II

104TH CONGRESS

2D SESSION S. 1799

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 SENATE OF THE UNITED STATES

MAY 23, 1996

Ms. SNOWE (for herself, Ms. MIKULSKI, Mrs. FEINSTEIN, Mrs. MURRAY, Ms.

MOSELEY-BRAUN, and Mr. KERRY) introduced the following bill; which

was read twice and referred to the Committee on Labor and Human

Resources

A BILL

To promote greater equity in the delivery of health care

services to American women through expanded research

on women’s health issues and through improved access

to health care services, including preventive health

services.

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

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Women’s Health Eq5 uity Act of 1996’’.
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1 SEC. 2. TABLE OF CONTENTS.

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

Sec. 1. Short title.

Sec. 2. Table of contents.

TITLE I—RESEARCH

Subtitle A—Breast Cancer Research Extension Act of 1996

Sec. 1101. Short title.

Sec. 1102. Extension of program of research on breast cancer.

Subtitle B—HHS Women Scientists Employment Opportunity Act

Sec. 1151. Short title.

Sec. 1152. Women’s scientific employment.

Subtitle C—Women and AIDS Research Initiative Amendments of 1996

Sec. 1191. Short title.

Sec. 1192. Establishment of general program of research regarding women and

acquired immune deficiency syndrome.

Subtitle D—Women’s Cardiovascular Diseases Research and Prevention Act

Sec. 1201. Short title.

Sec. 1202. Findings.

Sec. 1203. Expansion and intensification of activities regarding heart attack,

stroke and other cardiovascular diseases in women.

Subtitle E—Osteoporosis and Related Bone Diseases Research Act of 1996

Sec. 1251. Short title.

Sec. 1252. Findings.

Sec. 1253. Osteoporosis research.

Subtitle F—Lupus Research Amendments of 1996

Sec. 1291. Short title.

Sec. 1292. Findings.

Sec. 1293. Expansion and intensification of activities regarding lupus.

Subtitle G—Ovarian Cancer Research and Information Amendments of 1996

Sec. 1301. Short title.

Sec. 1302. Funding for research on ovarian cancer.

Sec. 1303. Public information and education on ovarian cancer.

Subtitle H—HPV Infection and Cervical Cancer Research Resolution of 1996

Sec. 1351. Short title.

Sec. 1352. Sense of Congress.

Subtitle I—Office for Rare Disease Research Act of 1996

Sec. 1391. Short title.

Sec. 1392. Establishment of Office for Rare Disease Research.
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Subtitle J—Federal Risk Assessment in Women’s Health Act of 1996

Sec. 1401. Short title.

Sec. 1402. Interagency review.

Sec. 1403. Study of research needs.

Subtitle K—Women’s Health Environmental Factors Act of 1996

Sec. 1451. Short title.

Sec. 1452. Report on effect of environmental factors on women’s health.

Subtitle L—Consumer Involvement in Breast Cancer Research Act

Sec. 1491. Short title.

Sec. 1492. Increased involvement of advocates in decision making regarding research on breast cancer.

Subtitle M—Women and Alcohol Research Equity Act of 1996

Sec. 1501. Short title.

Sec. 1502. Findings.

Sec. 1503. Provisions regarding increase in amount of funds expended for research on alcohol abuse and alcoholism among women.

Subtitle N—Breast Cancer Screening

Sec. 1601. Short title.

Sec. 1602. Sense of Congress regarding breast cancer screening.

TITLE II—SERVICES

Subtitle A—Women’s Health Office Act of 1996

Sec. 2101. Short title.

Sec. 2102. Public Health Service Office on Women’s Health.

Sec. 2103. Centers for Disease Control and Prevention Office of Women’s

Health.

Sec. 2104. Agency for Health Care Policy and Research Office of Women’s

Health.

Sec. 2105. Health Resources and Services Administration Office of Women’s

Health.

Sec. 2106. Food and Drug Administration Office of Women’s Health.

Subtitle B—Genetic Information Nondiscrimination in Health Insurance Act

of 1996

Sec. 2151. Short title.

Sec. 2152. Prohibition of health insurance discrimination on the basis of genetic information.

