition 
                characterized by the presence of excess parathormone in 
                the body resulting in disturbance of calcium metabolism 
                with loss of calcium from bone and renal damage;
                    ``(D) hypoparathyroidism, a condition characterized 
                by the absence of parathormone resulting in 
                disturbances of calcium metabolism;
                    ``(E) renal bone disease, a disease characterized 
                by metabolic disturbances from dialysis, renal 
                transplants, or other renal disturbances;
                    ``(F) primary or postmenopausal osteoporosis and 
                secondary osteoporosis, such as that induced by 
                corticosteroids; and
                    ``(G) other general disorders of bone and mineral 
                metabolism including abnormalities of vitamin D.
            ``(5) Resource center.--The term `Resource Center' means 
        the Resource Center on Osteoporosis and Related Disorders, 
        established in section 442E.

``SEC. 442B. EXPANSION OF RESEARCH ON OSTEOPOROSIS AND RELATED BONE 
              DISORDERS.

    ``(a) Research.--The Director of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases, the Director of the 
National Institute on Aging, and the Director of the National Institute 
of Diabetes and Digestive and Kidney Diseases shall expand and 
intensify research on osteoporosis and related bone disorders. The 
research shall be in addition to research that is authorized under any 
other provision of law.
    ``(b) Research Centers.--The Director of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases shall increase the 
number of Specialized Centers of Research devoted to research on 
osteoporosis and related bone disorders. The Director of the National 
Institute on Aging shall increase the number of program project grants 
devoted to creating centers of excellence in osteoporosis and related 
bone disorders. The Director of the National Institute of Diabetes and 
Digestive and Kidney Diseases shall increase the number of program 
projects grants in osteoporosis.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $36,000,000 for the National 
Institute of Arthritis and Musculoskeletal and Skin Diseases, 
$24,000,000 for the National Institute on Aging, and $2,000,000 for the 
National Institute of Diabetes and Digestive and Kidney Diseases for 
each of the fiscal years 1994 through 1996, and such sums as may be 
necessary for subsequent fiscal years. These funds are in addition to 
amounts authorized to be appropriated for biomedical research relating 
to osteoporosis and related bone disorders under any other provision of 
law.

``SEC. 442C. INTERAGENCY COUNCIL ON OSTEOPOROSIS AND RELATED BONE 
              DISORDERS.

    ``(a) Establishment.--There is established in the Department an 
Interagency Council on Osteoporosis and Related Disorders. The Council 
shall be composed of--
            ``(1) the Assistant Secretary for Health;
            ``(2) the Surgeon General of the United States;
            ``(3) the Assistant Secretary for Planning and Evaluation 
        of the Department;
            ``(4) the Director of the National Institute of Arthritis 
        and Musculoskeletal and Skin Diseases;
            ``(5) the Director of the National Institute on Aging;
            ``(6) the Director of the National Institute of Diabetes, 
        Digestive, and Kidney Diseases;
            ``(7) the Director of the National Institute of Mental 
        Health;
            ``(8) the Director of the National Institute of Child 
        Health and Human Development;
            ``(9) the Administrator of the Health Care Financing 
        Administration;
            ``(10) the Administrator for Health Care Policy and 
        Research;
            ``(11) the Director of the Bureau of Child and Maternal 
        Health;
            ``(12) the Commissioner of Food and Drugs;
            ``(13) the Director of the National Institute of Dental 
        Research;
            ``(14) the Commissioner on Aging;
            ``(15) the Director of the Office of Disease Prevention and 
        Health Promotion; and
            ``(16) such additional members as the Secretary considers 
        appropriate.
    ``(b) Functions.--The Council shall--
            ``(1) coordinate research conducted by or through the 
        Department on osteoporosis and related bone disorders;
            ``(2) establish a mechanism for sharing information on 
        osteoporosis and related bone disorders among all officers and 
        employees of the Department involved in carrying out programs 
        serving older persons, midlife women, and young persons, in 
        order to provide for full communication and exchange of 
        information;
            ``(3) review and coordinate the most promising areas of 
        research concerning osteoporosis and related bone disorders;
            ``(4) assist the National Institute of Arthritis and 
        Musculoskeletal and Skin Diseases, the National Institute on 
        Aging, the National Institute of Diabetes, Digestive and Kidney 
        Disease, the National Institute on Dental Research, and other 
        institutes in developing and coordinating plans for research on 
        osteoporosis and related bone disorders;
            ``(5) assist the Office of Disease Prevention and Health 
        Promotion and the Administration on Aging and other offices in 
        developing and coordinating plans for education and health 
        promotion on osteoporosis and related bone disorders; and
            ``(6) establish mechanisms to use the results of research 
        concerning osteoporosis and related bone disorders in the 
        development of policies, programs, and other measures to 
        improve the quality of life for older Americans.
    ``(c) Chairperson.--The Secretary shall select a Chairperson or co-
Chairpersons for the Council from among its members.
    ``(d) Quorum.--A majority of the members of the Council shall 
constitute a quorum, but a lesser number may hold hearings.
    ``(e) Meetings.--The Council shall meet periodically at the call of 
the Chairperson, but not less often than twice each year.
    ``(f) Executive Secretary.--The Secretary shall appoint an 
Executive Secretary for the Council.
    ``(g) Administrative Staff and Support.--The Secretary shall 
provide the Council with such additional administrative staff and 
support as may be necessary to enable the Council to carry out its 
functions.
    ``(h) Reports.--
            ``(1) Initial report.--
                    ``(A) Preparation.--Not later than 9 months after 
                the date of enactment of this division, the Executive 
                Secretary of the Council shall prepare a report 
                detailing the research plans referred to in paragraphs 
                (4) and (5) of subsection (b). The report shall 
                describe the activities to be carried out under the 
                research plans during each of the fiscal years 1994 
                through 1996.
                    ``(B) Other federal programs.--To the maximum 
                extent feasible, the report shall ensure that 
                activities carried out under the research plans are 
                coordinated with, and use the resources of, other 
                Federal programs concerning osteoporosis and related 
                bone disorders, including--
                            ``(i) centers supported by the National 
                        Institute of Arthritis and Musculoskeletal and 
                        Skin Diseases, the National Institute on Aging, 
                        and the National Institute of Diabetes, 
                        Digestive and Kidney Disease;
                            ``(ii) other centers supported by Federal 
                        funds involved in research on osteoporosis and 
                        related bone disorders; and
                            ``(iii) other programs concerning 
                        osteoporosis and related bone disorders that 
                        are planned or conducted by Federal agencies 
                        such as the Administration on Aging and the 
                        Office of Disease Prevention and Health 
                        Promotion, Federal agencies outside the 
                        Department, State or local agencies, community 
                        organizations, or private foundations.
                    ``(C) Distribution.--The Executive Secretary of the 
                Council shall--
                            ``(i) transmit the report to Congress; and
                            ``(ii) make the report available to the 
                        public and to the Advisory Panel.
            ``(2) Subsequent reports.--Not later than 12 months after 
        the date on which the report required by paragraph (1) is 
        transmitted to Congress, and annually thereafter, the Executive 
        Secretary of the Council shall--
                    ``(A) prepare a report that--
                            ``(i) describes research and educational 
                        initiatives sponsored by the Federal Government 
                        on osteoporosis and related bone disorders; and
                            ``(ii) makes recommendations for new 
                        research and educational initiatives on 
                        osteoporosis and related bone disorders; and
                    ``(B) transmit the report to Congress and make the 
                report available to the public.

 ``SEC. 442D. ADVISORY PANEL ON OSTEOPOROSIS AND RELATED DISORDERS.

    ``(a) Establishment.--There is established in the Department an 
Advisory Panel on Osteoporosis and Related Disorders. The Advisory 
Panel shall be composed of the following 15 voting members and 
additional nonvoting, ex officio members:
            ``(1) Voting members.--The Director of the Office of 
        Technology Assessment shall appoint to the Advisory Panel--
                    ``(A) 5 members who are biomedical research 
                scientists with demonstrated achievement in biomedical 
                research on osteoporosis and related bone disorders, 
                including at least 1 researcher at a specialized center 
                for research in osteoporosis;
                    ``(B) 2 members with demonstrated achievements in 
                research on community-based and family services 
                covering osteoporosis and related bone disorders;
                    ``(C) 1 member who is knowledgeable in health 
                promotion and disease prevention programs concerning 
                osteoporosis and related bone disorders;
                    ``(D) 2 members who are associated with specialized 
                bone programs affiliated with academic health centers;
                    ``(E) 2 members who are experts in private health 
                care insurance and long-term care financing; and
                    ``(F) 3 members who are representatives of national 
                voluntary organizations that are concerned with the 
                problems of individuals with osteoporosis and related 
                bone disorders and their families.
            ``(2) Nonvoting, ex officio members.--The Advisory Panel 
        shall include as nonvoting, ex officio members--
                    ``(A) the Chairperson of the Council;
                    ``(B) the Director of National Institute of 
                Arthritis and Musculoskeletal and Skin Diseases;
                    ``(C) the Director of the National Institute on 
                Aging;
                    ``(D) the Director of the National Institute of 
                Diabetes and Digestive and Kidney Diseases; and
                    ``(E) such other members as the Secretary may 
                appoint.
            ``(3) Appointment.--The Director of the Office of 
        Technology Assessment shall appoint members to the Advisory 
        Panel within 90 days after the date of enactment of this 
        division. The Director shall not appoint to the Advisory Panel 
        individuals who are officers or employees of the Federal 
        Government.
    ``(b) Functions.--The Advisory Panel shall advise the Secretary and 
Council with respect to the identification of--
            ``(1) research priorities for projects on osteoporosis, 
        related bone disorders, and the care of individuals with 
        osteoporosis or related bone disorders;
            ``(2) emerging issues in and promising areas of biomedical, 
        clinical, and behavioral research on osteoporosis and related 
        bone disorders;
            ``(3) emerging issues in research on health services for 
        individuals, and the families of individuals, with osteoporosis 
        or related bone disorders;
            ``(4) emerging issues in home-based and community-based 
        services and systems of services for individuals, and the 
        families of individuals, with osteoporosis or related bone 
        disorders;
            ``(5) emerging issues in financing health care services and 
        social services for individuals, and the families of 
        individuals, with osteoporosis and related bone disorders;
            ``(6) emerging issues in health promotion programs 
        concerning osteoporosis; and
            ``(7) emerging issues in professional and public education 
        concerning osteoporosis.
    ``(c) Chairperson.--The Secretary shall appoint a Chairperson of 
the Advisory Panel from among the members appointed.
    ``(d) Term of Office.--The term of a member of the Advisory Panel 
shall be for the life of the Advisory Panel. A vacancy on the Advisory 
Panel shall be filled in the same manner as the original appointment 
was made. A vacancy on the Advisory Panel shall not affect its powers.
    ``(e) Quorum.--A majority of the members of the Advisory Panel 
appointed shall constitute a quorum, but a lesser number may hold 
hearings. The Advisory Panel may establish such subcommittees as the 
Advisory Panel considers appropriate.
    ``(f) Meetings.--The Advisory Panel shall meet at the call of the 
Chairperson, but not less often than twice per year.
    ``(g) Executive Secretary.--The Executive Secretary of the Council 
shall serve as Executive Secretary of the Advisory Panel.
    ``(h) Staff and Support.--The Secretary shall provide the Advisory 
Panel with such additional administrative staff and support as may be 
necessary to enable the Advisory Panel to carry out its functions.
    ``(i) Compensation and Travel Expenses.--
            ``(1) Compensation.--Subject to paragraph (2), no member of 
        the Advisory Panel shall receive compensation for service on 
        the Advisory Panel.
            ``(2) Travel expenses.--Each member of the Advisory Panel 
        shall receive reimbursement for travel, subsistence, and other 
        necessary expenses incurred in the performance of duties of the 
        Advisory Panel.
    ``(j) Report.--The Advisory Panel shall--
            ``(1) prepare an annual report, which shall contain 
        recommendations for administrative and legislative actions to--
                    ``(A) improve services, education, and information 
                for individuals, and families of individuals, with 
                osteoporosis and related bone disorders;
                    ``(B) improve professional education; and
                    ``(C) provide for promising biomedical research 
                related to osteoporosis and related bone disorders; and
            ``(2) transmit the annual report to the Congress, the 
        Secretary, and the Council and make it available to the public.
    ``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $200,000 for each of fiscal 
years 1994 through 1996.

``SEC. 442E. RESOURCE CENTER ON OSTEOPOROSIS AND RELATED DISORDERS.

    ``(a) Establishment.--The Director of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases shall make grants or 
enter into contracts with eligible organizations to establish a 
Resource Center on Osteoporosis and Related Disorders.
    ``(b) Purpose.--The purpose of the Resource Center shall be to 
facilitate and enhance knowledge and understanding of osteoporosis and 
related bone disorders by disseminating information about research 
results, services and educational materials, to health professionals, 
patients, and the public.
    ``(c) Functions.--An organization receiving a grant or contract 
under this section shall--
            ``(1) compile, archive, and disseminate information 
        concerning research, demonstration, evaluation, and training 
        programs and projects concerning osteoporosis and related bone 
        disorders;
            ``(2) annually publish a summary of the information 
        compiled under paragraph (1) during the preceding 12-month 
        period, and make the information available on request to 
        appropriate individuals and entities, including educational 
        institutions, research entities, and Federal and public 
        agencies;
            ``(3) provide information and assistance in accessing 
        community services to patients and the public;
            ``(4) coordinate regional training programs for the 
        development of health professional resource networks on 
        osteoporosis and related bone disorders; and
            ``(5) maintain a resource library on osteoporosis and 
        related bone disorders.
    ``(d) Information System and Telephone Line.--
            ``(1) Information system.--An organization receiving a 
        grant or contract under this section shall establish a central 
        computerized information system to--
                    ``(A) compile and disseminate information 
                concerning initiatives by State and local governments 
                and private entities to provide programs and services 
                for individuals with osteoporosis; and
                    ``(B) translate scientific and technical 
                information concerning the initiatives into information 
                readily understandable by the general public, and make 
                the information available on request.
            ``(2) Telephone line.--An organization receiving a grant or 
        contract under this section shall establish a national toll-
        free telephone line to make available the information described 
        in paragraph (1) and information concerning Federal programs, 
        services, and benefits for individuals with osteoporosis and 
        their families.
    ``(e) Fees.--In accordance with regulations issued by the 
Secretary, the organization receiving a grant or contract under this 
section shall charge appropriate fees for providing information through 
the Research Center as specified in subsections (c) or (d). The 
organization may make exceptions to the fees for individuals and 
organizations who are not financially able to pay the fees. The 
organization shall transfer the sums obtained from payment of the fees 
to the Secretary, who shall use the sums to carry out this section.
    ``(f) Application or Proposal.--In order to receive a grant or 
enter into a contract under this section, an organization shall submit 
an application or proposal to the Director of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases. The application or 
proposal shall contain--
            ``(1) information demonstrating that the organization has a 
        network of contacts that will enable the organization to 
        receive information necessary to operate the central 
        computerized information system described in subsection (d)(1); 
        and
            ``(2) such other information as the Director may prescribe.
    ``(g) Eligible Organizations.--Organizations eligible to receive 
grants under this section shall include public and private nonprofit 
organizations that are knowledgeable about osteoporosis and related 
bone disorders. The Secretary shall establish additional eligibility 
criteria for organizations to receive grants or enter into contracts 
under this section.
    ``(h) Research Summaries.--The Director of the National Institute 
of Arthritis and Musculoskeletal and Skin Diseases, the National 
Institute on Aging, the National Institute of Diabetes, Digestive, and 
Kidney Diseases, the National Institute on Dental Research, and other 
agencies specified by the Secretary shall provide to the Resource 
Center summaries of the findings of research conducted on osteoporosis, 
related bone disorders, or relevant treatments for osteoporosis or 
related bone disorders.
    ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $500,000 for fiscal year 1994, 
and such sums as may be necessary for fiscal years 1995 and 1996.''.

 Subtitle H--Ovarian Cancer Research and Information Amendments of 1993

SEC. 141. SHORT TITLE.

    This subtitle may be cited as the ``Ovarian Cancer Research and 
Information Amendments of 1993''.

SEC. 142. FUNDING FOR RESEARCH ON OVARIAN CANCER.

    Section 417B(b)(2) of the Public Health Service Act, as added by 
section 403 of Public Law 103-43, is amended--
            (1) by striking ``cancers.--For the purpose of'' and all 
        that follows through ``417,'' and inserting the following: 
        ``cancers.--
                    ``(A) For the purpose of carrying out section 
                417(d),''; and
            (2) by adding at the end the following subparagraph:
                    ``(B)(i) For the purpose of carrying out research 
                under section 417(d) on ovarian cancer, there are 
                authorized to be appropriated $90,000,000 for fiscal 
                year 1994, and such sums as may be necessary for each 
                of the fiscal years 1995 and 1996. With respect to such 
                purpose, such authorizations of appropriations are in 
                addition to the authorizations of appropriations 
                established in subparagraph (A) and in subsection (a).
                    ``(ii) Of the amounts appropriated under clause 
                (i), the Director of the Institute shall reserve 50 
                percent for research described in such clause that does 
                not involve treatment or clinical trials, and 50 
                percent for research described in such clause that does 
                involve treatment and clinical trials.
                    ``(iii) In expending the amounts reserved under 
                clause (ii), the Director of the Institute shall ensure 
                that 1 or more programs of research on ovarian cancer 
                are carried out under the programs designated by the 
                Director as the Specialized Programs of Research 
                Excellence.''.

SEC. 143. PUBLIC INFORMATION AND EDUCATION ON OVARIAN CANCER.

    Section 417(d)(4) of the Public Health Service Act, as added by 
section 401 of Public Law 103-43, is amended by striking ``section 413; 
and'' and inserting the following: ``section 413, which programs shall 
include programs on ovarian cancer that (subject to changes in the 
applicable facts) provide information and education regarding--
                    ``(A) screening procedures for such cancer, 
                including the fact that there is not a procedure that 
                reliably provides for the early detection of such 
                cancer;
                    ``(B) the fact that there may be a genetic basis to 
                such cancer;
                    ``(C) factors indicating a substantial risk of such 
                cancer; and
                    ``(D) the various treatments for such cancer and 
                the extent to which the treatments are effective; 
                and''.

             Subtitle I--Antiprogestin Testing Act of 1993

SEC. 146. SHORT TITLE.

    This subtitle may be cited as the ``Antiprogestin Testing Act of 
1993''.

SEC. 147. RESEARCH.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the National Institutes of Health, may conduct 
and support research (including clinical trials) on antiprogestin drugs 
for their safety and efficacy for any potential use, including 
termination of pregnancy and contraception, and when used 
therapeutically for cancer, endocrine disorders, and endometriosis.
    (b) Institutional Review Boards and Peer Review.--Research 
conducted or supported under subsection (a) shall be subject to 
sections 491 and 492 of the Public Health Service Act (42 U.S.C. 289, 
289a).
    (c) Priorities.--In determining priorities for research under 
subsection (a), the Secretary shall consider data from previous 
research.

SEC. 148. REPORT.

    The Secretary of Health and Human Services shall report to Congress 
the results of research conducted or supported under section 2(a) on 
January 1, 1994, and annually thereafter.

 Subtitle J--Women's Health Environmental Factors Research Act of 1993

SEC. 151. SHORT TITLE.

    This subtitle may be cited as the ``Women's Health Environmental 
Factors Research Act of 1993''.

SEC. 152. RESEARCH ON EFFECT OF ENVIRONMENTAL FACTORS ON WOMEN'S 
              HEALTH.

    Subpart 12 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285), as amended by section 1301 of Public Law 103-43 (107 
Stat. 169), is amended by adding at the end the following section:

          ``effect of environmental factors on women's health

    ``Sec. 463B. (a) The Director of the Institute shall carry out 
research on the effects that environmental factors have on women's 
health conditions (as defined in section 486), including the effect of 
such factors on breast cancer, immune disfunction, and estrogen-like 
compounds (and related compounds).
    ``(b) For the purpose of carrying out subsection (a), there are 
authorized to be appropriated $30,000,000 for fiscal year 1994, and 
such sums as may be necessary for each of the fiscal years 1995 and 
1996. Such authorization is in addition to any other authorization of 
appropriations that is established with respect to such purpose.''.

   Subtitle K--Federal Risk Assessment in Women's Health Act of 1993

SEC. 156. SHORT TITLE.

    This subtitle may be cited as the ``Federal Risk Assessment in 
Women's Health Act of 1993''.

SEC. 157. INTERAGENCY REVIEW.

    The Office of Science and Technology Policy, through the Federal 
Coordinating Council for Science, Engineering, and Technology, and in 
consultation with the Office of Research on Women's Health of the 
National Institutes of Health, shall conduct a review of all Federal 
programs that assess or mitigate the risks to women's health from 
environmental exposures, including programs setting standards for 
exposure to various pollutants, toxic substances, pesticide use, and 
pesticide residues. The results of such review, including 
recommendations for ensuring that women's health needs are addressed by 
Federal programs and policies, shall be transmitted to the Congress 
within 6 months after the date of enactment of this Act.

SEC. 158. STUDY OF RESEARCH NEEDS.