Subtitle C—Improved Patient Access to Clinical Studies Act of 1996

Sec. 2191. Short title.

Sec. 2192. Coverage for individuals participating in approved clinical studies.

Subtitle D—Equitable Health Care for Neurobiological Disorders Act of 1996

Sec. 2201. Short title.

Sec. 2202. Findings.
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Sec. 2203. Standards for nondiscriminatory treatment of neurobiological disorders for employer health benefit plans.

Sec. 2204. Enforcement through excise tax.

Sec. 2205. Definitions.

Subtitle E—Victims of Abuse Insurance Protection Act

Sec. 2251. Short title.

Sec. 2252. Definitions.

Sec. 2253. Discriminatory acts prohibited.

Sec. 2254. Reasons for adverse actions.

Sec. 2255. Life insurance.

Sec. 2256. Subrogation without consent prohibited.

Sec. 2257. Enforcement.

Subtitle F—Insurance Protection for Victims of Domestic Violence Act

Sec. 2291. Short title.

Sec. 2292. Prohibition of health insurance discrimination with respect to victims of domestic violence.

Subtitle G—Domestic Violence Victims Insurance Protection Act of 1996

Sec. 2301. Short title.

Sec. 2302. Protection of domestic violence victims from health insurance discrimination.

Subtitle H—Fairness to Minority Women Health Act

Sec. 2351. Short title.

Sec. 2352. Exception to AFDC income and resources attribution rule for certain battered aliens.

Sec. 2353. Amendment to the Food Stamp Act of 1977.

Sec. 2354. Requiring certain recipients of Federal financial assistance to have

personnel available who speak predominant language used in

area.

Sec. 2355. Study regarding domestic violence and latina women.

Subtitle I—Adolescent Health Demonstration Projects Act

Sec. 2391. Short title.

Sec. 2392. Establishment or support of demonstration projects.

Sec. 2393. Project requirements.

Sec. 2394. Areas to be served.

Sec. 2395. Abortion restriction.

Sec. 2396. Report.

Subtitle J—Eating Disorders Information and Education Act of 1996

Sec. 2401. Short title.

Sec. 2402. Findings.

Sec. 2403. Public information and education on eating disorders.

Subtitle K—Women’s Choice and Reproductive Health Protection Act of 1996

Sec. 2451. Short title.

Sec. 2452. Findings.

Sec. 2453. Sense of Congress with respect to certain reproductive health issues.
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Sec. 2454. Family planning amendments.

Sec. 2455. Freedom of full disclosure.

Sec. 2456. Fairness in evaluation of RU–486.

Sec. 2457. Freedom of choice.

Sec. 2458. Fairness in insurance.

Sec. 2459. Abortions in facilities of the uniformed services not prohibited if not

federally funded.

Subtitle L—Women’s Right To Know Act of 1996

Sec. 2491. Short title.

Sec. 2492. First amendment rights.

Subtitle M—International Population Stabilization and Reproductive Health

Act

Sec. 2501. Short title.

Sec. 2502. Authorities relating to United States population assistance.

Sec. 2503. Authorizations of appropriations.

Sec. 2504. Oversight of multilateral development banks.

Sec. 2505. Economic and social development initiatives to stabilize world population.

Sec. 2506. AIDS prevention and control fund.

Sec. 2507. Support for United Nations forward looking strategies for the advancement of women.

Sec. 2508. Support for the convention on the elimination of all forms of discrimination against women.

Subtitle N—Federal Prohibition of Female Genital Mutilation Act of 1996

Sec. 2551. Short title.

Sec. 2552. Title 18 amendment.

Sec. 2553. Information and education regarding female genital mutilation.

Sec. 2554. Effective dates.

Subtitle O—Women and HIV Outreach and Prevention Act

Sec. 2591. Short title.

Sec. 2592. Preventive health programs regarding women and human

immunodeficiency virus.

Sec. 2593. Treatment of women for substance abuse.

Sec. 2594. Early intervention services for women.

Subtitle P—Smoking Prevention and Cessation in WIC Clinics Act

Sec. 2601. Short title.

Sec. 2602. Smoking cessation demonstration programs for WIC participants.