    The National Institute of Environmental Health Sciences shall enter 
into a contract with the National Research Council of the National 
Academy of Sciences for the carrying out by such Council, in 
consultation with the Office of Research on Women's Health of the 
National Institutes of Health, for a study to determine the status of 
the science base and needs of the Federal Government for research 
relating to the risks to women's health from environmental exposures, 
for the purpose of assessing and mitigating such risks. The results of 
such study shall be transmitted to the Congress within one year after 
the date of enactment of this Act.

           Subtitle L--Pharmaceutical Interactions Safety Act

SEC. 161. SHORT TITLE.

    This subtitle may be cited as the ``Pharmaceutical Interactions 
Safety Act''.

SEC. 162. CLINICAL INVESTIGATIONS.

    Section 505(b) of the Federal Food, Drug, and Cosmetic Act is 
amended by adding at the end the following:
    ``(4) Clinical investigations to be submitted as part of an 
application in accordance with paragraph (1)(A) shall include 
investigations of the possible interaction of the drug with relevant 
female or male hormones or related substances unless there is 
substantial evidence that there are no significant interactions between 
the drug under investigation and such substances or the inclusion of 
such investigations is otherwise inappropriate under guidelines 
established by the Secretary by rule.''.

SEC. 163. BIOLOGICAL PRODUCTS CLINICAL INVESTIGATIONS.  

    Section 351(c) of the Public Health Service Act (42 U.S.C. 262(c)) 
is amended by adding at the end the following:
    ``(3) Clinical investigations submitted as part of an application 
for a biological product in accordance with paragraph (1) shall include 
investigations of the possible interaction of the biological product 
with relevant female or male hormones or related substances unless 
there is substantial evidence that there are no significant 
interactions between the biological product under investigation and 
such substances or the inclusion of such investigations is otherwise 
inappropriate under guidelines established by the Secretary by rule.''.

            Subtitle M--Pharmaceutical Testing Fairness Act

SEC. 166. SHORT TITLE.

    This subtitle may be cited as the ``Pharmaceutical Testing Fairness 
Act''.

SEC. 167. NEW DRUG CLINICAL INVESTIGATIONS.

    Section 505(b) of the Federal Food, Drug, and Cosmetic Act is 
amended by adding at the end the following:
    ``(4)(A) Clinical investigations submitted as part of an 
application in accordance with paragraph (1)(A) shall include women and 
members of minority groups as subjects of such investigations unless 
the inclusion of women and minority groups is inappropriate with 
respect to the drug under investigation or is otherwise inappropriate 
under such guidelines as the Secretary shall by rule establish in 
accordance with subparagraph (B).
    ``(B) The guidelines of the Secretary respecting the inclusion of 
women and members of minority groups in clinical investigations--
            ``(i) shall provide that the costs of such inclusion is not 
        a permissible consideration in determining whether such 
        inclusion is inappropriate,
            ``(ii) shall provide that women or minority groups are not 
        required to be included if women or minority groups will not be 
        using the drug under investigation, and
            ``(iii) may provide that such inclusion is not required if 
        there is substantial scientific data demonstrating that there 
        is no significant difference between the effects that the 
        variables to be studied in the investigation have on women or 
        members of minority groups, respectively, and on the other 
        individuals who would serve as subjects in the investigation in 
        the event that the inclusion of women and members of minority 
        groups was not required.
    ``(C) Phase three clinical investigations which are submitted as 
part of an application in accordance with paragraph (1)(A) shall be 
designed so that there is a valid analysis of whether the drug under 
investigation affects women or members of minority groups differently 
than other users of the drug. If the Secretary determines that it would 
be appropriate for other phases of such investigations to be so 
designed, such other phases shall be so designed.''.

SEC. 168. DEVICE CLINICAL INVESTIGATIONS.

    Section 515(c) of the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 360e(c)) is amended by adding at the end the following:
    ``(3)(A) Clinical investigations submitted as part of an 
application in accordance with paragraph (1) shall include women and 
members of minority groups as subjects of such investigations unless 
the inclusion of women and minority groups is inappropriate with 
respect to the device under investigation or is otherwise inappropriate 
under such guidelines as the Secretary shall by rule establish in 
accordance with subparagraph (B).
    ``(B) The guidelines of the Secretary respecting the inclusion of 
women and members of minority groups in clinical investigations--
            ``(i) shall provide that the costs of such inclusion is not 
        a permissible consideration in determining whether such 
        inclusion is inappropriate,
            ``(ii) shall provide that women or minority groups are not 
        required to be included if women or minority groups will not be 
        using the device under investigation, and
            ``(iii) may provide that such inclusion is not required if 
        there is substantial scientific data demonstrating that there 
        is no significant difference between the effects that the 
        variables to be studied in the investigation have on women or 
        members of minority groups, respectively, and on the other 
        individuals who would serve as subjects in the investigation in 
        the event that the inclusion of women and members of minority 
        groups was not required.
    ``(C)(i) Clinical investigations designated by the Secretary under 
clause (ii) which are submitted as part of an application in accordance 
with paragraph (1) shall be designed so that there is a valid analysis 
of whether the device under investigation affects women or members of 
minority groups differently than other users of the device.
    ``(ii) The Secretary shall designate which of the clinical 
investigations submitted as part of an application under paragraph (1) 
shall be subject to the requirement of clause (i).''.

SEC. 169. BIOLOGICAL PRODUCTS CLINICAL INVESTIGATIONS.

    Section 351(c) of the Public Health Service Act (42 U.S.C. 262(c)) 
is amended by adding at the end the following:
    ``(3)(A) Clinical investigations submitted as part of an 
application in accordance with paragraph (1) shall include women and 
members of minority groups as subjects of such investigations unless 
the inclusion of women and minority groups is inappropriate with 
respect to the biological product under investigation or is otherwise 
inappropriate under such guidelines as the Secretary shall by rule 
establish in accordance with subparagraph (B).
    ``(B) The guidelines of the Secretary respecting the inclusion of 
women and members of minority groups in clinical investigations--
            ``(i) shall provide that the costs of such inclusion is not 
        a permissible consideration in determining whether such 
        inclusion is inappropriate,
            ``(ii) shall provide that women or minority groups are not 
        required to be included if women or minority groups will not be 
        using the biological product under investigation, and
            ``(iii) may provide that such inclusion is not required if 
        there is substantial scientific data demonstrating that there 
        is no significant difference between the effects that the 
        variables to be studied in the investigation have on women or 
        members of minority groups, respectively, and on the other 
        individuals who would serve as subjects in the investigation in 
        the event that the inclusion of women and members of minority 
        groups was not required.
    ``(C)(i) Clinical investigations designated by the Secretary under 
clause (ii) which are submitted as part of an application in accordance 
with paragraph (1) shall be designed so that there is a valid analysis 
of whether the device under investigation affects women or members of 
minority groups differently than other users of the device.
    ``(ii) The Secretary shall designate which of the clinical 
investigations submitted as part of an application under paragraph (1) 
shall be subject to the requirement of clause (i).''.

   Subtitle N--Tobacco Advertising and Promotion Studies Act of 1993

SEC. 171. SHORT TITLE.

    This subtitle may be cited as the ``Tobacco Advertising and 
Promotion Studies Act of 1993''.

SEC. 172. FINDINGS.

    (a) Women.--The Congress makes the following findings respecting 
women and tobacco:
            (1) The fastest growing sector of smokers in the United 
        States are women under the age of 23. Approximately 2,000 women 
        smoke their first cigarette every day.
            (2) It is expected that between the years 2005 and 2010, 
        the number of women dying from smoking related diseases will 
        exceed the number of men so dying.
            (3) Each year tobacco kills more than 147,000 women in the 
        United States, mostly through cigarette smoking induced heart 
        disease, lung cancer, and other lung diseases.
            (4) As smoking by women has increased, lung cancer in women 
        has skyrocketed. In 1987 lung cancer surpassed breast cancer as 
        the leading cancer killer of women.
            (5) Women who smoke as little as one to 4 cigarettes each 
        day increase their risk of heart attack by 2 to 3 times.
            (6) Once women start to smoke they find it more difficult 
        to quit than do men.
            (7) Women who smoke cigarettes during pregnancy increase 
        the risk for low birth weight and premature infants, 
        miscarriage, stillbirths, sudden infant death syndrome, and 
        infant mortality.
            (8) Pregnant women who smoke deliver babies an average of 
        one-half inch shorter and 7 ounces lighter than the babies of 
        nonsmoking mothers. There is a 25 to 50 percent higher rate of 
        fetal and infant death among women who smoke during pregnancy 
        compared with those who do not smoke. It is estimated that 
        4,000 infants die each year because of their mother's smoking.
            (9) Approximately 44 percent of all women who currently 
        smoke have attempted to quit smoking in the past year.
            (10) Cigarette smoking increases women's risk of 
        contracting cervical cancer.
    (b) Minorities.--The Congress makes the following findings 
respecting minorities and tobacco:
            (1) Tobacco use by African-Americans is responsible for 
        nearly 48,000 deaths each year in the United States.
            (2) Tobacco companies aggressively target members of the 
        African-American community and the growing Hispanic population, 
        particularly in the urban, inner-city environment.
            (3) As of 1991, 29.2 percent of African-American adults 
        (aged 18 and older) smoked cigarettes, including 35.1 percent 
        of African-American men and 24.4 percent of African-American 
        women.
            (4) As of 1991, 16 percent of Asian/Pacific Islander adults 
        (aged 18 and older) smoke cigarettes, including 24.2 percent of 
        Asian/Pacific Islander men and 7.5 percent of Asian/Pacific 
        Islander women.
            (5) As of 1991, 31.4 percent of American Indian/Alaskan 
        Natives adults (aged 18 and older) smoked cigarettes, including 
        27.9 percent of American Indian/Alaskan Natives men and 35.2 
        percent of American Indian/Alaskan Natives women.
            (6) As of 1991, 20.2 percent of Hispanic adults (aged 18 
        and older) smoked cigarettes, including 25.2 percent of 
        Hispanic men and 15.5 percent Hispanic women.
            (7) African Americans suffer from tobacco-related disease 
        at a higher rate than whites, including a higher incidence of 
        respiratory system, esophagus, and oral cavity cancers.
            (8) Lung cancer is increasing among Hispanic men.

SEC. 173. TOBACCO ADVERTISING STUDIES.

    (a) Studies.--The Federal Trade Commission shall conduct the 
following studies which should be based on existing studies and on 
significant original market research:
            (1) Women and minorities.--A study of current tobacco 
        advertising to determine--
                    (A) if and in what forms such advertising is 
                designed and disseminated in such a way as to appeal 
                specifically to (i) girls and women and (ii) minorities 
                to promote their use of tobacco, and
                    (B) whether targeting girls, women, and minorities 
                increases tobacco use.
        In connection with such study, advertising of alcoholic 
        beverages shall be reviewed to determine the extent to which 
        such advertising targets girls and women and minorities.
            (2) Weight loss and maintenance.--
                    (A) In general.--A study of current cigarette 
                advertising to investigate the targeting of girls and 
                women in cigarette advertising and tobacco companies' 
                use of messages in their advertising concerning weight 
                loss and weight maintenance, the wording and overall 
                imagery used in such advertising and its impact on 
                girls and women, and the perception of girls and women, 
                including smokers and non-smokers, of the relation 
                between the use of tobacco and weight control and 
                maintenance.
                    (B) Terms and imagery.--In conducting the study 
                under subparagraph (A), the Federal Trade Commission 
                shall examine--
                            (i) whether women interpret the use of the 
                        terms ``slim'', ``light'', ``thin'', 
                        ``superslim'', and related terms and the shape 
                        of cigarettes employing such terms as implying 
                        that cigarette smoking results in weight loss 
                        or weight maintenance,
                            (ii) whether girl's and women's 
                        interpretation of such terms and imagery 
                        accurately reflects the actual effect of 
                        cigarette smoking on weight,
                            (iii) the relative impact of cigarette 
                        smoking on the health of girls and women, and
                            (iv) what action should be taken by the 
                        Federal Trade Commission with respect to 
                        advertising using such terms and imagery.
            (3) Demographics.--A study of the demographics of cigarette 
        advertising and promotions which are targeted at girls, women, 
        and minorities, including the age, gender, race, ethnicity, and 
        socio-economic groups of the girls, women, and minorities and, 
        in the case of minorities, the demographics of such advertising 
        and promotions for smokeless tobacco products. Such study shall 
        include an examination of the expenditures for advertising and 
        promotions for each of the aspects of girls, women, and 
        minorities referred to in the preceding sentence.
    (b) Report.--The Federal Trade Commission shall complete each of 
the studies identified in subsection (a) not later than 9 months after 
the date of the enactment of this Act and shall, not later than 12 
months after such date, report to the Congress--
            (1) the results of such studies, and
            (2) any actions the Commission proposes to take on the 
        basis of such findings.

              TITLE II--SERVICES REGARDING WOMEN'S HEALTH

         Subtitle A--Equity in Health Professions Education Act

SEC. 201. SHORT TITLE.

    This subtitle may be cited as the ``Equity in Health Professions 
Education Act''.

SEC. 202. STUDY REGARDING CURRICULA OF HEALTH PROFESSIONS SCHOOLS AND 
              WOMEN'S HEALTH CONDITIONS.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Administrator of the Health Resources and Services 
Administration, shall conduct a study for the purpose of determining 
the extent to which health professions schools provide adequate 
education to students on women's health conditions. The Secretary shall 
give priority in the study to schools of medicine and osteopathic 
medicine.
    (b) Consultations.--The Secretary shall carry out subsection (a) in 
consultation with the Director of the Office of Research on Women's 
Health and the Director of the Office of Women's Health.
    (c) Certain Elements of Study.--In conducting the study under 
subsection (a), the Secretary--
            (1) shall assess the content of the educational programs of 
        health professions schools with respect to women's health 
        conditions, including the content of programs providing 
        clinical training; and
            (2) shall, if the Secretary determines that the extent of 
        education on such conditions is inadequate, determine the 
        extent to which such inadequacy is affecting the health of 
        women.
    (d) Comments and Recommendations of Public and Private Entities.--
In carrying out subsection (a), the Secretary shall consider the 
comments and recommendations of public and private entities regarding 
the study under such subsection, including representatives of health 
professions schools and representatives of organizations concerned with 
women's health conditions.
    (e) Report.--Not later than April 1, 1995, the Secretary shall 
complete the study required in subsection (a) and submit to the 
Committee on Energy and Commerce and the Committee on Appropriations of 
the House of Representatives, and to the Committee on Labor and Human 
Resources and the Committee on Appropriations of the Senate, a report 
describing the findings made as a result of the study and containing 
any recommendations of the Secretary regarding such findings, including 
recommendations regarding the accreditation of health professions 
schools and the licensure of health professionals.
    (f) Definitions.--For purposes of this section:
            (1) The term ``health professions schools'' means--
                    (A) the schools and programs defined in section 
                799(1) of the Public Health Service Act (other than 
                schools of veterinary medicine); and
                    (B) schools of nursing, as defined in section 853 
                of such Act.
            (2) The term ``Office of Research on Women's Health'' means 
        the Office of Research on Women's Health established within the 
        Office of the Director of the National Institutes of Health.
            (3) The term ``Office of Women's Health'' means the Office 
        of Women's Health established within the Office of the 
        Assistant Secretary for Health.
            (4) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (5) The term ``women's health conditions'' has the meaning 
        given such term in section 486 of the Public Health Service 
        Act.

             Subtitle B--Women's Health Office Act of 1993

SEC. 206. SHORT TITLE.

    This subtitle may be cited as the ``Women's Health Office Act of 
1993''.

SEC. 207. PUBLIC HEALTH SERVICE OFFICE OF WOMEN'S HEALTH.

    Part A of title III of the Public Health Service Act (42 U.S.C. 241 
et seq.) is amended by adding at the end thereof the following new 
section:

            ``public health service office of women's health

    ``Sec. 310A. (a) Establishment of Office.--There is established an 
Office of Women's Health (hereafter referred to in this section as the 
`Office') within the Office of the Assistant Secretary for Health.
    ``(b) Assistant Secretary.--There shall be in the Department of 
Health and Human Services a Deputy Assistant Secretary for Women's 
Health, who shall be the head of the Office. The Secretary, acting 
through such Deputy Assistant Secretary, shall carry out this section.
    ``(c) Duties.--The Secretary, acting through the Office, shall, 
with respect to the health concerns of women--
            ``(1) establish short-range and long-range goals and 
        objectives and coordinate all other activities within the 
        Department of Health and Human Services that relate to disease 
        prevention, health promotion, service delivery, and research 
        concerning women;
            ``(2) advise the Assistant Secretary for Health concerning 
        scientific, legal, ethical, and policy issues relating to 
        women's health;
            ``(3) monitor Public Health Service agency and regional 
        activities regarding women's health, and coordinate activities 
        of such agency Offices of Women's Health;
            ``(4) establish a women's health resource center to 
        facilitate the exchange of information regarding matters 
        relating to health information and health promotion, preventive 
        health services, and education in the appropriate use of health 
        care, to facilitate access to such information, to assist in 
        the analysis of issues and problems relating to such matters, 
        and to provide technical assistance with respect to the 
        exchange of such information (including facilitating the 
        development of materials for such technical assistance); and
            ``(5) coordinate efforts to promote women's health programs 
        and policies in the voluntary and corporate sectors.
    ``(d) Reports.--Not later than January 31, 1995, and January 31 of 
each second year thereafter, the Secretary shall prepare and submit to 
the appropriate committees of Congress a report describing the 
activities carried out under this section during the preceding 2 fiscal 
years.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 1994 through 1996.''.

SEC. 208. CENTERS FOR DISEASE CONTROL AND PREVENTION OFFICE OF WOMEN'S 
              HEALTH.

    Part A of title III of the Public Health Service Act (42 U.S.C. 241 
et seq.) (as amended by section 2) is further amended by adding at the 
end thereof the following new section:

 ``centers for disease control and prevention office of women's health

    ``Sec. 310B. (a) Establishment.--There is established within the 
Office of the Director of the Centers for Disease Control and 
Prevention an office to be known as the Office of Women's Health 
(hereafter referred to in this section as the `Office'). The Office 
shall be headed by a director who shall be appointed by the Director of 
the Centers.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) determine the current level of the Centers activity 
        regarding women's health conditions, across age, biological, 
        and sociocultural contexts, in all aspects of the Centers work, 
        including prevention programs, public and professional 
        education, services, and treatment;
            ``(2) establish short-range and long-range goals and 
        objectives for women's health and coordinate all other 
        activities within the Centers that relate to prevention, 
        research, education and training, service delivery, and policy 
        development;
            ``(3) identify projects in women's health that should be 
        conducted or supported by the National Centers;
            ``(4) consult with health professionals, non-governmental 
        organizations, consumer organizations, women's health 
        professionals, and other individuals and groups, as 
        appropriate, on the policy of the Centers with regard to women; 
        and
            ``(5) coordinate agency activities on women's health with 
        the Public Health Service Office of Women's Health established 
        under section 310A.
    ``(c) Coordinating Committee.--
            ``(1) Establishment.--In carrying out subsection (b), the 
        Director of the Office shall establish a committee to be known 
        as the Coordinating Committee on Research on Women's Health 
        (hereafter referred to in this subsection as the `Coordinating 
        Committee').
            ``(2) Composition.--The Coordinating Committee shall be 
        composed of the Directors of the National Centers.
            ``(3) Chairperson.--The Director of the Office shall serve 
        as the chairperson of the Coordinating Committee.
            ``(4) Duties.--With respect to women's health, the 
        Coordinating Committee shall assist the Director of the Office 
        in--
                    ``(A) identifying the need for programs and 
                activities that focus on women's health;
                    ``(B) identifying needs regarding the coordination 
                of activities, including intramural and extramural 
                multidisciplinary activities; and
                    ``(C) making recommendations to the Director of the 
                Centers for Disease Control and Prevention concerning 
                findings made under subparagraphs (A) and (B).
    ``(d) Reports.--Not later than January 31, 1995, and January 31 of 
each second year thereafter, the Director shall prepare and submit to 
the Director of the Public Health Service Office of Women's Health, a 
report describing the activities carried out under this section during 
the preceding 2 fiscal years.
    ``(e) Definition.--As used in this section the term `women's health 
conditions', with respect to women of all age, ethnic, and racial 
groups, means all diseases, disorders, and conditions--
            ``(1) unique to, more serious, or more prevalent in women; 
        and
            ``(2) for which the factors of medical risk or type of 
        medical intervention are different for women, or for which it 
        is unknown whether such factors or types are different for 
        women.''.

SEC. 209. AGENCY FOR HEALTH CARE POLICY AND RESEARCH OFFICE OF WOMEN'S 
              HEALTH.

    Part C of title IX of the Public Health Service Act (42 U.S.C. 299c 
et seq.) is amended--
            (1) by redesignating section 927 as section 928; and
            (2) by inserting after section 926, the following new 
        section:

``SEC. 927. OFFICE OF WOMEN'S HEALTH.

    ``(a) Establishment.--There is established within the Office of the 
Director of the Agency for Health Care Policy and Research an office to 
be known as the Office of Women's Health (hereafter referred to in this 
section as the `Office'). The Office shall be headed by a Director who 
shall be appointed by the Director of the Agency.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) determine the current Agency level of activity 
        regarding women's health, across age, biological, and 
        sociocultural contexts, in all aspects of Agency work, 
        including drafting clinical practice guidelines, and conducting 
        research into patient outcomes, delivery of health care 
        services, and access to health care;
            ``(2) establish short-range and long-range goals and 
        objectives for research important to women's health and 
        coordinate all other activities within the Agency that relate 
        to health services and medical effectiveness research;
            ``(3) identify projects in women's health that should be 
        conducted or supported by the Agency;
            ``(4) consult with health professionals, non-governmental 
        organizations, consumer organizations, women's health 
        professionals, and other individuals and groups, as 
        appropriate, on Agency policy with regard to women; and
            ``(5) coordinate agency activities on women's health with 
        the Public Health Service Office of Women's Health established 
        under section 310A.
    ``(c) Coordinating Committee.--
            ``(1) Establishment.--In carrying out subsection (b), the 
        Director of the Office shall establish a committee to be known 
        as the Coordinating Committee on Research on Women's Health 
        (hereafter referred to in this subsection as the `Coordinating 
        Committee').
            ``(2) Composition.--The Coordinating Committee shall be 
        composed of the Directors of the Offices.
            ``(3) Chairperson.--The Director of the Office shall serve 
        as the chairperson of the Coordinating Committee.
            ``(4) Duties.--With respect to research on women's health, 
        the Coordinating Committee shall assist the Director of the 
        Office in--
                    ``(A) identifying the need for such research, and 
                making an estimate each fiscal year of the funds needed 
                to adequately support the research;
                    ``(B) identifying needs regarding the coordination 
                of research activities, including intramural and 
                extramural multidisciplinary activities; and
                    ``(C) making recommendations to the Director of the 
                Agency for Health Care Policy and Research concerning 
                findings made under subparagraphs (A) and (B).
    ``(d) Reports.--Not later than January 31, 1995, and January 31 of 
each second year thereafter, the Director shall prepare and submit to 
the Director of the Public Health Service Office of Women's Health, a 
report describing the activities carried out under this section during 
the preceding 2 fiscal years.''.

SEC. 210. HEALTH RESOURCES AND SERVICES ADMINISTRATION OFFICE OF 
              WOMEN'S HEALTH.

    Title VII of the Social Security Act (42 U.S.C. 901 et seq.) is 
amended by adding at the end thereof the following new section:

                       ``office of women's health

    ``Sec. 712. (a) Establishment.--There is established within the 
Office of the Administrator of the Health Resources and Services 
Administration an office to be known as the Office of Women's Health 
(hereafter referred to in this section as the `Office'). The Office 
shall be headed by a director who shall be appointed by the Director of 
the Administration.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) determine the current agency level of activity 
        regarding women's health across age, biological, and 
        sociocultural contexts;
            ``(2) establish short-range and long-range goals and 
        objectives for women's health and coordinate all other 
        activities within the agency that relate to health care 
        provider training, health service delivery, research, and 
        demonstration projects;
            ``(3) identify projects in women's health that should be 
        conducted or supported by the Bureaus;
            ``(4) consult with health professionals, non-governmental 
        organizations, consumer organizations, women's health 
        professionals, and other individuals and groups, as 
        appropriate, on agency policy with regard to women; and
            ``(5) coordinate agency activities on women's health with 
        the Public Health Service Office of Women's Health established 
        under section 310A of the Public Health Service Act.
    ``(c) Coordinating Committee.--
            ``(1) Establishment.--In carrying out subsection (b), the 
        Director of the Office shall establish a committee to be known 
        as the Coordinating Committee on Research on Women's Health 
        (hereafter referred to in this subsection as the `Coordinating 
        Committee').
            ``(2) Composition.--The Coordinating Committee shall be 
        composed of the Directors of the Bureaus.
            ``(3) Chairperson.--The Director of the Office shall serve 
        as the Chairperson of the Coordinating Committee.
            ``(4) Duties.--With respect to research on women's health, 
        the Coordinating Committee shall assist the Director of the 
        Office in--
                    ``(A) identifying the need for programs and 
                activities that focus on women's health;
                    ``(B) identifying needs regarding the coordination 
                of activities, including intramural and extramural 
                multidisciplinary activities; and
                    ``(C) making recommendations to the Director of the 
                Centers for Disease Control and Prevention concerning 
                findings made under subparagraphs (A) and (B).
    ``(d) Reports.--Not later than January 31, 1995, and January 31 of 
each second year thereafter, the Director of the Office shall prepare 
and submit to the Director of the Public Health Service Office of 
Women's Health, a report describing the activities carried out under 
this section during the preceding 2 fiscal years.''.

SEC. 210A. FOOD AND DRUG ADMINISTRATION OFFICE OF WOMEN'S HEALTH.

    Chapter IX of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
391 et seq.) is amended by adding at the end thereof the following new 
section:

``SEC. 906. OFFICE OF WOMEN'S HEALTH.

    ``(a) Establishment.--There is established within the Office of the 
Commissioner of the Food and Drug Administration an office to be known 
as the Office of Women's Health (hereafter referred to in this section 
as the `Office'). The Office shall be headed by a Director who shall be 
appointed by the Commissioner of the Administration.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) determine current Commission levels of activity 
        regarding women's participation in clinical trials the study of 
        gender differences in the testing of drugs, medical devices, 
        and biological products, across, age, sociocultural, and, where 
        deemed appropriate, biological contexts.
            ``(2) establish short-range and long-range goals and 
        objectives for adequate inclusion of women in all Commission 
        protocols and policies;
            ``(3) provide guidance or criteria for drug and device 
        manufacturers to use in determining the extent and sufficiency 
        of female representation in clinical trials;
            ``(4) consult with pharmaceutical manufacturers, health 
        professionals with expertise in women's issues, consumer 
        organizations, and women's health professionals on Commission 
        policy with regard to women;
            ``(5) make annual estimates of funds needed to monitor 
        clinical trials in accordance with needs that are identified; 
        and
            ``(6) coordinate Commission activities on women's health 
        with the Public Health Service Office of Women's Health 
        established under section 310A of the Public Health Service 
        Act.
    ``(c) Coordinating Committee.--
            ``(1) Establishment.--In carrying out subsection (b), the 
        Director of the Office shall establish a committee to be known 
        as the Coordinating Committee on Women's Health (hereafter 
        referred to in this subsection as the `Coordinating 
        Committee').
            ``(2) Composition.--The Coordinating Committee shall be 
        composed of the Directors of the Food and Drug Administration 
        Centers.
            ``(3) Chairperson.--The Director of the Office shall serve 
        as the Chairperson of the Coordinating Committee.
            ``(4) Duties.--With respect to studies on women's health, 
        the Coordinating Committee shall assist the Director of the 
        Office in--
                    ``(A) identifying the need for further studies in 
                specific areas of women's health that fall within the 
                mission of the Commission, and developing strategies to 
                foster such studies;
                    ``(B) identifying needs regarding the coordination 
                of Commission activities, including intramural and 
                extramural studies;
                    ``(C) maintaining the Commission's focus in areas 
                of importance to women;
                    ``(D) supporting the development of methodologies 
                to determine the circumstances in which obtaining data 
                specific to women (including data relating to the age 
                of women and the membership of women in ethnic or 
                racial groups) is an appropriate function of clinical 
                trials of treatments and therapies;
                    ``(E) supporting the development and expansion of 
                clinical trials of treatments and therapies for which 
                obtaining such data has been determined to be an 
                appropriate function; and
                    ``(F) encouraging the Food and Drug Administration 
                Centers to conduct and support such studies, including 
                such clinical trials.
    ``(d) Reports.--Not later than January 31, 1995, and January 31 of 
each second year thereafter, the Director shall prepare and submit to 
the Director of the Public Health Service Office of Women's Health, a 
report describing the activities carried out under this section during 
the preceding 2 fiscal years.''.

           Subtitle C--Women's Health Information Act of 1993

SEC. 211. SHORT TITLE.

    This subtitle may be cited as the ``Women's Health Information Act 
of 1993''.

SEC. 212. FINDINGS.

    The Congress finds as follows:
            (1) A report by the General Accounting Office indicates 
        that the Department of Health and Human Services, which is 
        responsible for providing health information to the public, 
        lacks an overall strategy for providing such information to 
        women.
            (2) Such Department has no overall strategy to ensure that 
        the most needed and useful health information is distributed to 
        the public.
            (3) Health information activities of the Department are 
        left to the discretion of the agencies of the Public Health 
        Service, each of which largely plans the production and 
        dissemination of information independently of the other 
        agencies of the Service.
            (4) Even when health information for the public is produced 
        and disseminated by the Department, it is not always easily 
        accessible to the public.
            (5) With respect to health information, the agencies of 
        such Department cannot determine whether the efforts of the 
        agencies are appropriately targeted to raise women's awareness 
        and increase their knowledge about conditions that confront 
        them.

SEC. 213. INTERAGENCY COMMITTEE ON HEALTH COMMUNICATIONS.

    (a) In General.--The Secretary of Health and Human Services shall 
establish an Interagency Committee on Health Communications (in this 
section referred to as the ``Committee'').
    (b) Duties.--
            (1) In general.--The Committee shall provide advice to the 
        Secretary of Health of Human Services on developing, 
        overseeing, and coordinating Federal promotion and education 
        activities, including such activities within the Public Health 
        Service.
            (2) Women's health.--In carrying out paragraph (1), the 
        Committee shall give priority to carrying activities regarding 
        women's health.
    (c) Chair.--The Committee shall be chaired by the Assistant 
Secretary for Health.
    (d) Composition.--
            (1) In general.--Subject to paragraph (2), the Committee 
        shall be composed of one representative from each agency with 
        authority to speak for the agency, in order to address 
        activities and goal-setting with regard to communications 
        specific to women's health. Decisions shall be implemented 
        either individually or collectively as required.
            (2) Women's health.--The Director of the Office of Women's 
        Health at the Public Health Service shall serve as a member of 
        the Committee to ensure that the efforts of the Committee and 
        the Public Health Service reflect pertinent recommendations and 
        objectives to improve women's health.
    (e) Meetings.--
            (1) In general.--The Committee shall, as appropriate, meet 
        not fewer than 4 times a year in order to promote 
        collaboration, enhance cooperation, and develop effective 
        strategies in this effort.
            (2) Annual forum.--The Assistant Secretary for Health shall 
        convene a forum once a year to hear testimony by interested 
        public and private individuals and organizations regarding 
        priorities for areas of women's health, and shall respond to 
        the testimony and make recommendations regarding the testimony.
    (f) Report.--The Assistant Secretary of Health shall issue a yearly 
report on the progress of the Committee's efforts to establish a 
coordinated strategy of health promotion and disease prevention 
activities at the Public Health Service.

SEC. 214. DISSEMINATION EFFORTS OF WOMEN'S HEALTH INFORMATION WITHIN 
              PUBLIC HEALTH SERVICE.

    (a) Clearinghouse on Women's Health.--The Assistant Secretary for 
Health shall establish the Clearinghouse on Women's Health to compile, 
archive, and disseminate information concerning women's health and to 
publish a yearly summary of such materials to be made available upon 
request.
    (b) Other Activities.--
            (1) In general.--The Secretary of Health and Human Services 
        may make a grant, or enter into a contract with one or more 
        organizations representing women--
                    (A) to make available information concerning 
                Federal programs, services, informational resources, 
                and benefits related to women's health;
                    (B) establish a toll-free hotline; and
                    (C) assess demand for publications and costs on an 
                annual basis, and develop publications as needed.
            (2) Fees regarding toll-free hotline.--The Clearinghouse 
        may, as necessary, charge an appropriate fee for information 
        provided by the toll-free hotline. Exceptions shall be made for 
        individuals or organizations that are financially unable to pay 
        such fees.
    (c) Advertising Campaign.--The Secretary of Health and Human 
Services shall conduct an outreach and advertising campaign to women 
and health professionals regarding the existence of the clearinghouse 
and the toll-free number.
    (d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 1994 through 1999.

SEC. 215. STUDY ON EFFECTIVENESS OF HEALTH COMMUNICATIONS.

    The Secretary of Health and Human Services shall convene a study of 
the Agency for Health Care Policy and Research to evaluate the overall 
effectiveness of health communications, including the efficacy of 
existing policies and techniques utilized by the Public Health Service 
to develop and disseminate such information. The study shall involve 
evaluation of effort, mode, use of toll-free numbers, and assessment of 
organization and competency. The study shall also include an analysis 
of efforts regarding reaching underserved populations. The Agency for 
Health Care Policy and Research shall make recommendations to the 
Assistant Secretary for Health on the most effective strategy for 
reaching the public and presenting health communications.

       Subtitle D--Breast and Cervical Cancer Amendments of 1993

SEC. 216. SHORT TITLE.

    This subtitle may be cited as the ``Breast and Cervical Cancer 
Amendments of 1993''.

SEC. 217. REVISIONS IN PROGRAM OF STATE GRANTS REGARDING BREAST AND 
              CERVICAL CANCER.

    (a) Limited Authority Regarding For-Profit Entities.--
            (1) In general.--Section 1501(b) of the Public Health 
        Service Act (42 U.S.C. 300k(b)) is amended--
                    (A) by striking ``States.--A State'' and all that 
                follows through ``may expend'' and inserting the 
                following: ``States.--
            ``(1) In general.--A State receiving a grant under 
        subsection (a) may, subject to paragraph (2), expend''; and
                    (B) by adding at the end the following paragraph:
            ``(2) Limited authority regarding other entities.--In 
        addition to the authority established in paragraph (1) for a 
        State with respect to grants and contracts, the State may 
        provide for screenings under subsection (a)(1) through entering 
        into contracts with private entities. The amount paid by a 
        State to a private entity under the preceding sentence for a 
        screening procedure may not exceed the amount that would be 
        paid under part B of title XVIII of the Social Security Act if 
        payment were made under such part for furnishing the procedure 
        to a woman enrolled under such part.''.
            (2) Conforming amendment.--Section 1505(3) of the Public 
        Health Service Act (42 U.S.C. 300n-1(3)) is amended by 
        inserting before the semicolon the following: ``(and 
        additionally, in the case of services and activities under 
        section 1501(a)(1), with any similar services or activities of 
        private entities)''.
    (b) Quality Assurance Regarding Screening Procedures.--
            (1) In general.--Section 1503 of the Public Health Service 
        Act (42 U.S.C. 300m) is amended by striking subsections (c) 
        through (e) and inserting the following:
    ``(c) Quality Assurance Regarding Screening Procedures.--The 
Secretary may not make a grant under section 1501 unless the State 
involved agrees that the State will, in accordance with applicable law, 
assure the quality of screening procedures conducted pursuant to such 
section.''.
            (2) Transition rule regarding mammographies.--With respect 
        to the screening procedure for breast cancer known as a 
        mammography, the requirements in effect on the day before the 
        date of the enactment of this subtitle under section 1503(c) of 
        the Public Health Service Act remain in effect (for an 
        individual or facility conducting such procedures pursuant to a 
        grant to a State under section 1501 of such Act) until there is 
        in effect for the facility a certificate (or provisional 
        certificate) issued under section 354 of such Act.
    (c) Statewide Provision of Services.--Section 1504(c) of the Public 
Health Service Act (42 U.S.C. 300n(c)) is amended by adding at the end 
the following paragraph:
            ``(3) Grants to tribes and tribal organizations.--
                    ``(A) The Secretary, acting through the Director of 
                the Centers for Disease Control and Prevention, may 
                make grants to tribes and tribal organizations (as such 
                terms are used in paragraph (1)) for the purpose of 
                carrying out programs described in section 1501(a). 
                This title (other than section 1501(c)) applies to such 
                a grant (in relation to the jurisdiction of the tribe 
                or organization) to the same extent and in the same 
                manner as such title applies to grants to States under 
                section 1501 (in relation to the jurisdiction of the 
                States).
                    ``(B) If a tribe or tribal organization is 
                receiving a grant under subparagraph (A) and the State 
                in which the tribe or organization is located is 
                receiving a grant under section 1501, the requirement 
                established in paragraph (1) for the State regarding 
                the tribe or organization is deemed to have been waived 
                under paragraph (2).''.
    (d) Evaluations and Reports.--Section 1508 of the Public Health 
Service Act (42 U.S.C. 300n-4) is amended--
            (1) in subsection (a), by adding at the end the following 
        sentence: ``Such evaluations shall include evaluations of the 
        extent to which States carrying out such programs are in 
        compliance with section 1501(a)(2) and with section 1504(c).''; 
        and
            (2) in subsection (b), by inserting before the period the 
        following: ``, including recommendations regarding compliance 
        by the States with section 1501(a)(2) and with section 
        1504(c)''.
    (e) Establishment of Coordinating Committee.--Section 1501 of the 
Public Health Service Act (42 U.S.C. 300k) is amended by adding at the 
end the following subsection:
    ``(c) Coordinating Committee Regarding Year 2000 Health 
Objectives.--The Secretary, acting through the Director of the Centers 
for Disease Control and Prevention, shall establish a committee to 
coordinate the activities of the agencies of the Public Health Service 
(and other appropriate Federal agencies) that are carried out toward 
achieving the objectives established by the Secretary for reductions in 
the incidence of breast and cervical cancer in the United States by the 
year 2000. Such committee shall be comprised of Federal officers or 
employees designated by the heads of the agencies involved to serve on 
the committee as representatives of the agencies, and such 
representatives from other public or private entities as the Secretary 
determines to be appropriate.''.
    (f) Technical Corrections.--Title XV of the Public Health Service 
Act (42 U.S.C. 300k et seq.) is amended--
            (1) in section 1501(a), in the matter preceding paragraph 
        (1), by striking ``Control,'' and inserting ``Control and 
        Prevention,''; and
            (2) in section 1505(4), by inserting ``will'' before ``be 
        used''.

SEC. 218. FUNDING.

    Section 1509(a) of the Public Health Service Act (42 U.S.C. 300n-
5(a)) is amended--
            (1) by striking ``and'' after ``1991,''; and
            (2) by inserting before the period the following: ``, 
        $100,000,000 for fiscal year 1994, and such sums as may be 
        necessary for each of the fiscal years 1995 through 1998''.

        Subtitle E--Women's Preventive Health Amendments of 1993

SEC. 221. SHORT TITLE.

    This subtitle may be cited as the ``Women's Preventive Health 
Amendments of 1993''.

SEC. 222. ESTABLISHMENT OF DEMONSTRATION PROGRAM OF GRANTS FOR 
              ADDITIONAL PREVENTIVE HEALTH SERVICES FOR WOMEN.

    Title XV of the Public Health Service Act (42 U.S.C. 300k et seq.) 
is amended--
            (1) by redesignating section 1509 as section 1510; and
            (2) by inserting after section 1508 the following section:

``SEC. 1509. SUPPLEMENTAL GRANTS FOR ADDITIONAL PREVENTIVE HEALTH 
              SERVICES.

    ``(a) Demonstration Projects.--In the case of States receiving 
grants under section 1501, the Secretary, acting through the Director 
of the Centers for Disease Control and Prevention, may make grants to 
not more than 3 such States to carry out demonstration projects for the 
purpose of--
            ``(1) providing to women preventive health services, and 
        health promotion services, in addition to the services 
        authorized in such section;
            ``(2) providing appropriate referrals for medical treatment 
        of women receiving services pursuant to paragraph (1) and 
        ensuring, to the extent practicable, the provision of 
        appropriate follow-up services; and
            ``(3) evaluating activities conducted under paragraphs (1) 
        and (2) through appropriate surveillance or program-monitoring 
        activities.
    ``(b) Status as Participant in Program Regarding Breast and 
Cervical Cancer.--The Secretary may not make a grant under subsection 
(a) unless the State involved agrees that services under the grant will 
be provided only through entities that are screening women for breast 
or cervical cancer pursuant to a grant under section 1501.
    ``(c) Requirements Regarding Matching Funds, Fees for Services, and 
Certain Other Matters.--The Secretary may not make a grant under 
subsection (a) unless the State involved agrees that section 1502, and 
sections 1504 through 1506, apply to a grant under subsection (a) to 
the same extent and in the same manner as such sections apply to a 
grant under section 1501.
    ``(d) Technical Assistance; Supplies and Services in Lieu of Grant 
Funds.--Section 1507 applies to a grant under subsection (a) to the 
same extent and in the same manner as such section applies to a grant 
under section 1501.
    ``(e) Evaluations and Reports.--Section 1508 applies to a grant 
under subsection (a) to the same extent and in the same manner as such 
section applies to a grant under section 1501.''.

SEC. 223. FUNDING.

    Section 1510 of the Public Health Service Act, as redesignated by 
section 222 of this Act, is amended to read as follows:

``SEC. 1510. FUNDING.

    ``(a) Program Regarding Breast and Cervical Cancer.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this title other than section 1509, there are 
        authorized to be appropriated such sums as may be necessary for 
        fiscal year 1994.
            ``(2) Set-aside for technical assistance and provision of 
        supplies and services.--Of the amounts appropriated under 
        paragraph (1) for a fiscal year, the Secretary shall reserve 
        not more than 20 percent for carrying out section 1507.
    ``(b) Program Regarding Additional Preventive Health Services.--
            ``(1) Authorization of appropriations.--Subject to 
        paragraph (2), for the purpose of carrying out section 1509, 
        there are authorized to be appropriated such sums as may be 
        necessary for each of the fiscal years 1994 through 1996.
            ``(2) Limitation regarding funding with respect to breast 
        and cervical cancer.--The authorization of appropriations 
        established in paragraph (1) is not effective for a fiscal year 
        unless the amount appropriated under subsection (a)(1) for the 
        fiscal year equals or exceeds the amount appropriated under 
        such subsection for the preceding fiscal year.''.