Subtitle Q—Comprehensive Fetal Alcohol Syndrome Prevention Act

Sec. 2651. Short title.

Sec. 2652. Prevention of fetal alcohol syndrome; program of National Institute

on Alcohol Abuse and Alcoholism.

Subtitle R—Postreproductive Health Care Act

Sec. 2691. Short title.

Sec. 2692. Establishment of program for postreproductive health care.
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Subtitle S—Family Caregiver Support and Protection Act of 1996

Sec. 2701. Short title.

Sec. 2702. Coverage of respite care services under medicare.

Sec. 2703. Treatment of long-term care services as medical care.

Subtitle T—Medicare Mammography Enhancement Act of 1996

Sec. 2751. Short title.

Sec. 2752. Expanding screening mammography under the medicare program.

Subtitle U—Medicare Bone Mass Measurement Standardization Act of 1996

Sec. 2791. Short title.

Sec. 2792. Medicare coverage of bone mass measurements.

Subtitle V—Osteoporosis and Related Bone Disorders Resource Center Act of

1996

Sec. 2801. Short title.

Sec. 2802. Funding for information clearinghouse on osteoporosis, Paget’s disease, and related bone disorders.

Subtitle W—Women Veterans Health Improvement Act of 1996

Sec. 2851. Short title.

Sec. 2852. Women’s health services.

Sec. 2853. Report on women’s health care and research.

Sec. 2854. Expansion of research relating to women veterans.

Sec. 2855. Population study.

Sec. 2856. Outreach services for homeless women veterans.

Sec. 2857. Safe and effective treatment for women psychiatric patients.

Sec. 2858. Mammography quality standards.

Subtitle X—Newborns’ and Mothers’ Health Protection

Sec. 2901. Short title.

Sec. 2902. Finding.

Sec. 2903. Required coverage for minimum hospital stay following birth.

Sec. 2904. Post-delivery follow-up care.

Sec. 2905. Prohibitions.

Sec. 2906. Notice.

Sec. 2907. Applicability.

Sec. 2908. Enforcement.

Sec. 2909. Definitions.

Sec. 2910. Preemption.

Sec. 2911. Effective date.

Subtitle Y—Obstetrician-Gynecologists as Primary Care Providers

Sec. 2951. Sense of the Senate regarding obstetrician-gynecologists.
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1 TITLE I—RESEARCH

2 Subtitle A—Breast Cancer

3 Research Extension Act of 1996

4 SEC. 1101. SHORT TITLE.

5 This subtitle may be cited as the ‘‘Breast Cancer Re6 search Extension Act of 1996’’.

7 SEC. 1102. EXTENSION OF PROGRAM OF RESEARCH ON

8 BREAST CANCER.

9 Section 417B(b)(1) of the Public Health Service Act

10 (42 U.S.C. 286a–8(b)(1)) is amended to read as follows:

11 ‘‘(1) BREAST CANCER.—For the purpose of car12 rying out section 417(c), there are authorized to be

13 appropriated $575,000,000 for fiscal year 1997, and

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

15 years 1998 through 2001. Such authorizations of

16 appropriations are in addition to the authorizations

17 of appropriations established in subsection (a) with

18 respect to such purpose.’’.

19 Subtitle B—HHS Women Scientists

20 Employment Opportunity Act

21 SEC. 1151. SHORT TITLE.

22 This subtitle may be cited as the ‘‘HHS Women Sci23 entist Employment Opportunity Act’’.
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1 SEC. 1152. WOMEN’S SCIENTIFIC EMPLOYMENT.

2 The Public Health Service Act (42 U.S.C. 281 et

3 seq.) is amended by adding at the end the following title:

4 ‘‘TITLE XXVII—WOMEN’S SCIENTIFIC EMPLOY5 MENT WITH DEPARTMENT OF HEALTH

6 AND HUMAN SERVICES

7 ‘‘SEC. 2701. WOMEN’S SCIENTIFIC EMPLOYMENT.