              Subtitle F--Postreproductive Health Care Act

SEC. 226. SHORT TITLE.

    This subtitle may be cited as the ``Postreproductive Health Care 
Act''.

SEC. 227. ESTABLISHMENT OF PROGRAM FOR POSTREPRODUCTIVE HEALTH CARE.

    Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by adding at the end the following new 
subpart:

               ``Subpart IX--Postreproductive Health Care

                     ``postreproductive health care

    ``Sec. 340D. (a) In General.--The Secretary shall make grants for 
the purpose of providing the services described in subsection (b) to 
women who are of menopausal age or older. Such grants may be made only 
to public or nonprofit private entities that provide health services to 
a significant number of low-income women.
    ``(b) Authorized Services.--The services referred to in subsection 
(a) are as follows:
            ``(1) The prevention and outpatient treatment of health 
        conditions--
                    ``(A) unique to, more serious, or more prevalent 
                for eligible women; or
                    ``(B) for which, in the case of such women, the 
                factors of medical risk or types of medical 
                intervention are different.
            ``(2) Counseling on the conditions described in paragraph 
        (1).
            ``(3) The education and training of health professionals 
        (including allied health professionals) on the prevention and 
        treatment of such conditions and on the provision of such 
        counseling.
    ``(c) Priority in Provision of Services.--The Secretary may make a 
grant under subsection (a) only if the applicant involved agrees that, 
in expending the grant to provide authorized services to eligible 
women, the applicant will give priority to providing the services for 
menopausal health conditions.
    ``(d) Outreach.--The Secretary may make a grant under subsection 
(a) only if the applicant involved agrees--
            ``(1) to conduct outreach services to inform women in the 
        community involved of the fact that authorized services are 
        available from the applicant; and
            ``(2) to give priority to providing the outreach services 
        to low-income women.
    ``(e) Limitation on Imposition of Fees for Services.--The Secretary 
may make a grant under subsection (a) only if the applicant involved 
agrees that, if a charge is imposed for the provision of services or 
activities under the grant, such charge--
            ``(1) will be made according to a schedule of charges that 
        is made available to the public;
            ``(2) will be adjusted to reflect the income of the woman 
        involved; and
            ``(3) will not be imposed on any woman with an income equal 
        to or less than 100 percent of the official poverty line, as 
        established by the Director of the Office of Management and 
        Budget and revised by the Secretary in accordance with section 
        673(2) of the Omnibus Budget Reconciliation Act of 1981.
    ``(f) Reports to Secretary.--The Secretary may make a grant under 
subsection (a) only if the applicant involved agrees to submit to the 
Secretary, for each fiscal year for which such a grant is made to the 
applicant, a report describing the purposes for which the grant has 
been expended.
    ``(g) Requirement of Application.--The Secretary may make a grant 
under subsection (a) only if the applicant involved makes an agreement 
that the grant will not be expended for any purpose other than the 
purpose described in such subsection and for compliance with any other 
agreements required in this section. Such a grant may be made only if 
an application for the grant is submitted to the Secretary containing 
such agreements, and the application is in such form, is made in such 
manner, and contains such other agreements, and such assurances and 
information, as the Secretary determines to be necessary to carry out 
this section.
    ``(h) Definitions.--For purposes of this section:
            ``(1) The term `authorized services' means the services 
        described in subsection (b).
            ``(2) The term `eligible women' means women described in 
        subsection (a).
            ``(3) The term `health conditions' includes diseases and 
        disorders.
            ``(4) The term `health' includes mental health.
            ``(5) The term `menopausal age', with respect to a woman, 
        includes the age at which the woman is nearing menopause and 
        includes any age at which the woman experiences menopausal 
        health conditions.
            ``(6) The term `menopausal health conditions' means 
        conditions arising from the diminished or complete cessation of 
        the functioning of the ovaries, whether occurring naturally or 
        otherwise.
    ``(i) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $25,000,000 
for fiscal year 1994, and such sums as may be necessary for each of the 
fiscal years 1995 and 1996.''.

    Subtitle G--Medicare Bone Mass Measurement Coverage Act of 1993

SEC. 231. SHORT TITLE.

    This subtitle may be cited as the ``Medicare Bone Mass Measurement 
Coverage Act of 1993''.

SEC. 232. MEDICARE COVERAGE OF BONE MASS MEASUREMENTS.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)--
                    (A) in paragraph (12)(C), by striking ``and'' at 
                the end,
                    (B) by striking the period at the end of paragraph 
                (14) and inserting ``; and'',
                    (C) by redesignating paragraphs (15) and (16) as 
                paragraphs (16) and (17), and
                    (D) by inserting after paragraph (14) the following 
                new paragraph:
            ``(15) bone mass measurement (as defined in subsection 
        (oo));''; and
            (2) by inserting after subsection (nn) the following new 
        subsection:

                        ``Bone Mass Measurement

    ``(oo)(1) The term `bone mass measurement' means a radiologic or 
radioisotopic procedure performed on a qualified individual (as defined 
in paragraph (2)) for the purpose of detecting bone loss through the 
use of single and dual photon absorptiometry, dual energy X-ray 
absorptiometry or similar dual energy techniques, or quantitative 
computed tomography, and includes a physician's interpretation of the 
results of the procedure.
    ``(2) For purposes of paragraph (1), the term `qualified 
individual' means (in accordance with regulations prescribed by the 
Secretary)--
            ``(A) an estrogen-deficient woman at clinical risk for 
        osteoporosis;
            ``(B) an individual with vertebral abnormalities;
            ``(C) an individual receiving long-term glucocorticoid 
        steroid therapy; or
            ``(D) an individual with primary hyperparathyroidism.''.
    (b) Conforming Amendments.--The Social Security Act is amended by 
striking ``paragraphs (15) and (16)'' each place it appears in sections 
1864(a), 1865(a), 1902(a)(9)(C), and 1915(a)(1)(B)(ii)(I) and inserting 
``paragraphs (16) and (17)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to bone mass measurements performed on or after January 1, 1994.

     Subtitle H--Mickey Leland Adolescent Pregnancy Prevention and 
                         Parenthood Act of 1993

SEC. 236. SHORT TITLE.

    This subtitle may be cited as the ``Mickey Leland Adolescent 
Pregnancy Prevention and Parenthood Act of 1993''.

SEC. 237. ADOLESCENT PREGNANCY PREVENTION, CARE, AND RESEARCH GRANTS.

    Title XX of the Public Health Service Act (42 U.S.C. 300z et seq.) 
is amended to read as follows:

 ``TITLE XX--ADOLESCENT PREGNANCY PREVENTION, CARE, AND RESEARCH GRANTS

``SEC. 2001. FINDINGS AND PURPOSES.

    ``(a) Findings.-- The Congress finds that--
            ``(1) adolescents are at a high risk of unwanted pregnancy;
            ``(2) in 1988, more than 1,000,000 teenagers became 
        pregnant, and nearly 500,000 teenagers carried their 
        pregnancies to term, of which more than 6 out of 10 births were 
        out of wedlock;
            ``(3) the birthrate for adolescents between the ages of 15 
        and 17 increased 23 percent between 1986 and 1989;
            ``(4) in a high proportion of cases, the pregnant 
        adolescent is herself the product of an unmarried parenthood 
        during adolescence and is continuing the pattern in her own 
        lifestyle;
            ``(5) pregnancy and childbirth among unmarried adolescents, 
        particularly young adolescents, often results in severe adverse 
        health, social, and economic consequences, including--
                    ``(A) higher percentage of pregnancy and childbirth 
                complications;
                    ``(B) higher incidence of low birth weight babies;
                    ``(C) higher infant mortality and morbidity;
                    ``(D) greater likelihood that an adolescent 
                marriage will end in divorce;
                    ``(E) decreased likelihood of completing schooling; 
                and
                    ``(F) higher risks of unemployment and welfare 
                dependency; and
        therefore, education, training, and job research services are 
        important for adolescent parents; and
            ``(6) an adolescent who becomes pregnant once is likely to 
        experience rapid repeat pregnancies and childbearing, with 
        increased risks;
            ``(7) research has shown that in cases in which there is a 
        family involvement in comprehensive values-based projects and 
        services--
                    ``(A) low birth weight is significantly reduced;
                    ``(B) delays in initiating sexual activity occur;
                    ``(C) there are significant reductions in repeat 
                pregnancy, welfare costs, and child abuse; and
                    ``(D) teens are more likely to return and complete 
                their high school education; and
        therefore, the family should become a partner in the 
        development of curriculum and programs that reflect the values 
        of the community;
            ``(8) the problems of adolescent pregnancy and parenthood 
        are multiple and complex and are best approached through a 
        variety of integrated and essential services, particularly 
        those that allow the pregnant adolescent and adolescent parent 
        to stay in school;
            ``(9) such services, including a wide array of educational 
        and supportive services, often are not available to the 
        adolescents who need them, or are available but fragmented and 
        thus of limited effectiveness in preventing pregnancies and 
        future welfare dependency; and
            ``(10) Federal policy therefore should encourage the 
        development of appropriate health, educational, and social 
        services where they are now lacking or inadequate, and the 
        better coordination of existing services where they are 
        available in order to prevent unwanted early and repeat 
        pregnancies and to help adolescents become productive, 
        independent contributors to family and community life.
    ``(b) Purposes.--It is the purpose of this title--
            ``(1) to establish better coordination, integration, and 
        linkages among existing programs in order to expand and improve 
        the availability of, and access to, needed comprehensive 
        community services that assist in preventing unwanted initial 
        and repeat pregnancies among adolescents, enable pregnant 
        adolescents to obtain proper care and assist pregnant 
        adolescents, their male partners, and adolescent parents to 
        become productive independent contributors to family and 
        community life, with primary emphasis on services to 
        adolescents who are 17 years of age and under;
            ``(2) to expand the availability of such services that are 
        essential to that objective;
            ``(3) to promote innovative, comprehensive, and integrated 
        approaches to the delivery of such services;
            ``(4) to encourage and support research programs concerning 
        the societal causes and consequences of pregnancy, 
        childbearing, and child rearing for adolescent females and 
        males;
            ``(5) to support evaluative research to identify effective 
        services that reduce adolescent pregnancy rates and that 
        improve the outcome of adolescent childbearing for the parents, 
        the child, and their families; and
            ``(6) to encourage and provide for the dissemination of 
        results, findings, and information from programs and research 
        projects relating to adolescent pregnancy and parenthood.

``SEC. 2002. DEFINITIONS.

    ``For the purposes of this title:
            ``(1) Adolescent.--The term `adolescent' means an 
        individual under the age of 21.
            ``(2) Care services.--The term `care services' means all 
        services for the provision of care to adolescents, both male 
        and female, pregnant adolescents and their male partners, and 
        adolescent parents. Such term shall include all core services 
        and may include supplementary services, in accordance with 
        regulations prescribed by the Secretary.
            ``(3) Core services.--The term `core services' means those 
        services that shall be provided by a grantee, as determined by 
        the Secretary by regulation, which shall include--
                    ``(A) pregnancy testing and maternity counseling, 
                or referral for such services;
                    ``(B) family planning services, except that such 
                services for adolescents who are not already parents 
                may be limited to counseling and referral unless 
                suitable and appropriate family planning services are 
                not otherwise available in the community;
                    ``(C) counseling on all options regarding 
                pregnancy, or referral for such services;
                    ``(D) primary and preventive health services, 
                including prenatal and postnatal care for mother and 
                children and arrangements for delivery;
                    ``(E) well-baby care;
                    ``(F) nutrition information and counseling;
                    ``(G) screening, counseling and treatment or 
                referral for treatment and prevention of sexually 
                transmitted diseases, including acquired 
                immunodeficiency syndrome;
                    ``(H) referral to appropriate pediatric care;
                    ``(I) educational services relating to sexuality 
                and family life, including--
                            ``(i) education on responsible 
                        decisionmaking regarding sexual activity;
                            ``(ii) education on the responsibilities of 
                        parenting;
                            ``(iii) education on a full range of means 
                        for delaying becoming pregnant, including 
                        abstinence, natural family planning, and 
                        contraception;
                            ``(iv) education on the prevention of 
                        sexually transmitted diseases, including 
                        acquired immunodeficiency syndrome; and
                            ``(v) assistance to parents, schools, youth 
                        agencies, and health care providers to educate 
                        adolescents and pre-adolescents concerning 
                        self-discipline and responsibility in human 
                        sexuality;
                    ``(J) referral to appropriate educational, 
                employment, employment training, and vocational 
                services;
                    ``(K) mental health services and referral to mental 
                health services and to other appropriate physical 
                health and social services; and
                    ``(L) encouragement of parent and family 
                involvement in each of the core services described in 
                subparagraphs (A) through (K).
            ``(4) Eligible grant recipient.--The term `eligible grant 
        recipient' means a public or nonprofit private organization or 
        agency that demonstrates, to the satisfaction of the 
        Secretary--
                    ``(A) in the case of an organization that will 
                provide care services, the capability of providing all 
                care services in a single setting or the capability of 
                creating a network through which all care services 
                would be provided; or
                    ``(B) in the case of an organization that will 
                provide prevention services, the capability of 
                providing such services.
            ``(5) Eligible person.--The term `eligible person' means--
                    ``(A) with regard to the provision of prevention 
                services and referral to such other services as may be 
                appropriate, any adolescent; or
                    ``(B) with regard to the provision of care 
                services, adolescent parents and (when appropriate) 
                adolescents who are not parents.
            ``(6) Prevention services.--The term `prevention services' 
        means services described in subparagraphs (B) and (I) of 
        paragraph (3) and referrals to such other services as may be 
        appropriate, including services to be offered in schools at 
        local discretion.
            ``(7) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services.
            ``(8) Supplemental services.--The term `supplemental 
        services' means those services that may be provided by a 
        grantee, as determined by the Secretary by regulation, which 
        may include--
                    ``(A) child care sufficient to enable the 
                adolescent parent to continue education or to enter 
                into employment, including services to be provided 
                within secondary schools at local discretion;
                    ``(B) consumer education and homemaking;
                    ``(C) counseling for the immediate and extended 
                family members of the eligible person;
                    ``(D) transportation;
                    ``(E) referral to licensed residential care or 
                maternity home services;
                    ``(F) referral to licensed adoption agencies for 
                adoption placement services;
                    ``(G) employability training and counseling; and
                    ``(H) such other services as are consistent with 
                this title as the Secretary may approve in accordance 
                with regulations promulgated by the Secretary.

``SEC. 2003. AUTHORITY TO MAKE GRANTS FOR SERVICES.

    ``The Secretary may make grants to provide prevention and care 
services to pregnant adolescents and their male partners, adolescent 
parents, and nonpregnant adolescents. Grants shall be used to provide, 
supplement, or improve the quality of such services.

``SEC. 2004. USE OF GRANTS FOR SERVICES.

    ``(a) Uses.--A grant made under this title may be used to--
            ``(1) provide eligible persons--
                    ``(A) prevention services;
                    ``(B) care services; or
                    ``(C) any combination of prevention and care 
                services;
            ``(2) coordinate, integrate, and provide linkages among 
        providers of prevention, care, and other services for eligible 
        persons in furtherance of the purposes of this title;
            ``(3) provide supplemental services where such services are 
        not adequate or not available to eligible persons in the 
        community and that are essential to the care of eligible 
        persons and to the prevention of adolescent pregnancy;
            ``(4) plan, for a period of not more than 1 year, for the 
        administration and coordination of pregnancy prevention 
        services and programs of care for eligible persons that will 
        further the objectives of this title; and
            ``(5) fulfill assurances required for grant approval by 
        section 2006.
    ``(b) Fees.--Grantees shall charge fees for services only pursuant 
to a fee schedule, approved by the Secretary as a part of the 
application described in section 2006, that bases fees charged by the 
grantee on the income of the eligible person and takes into account the 
difficulty adolescents face in obtaining resources to pay for services. 
In no case may a grantee discriminate with regard to the provision of 
services to any individual because of that individual's inability to 
provide payment for such services.

``SEC. 2005. PRIORITIES, AMOUNTS, AND DURATION OF GRANTS FOR SERVICES.

    ``(a) Priorities.--In approving applications for grants for 
services under this title, the Secretary shall give priority to 
applicants who--
            ``(1) serve an area where there is a high incidence of 
        adolescent pregnancy;
            ``(2) serve an area with a high proportion of low-income 
        families and where the availability of programs of prevention 
        and care for eligible persons is low;
            ``(3) show evidence--
                    ``(A) in the case of an applicant who will provide 
                prevention services, of having the ability to provide 
                prevention services for adolescents and their families 
                that are appropriate for the target population and the 
                geographic area to be served, including the special 
                needs of rural areas; or
                    ``(B) in the case of an applicant who will provide 
                care services, of having the ability to bring together 
                a wide range of needed core services and, as 
                appropriate, supplemental services in comprehensive 
                single-site programs, or to establish a well-integrated 
                network of such services (appropriate for the target 
                population and geographic area to be served including 
                the special needs of rural areas) for eligible persons;
            ``(4) will utilize to the maximum extent feasible existing 
        available programs and facilities such as community health 
        centers, child welfare agencies, children and youth centers, 
        maternal and infant health centers, regional rural health 
        facilities, licensed adoption agencies, maternity homes, school 
        and other educational programs, family planning clinics, mental 
        health programs, nutrition programs, recreation programs, and 
        other ongoing pregnancy prevention and pregnancy-related 
        services;
            ``(5) make use, to the maximum extent feasible, of other 
        Federal, State, and local funds, programs, contributions, and 
        other third-party reimbursements;
            ``(6) can demonstrate a community commitment to the program 
        by making available to the program non-Federal funds, 
        personnel, and facilities;
            ``(7) have involved the community to be served, including 
        public and nonprofit private agencies, adolescents, and 
        families, in the planning and implementation of the program; 
        and
            ``(8) will demonstrate innovative and effective approaches 
        in addressing the problems of adolescent pregnancy or 
        parenthood, including outreach to adolescent males and 
        approaches for providing pregnant adolescents with adequate 
        information about adoption.
    ``(b) Amounts.--
            ``(1) In general.--The amount of a grant for a program for 
        services under this title shall be determined by the Secretary, 
        based on factors such as the incidence of adolescent pregnancy 
        in the geographic area to be served, and the adequacy of 
        pregnancy prevention services and programs of care for eligible 
        persons in such area.
            ``(2) Rural areas.--In making grants for services under 
        this title, the Secretary shall consider the special needs of 
        rural areas and, to the maximum extent practicable, shall 
        distribute funds taking into consideration the relative number 
        of adolescents in such areas in need of such services.
    ``(c) Federal Share.--
            ``(1) In general.--Subject to paragraph (3), a grant for 
        services under this title may not exceed 75 percent of the 
        costs of the program for any year.
            ``(2) Form of non-federal contributions.--Non-Federal 
        contributions required by paragraph (1) may be in cash or in 
        kind, fairly evaluated, including plant, equipment, or 
        services.
            ``(3) Waiver.--The Secretary may waive the limitation 
        specified in paragraph (1) for any year in accordance with 
        criteria established by regulation.

``SEC. 2006. REQUIREMENTS FOR APPLICATIONS FOR GRANTS FOR SERVICES.

    ``(a) In General.--An application for a grant for services under 
this title shall be in such form and contain such information as the 
Secretary may require, and shall include--
            ``(1) an identification of the incidence of adolescent 
        pregnancy and related problems;
            ``(2) a description of the economic conditions and income 
        levels in the geographic area to be served;
            ``(3) a description of existing pregnancy prevention 
        services and programs of care for eligible persons (including 
        adoption services), and including where, how, by whom, and to 
        which population groups such services are provided, and the 
        extent to which they are coordinated in the geographic area to 
        be served;
            ``(4) a description of the major unmet needs for services 
        for adolescents at risk of initial or recurrent pregnancies and 
        an estimate of the number of adolescents not being served in 
        the area;
            ``(5)(A) in the case of an applicant who will provide 
        prevention services, a description of the necessary services to 
        be provided and how the applicant will provide such services; 
        or
            ``(B) in the case of an applicant who will provide care 
        services, a description of how all core services will be 
        provided in the program using funds under this title or will 
        otherwise be provided by the grantee in the area to be served, 
        the population to which such services will be provided, how 
        such services will be coordinated, integrated, and linked with 
        other related programs and services and the source or sources 
        of funding of such core services in the public and private 
        sectors; or
            ``(6) a description of the manner in which adolescents 
        needing services other than the services provided directly by 
        the applicant will be identified and how access and appropriate 
        referral to such other services (such as but not limited to 
        medicaid; licensed adoption agencies; maternity home services; 
        public assistance; employment services; child care services for 
        adolescent parents; and other city, county, and State programs 
        related to adolescent pregnancy) will be provided, including a 
        description of a plan to coordinate such other services with 
        the services supported under this title;
            ``(7) a description of the results expected from the 
        provision of services, and the procedures to be used for 
        evaluating those results;
            ``(8) assurances that the applicant will have an ongoing 
        quality assurance program;
            ``(9) assurances that the applicant shall have a system for 
        maintaining the confidentiality of patient records in 
        accordance with regulations prescribed by the Secretary;
            ``(10) assurances that the applicant will demonstrate its 
        financial responsibility by the use of such accounting 
        procedures and other requirements as may be prescribed by the 
        Secretary;
            ``(11) assurances that the applicant will make maximum use 
        of other sources of Federal and State funding;
            ``(12)(A) a description of--
                    ``(i) the schedule of fees to be used in the 
                provision of services, which shall comply with section 
                2004(c); and
                    ``(ii) a corresponding schedule of discounts to be 
                applied to the payment of such fees, which shall--
                            ``(I) comply with section 2004(b);
                            ``(II) be adjusted on the basis of the 
                        ability of the eligible person to pay; and
                            ``(III) provide that no fee will be imposed 
                        on any eligible individual with an income of 
                        less than 100 percent of the official poverty 
                        line;
            ``(B) assurances that the applicant has made and will 
        continue to make every reasonable effort--
                    ``(i) to secure from eligible persons payment for 
                services in accordance with such schedules;
                    ``(ii) to collect reimbursement for health or other 
                services provided to persons who are entitled to have 
                payment made on their behalf for such services under 
                any Federal or other government program or private 
                insurance program; and
                    ``(iii) to seek such reimbursement on the basis of 
                the full amount of fees for services without 
                application of any discount; and
            ``(C) assurances that the applicant has submitted or will 
        submit to the Secretary such reports as the Secretary may 
        require to determine compliance with this paragraph;
            ``(13) assurances that the applicant will make maximum use 
        of funds available under title X;
            ``(14) assurances that the acceptance by any individual of 
        family planning services or family planning information 
        (including educational materials) provided through financial 
        assistance under this title shall be voluntary and shall not be 
        a prerequisite to eligibility for or receipt of any other 
        service furnished by the applicant;
            ``(15) assurances that fees collected by the applicant for 
        services rendered in accordance with this title shall be used 
        by the applicant to further the purposes of this title;
            ``(16) assurances that the applicant, if providing both 
        prevention and care services, will not exclude or discriminate 
        against any adolescent who receives prevention services and 
        subsequently requires care services as a pregnant adolescent;
            ``(17) a description of how the applicant will ascertain 
        whether services for which adolescents have been referred have 
        actually been obtained and develop a plan to ensure that needed 
        services actually are received;
            ``(18) assurances that unemancipated minors requesting 
        services from the applicant will be encouraged to consult with 
        their parents with respect to such services and that services 
        shall not be denied to unemancipated minors who decide not to 
        consult their parents;
            ``(19) assurances that all pregnant adolescents receiving 
        services will be informed of the availability of counseling 
        (either by the entity providing core services or through a 
        referral agreement with such other entity that provides such 
        counseling) on all options, regarding the pregnancy;
            ``(20) assurances that primary emphasis for services 
        supported under this title shall be given to adolescents 17 and 
        under who are not able to obtain needed assistance through 
        other means;
            ``(21) assurances that funds received under this title 
        shall not supplant funds received from any other Federal, 
        State, or local program or any private sources of funds; and
            ``(22) a plan for the conduct of, and assurances that the 
        applicant will conduct, evaluations of the effectiveness of the 
        services supported under this title in accordance with 
        subsection (b).
    ``(b) Evaluations.--
            ``(1) In general.--Each grantee that receives funds for a 
        grant for services under this title shall expend at least 3 
        percent but not in excess of 10 percent of the amounts received 
        under this title for the conduct of evaluations of the services 
        supported under this title. The Secretary may, for a particular 
        grantee on good cause shown, waive the preceding sentence with 
        respect to the amounts to be expended on evaluations, but may 
        not waive the requirement that such evaluations be conducted.
            ``(2) Independent evaluation.--Evaluations required by 
        paragraph (1) shall be conducted by an organization or entity 
        that is independent of the grantee providing services supported 
        under this title.
    ``(c) Reports.--
            ``(1) In general.--Each grantee that participates in the 
        program established by this title shall make such reports 
        concerning its use of Federal funds as the Secretary may 
        require, including reports on prevention programs and care 
        programs.
            ``(2) Contents of reports on prevention programs.--Reports 
        on prevention programs shall be in a standard format as 
        prescribed by the Secretary and shall include a description 
        of--
                    ``(A) the characteristics, educational attainments, 
                and economic status of clients;
                    ``(B) the clients' previous exposure in home, 
                school, or other locations to educational efforts 
                regarding sexuality and family life;
                    ``(C) the types of interventions employed in the 
                prevention program;
                    ``(D) the before and after outcome measurements on 
                variables appropriate to the intervention;
                    ``(E) to the extent possible and where appropriate 
                to program goals, the pregnancy and sexually 
                transmitted disease rates subsequent to intervention; 
                and
                    ``(F) the extent of parent or family involvement in 
                the program.
            ``(3) Contents of reports on care programs.--Reports on 
        care programs shall be in standard format as prescribed by the 
        Secretary and shall include a description of--
                    ``(A) the characteristics, health history, 
                educational attainments, and economic status of clients 
                at the time of entry;
                    ``(B) the client prenatal care and pregnancy 
                outcome, complications of pregnancy and delivery, and 
                infant birth outcomes;
                    ``(C) the characteristics, educational attainments, 
                and economic status of clients at time of follow-up and 
                infant follow-up information;
                    ``(D) the types of services provided to clients; 
                and
                    ``(E) the extent of parent or family involvement in 
                the services provided.
            ``(4) Comparison data.--Reports on prevention programs and 
        care programs shall include control group data or other 
        appropriate comparison data to provide comparisons with project 
        data and to indicate program impact or effectiveness.
            ``(5) Follow-up data.--Reports on prevention programs and 
        care programs shall include, to the extent possible, follow-up 
        data on a random sample of program graduates and dropouts.
    ``(d) Timing of Services.--No application submitted for a grant for 
a program for care services under this title may be approved unless the 
Secretary is satisfied that core services shall be available through 
the applicant within a reasonable time after such grant is received.

``SEC. 2007. COORDINATION OF FEDERAL AND STATE PROGRAMS.

    ``(a) Federal Programs.--The Secretary shall coordinate Federal 
policies and programs providing services relating to the prevention of 
initial and recurrent adolescent pregnancies and providing care 
services for eligible persons. In achieving such coordination, the 
Secretary shall--
            ``(1) require grantees who receive grants for services 
        under this title to report periodically to the Secretary 
        concerning Federal, State, and local policies and programs that 
        interfere with the delivery of and coordination of pregnancy 
        prevention services and other programs of care for pregnant 
        adolescents and adolescent parents;
            ``(2) provide technical assistance to facilitate 
        coordination by State and local recipients of Federal 
        assistance;
            ``(3) give priority in the provision of funds, where 
        appropriate, to applicants using single or coordinated grant 
        applications for multiple programs; and
            ``(4) give priority, where appropriate, to the provision of 
        funds under Federal programs administered by the Secretary 
        (other than the program established by this title) to programs 
        providing comprehensive prevention services and comprehensive 
        programs of care for eligible persons.
    ``(b) Other Recipients.--Any recipient of a grant for services 
under this title shall coordinate its activities with any other 
recipient of such a grant that is located in the same locality.

``SEC. 2008. GRANTS FOR RESEARCH.

    ``(a) In General.--
            ``(1) Authorization.--The Secretary may make grants to 
        public agencies or nonprofit private organizations or 
        institutions of higher education to support the research and 
        dissemination activities described in paragraphs (4), (5), and 
        (6) of section 2001(b).
            ``(2) Duration.--The Secretary may make grants or enter 
        into contracts under this section for a period of 1 year. A 
        grant or contract under this section for a program may be 
        renewed for 4 additional 1-year periods, which need not be 
        consecutive.
            ``(3) Amount limitation.--A grant or contract for any 1-
        year period under this section may not exceed $100,000 for the 
        direct costs of conducting research or dissemination activities 
        under this section and may include such additional amounts for 
        the indirect costs of conducting such activities as the 
        Secretary determines appropriate. The Secretary may waive the 
        preceding sentence with respect to a specific program if the 
        Secretary determines that--
                    ``(A) exceptional circumstances warrant such waiver 
                and that the program will have national impact;
                    ``(B) additional amounts are necessary for the 
                direct costs of conducting limited programs for the 
                provision of necessary services in order to provide 
                data for research carried out under this title; or
                    ``(C) several grantees together require more than 
                $100,000 to evaluate the effectiveness of different 
                combinations of services, and if such grantees 
                demonstrate evidence of reasonable progress in the 
                first year, such multisite evaluation studies shall 
                receive preference for funding renewal.
            ``(4) Carryover for report.--The amount of any grant or 
        contract made under this section may remain available for 
        obligation or expenditure after the close of the 1-year period 
        for which such grant or contract is made in order to assist the 
        recipient in preparing the report required by subsection 
        (f)(1).
    ``(b) Use of Funds.--
            ``(1) In general.--Funds provided for research under this 
        section may be used for descriptive or explanatory surveys, 
        evaluation studies, longitudinal studies, or limited programs 
        for services that are for the purpose of increasing knowledge 
        and understanding of the matters described in paragraphs (4) 
        and (5) of section 2001(b).
            ``(2) Limitations.--Funds provided under this section may 
        not be used for the purchase or improvement of land, or the 
        purchase, construction, or permanent improvement (other than 
        minor remodeling) of any building or facility.
    ``(c) Prerequisites.--The Secretary may not make any grant or enter 
into any contract to support research or dissemination activities under 
this section unless--
            ``(1) the Secretary has received an application for such 
        grant or contract that is in such form and that contains such 
        information as the Secretary may by regulation require;
            ``(2) the applicant has demonstrated that the applicant is 
        capable of conducting one or more of the types of research or 
        dissemination activities described in paragraph (4), (5), or 
        (6) of section 2001(b); and
            ``(3) in the case of an application for a research program, 
        the panel established by subsection (e)(2) has determined that 
        the program is of scientific merit.
    ``(d) Coordination.--The Secretary shall coordinate research and 
dissemination activities carried out under this section with research 
and dissemination activities carried out by the National Institutes of 
Health.
    ``(e) Review of Applications.--
            ``(1) System.--The Secretary shall establish a system for 
        the review of applications for grants and contracts under this 
        section. Such system shall be substantially similar to the 
        system for scientific peer review of the National Institutes of 
        Health and shall meet the requirements of paragraphs (2) and 
        (3).
            ``(2) Panel.--
                    ``(A) Establishment.--In establishing the system 
                required by paragraph (1), the Secretary shall 
                establish a panel to review applications under this 
                section.
                    ``(B) Expertise.--Panel members should have 
                expertise in research and evaluation and should 
                represent disciplines relevant to the study of 
                adolescent pregnancy and parenting.
                    ``(C) Limit on physicians.--Not more than 25 
                percent of the members of the panel shall be 
                physicians.
                    ``(D) Meetings.--The panel shall meet as often as 
                may be necessary to facilitate the expeditious review 
                of applications under this section, but not less than 
                once each year.
                    ``(E) Review.--The panel shall review each program 
                for which an application is made under this section, 
                evaluate the scientific merit of the program, determine 
                whether the program is of scientific merit, and make 
                recommendations to the Secretary concerning whether the 
                application for the program should be approved.
            ``(3) Grant determination.--The Secretary shall make grants 
        under this section from among the programs that the panel 
        established by paragraph (2) has determined to be of scientific 
        merit and may only approve an application for a program if the 
        panel has made such determination with respect to such a 
        program. The Secretary shall make a determination with respect 
        to an application within 1 month after receiving the 
        determinations and recommendations of such panel with respect 
        to the application.
    ``(f) Reports.--
            ``(1) Research reports.--
                    ``(A) In general.--The recipient of a grant or 
                contract for a research program under this section 
                shall prepare and transmit to the Secretary a report 
                describing the results and conclusions of such 
                research. Except as provided in subparagraph (B), such 
                report shall be transmitted to the Secretary not later 
                than 12 months after the end of the year for which 
                funds are provided under this section. The recipient 
                may utilize reprints of articles published or accepted 
                for publication in professional journals to supplement 
                or replace such report if the research contained in 
                such articles was supported under this section during 
                the year for which the report is required.
                    ``(B) Multiyear programs.--In the case of any 
                research program for which assistance is provided under 
                this section for 2 or more consecutive 1-year periods, 
                the recipient of such assistance shall prepare and 
                transmit the report required by subparagraph (A) to the 
                Secretary not later than 12 months after the end of 
                each 1-year period for which such funding is provided.
            ``(2) Other reports.--Recipients of grants and contracts 
        for dissemination under this section shall submit to the 
        Secretary such reports as the Secretary determines appropriate.

``SEC. 2009. EVALUATION.

    ``Of the funds appropriated under this title, the Secretary shall 
reserve not less than 1 percent and not more than 3 percent for the 
evaluation of activities carried out under this title. The Secretary 
shall submit to the appropriate committees of Congress a summary of 
each evaluation conducted under this section and a summary of the data 
reported by grantees under section 2006(c).

``SEC. 2010. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) In General.--For the purpose of carrying out this title, 
there are authorized to be appropriated $60,000,000 for each of the 
fiscal years 1995 through 1997.
    ``(b) Grants for Services.--At least two-thirds of the amounts 
appropriated to carry out this title shall be used to make grants for 
services.
    ``(c) Prevention Services.--Two-thirds of the amounts specified 
under subsection (b) for use for grants for services shall be used for 
grants for prevention services.

``SEC. 2011. FUND RESTRICTION.

    ``No funds for grants made under this title may be used for payment 
for the performance of an abortion.''.

   Subtitle I--Adolescent Health Demonstrations Projects Act of 1993

SEC. 241. SHORT TITLE.

    This subtitle may be cited as the ``Adolescent Health 
Demonstrations Projects Act of 1993''.

SEC. 242. ESTABLISHMENT OR SUPPORT OF DEMONSTRATION PROJECTS.

    The Secretary of Health and Human Services (hereinafter in this 
subtitle referred to as the ``Secretary'') shall make grants in fiscal 
years 1994 through 1998 to public and nonprofit private entities to 
establish or support adolescent health demonstration projects in 
secondary schools or entities associated with secondary schools for the 
purpose of demonstrating how such projects may be established 
throughout the United States.

SEC. 243. PROJECT REQUIREMENTS.

    An adolescent health demonstration project established or supported 
under section 242 shall (1) provide nutrition and hygiene counseling, 
health care related to sports, family planning information and 
services, prenatal and postpartum care, family life and parenting 
counseling, and alcohol and drug abuse education and treatment, (2) 
serve adolescents before their graduation from high school, (3) 
encourage family participation, to the extent practical, (4) obtain the 
approval of the school board in the locality to be served by the 
project before the project is implemented, (5) furnish such reports and 
data as the Secretary may require, including, at a minimum, the number 
and characteristics of individuals served, the services provided, and 
the results achieved, and (6) establish a community advisory committee 
to oversee the establishment and implementation of such project. Such 
community advisory committee shall include students, parents, school 
personnel, physicians, religious and business leaders, and other 
community representatives and shall establish policies for the project 
with respect to the services to be provided under the project, the 
populations to be served, the personnel who will provide services, fees 
to be charged, and other policy issues.

SEC. 244. AREAS TO BE SERVED.

    In making grants under section 242, the Secretary shall give 
priority to applications for projects which will serve areas with low-
income residents or minority populations.

SEC. 245. ABORTION RESTRICTION.

    None of the funds provided under a grant under section 242 may be 
used to perform or pay for abortions.

SEC. 245A. REPORT.

    The Secretary shall, in each fiscal year, set aside not more than 5 
percent of the amount appropriated for grants under section 242 to 
evaluate the operations of the projects for which grants were made 
under such section. Not later than December 1, 1999, the Secretary 
shall report to the Congress the result of such evaluation together 
with such recommendations as the Secretary may have respecting the 
extension of the grant authority under section 242 or the establishment 
of a continuing service program.

   Subtitle J--Eating Disorders Information and Education Act of 1993

SEC. 246. SHORT TITLE.

    This subtitle may be cited as the ``Eating Disorders Information 
and Education Act of 1993''.

SEC. 247. FINDINGS.

    The Congress finds the following:
            (1) Eating disorders include anorexia nervosa and bulimia 
        nervosa, as well as eating disorders not otherwise defined.
            (2) Anorexia nervosa and bulimia each can result in death, 
        cardiac impairments, depression, substance abuse, osteoporosis, 
        infertility, amenorrhea, anemia, and other medical conditions.
            (3) Medical authorities are uncertain to what extent eating 
        disorders are caused by physiological factors, by psychosocial 
        factors, or by both.
            (4) Such disorders primarily affect women. As many as 6 
        percent of women may be experiencing eating disorders, and the 
        rate of new cases is increasing. As many as 30 percent of women 
        in institutions of higher education may be displaying symptoms 
        of eating disorders.
            (5) There are effective treatments for some eating 
        disorders.

SEC. 248. PUBLIC INFORMATION AND EDUCATION ON EATING DISORDERS.

    Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb-31 et seq.), as added by section 115 of Public Law 102-321 
(106 Stat. 346), is amended by adding at the end the following section:

                           ``eating disorders

    ``Sec. 520C. (a) Information and Education.--The Secretary, acting 
through the Director of the Center for Mental Health Services, shall 
carry out a program to provide information and education to the public 
on the prevention and treatment of eating disorders.
    ``(b) Toll-Free Telephone Communications.--In carrying out 
subsection (a), the Secretary shall provide for the operation of toll-
free telephone communications to provide information to the public on 
eating disorders, including referrals for services for the prevention 
and treatment of such disorders. Such communications shall be available 
on a 24-hour, 7-day basis.
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $2,000,000 
for fiscal year 1994, and such sums as may be necessary for each of the 
fiscal years 1994 through 1996.''.

         Subtitle K--Women and HIV Outreach and Prevention Act

SEC. 251. SHORT TITLE.

    This subtitle may be cited as the ``Women and HIV Outreach and 
Prevention Act''.

SEC. 252. PREVENTIVE HEALTH PROGRAMS REGARDING WOMEN AND HUMAN 
              IMMUNODEFICIENCY VIRUS.

    Title XXV of the Public Health Service Act (42 U.S.C. 300ee et 
seq.) is amended by adding at the end the following part:

                      ``Part C--Programs for Women

``SEC. 2531. PREVENTIVE HEALTH SERVICES.

    ``(a) In General.--The Secretary may make grants for the following 
purposes:
            ``(1) Providing to women preventive health services that 
        are related to acquired immune deficiency syndrome, including--
                    ``(A) counseling on the prevention of infection 
                with, and the transmission of, the etiologic agent for 
                such syndrome; and
                    ``(B) screening women for infection with such 
                agent.
            ``(2) Providing appropriate referrals regarding the 
        provision of other services to women who are receiving services 
        pursuant to paragraph (1), including, as appropriate, referrals 
        for treatment for such infection, referrals for treatment for 
        substance abuse, referrals for mental health services, 
        referrals regarding pregnancy, childbirth, and pediatric care, 
        and referrals for housing services.
            ``(3) Providing follow-up services regarding such 
        referrals, to the extent practicable.
            ``(4) Improving referral arrangements for purposes of 
        paragraph (2).
            ``(5) In the case of a woman receiving services pursuant to 
        any of paragraphs (1) through (3), providing to the partner of 
        the woman the services described in such paragraphs, as 
        appropriate.
            ``(6) With respect to the services specified in paragraphs 
        (1) through (5)--
                    ``(A) providing outreach services to inform women 
                of the availability of such services; and
                    ``(B) providing training regarding the effective 
                provision of such services.
    ``(b) Minimum Qualifications of Grantees.--The Secretary may make a 
grant under subsection (a) only if the applicant for the grant is a 
grantee under section 329, section 330, or section 1001, or is another 
public or nonprofit private entity that provides health or voluntary 
family planning services to a significant number of low-income women in 
a culturally sensitive and language-appropriate manner.
    ``(c) Confidentiality.--The Secretary may make a grant under 
subsection (a) only if the applicant for the grant agrees to maintain 
the confidentiality of information on individuals regarding screenings 
pursuant to subsection (a), subject to complying with applicable law.
    ``(d) Application for Grant.--The Secretary may make a grant under 
subsection (a) only if an application for the grant is submitted to the 
Secretary and the application is in such form, is made in such manner, 
and contains such agreements, assurances, and information as the 
Secretary determines to be necessary to carry out such subsection.
    ``(e) Evaluations and Reports.--
            ``(1) Evaluations.--The Secretary shall, directly or 
        through contracts with public or private entities, provide for 
        evaluations of projects carried out pursuant to subsection (a).
            ``(2) Reports.--Not later than 1 year after the date on 
        which amounts are first appropriated under subsection (f), and 
        annually thereafter, the Secretary shall submit to the Congress 
        a report summarizing evaluations carried out under paragraph 
        (1) during the preceding fiscal year.
    ``(f) Authorizations of Appropriations.--
            ``(1) Title x clinics.--For the purpose of making grants 
        under subsection (a) to entities that are grantees under 
        section 1001, and for the purpose of otherwise carrying out 
        this section with respect to such grants, there are authorized 
        to be appropriated $30,000,000 for fiscal year 1994, and such 
        sums as may be necessary for each of the fiscal years 1995 and 
        1996.
            ``(2) Community and migrant health centers; other 
        providers.--For the purpose of making grants under subsection 
        (a) to entities that are grantees under section 329 or 330, and 
        to other entities described in subsection (b) that are not 
        grantees under section 1001, and for the purpose of otherwise 
        carrying out this section with respect to such grants, there 
        are authorized to be appropriated $20,000,000 for fiscal year 
        1994, and such sums as may be necessary for each of the fiscal 
        years 1995 and 1996.

``SEC. 2532. PUBLIC EDUCATION.

    ``(a) In General.--The Secretary may make grants for the purpose of 
developing and carrying out programs to educate women on the prevention 
of infection with, and the transmission of, the etiologic agent for 
acquired immune deficiency syndrome.
    ``(b) Minimum Qualifications of Grantees.--The Secretary may make a 
grant under subsection (a) only if the applicant involved is a public 
or nonprofit private entity that is experienced in carrying out health-
related activities for women, with a priority given to such entities 
that have successfully targeted women of color.
    ``(c) Application for Grant.--The Secretary may make a grant under 
subsection (a) only if an application for the grant is submitted to the 
Secretary and the application is in such form, is made in such manner, 
and contains such agreements, assurances, and information as the 
Secretary determines to be necessary to carry out such subsection.
    ``(d) Evaluations and Reports.--
            ``(1) Evaluations.--The Secretary shall, directly or 
        through contracts with public or private entities, provide for 
        evaluations of projects carried out pursuant to subsection (a).
            ``(2) Reports.--Not later than 1 year after the date on 
        which amounts are first appropriated under subsection (e), and 
        annually thereafter, the Secretary shall submit to the Congress 
        a report summarizing evaluations carried out under paragraph 
        (1) during the preceding fiscal year.
    ``(e) Authorizations of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be appropriated 
$30,000,000 for fiscal year 1994, and such sums as may be necessary for 
each of the fiscal years 1995 and 1996.''.

SEC. 253. TREATMENT OF WOMEN FOR SUBSTANCE ABUSE.

    Subpart 1 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb et seq.), as amended by section 108 of Public Law 102-321 
(106 Stat. 336), is amended by inserting after section 509 the 
following section:

                ``treatment of women for substance abuse

    ``Sec. 509A. (a) In General.--The Director of the Center for 
Substance Abuse Treatment may make awards of grants, cooperative 
agreements, and contracts for the purpose of carrying out programs--
            ``(1) to provide treatment for substance abuse to women, 
        including but not limited to, women with dependent children;
            ``(2) to provide to women who engage in such abuse 
        counseling on the prevention of infection with, and the 
        transmission of, the etiologic agent for acquired immune 
        deficiency syndrome; and
            ``(3) to provide such counseling to women who are the 
        partners of individuals who engage in such abuse.
    ``(b) Authorization of Appropriations.--For the purpose of carrying 
out subsection (a), there are authorized to be appropriated $20,000,000 
for fiscal year 1994, and such sums as may be necessary for each of the 
fiscal years 1995 and 1996.''.

SEC. 254. EARLY INTERVENTION SERVICES FOR WOMEN.

    Section 2655 of the Public Health Service Act (42 U.S.C. 300ff-55) 
is amended--
            (1) by striking ``For the purpose of'' and inserting ``(a) 
        In General.--For the purpose of''; and
            (2) by adding at the end the following subsection:
    ``(b) Programs for Women.--For the purpose of making grants under 
section 2651 to provide to women early intervention services described 
in such section, and for the purpose of providing technical assistance 
under section 2654(b) with respect to such grants, there are authorized 
to be appropriated $20,000,000 for fiscal year 1994, and such sums as 
may be necessary for each of the fiscal years 1995 and 1996.''.

                  Subtitle L--Standby Guardianship Act

SEC. 256. SHORT TITLE.

    This subtitle may be cited as the ``Standby Guardianship Act''.

SEC. 257. STATES REQUIRED TO HAVE STANDBY GUARDIANSHIP LAW AS A 
              CONDITION OF ELIGIBILITY FOR FEDERAL FUNDS FOR FOSTER 
              CARE AND ADOPTION ASSISTANCE.

    (a) In General.--Part E of title IV of the Social Security Act (42 
U.S.C. 670-679) is amended by inserting after section 477 the 
following:

``SEC. 478. STANDBY GUARDIANSHIP LAWS AND PROCEDURES.

    ``To be eligible for payments under this part, a State must have in 
effect laws and procedures that permit any parent who is chronically 
ill or near death, without surrendering parental rights, to designate a 
standby guardian for the parent's minor children, whose authority would 
take effect upon--
            ``(1) the death of the parent;
            ``(2) the mental incapacity of the parent; or
            ``(3) the physical debilitation and consent of the 
        parent.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect at the end of the first calendar quarter that begins 60 or 
more months after the date of the enactment of this Act, and shall 
apply to payments under part E of title IV of the Social Security Act 
for the quarter and payments made under such part for any succeeding 
quarter.

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

SEC. 261. SHORT TITLE.

    This subtitle may be cited as the ``Federal Prohibition of Female 
Genital Mutilation Act of 1993''.

SEC. 262. TITLE 18 AMENDMENT.

    (a) In General.--Chapter 7 of title 18, United States Code, is 
amended by adding at the end the following new section:
``Sec. 116. Female genital mutilation
    ``(a) Except as provided in subsection (b), whoever knowingly 
circumcises, excises, or infibulates the whole or any part of the labia 
majora or labia minora or clitoris of another person who has not 
attained the age of 18 years shall be fined under this title or 
imprisoned not more than 5 years, or both.
    ``(b) A surgical operation is not a violation of this section if 
the operation is--
            ``(1) necessary to the health of the person on whom it is 
        performed, and is performed by a person licensed in the place 
        of its performance as a medical practitioner; or
            ``(2) performed on a person in labor or who has just given 
        birth and is performed for medical purposes connected with that 
        labor or birth by a person licensed in the place it is 
        performed as a medical practitioner, midwife, or person in 
        training to become such a practitioner or midwife.
    ``(c) In applying subsection (b)(1), no account shall be taken of 
the effect on the person on whom the operation is to be performed of 
any belief on the part of that or any other person that the operation 
is required as a matter of custom or ritual.
    ``(d) Whoever knowingly denies to any person medical care or 
services or otherwise discriminates against any person in the provision 
of medical care or services, because--
            ``(1) that person has undergone female circumcision, 
        excision, or infibulation; or
            ``(2) that person has requested that female circumcision, 
        excision, or infibuation be performed on any person;
shall be fined under this title or imprisoned not more than one year, 
or both.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 7 of title 18, United States Code, is amended by adding at the 
end the following new item:

``116. Female genital mutilation.''.

SEC. 263. EDUCATION AND OUTREACH.

    The Secretary of Health and Human Services shall carry our 
appropriate education, preventive, and outreach activities in 
communities that traditionally practice female circumcision, excision, 
or infibulation, to inform people in those communities about the health 
risks and emotional trauma inflicted by those practices, and to inform 
them and the medical community about the provisions of section 262.

SEC. 264. EFFECTIVE DATES.

    Section 263 shall take effect immediately, and the Secretary of 
Health and Human Services shall commence carrying it out not later than 
90 days after the date of the enactment of this Act. Section 262 shall 
take effect 180 days after the date of the enactment of this Act.

    Subtitle N--Smoking Prevention and Cessation in WIC Clinics Act

SEC. 266. SHORT TITLE.

    This subtitle may be cited as the ``Smoking Prevention and 
Cessation in WIC Clinics Act''.

SEC. 267. SMOKING CESSATION DEMONSTRATION PROGRAMS FOR WIC 
              PARTICIPANTS.

    Section 17(e) of the Child Nutrition Act of 1966 (42 U.S.C. 
1786(e)) is amended--
            (1) by redesignating paragraphs (3) (the second place it 
        appears), (4), and (5) as paragraphs (4) through (6), 
        respectively; and
            (2) by adding at the end the following new paragraph:
    ``(7)(A) The State agency shall ensure that each local agency 
operating the program under this section--
            ``(i) establishes and carries out an on-site smoking 
        cessation demonstration program for pregnant participants on a 
        voluntary basis; and
            ``(ii) educates all participants about the adverse health 
        effects of cigarette smoking.
    ``(B) The program described in subparagraph (A)(i) shall--
            ``(i) be provided to participants during regular visits to 
        the clinic;
            ``(ii) be incorporated into the program under this section;
            ``(iii) include a public information and education 
        component, which shall include the dissemination of risk 
        information and materials relating to the adverse health 
        effects of cigarette smoking during pregnancy; and
            ``(iv) include a self-monitoring component, which shall 
        include--
                    ``(I) one-on-one counseling designed to help 
                participants quit smoking; and
                    ``(II) the utilization of a process whereby the 
                participant develops and signs, and a representative 
                from the local agency and an individual chosen by the 
                participant also sign, a written statement containing a 
                promise by the participant to quit smoking beginning on 
                a certain date.
    ``(C)(i) The State agency shall ensure that each local agency 
operating the program under this section submits to such State agency 
an annual report containing a description and evaluation of the program 
established and carried out by such local agency, including a 
description of the total number of participants receiving services 
under such program and the success rate of such participants in 
quitting smoking. The State agency shall compile such reports into 1 
annual report and submit such report to the Secretary.
    ``(ii) The Secretary shall submit to the Congress an annual report 
containing--
            ``(I) a compilation of the information contained in the 
        reports received by the Secretary from each State agency under 
        clause (i); and
            ``(II) an evaluation of the effectiveness of the smoking 
        cessation demonstration programs.''.

 Subtitle O--Family and Medical Leave Health Care Reform Resolution of 
                                  1993

SEC. 271. SHORT TITLE.

    This subtitle may be cited as the ``Family and Medical Leave Health 
Care Reform Resolution of 1993''.

SEC. 272. FINDINGS.

    The Congress finds that--
    (1) the number of single-parent and 2-parent households in which 
the single parent or both parents work is increasing significantly;
            (2) it is important for the development of children and the 
        family unit that fathers and mothers be able to participate in 
        early childrearing and the care of family members who have 
        serious health conditions;
            (3) the lack of employment policies to accommodate working 
        parents can force individuals to choose between job security 
        and parenting;
            (4) there is inadequate job security for employees who have 
        serious health conditions that prevent them from working for 
        temporary periods;
            (5) due to the nature of the roles of men and women in the 
        society of the United States, the primary responsibility for 
        family caretaking often falls on women, and such responsibility 
        affects the working lives of women more than it affects the 
        working lives of men;
            (6) more than 70 percent of women with school-aged children 
        and 56 percent of women with preschool-aged children work 
        outside the home;
            (7) employment standards that apply only to 1 gender have 
        serious potential for encouraging employers to discriminate 
        against employees and applicants for employment who are of the 
        gender;
            (8) numerous bills to reform the health insurance system in 
        the United States have been introduced in the Senate and the 
        House of Representatives;
            (9) several of the bills, if they were enacted, would 
        significantly alter the existing health insurance system; and
            (10) granting employees family and temporary medical leave 
        as part of a reform of the health insurance system promises to 
        improve both the prevention and cure of serious health 
        conditions by averting undue stress on the part of employees 
        and permitting them personally to attend to family members who 
        have such conditions.

SEC. 273. SENSE OF CONGRESS.

    It is the sense of the Congress that any bill to address the 
ongoing and unmet health insurance needs of the people of the United 
States that is enacted should require that paid or unpaid leave, as 
detailed in the Family and Medical Leave Act of 1993, be incorporated 
as a basic or elective option for plan participants for 1 or more of 
the following:
            (1) Because of the birth of a son or daughter of an 
        employee and in order to care for the son or daughter.
            (2) Because of the placement of a son or daughter with an 
        employee for adoption or foster care.
            (3) In order to care for the spouse, or a son, daughter, or 
        parent, of an employee, if the spouse, son, daughter, or parent 
        has a serious health condition.
            (4) Because of a serious health condition that makes an 
        employee unable to perform the functions of the position of the 
        employee.

       Subtitle P--Veteran Women's Health Improvement Act of 1993

SEC. 276. SHORT TITLE.

    This subtitle may be cited as the ``Veteran Women's Health 
Improvement Act of 1993''.

SEC. 277. WOMEN'S HEALTH SERVICES.

    (a) Women's Health Services.--Section 1701 of title 38, United 
States Code, is amended--
            (1) in paragraph (6)(A)(i), by inserting ``women's health 
        services,'' after ``preventive health services,''; and
            (2) by adding at the end the following:
    ``(10) The term `women's health services' means health care 
services provided to women, including counseling and services relating 
to the following:
            ``(A) Papanicolaou tests (pap smear).
            ``(B) Breast examinations and mammography.
            ``(C) Comprehensive reproductive health care, including 
        pregnancy-related care.
            ``(D) The management of infertility.
            ``(E) The management and prevention of sexually-transmitted 
        diseases.
            ``(F) Menopause, osteoporosis, and other conditions 
        relating to aging.
            ``(G) Physical or psychological conditions arising out of 
        acts of sexual violence.''.
    (b) Contracts for Women's Health Services.--Section 1703(a) of such 
title is amended by adding at the end the following:
            ``(9) Women's health services for veterans on an ambulatory 
        or outpatient basis.''.
    (c) Repeal of Superseded Authority.--Section 106 of the Veterans 
Health Care Act of 1992 (Public Law 102-585; 38 U.S.C. 1710 note) is 
amended--
            (1) by striking out subsection (a); and
            (2) by striking out ``(b) Responsibilities of Directors of 
        Facilities.--'' before ``The Secretary''.
    (d) Report on Health Care and Research.--Section 107(b) of such Act 
(38 U.S.C. 1710 note) is amended--
            (1) in paragraph (1), by inserting ``and women's health 
        services (as such term is defined in section 1701(10) of title 
        38, United States Code)'' after ``section 106 of this Act'';
            (2) in paragraph (2), by striking out ``and (B)'' and 
        inserting in lieu thereof ``(B) the type and amount of services 
        provided by such personnel, including information on the 
        numbers of inpatient stays and the number of outpatient visits 
        through which such services were provided, and (C)'';
            (3) by redesignating paragraph (4) as paragraph (7);
            (4) by adding after paragraph (3) the following new 
        paragraphs:
            ``(4) A description of the personnel of the Department who 
        provided such services to women veterans, including the number 
        of employees (including both the number of individual employees 
        and the number of full-time employee equivalents) and the 
        professional qualifications or specialty training of such 
        employees and the Department facilities to which such personnel 
        were assigned.
            ``(5) A description of any actions taken by the Secretary 
        to ensure the retention of the personnel described in paragraph 
        (4) and any actions undertaken to recruit additional such 
        personnel or personnel to replace such personnel.
            ``(6) An assessment by the Secretary of any difficulties 
        experienced by the Secretary in the furnishing of such services 
        and the actions taken by the Secretary to resolve such 
        difficulties.''; and
            (5) by adding after paragraph (7), as redesignated by 
        paragraph (3) of this subsection, the following:
            ``(8) A description of the actions taken by the Secretary 
        to foster and encourage the expansion of such research.''.

SEC. 278. EXPANSION OF RESEARCH RELATING TO WOMEN VETERANS.

    (a) Health Research.--Section 109(a) of the Veterans Health Care 
Act of 1992 (Public Law 102-585; 38 U.S.C. 7303 note) is amended--
            (1) by inserting ``(1)'' before ``The Secretary'';
            (2) in paragraph (1), as so designated, by striking out 
        ``veterans who are women'' and inserting in lieu thereof 
        ``women veterans''; and
            (3) by adding at the end the following:
    ``(2) In carrying out this section, the Secretary shall consult 
with the following:
            ``(A) The Director of the Nursing Service.
            ``(B) Officials of the Central Office assigned 
        responsibility for women's health programs and sexual trauma 
        services.
            ``(C) The members of the Advisory Committee on Women 
        Veterans established under section 542 of title 38, United 
        States Code.
            ``(D) Members of appropriate task forces and working groups 
        within the Department of Veterans Affairs (including the Women 
        Veterans Working Group and the Task Force on Treatment of Women 
        Who Suffer Sexual Abuse).
    ``(3) The Secretary shall foster and encourage research under this 
section on the following matters as they relate to women:
            ``(A) Breast cancer.
            ``(B) Gynecological and reproductive health, including 
        gynecological cancer, infertility, sexually-transmitted 
        diseases, and pregnancy.
            ``(C) Human Immunodeficiency Virus and Acquired Immune 
        Deficiency Syndrome.
            ``(D) Mental health, including post-traumatic stress 
        disorder, depression, combat related stress, and trauma.
            ``(E) Diseases related to aging, including menopause, 
        osteoporosis, and Alzheimer's Disease.
            ``(F) Substance abuse.
            ``(G) Sexual violence and related trauma.
            ``(H) Exposure to toxic chemicals and other environmental 
        hazards.
    ``(4) The Secretary shall, to the maximum extent practicable, 
ensure that personnel of the Department of Veterans Affairs engaged in 
the research referred to in paragraph (1) include the following:
            ``(A) Personnel of the geriatric research, education, and 
        clinical centers designated pursuant to section 7314 of title 
        38, United States Code.
            ``(B) Personnel of the National Center for Post-Traumatic 
        Stress Disorder established pursuant to section 110(c) of the 
        Veterans Health Care Act of 1984 (Public Law 98-528; 98 Stat. 
        2692).
    ``(5) The Secretary shall ensure that personnel of the Department 
engaged in research relating to the health of women veterans are 
advised and informed of such research engaged in by other personnel of 
the Department.''.
    (b) Inclusion of Women and Minorities in Clinical Research 
Projects.--(1) In conducting or supporting clinical research, the 
Secretary of Veterans Affairs shall ensure that--
            (A) women who are veterans are included as subjects in each 
        project of such research; and
            (B) members of minority groups who are veterans are 
        included as subjects of such research.
    (2) The requirement in paragraph (1) regarding women and members of 
minority groups who are veterans may be waived by the Secretary of 
Veterans Affairs with respect to a project of clinical research if the 
Secretary determines that the inclusion, as subjects in the project, of 
women and members of minority groups, respectively--
            (A) is inappropriate with respect to the health of the 
        subjects;
            (B) is inappropriate with respect to the purpose of the 
        research; or
            (C) is inappropriate under such other circumstances as the 
        Secretary of Veterans Affairs may designate.
    (3) In the case of a project of clinical research in which women or 
members of minority groups will under paragraph (1) be included as 
subjects of the research, the Secretary of Veterans Affairs shall 
ensure that the project is designed and carried out so as to provide 
for a valid analysis of whether the variables being tested in the 
research affect women or members of minority groups, as the case may 
be, differently than other persons who are subjects of the research.
    (c) Population Study.--Section 110(a) of such Act (38 U.S.C. 1710 
note) is amended--
            (1) in paragraph (1), by striking out the second sentence; 
        and
            (2) by amending paragraph (3) to read as follows:
    ``(3)(A) Subject to subparagraph (B), the study shall be based on--
            ``(i) an appropriate sample of veterans who are women; and
            ``(ii) an examination of the medical and demographic 
        histories of the women comprising such sample.
    ``(B) The sample referred to in subparagraph (A) shall constitute a 
representative sampling (as determined by the Secretary) of the ages, 
the ethnic, social and economic backgrounds, the enlisted and officer 
grades, and the branches of service of all veterans who are women.
    ``(C) In carrying out the examination referred to in subparagraph 
(A)(ii), the Secretary shall determine the number of women of the 
sample who have used medical facilities of the Department, nursing home 
facilities of or under the jurisdiction of the Department, and 
outpatient care facilities of or under the jurisdiction of the 
Department.''.

SEC. 279. MAMMOGRAPHY QUALITY STANDARDS.

    (a) Applicability to Department of Veterans Affairs of Mammography 
Quality Standards Act of 1992.--Subsections (a) through (k) of section 
354 of the Public Health Service Act (42 U.S.C. 263b) shall apply with 
respect to facilities of the Department of Veterans Affairs without 
regard to the last sentence of subparagraph (A) of subsection (a)(3) of 
such section.
    (b) Extension of Deadlines.--Any deadline for the completion of any 
action prescribed under any provision referred to in subsection (a) 
shall be applied with respect to facilities of the Department of 
Veterans Affairs by extending such deadline so as to be two years after 
the date of the enactment of this Act or two years after the date which 
would otherwise be applicable under such provision, whichever is later.
    (c) Interagency Cooperation.--The Secretary of Veterans Affairs 
shall take appropriate steps to cooperate with the Secretary of Health 
and Human Services in the implementation of this section.

       Subtitle Q--Defense Women's Health Improvement Act of 1993

SEC. 281. SHORT TITLE.

    This subtitle may be cited as the ``Defense Women's Health 
Improvement Act of 1993''.

                      PART I--WOMEN'S HEALTH CARE

SEC. 282. PRIMARY AND PREVENTIVE HEALTH-CARE SERVICES FOR WOMEN.

    (a) Female Members and Retirees of the Uniformed Services.--(1) 
Chapter 55 of title 10, United States Code, is amended by inserting 
after section 1074c the following new section:
``Sec. 1074d. Primary and preventive health-care services for women
    ``Female members and former members of the uniformed services who 
are entitled to medical care under section 1074 or 1074a of this part 
shall be furnished with primary and preventive health-care services for 
women as part of such medical care.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1074c the 
following new item:

``1074d. Primary and preventive health-care services for women.''.
    (b) Female Dependents.--Section 1077(a) of such title is amended by 
adding at the end the following new paragraph:
            ``(13) Primary and preventive health-care services for 
        women.''.
    (c) Definition.--Section 1072 of such title is amended by adding at 
the end the following new paragraph:
            ``(6) The term `primary and preventive health-care services 
        for women' means health-care services provided to women, 
        including counseling, relating to the following:
                    ``(A) Papanicolaou tests (pap smear).
                    ``(B) Breast examinations and mammography.
                    ``(C) Comprehensive reproductive health care, 
                including care related to pregnancy.
                    ``(D) Infertility and sexually transmitted 
                diseases, including prevention.
                    ``(E) Menopause.
                    ``(F) Physical or psychological conditions arising 
                out of acts of sexual violence.''.

SEC. 283. REPORT ON THE PROVISION OF HEALTH-CARE SERVICES TO WOMEN.

    (a) Report Required.--The Secretary of Defense shall prepare a 
report evaluating the provision of health-care services through 
military medical treatment facilities and the Civilian Health and 
Medical Program of the Uniformed Services to female members of the 
uniformed services and female covered beneficiaries eligible for health 
care under chapter 55 of title 10, United States Code.
    (b) Contents.--The report required by subsection (a) shall contain 
the following:
            (1) A description of the medical personnel of the 
        Department of Defense who provided health-care services during 
        fiscal year 1993 to female members and covered beneficiaries, 
        including--
                    (A) the number of such personnel (including both 
                the number of individual employees and the number of 
                full-time employee equivalents);
                    (B) the professional qualifications or specialty 
                training of such personnel; and
                    (C) the medical facilities to which such personnel 
                were assigned.
            (2) A description of any actions, including the use of 
        special pays and incentives, taken by the Secretary during 
        fiscal year 1993--
                    (A) to ensure the retention of the medical 
                personnel described in paragraph (1);
                    (B) to recruit additional personnel to provide 
                health-care services to female members and female 
                covered beneficiaries; and
                    (C) to replace departing personnel who provided 
                such services.
            (3) A description of any existing or proposed programs to 
        encourage specialization of health care professionals in fields 
        related to primary and preventive health-care services for 
        women.
            (4) An assessment of any difficulties experienced by 
        military medical treatment facilities or the Civilian Health 
        and Medical Program of the Uniformed Services in furnishing 
        primary and preventive health-care services for women and a 
        description of those actions taken by the Secretary to resolve 
        such difficulties.
            (5) An assessment of the extent to which gender-related 
        factors impede or complicate diagnoses (such as inappropriate 
        psychiatric referrals and admissions) made by medical personnel 
        described in paragraph (1).
            (6) A description of the actions taken by the Secretary to 
        foster and encourage the expansion of research relating to 
        health care issues of concern to female members of the 
        uniformed services and female covered beneficiaries.
    (c) Population Study of the Need of Female Members and Female 
Covered Beneficiaries for Health-Care Services.--(1) As part of the 
report required by subsection (a), the Secretary shall conduct a study 
to determine the needs of female members of the uniformed services and 
female covered beneficiaries for health-care services, including 
primary and preventive health-care services for women.
    (2) The study shall examine the health needs of current members and 
covered beneficiaries and future members and covered beneficiaries 
based upon the anticipated size and composition of the Armed Forces in 
the year 2000 and should be based on the demographics of society as a 
whole.
    (d) Submission and Revision.--The Secretary of Defense shall submit 
the report required by subsection (a) to Congress not later than April 
1, 1994. The Secretary shall revise and resubmit the report to Congress 
not later than April 1, 1999.
    (e) Definitions.--For purposes of this section:
            (1) The term ``primary and preventive health care services 
        for women'' has the meaning given such term in paragraph (6) of 
        section 1072 of title 10, United States Code, as added by 
        section 101(c)).
            (2) The term ``covered beneficiary'' has the meaning given 
        such term in paragraph (5) of such section.

                    PART II--WOMEN'S HEALTH RESEARCH

SEC. 284. DEFENSE WOMEN'S HEALTH RESEARCH CENTER.

    (a) Establishment of the Center.--The Secretary of Defense shall 
establish a Defense Women's Health Research Center (hereinafter in this 
section referred to as the ``Center'') in the Department of the Army. 
The Center shall be under the authority of the Army Health Services 
Command.
    (b) Purposes.--(1) The Center shall be the coordinating agent for 
multidisciplinary and multiinstitutional research within the Department 
of Defense on women's health issues related to service in the Armed 
Forces. The Center shall be dedicated to development and application of 
new knowledge, procedures, techniques, training, and equipment for the 
improvement of the health of women in the Armed Forces.
    (2) In carrying out or sponsoring research studies, the Center 
shall provide that the cohort of women in the Armed Forces shall be 
considered as a control group.
    (3) The Center shall support the goals and objectives recognized by 
the Department of Defense under the plan of the Department of Health 
and Human Services designated as ``Healthy People 2000''.
    (4) The Center shall support initiation and expansion of research 
into matters relating to women's health in the military, including the 
following matters as they relate to women in the military:
            (A) Combat stress and trauma.
            (B) Exposure to toxins and other environmental hazards 
        associated with military hardware.
            (C) Psychology related stresses in warfare situations.
            (D) Breast cancer.
            (E) Reproductive health, including pregnancy.
            (F) Gynecological cancers.
            (G) Infertility and sexually transmitted diseases.
            (H) HIV and AIDS.
            (I) Mental health, including post-traumatic stress disorder 
        and depression.
            (J) Menopause, osteoporosis, Alzheimer's disease, and other 
        conditions and diseases related to aging.
            (K) Substance abuse.
            (L) Sexual violence and related trauma.
            (M) Human factor studies related to women in combat.
    (c) Preparation of a Plan.--The Secretary of Defense, acting 
through the Secretary of the Army and in coordination with the other 
military departments, shall prepare a plan for the implementation of 
this section. The plan shall be submitted to the Committees on Armed 
Services of the Senate and House of Representatives before May 1, 1994.
    (d) Requirements Relating to Establishment of Center.--(1) The 
Secretary shall provide for the establishment of the Center at an 
existing Army facility.
    (2) The Center may be established only at a facility having the 
following characteristics:
            (A) A physical plant immediately available to serve as 
        headquarters for the medical activities to be carried out by 
        the Center.
            (B) Ongoing fellowship and residency programs colocated 
        with ongoing collaborative health-related and interdisciplinary 
        research of (i) a facility of the Department of Veterans 
        Affairs, (ii) an accredited university with specialties in 
        medical research and clinical diagnostics, and (iii) a hospital 
        owned and operated by a municipality.
            (C) A technologically modern laboratory capability at the 
        site and at the affiliated sites referred to in subparagraph 
        (B), with the capability to include state-of-the-art clinical 
        diagnostic instrumentation, data processing, telecommunication, 
        and data storage systems.
            (D) Compatibility with and capability to effectively expand 
        its existing mission in accordance with the mission of the 
        Center under this section.
            (E) Maximum multi-State geographic jurisdiction to permit 
        regional health-related issues to be researched and integrated 
        into national military databases.
            (F) An existing relationship for the provision of services 
        to Native Americans through the Indian Health Service.
    (e) Activities for Fiscal Year 1994.--During fiscal year 1994, the 
Center shall address the following:
            (1) Program planning, infrastructure development, baseline 
        information gathering, technology infusion, and connectivity.
            (2) Management and technical staffing.
            (3) Data base development of health issues related to 
        service on active duty as compared to service in the National 
        Guard or Reserves.
            (4) Research protocols, cohort development, health 
        surveillance and epidemiologic studies.

SEC. 285. CONTINUATION OF ARMY BREAST CANCER RESEARCH PROGRAM.

    During fiscal year 1994, the Secretary of the Army shall continue 
the breast cancer research program established in the second and third 
provisos in the paragraph in title IV of the Department of Defense 
Appropriations Act, 1993 (Public Law 102-396; 106 Stat. 1890) under the 
heading ``Research, Development, Test, and Evaluation, Army'' .

SEC. 286. INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH 
              PROJECTS.

    (a) General Rule.--In conducting or supporting clinical research, 
the Secretary of Defense shall ensure that--
            (1) women who are members of the Armed Forces are included 
        as subjects in each project of such research; and
            (2) members of minority groups who are members of the Armed 
        Forces are included as subjects of such research.
    (b) Waiver Authority.--The requirement in subsection (a) regarding 
women and members of minority groups who are members of the Armed 
Forces may be waived by the Secretary of Defense with respect to a 
project of clinical research if the Secretary determines that the 
inclusion, as subjects in the project, of women and members of minority 
groups, respectively--
            (1) is inappropriate with respect to the health of the 
        subjects;
            (2) is inappropriate with respect to the purpose of the 
        research; or
            (3) is inappropriate under such other circumstances as the 
        Secretary of Defense may designate.
    (c) Requirement for Analysis of Research.--In the case of a project 
of clinical research in which women or members of minority groups will 
under subsection (a) be included as subjects of the research, the 
Secretary of Defense shall ensure that the project is designed and 
carried out so as to provide for a valid analysis of whether the 
variables being tested in the research affect women or members of 
minority groups, as the case may be, differently than other persons who 
are subjects of the research.

SEC. 287. REPORT ON RESEARCH RELATING TO FEMALE MEMBERS OF THE 
              UNIFORMED SERVICES AND FEMALE COVERED BENEFICIARIES.

    Not later than July 1 of each of 1995, 1996, and 1997, the 
Secretary of Defense shall submit to Congress a report containing--
            (1) a description (as of May 31 of the year in which the 
        report is submitted) of the status of any health research that 
        is being carried out by or under the jurisdiction of the 
        Secretary relating to female members of the uniformed services 
        and female covered beneficiaries under chapter 55 of title 10, 
        United States Code; and
            (2) recommendations of the Secretary as to future health 
        research (including a proposal for any legislation relating to 
        such research) relating to such female members and covered 
        beneficiaries.

                   PART III--WOMEN'S HEALTH EDUCATION

SEC. 288. WOMEN'S HEALTH CURRICULUM ADVISORY COMMITTEE.

    The Secretary of Defense shall establish at the F. Edward Hebert 
School of Medicine of the Uniformed Services University of the Health 
Sciences a women's health curriculum advisory committee to promote the 
comprehensive integration of women's health issues into the curriculum 
at the University. The committee shall include the surgeon general of 
each of the military departments and the dean of the School of 
Medicine. The committee shall be established by April 1, 1994.

  Subtitle R--International Population Stabilization and Reproductive 
                               Health Act

SEC. 291. SHORT TITLE.

    This subtitle may be cited as the ``International Population 
Stabilization and Reproductive Health Act''.

SEC. 292. AUTHORITIES RELATING TO UNITED STATES POPULATION ASSISTANCE.

    Part I of the Foreign Assistance Act of 1961 is amended--
            (1) in section 104(b), by striking ``on such terms and 
        conditions as he may determine'' and inserting ``in accordance 
        with the provisions of chapter 12''; and
            (2) by adding at the end the following new chapter:

           ``CHAPTER 12--UNITED STATES POPULATION ASSISTANCE

``SEC. 499. DEFINITION.

    ``For purposes of this chapter, the term `United States population 
assistance' means assistance provided under section 104(b) of this Act.

``SEC. 499A. CONGRESSIONAL FINDINGS.

    ``The Congress makes the following findings:
            ``(1) Throughout much of the world, the lack of access of 
        women, particularly poor women, to basic reproductive health 
        services and information undermines women's struggle for self-
        determination, contributes to death and suffering among women 
        and their children, puts pressure on the land, forests, and 
        other natural resources on which many poor families depend for 
        their survival, and in other ways vitiates the efforts of 
        families to lift themselves out of the poverty in which over 
        1,000,000,000 of the world's more than 5,000,000,000 people 
        live.
            ``(2) During the 1980s, nearly 800,000,000 people, a number 
        three times greater than the population of the United States, 
        were added to the world's population.
            ``(3) Birthrates in many developing countries are declining 
        too slowly to prevent a near tripling of the world's population 
        before stabilization can occur, and although birthrates in some 
        countries have declined faster in recent years than 
        anticipated, world progress toward stabilization was noticeably 
        slower in the 1980s than in the 1970s.
            ``(4) After more than a quarter century of experience and 
        research, the actions needed to bring about a rapid decline in 
        birthrates are well documented. The ability to exercise 
        reproductive choice must be expanded, and such expansion should 
        occur through broader dissemination and choice of contraceptive 
        services that involve the community and are sufficient to meet 
        the needs and values of those who use them.
            ``(5) Although a number of religious and cultural barriers 
        to family planning remain, attitudes toward modern 
        contraception have changed over the last decade, and in many 
        countries a large and growing unmet desire exists for deferring 
        or preventing pregnancy among women and men who are too poor to 
        pay the full cost of services.
            ``(6) Although many social and economic factors affect 
        desired family size, organized, accessible, and affordable 
        family planning programs have the most rapid and strongest 
        effect on birthrate because they enable women and their 
        families to determine the timing and number of their children. 
        Widespread voluntary adoption of modern family planning methods 
        and their successful long-term use depend on the quality of 
        reproductive health care services offered and their 
        responsiveness to individual and community needs and values.
            ``(7) Millions of women, most of them mothers, are killed 
        or injured each year as a result of unsafe abortions. The 
        availability of safe and effective family planning methods and 
        services can help prevent many of these tragedies.
            ``(8) The impact of human population growth, combined with 
        widespread poverty and unsustainable patterns of natural 
        resource consumption, is evident in mounting signs of stress on 
        the world's environment, particularly in tropical 
        deforestation, erosion of arable land and watersheds, 
        extinction of plant and animal species, global climate change, 
        waste management, and air and water pollution.
            ``(9) Traditionally, United States population assistance 
        has not focused on achieving specific goals with respect to 
        international population stabilization or the expansion of 
        reproductive choice. The absence of clear goals in those areas 
        has led to a lack of criteria for allocating funds and 
        evaluating program success.

``SEC. 499B. DECLARATION OF POLICY.

    ``(a) In General.--The Congress declares that to reduce population 
growth and stabilize world population at the lowest level feasible and 
thereby protect the global environment, to provide greater self-
determination for women, and to improve the health and well-being of 
the world's families, a principal objective of the foreign policy of 
the United States shall be to assist the international community to--
            ``(1) achieve universal availability of high quality family 
        planning services through a wide choice of safe and effective 
        means of contraception, including programs of public education 
        and other health and development efforts that enable 
        individuals to choose smaller families;
            ``(2) ensure that all individuals and couples, regardless 
        of age or marital status, are able to exercise their right to 
        decide whether and how many children to have and their right to 
        reproductive health by improving the quality and accessibility 
        of accountable family planning and reproductive health 
        programs;
            ``(3) improve reproductive health, especially of women and 
        young people, through maternal and child health and nutrition 
        services, and through sexuality and gender education services, 
        especially for young people; and
            ``(4) achieve population stabilization at a level 
        consistent with the maintenance of the natural resource base 
        and with investment in human resources, within a broad strategy 
        to adjust consumption levels and patterns in all countries.
    ``(b) Financial Targets.--The Congress establishes a target for 
global expenditures in developing countries from all domestic and 
international sources by the year 2000 of at least $11,000,000,000 for 
population programs described in section 499C, and establishes a goal 
for United States population assistance by the year 2000 of 
$1,400,000,000 in constant 1990 dollars, not including funds available 
for other reproductive health programs.

``SEC. 499C. AUTHORIZED ACTIVITIES.

    ``United States population assistance is authorized to provide--
            ``(1) support for the expansion of quality, affordable, 
        voluntary family planning services, which emphasize informed 
        choice among a variety of safe and effective family planning 
        methods and closely related reproductive health care services, 
        including the prevention and control of sexually transmitted 
        diseases and reproductive tract infections;
            ``(2) support for adequate and regular supplies of quality 
        contraceptive and other commodities, comprehensive counseling, 
        appropriate followup, and support for programs that emphasize 
        the use of the mass media to improve public knowledge of 
        contraceptive methods and related disease prevention methods 
        and where they may be obtained and to promote the benefits of 
        family planning and reproductive health to individuals, 
        families, and communities;
            ``(3) support to United States and foreign research 
        institutions and other appropriate entities for biomedical 
        research to develop and evaluate improved methods of safe and 
        effective contraception and related disease control, with 
        particular emphasis on methods which--
                    ``(A) are likely to be safer, easier to use, easier 
                to make available in developing country settings, and 
                less expensive than current methods;
                    ``(B) are controlled by women, including barrier 
                methods and vaginal microbicides;
                    ``(C) are likely to prevent the spread of sexually 
                transmitted diseases; and
                    ``(D) encourage and enable men to take greater 
                responsibility for their own fertility;
            ``(4) support for field research on the characteristics of 
        programs most likely to result in sustained use of effective 
        family planning in meeting each individual's lifetime 
        reproductive goals, with particular emphasis on the 
        perspectives of family planning users, including support for 
        relevant social and behavioral research focusing on such 
        factors as the use, non-use, and unsafe or ineffective use of 
        various contraceptive and related-disease control methods;
            ``(5) support for the development of new evaluation 
        techniques and performance criteria for family planning 
        programs, emphasizing the family planning user's perspective 
        and reproductive goals;
            ``(6) support for research and research dissemination 
        related to population policy development, including demographic 
        and health surveys to assess population trends, measure unmet 
        needs, and evaluate program impact, and support for policy-
        relevant research on the relationships between population 
        trends, poverty, and environmental management, including 
        implications for sustainable agriculture, agroforestry, 
        biodiversity, water resources, energy use, and local and global 
        climate change;
            ``(7) support for research and public information 
        dissemination on the health and welfare consequences of unsafe 
        abortions and for the equipment and training necessary for the 
        medical treatment of the complications of unsafe abortions;
            ``(8) support for special programs to reach adolescents and 
        young adults, regardless of marital status, before they begin 
        childbearing, including health education programs which stress 
        responsible parenthood and the health risks of unprotected 
        sexual intercourse, as well as service programs designed to 
        meet the information and contraception needs of adolescents and 
        young adults; and
            ``(9) support for a broad array of governmental and 
        nongovernmental communication strategies designed--
                    ``(A) to create public awareness worldwide;
                    ``(B) to generate a consensus on the need to 
                address reproductive health issues and the problems 
                associated with continued world population growth;
                    ``(C) to emphasize the need to educate men as well 
                as women and mobilize their support for reproductive 
                rights and responsibilities; and
                    ``(D) to make family planning an established 
                community norm.

``SEC. 499D. TERMS AND CONDITIONS.

    ``United States population assistance is authorized to be provided 
subject to the following conditions:
            ``(1) Such assistance may only support, directly or through 
        referral, those activities which provide a broad range of 
        contraceptive methods permitted by individual country policy 
        and a broad choice of public and private family planning 
        services, including networks for community-based and subsidized 
        commercial distribution of contraceptives.
            ``(2) No program supported by United States population 
        assistance may deny an individual family planning services 
        because of such individual's inability to pay all or part of 
        the cost of such services.
            ``(3) Family planning services and related reproductive 
        health care services supported by United States population 
        assistance shall maintain the highest medical standards 
        possible under local conditions and shall ensure regular 
        oversight of the quality of medical care and other services 
        offered.
            ``(4) United States-supported reproductive health programs 
        shall in each recipient country support to the extent possible 
        an integrated approach, consistent with respect for the rights 
        of women as decisionmakers in matters of reproduction and 
        sexuality, for the provision of public and private reproductive 
        health services.
            ``(5) United States population assistance programs shall 
        furnish only those contraceptive drugs and devices which have 
        received approval for marketing in the United States by the 
        Food and Drug Administration or which have been tested and 
        determined to be safe and effective under research protocols 
        comparable to those required by the Food and Drug 
        Administration or have been determined to be safe by an 
        appropriate international organization or the relevant health 
        authority in the country to which they are provided.
            ``(6) Reproductive health services supported by the United 
        States shall be designed to take into account the needs of 
        individuals and couples, including the constraints on women's 
        time, by involving communities, particularly representatives of 
        women, through appropriate training and recruitment efforts, in 
        the design, management, and ongoing evaluation of services. The 
        design of such services shall stress easy accessibility, by 
        locating services as close as possible to potential users, by 
        keeping hours of service convenient, and by improving 
        communications between users and providers through community 
        outreach and involvement. The evaluation of reproductive health 
        services also shall not use as a measure of program success the 
        degree of longevity or permanency of any contraceptive method.
            ``(7) United States population assistance to adolescent 
        fertility programs shall be provided in the context of 
        prevailing norms and customs in the recipient country.
            ``(8) None of the funds made available by the United States 
        Government to foreign governments, international organizations, 
        or nongovernmental organizations may be used to coerce any 
        person to undergo contraceptive sterilization or involuntary 
        abortion or to accept any other method of fertility control.

``SEC. 499E. ELIGIBILITY FOR POPULATION ASSISTANCE.

    ``(a) Eligible Countries.--Notwithstanding any other provision of 
law, United States population assistance shall be available, directly 
or through intermediary organizations, to any country which the 
President determines has met one or more of the following criteria:
            ``(1) The country accounts for a significant proportion of 
        the world's annual population increment.
            ``(2) The country has significant unmet needs for methods 
        of contraception, prevention and treatment of sexually 
        transmitted diseases and acquired immune deficiency syndrome 
        (AIDS), and obstetric and gynecological care, and requires 
        foreign assistance to directly implement, expand, or sustain 
        quality reproductive health services for all its people.
            ``(3) The country demonstrates a strong commitment to 
        population stabilization and to comprehensive reproductive 
        health care strategies through policies, programs and the 
        commitment of domestic funds to improve service and make 
        services more widely available.
    ``(b) Eligibility of Nongovernmental and Multilateral 
Organizations.--In determining eligibility for United States population 
assistance, the President shall not subject nongovernmental and 
multilateral organizations to requirements which are more restrictive 
than requirements applicable to foreign governments for such 
assistance.

``SEC. 499F. PARTICIPATION IN MULTILATERAL ORGANIZATIONS.

    ``(a) Finding.--The Congress recognizes that the recent attention 
in government policies toward population stabilization owes much to the 
efforts of the United Nations and its specialized agencies and 
organizations, particularly the United Nations Population Fund.
    ``(b) Availability of Funds.--United States population assistance 
shall be available for contributions to the United Nations Population 
Fund in such amounts as the President determines would be commensurate 
with United States contributions to other multilateral organizations 
and with the contributions of other donor countries.
    ``(c) Prohibitions.--(1) The prohibitions contained in section 
104(f) of this Act shall apply to the funds made available for the 
United Nations Population Fund.
    ``(2) No United States population assistance may be available to 
the United Nations Population Fund unless such assistance is held in a 
separate account and not commingled with any other funds.
    ``(3) No funds may be available for the United Nations Population 
Fund unless the Fund agrees to prohibit the use of those funds to carry 
out any program, project, or activity that involves the use of coerced 
abortion or involuntary sterilization.
    ``(d) Allocation of Funds.--Of the funds made available for United 
States population assistance, the President shall make available for 
the Special Programme of Research, Development and Research Training in 
Human Reproduction for each of the fiscal years 1994 and 1995 an amount 
commensurate with the contributions of the other donor countries for 
the purpose of furthering international cooperation in the development 
and evaluation of contraceptive technology.

``SEC. 499G. SUPPORT FOR NONGOVERNMENTAL ORGANIZATIONS.

    ``(a) Findings.--The Congress finds that--
            ``(1) in many developing countries, nongovernmental 
        entities, including private and voluntary organizations and 
        private sector entities, such as the International Planned 
        Parenthood Federation and the Planned Parenthood Federation of 
        America, are the most appropriate and effective providers of 
        United States assistance to population and family planning 
        activities; and
            ``(2) in particular, organizations and groups founded by 
        women or in which women have significant and meaningful 
        participation, and which are committed to promoting women's 
        reproductive health rights through client-oriented programs and 
        activities, have proven the most effective of all.
    ``(b) Procedures.--The President shall establish simplified 
procedures for the development and approval of programs to be carried 
out by nongovernmental organizations that have demonstrated--
            ``(1) a capacity to undertake quality, effective, client-
        oriented reproductive health and population activities which 
        encourage significant involvement by private health 
        practitioners, employer-based health services, unions, and 
        cooperative health organizations; and
            ``(2) a commitment to quality, client-oriented reproductive 
        health care for women.
    ``(c) Priority for Nongovernmental Organizations.--The largest 
share of United States population assistance made available for any 
fiscal year shall be made available through United States and foreign 
nongovernmental organizations.

``SEC. 499H. REPORTS TO CONGRESS.

    ``The President shall prepare and submit to the Congress, as part 
of the annual presentation materials on foreign assistance, a report on 
world progress toward population stabilization and universal 
reproductive choice. The report shall include--
            ``(1) estimates of expenditures on the population 
        activities described in section 499C by national governments, 
        donor agencies, and private sector entities;
            ``(2) an assessment by country of the availability and use 
        of all methods of contraception and abortion, whether lawful or 
        unlawful in that country;
            ``(3) an analysis by country and region of the impact of 
        population trends on a set of key social, economic, political, 
        and environmental indicators, which shall be identified by the 
        President in the first report submitted pursuant to this 
        section and analyzed in that report and each subsequent report; 
        and
            ``(4) a detailed statement of prior year and proposed 
        direct and indirect allocations of population assistance, by 
        country, which describes how each country allocation meets the 
        criteria set forth in this section.''.

SEC. 293. AUTHORIZATIONS OF APPROPRIATIONS.

    Section 104(g)(1) of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151b(g)(1) is amended by amending subparagraph (A) to read as follows:
            ``(A) $725,000,000 for fiscal year 1994 and $800,000,000 
        for fiscal year 1995 to carry out subsection (b) of this 
        section; and''.

SEC. 294. ECONOMIC AND SOCIAL DEVELOPMENT INITIATIVES TO STABILIZE 
              WORLD POPULATION.

    (a) Congressional Findings.--The Congress makes the following 
findings:
            (1) Women represent 50 percent of the world's human 
        resource potential. Therefore, improving the health, social, 
        and economic status of women and increasing their productivity 
        are essential for economic progress in all countries.
            (2) Throughout the world, women who participate in the 
        social, economic, and political affairs of their communities 
        are more likely to exercise their choice about childbearing 
        than women who do not participate in such activities.
            (3) Effective economic development strategies address 
        issues such as infant and child survival rates, educational 
        opportunities, especially literacy programs, for girls and 
        women, and gender equality in development.
            (4) Comprehensive population stabilization efforts which 
        include both family planning services and economic development 
        activities achieve lower birth rates and stimulate more 
        development than those which pursue these objectives 
        independently.
            (5) The most powerful, long-term influence on birthrates is 
        education, especially educational attainment among women. The 
        education of women also has a strong influence on other aspects 
        of family welfare, including child survival. World-wide 
        statistics, however, indicate that the number of school-age 
        children, especially girls, not attending school is growing 
        annually.
            (6) Each year, nearly 15,000,000 children under the age of 
        5 die, most from preventable causes. Wider availability of 
        vaccines, simple treatments for diarrheal disease and 
        respiratory infections, and improved nutrition could prevent 
        many of these deaths.
            (7) Each year, 500,000 or more women worldwide die from 
        complications related to pregnancy, childbirth, or illegal 
        abortion. Another 10 million women annually suffer long-term 
        illness or permanent physical impairment from such causes.
            (8) In many countries, high levels of mortality and 
        morbidity among women of childbearing age are directly related 
        to inadequate or inaccessible reproductive health care 
        services.
            (9) Many women are their family's principal caregiver and 
        chief source of economic support. The death of a mother 
        substantially increases the risk of neglect, abandonment, or 
        death for her young children.
            (10) Malnutrition and anemia are widespread among poor 
        women in their childbearing years, yet the worldwide campaign 
        to encourage breastfeeding has devoted little attention to the 
        nutritional needs of nursing mothers, or in the improvement of 
        nutritional and health levels of women in general.
            (11) During the 1990s, women, especially in Africa, face 
        substantially increased risks of death or disability from 
        sexually transmitted diseases. During the 1990s, more than 
        3,000,000 women in Africa will die of the acquired immune 
        deficiency syndrome (AIDS), leaving more than 5,000,000 
        orphans.
    (b) Declaration of Policy.--Congress declares that, in order to 
further the United States foreign policy objective of assisting the 
international community in achieving universal availability of quality 
family planning services and stabilizing world population, additional 
objectives of the foreign policy of the United States shall be--
            (1) to expand basic education opportunities for girls and 
        women;
            (2) to reduce the gap between male and female levels of 
        literacy and between male and female levels of primary and 
        secondary school enrollment;
            (3) to help ensure that women worldwide have the 
        opportunity to become equal partners with men in the 
        development of their societies;
            (4) to reduce global maternal and infant mortality rates; 
        and
            (5) to improve worldwide overall reproductive health, 
        maternal and child health status, and quality of life.
    (c) Authorized Activities.--United States development assistance 
shall be available, on a priority basis, for--
            (1) countries which either have adopted and implemented, or 
        have agreed to adopt and implement, strategies to help ensure, 
        by the year 2000--
                    (A) the completion of primary school education by 
                no less than 80 percent of the country's primary 
                school-age children;
                    (B) the reduction of adult illiteracy by at least 
                one-half the country's 1990 level; and
                    (C) the elimination of the gap between male and 
                female levels of literacy and between male and female 
                levels of primary and secondary school enrollment;
            (2) governmental and nongovernmental programs which, with 
        respect to a targeted country, are intended--
                    (A) to reduce significantly malnutrition among the 
                country's children under 5 years of age;
                    (B) to maintain immunizations against childhood 
                diseases for significant segments of the country's 
                children; and
                    (C) to reduce the number of childhood deaths in the 
                country which result from diarrheal disease and acute 
                respiratory infections;
            (3) governmental and nongovernmental programs which are 
        intended to increase women's productivity through improved 
        access to appropriate labor-saving technology, vocational 
        training, and extension services and access to credit and child 
        care; and
            (4) governmental and nongovernmental programs which are 
        intended to increase the access of girls and women to 
        comprehensive reproductive health care services pursuant to 
        subsection (d).
    (d) Safe Motherhood Initiative.--(1)(A) The President is authorized 
to establish a grant program, to be known as the Safe Motherhood 
Initiative, to help improve the access of girls and women worldwide to 
comprehensive reproductive health care services.
    (B) Such program shall be carried out in accordance with this 
section and shall be subject to the same terms, conditions, 
prohibitions, and restrictions as are applicable to assistance made 
available under sections 499D, 499E, and 499F of the Foreign Assistance 
Act of 1961.
    (2) Eligible for assistance under this section are comprehensive 
reproductive health programs which emphasize--
            (A) contraceptive services;
            (B) prenatal care and screening for high risk pregnancies, 
        and improved access to safe delivery services for women with 
        high risk pregnancies;
            (C) supplemental food programs for pregnant and nursing 
        women;
            (D) expanded and coordinated programs to prevent, detect, 
        and treat sexually transmitted diseases, including acquired 
        immune deficiency syndrome (AIDS), reproductive tract 
        infections, and other chronic reproductive health problems;
            (E) programs to eliminate traditional practices injurious 
        to women's health, including female genital mutilation; and
            (F) improvements in the practice of midwifery, including 
        outreach to traditional birth attendants.
    (e) Reports to Congress.--(1) Not later than December 31, 1994, the 
President shall prepare and submit to the Congress a report which 
includes--
            (A) estimates of the total financial resources needed to 
        achieve, by the year 2000, the specific objectives set forth in 
        subsection (c) with respect to education, rates of illiteracy, 
        malnutrition, immunization, maternal and child mortality and 
        morbidity, and improvements in the economic productivity of 
        women;
            (B) an analysis of such estimates which separately lists 
        the total financial resources needed from the United States, 
        other donor nations, and non-governmental organizations;
            (C) an analysis, by country, which--
                    (i) identifies the legal, social, economic, and 
                cultural barriers to women's self-determination and to 
                improvements in the economic productivity of women in 
                traditional and modern labor sectors; and
                    (ii) describes initiatives needed to develop 
                appropriate technologies for use by women, credit 
                programs for low-income women, expanded child care, 
                vocational training, and extension services for women; 
                and
            (D) a comprehensive description of--
                    (i) new and expanded initiatives to ensure safe 
                motherhood worldwide;
                    (ii) findings on the major causes of mortality and 
                morbidity among women of childbearing age in various 
                regions of the world;
                    (iii) actions needed to reduce, by the year 2000, 
                world maternal mortality by one-half of the worldwide 
                1990 level; and
                    (iv) the financial resources needed to meet this 
                goal from the United States, other donor nations, and 
                nongovernmental organizations.
    (2) In each annual country human rights report, the Secretary of 
State shall include--
                    (A) information on any patterns within the country 
                of discrimination against women in inheritance laws, 
                property rights, family law, access to credit and 
                technology, hiring practices, formal education, and 
                vocational training; and
                    (B) an assessment which makes reference to all 
                significant forms of violence against women, including 
                rape, domestic violence, and female genital mutilation, 
                the extent of involuntary marriage and childbearing, 
                and the prevalence of marriage among women under the 
                age of 18 years.
    (f) Authorization of Appropriations.--(1) Of the aggregate amounts 
available for United States development and economic assistance 
programs for education activities, $350,000,000 for fiscal year 1994 
and $350,000,000 for fiscal year 1995 shall be available only for 
programs in support of equalizing male and female levels of primary and 
secondary school enrollment.
    (2) There are authorized to be appropriated $405,000,000 for fiscal 
year 1994 and $490,000,000 for fiscal year 1995 to the Child Survival 
Fund under section 104(c)(2) of the Foreign Assistance Act of 1961, 
which amounts shall be available for child survival activities only, 
including the Children's Vaccine Initiative, the worldwide immunization 
effort, and oral rehydration programs.
    (3) There are authorized to be appropriated $100,000,000 for the 
Safe Motherhood Initiative for each of fiscal years 1994 and 1995.
    (g) Definitions.--For purposes of this section--
            (1) the term ``annual country human rights report'' refers 
        to the report required to be submitted pursuant to section 
        502B(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 
        2304(b)); and
            (2) the term ``United States development and economic 
        assistance'' means assistance made available under chapter 1 of 
        part I and chapter 4 of part II of the Foreign Assistance Act 
        of 1961.

SEC. 295. AIDS PREVENTION AND CONTROL FUND.

    (a) In General.--Section 104(c) of the Foreign Assistance Act of 
1961 (22 U.S.C. 2151b(c)) is amended by adding at the end the following 
new paragraph:
    ``(4)(A)(i) The President is authorized to provide assistance, 
under such terms and conditions as he may determine, with respect to 
activities relating to research on, and the treatment and control of, 
acquired immune deficiency syndrome (AIDS) in developing countries.
    ``(ii) Assistance provided under clause (i) shall include--
            ``(I) funds made available directly to the World Health 
        Organization for its use in financing the Global Program on 
        AIDS (including activities implemented by the Pan American 
        Health Organization); and
            ``(II) funds made available to the United Nations 
        Children's Fund (UNICEF) for AIDS-related activities.
    ``(B) Appropriations pursuant to subparagraph (A) may be referred 
to as the `AIDS Prevention and Control Fund'.''.
    (b) Authorization of Appropriations.--Section 104(g)(1) of the 
Foreign Assistance Act of 1961 (22 U.S.C. 2151b(g)) is amended--
            (1) by striking ``and'' at the end of subparagraph (A);
            (2) in subparagraph (B), by striking ``subsection (c) of 
        this section.'' and inserting ``subsection (c) of this section 
        (other than paragraph (4) thereof); and''; and
            (3) by adding at the end thereof the following new 
        subparagraph:
                    ``(C) $100,000,000 for fiscal year 1994 and 
                $165,000,000 for fiscal year 1995 to carry out 
                subsection (c)(4) of this section.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect October 1, 1993.

SEC. 296. OVERSIGHT OF MULTILATERAL DEVELOPMENT BANKS.

    (a) Finding.--The Congress considers insufficient the role 
currently played in global population efforts by the International Bank 
for Reconstruction and Development, the Asian Development Bank, the 
Inter-American Development Bank and the African Development Bank. 
Although these multilateral development banks are singularly important 
sources of support for development activities, together they provided 
less than $200,000,000 in 1990 in assistance for core population 
programs. Nor have these institutions consistently encouraged 
appropriate population and reproductive health care policies.
    (b) Report Required.--(1) The Congress believes that the 
multilateral development banks should together increase their support 
for the population activities described in section 499C of the Foreign 
Assistance Act of 1961 to no less than $1,000,000,000 by the end of 
1999.
    (2) Not later than July 31 of each year, the United States 
Executive Directors of the International Bank for Reconstruction and 
Development, the Asian Development Bank, the Inter-American Development 
Bank and the African Development Bank shall prepare and transmit to 
Congress a report which sets forth information on allocations by each 
of these institutions to the population activities described in section 
499C of the Foreign Assistance Act of 1961 and, if such allocations 
total less than $1,000,000,000, set forth any specific actions taken by 
the Executive Directors to encourage increases in such allocations and 
in policy level discussions with donor and developing country 
governments.

SEC. 297. COMMISSION ON WORLD POPULATION STABILIZATION AND REPRODUCTIVE 
              HEALTH.

    (a) Establishment of Commission.--There is established the 
Commission on World Population Stabilization and Reproductive Health 
for the purpose of coordinating United States preparation for, and 
participation in, the 1994 International Conference on Population and 
Development and for other purposes.
    (b) Composition of Commission.--The Commission shall be composed 
of--
            (1) the Under Secretary of State for Global Population, 
        Environment and National Resources;
            (2) the Administrator of the Agency for International 
        Development;
            (3) the Deputy Assistant Secretary for Population Affairs 
        of the Department of Health and Human Services;
            (4) the Assistant Administrator for International 
        Activities of the Environmental Protection Agency;
            (5) the Director of the Congressional Office of Technology 
        Assessment; and
            (6) three individuals appointed by the President, by and 
        with the advice and consent of the Senate, one of whom the 
        President shall designate as Chairman.
    (c) Period of Appointment; Vacancies.--Members shall be appointed 
for the life of the Commission. Any vacancy in the Commission shall not 
affect its powers, but shall be filled in the same manner as the 
original appointment.
    (d) Quorum.--A majority of the members of the Commission shall 
constitute a quorum, but a lesser number of members may hold hearings.
    (e) Hearings.--The Commission may hold such hearings, sit and act 
at such times and places, take such testimony, and receive such 
evidence as the Commission considers advisable to carry out the 
purposes of this section.
    (f) Information From Federal Agencies.--The Commission may secure 
directly from any Federal department or agency such information as the 
Commission considers necessary to carry out the provisions of this 
subtitle. Upon request of the Chairman of the Commission, the head of 
such department or agency shall furnish such information to the 
Commission.
    (g) Postal Services.--The Commission may use the United States 
mails in the same manner and under the same conditions as other 
departments and agencies of the Federal Government.
    (h) Gifts.--The Commission may accept, use, and dispose of gifts or 
donations of services or property.
    (i) Compensation of Members.--Each member of the Commission who is 
not an officer or employee of the Federal Government shall be 
compensated at a rate equal to the daily equivalent of the annual rate 
of basic pay prescribed for level IV of the Executive Schedule under 
section 5315 of title 5, United States Code, for each day (including 
travel time) during which such member is engaged in the performance of 
the duties of the Commission. All members of the Commission who are 
officers or employees of the United States shall serve without 
compensation in addition to that received for their services as 
officers or employees of the United States.
    (j) Travel Expenses.--The members of the Commission shall be 
allowed travel expenses, including per diem in lieu of subsistence, at 
rates authorized for employees of agencies under subchapter I of 
chapter 57 of title 5, United States Code, while away from their homes 
or regular places of business in the performance of services for the 
Commission.
    (k) Staff Compensation.--The Chairman of the Commission may fix the 
compensation of personnel without regard to the provisions of chapter 
51 and subchapter III of chapter 53 of title 5, United States Code, 
relating to classification of positions and General Schedule pay rates, 
except that the rate of pay for the executive director and other 
personnel may not exceed the rate payable for level V of the Executive 
Schedule under section 5316 of such title.
    (l) Detail of Government Employees.--Any Federal Government 
employee may be detailed to the Commission without reimbursement, and 
such detail shall be without interruption or loss of civil service 
status or privilege.
    (m) Procurement of Temporary and Intermittent Services.--The 
Chairman of the Commission may procure temporary and intermittent 
services under section 3109(b) of title 5, United States Code, at rates 
for individuals which do not exceed the daily equivalent of the annual 
rate of basic pay prescribed for level V of the Executive Schedule 
under section 5316 of such title.
    (n) Report.--Not later than June 30, 1994, the Commission shall 
submit to the President a public report on national and international 
population trends and the probable impact of such trends on efforts to 
alleviate poverty and protect the environment. The report, which should 
be made available for consideration at the 1994 International 
Conference on Population and Development, shall specify, among other 
things, modifications in policy and financial commitments required by 
foreign governments to achieve universal reproductive choice and early 
population stabilization.
    (o) Termination of the Commission.--The Commission shall terminate 
90 days after the date on which the Commission submits its report under 
subsection (n).
    (p) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated to the Commission $1,000,000 
for fiscal year 1994.

SEC. 298. SUPPORT FOR UNITED NATIONS FORWARD LOOKING STRATEGIES FOR THE 
              ADVANCEMENT OF WOMEN.

    (a) In General.--The President shall direct the United States 
representatives to the United Nations Commission on the Status of Women 
to take all actions necessary to ensure the rapid implementation of the 
United Nations Forward Looking Strategies for the Advancement of Women, 
as adopted in 1985 at the United Nations Conference ending the Decade 
for Women.
    (b) Review and Annual Reports.--Not later than December 31, 1993, 
the Secretary of State shall submit the 5-year review of the status of 
United States women, as called for at the conference, and shall submit 
such annual reports as are requested by the United Nations Commission 
on the Status of Women.

SEC. 299. SUPPORT FOR THE CONVENTION ON THE ELIMINATION OF ALL FORMS OF 
              DISCRIMINATION AGAINST WOMEN.

    The President shall promptly complete the review of the United 
Nations Convention on the Elimination of All Forms of Discrimination 
Against Women, which was signed by the United States on July 17, 1980, 
and submit to the Senate any reservations, understandings, or 
declarations that the President considers necessary in order that the 
Senate may give its advice and consent to ratification, or report to 
the Congress why he is unable or unwilling to do so.

                                 <all>

HR 3075 IH----2
HR 3075 IH----3
HR 3075 IH----4
HR 3075 IH----5
HR 3075 IH----6
HR 3075 IH----7
HR 3075 IH----8
HR 3075 IH----9
HR 3075 IH----10
HR 3075 IH----11
HR 3075 IH----12
HR 3075 IH----13
HR 3075 IH----14
HR 3075 IH----15
```