8 ‘‘(a) IN GENERAL.—

9 ‘‘(1) IN GENERAL.—For each agency specified

10 in paragraph (2), the Secretary, in collaboration

11 with the head of the agency, shall—

12 ‘‘(A) establish policies for the agency on

13 matters relating to the employment by the

14 agency of women as scientists, and periodically

15 review and as appropriate revise such policies;

16 and

17 ‘‘(B) monitor the extent of compliance with

18 such policies and take appropriate action in

19 cases in which the Secretary determines that

20 the policies have been violated.

21 ‘‘(2) SPECIFIED AGENCIES.—The agencies re22 ferred to in paragraph (1) are the National Insti23 tutes of Health, the Centers for Disease Control and

24 Prevention, the Food and Drug Administration, and

25 such other agencies or offices of the Department of
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1 Health and Human Services as the Secretary deter2 mines to be appropriate.

3 ‘‘(b) CERTAIN FUNCTIONS.—

4 ‘‘(1) IN GENERAL.—In carrying out subsection

5 (a) with respect to a specified agency, the Secretary

6 shall provide for the following:

7 ‘‘(A) Determining the concerns of women

8 scientists employed at the agency.

9 ‘‘(B) Developing a policy defining the

10 standard tenure process for employment at the

11 agency.

12 ‘‘(C) Determining the reason for departure

13 from the agency by interviewing women and

14 men scientists as they leave.

15 ‘‘(D) Distributing yearly to all employees

16 of the agency the policy of the agency on flexi17 ble family leave.

18 ‘‘(E) Monitoring the number of women, in19 cluding minority women, included on the com20 mittees, panels, and other working groups (and

21 in meetings) of the agency.

22 ‘‘(F) Making efforts to recruit minority

23 women, based on the small numbers of tenured

24 minority women scientists.
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1 ‘‘(G) Developing additional goals related to

2 women and minority women scientists at the

3 agency.

4 ‘‘(2) AGENCY-SPECIFIC PROVISIONS.—With re5 spect to the National Institutes of Health, in carry6 ing out subsection (a), the Secretary shall (in addi7 tion to activities under paragraph (1)) provide for

8 the implementation of the recommendations of the

9 group known as the Task Force on the Status of

10 NIH Intramural Women Scientists.

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

12 EXTRAMURAL CONFERENCES AND OTHER GROUPS.—

13 ‘‘(1) IN GENERAL.—The Secretary shall estab14 lish a policy at each specified agency of requiring in15 clusion of women scientists in greater numbers on or

16 in conferences, workshops, meetings, international

17 congresses, and other groups funded or sponsored by

18 the agency. Such policy shall provide for the inclu19 sion of not less than one woman scientist in each

20 such group, except as provided in paragraph (2).

21 This paragraph applies whether such groups are

22 held for employees of the agency headquarters, for

23 employees of field offices, or both.

24 ‘‘(2) EXCLUSION; WRITTEN EXPLANATION.—

25 The policy established in paragraph (1) may provide
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1 that no woman scientist will be included in a group

2 for purposes of such paragraph if the Secretary pro3 vides a waiver of the requirement. The Secretary

4 may grant such a waiver only if—

5 ‘‘(A) the individual with the chief respon6 sibility for the group involved submits to the

7 Secretary a written request for the waiver and

8 the request provides an explanation of the rea9 sons underlying the need for the waiver; and

10 ‘‘(B) the Secretary makes a determination

11 that extraordinary circumstances justify provid12 ing the waiver.

13 ‘‘(d) STUDY ON PAY EQUITY.—

14 ‘‘(1) IN GENERAL.—For each specified agency,

15 the Secretary shall provide for a study to identify

16 any pay differences among men and women sci17 entists employed by the agency, both tenured and

18 untenured. The study shall include recommendations

19 on measures to adjust any disparities or inequities,

20 and shall identify a program to communicate infor21 mation on salary ranges to all employees.

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

23 the date of the enactment of the HHS Women Sci24 entist Employment Opportunity Act of 1996, the

25 Secretary shall complete the study required in para-
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1 graph (1) and submit to the Committee on Com2 merce of the House of Representatives, and to the

3 Committee on Labor and Human Resources of the

4 Senate, a report describing the findings made as a

5 result of the study.

6 ‘‘(e) DEFINITIONS.—For purposes of this section, the

7 term ‘specified agency’ means an agency specified in sub8 section (a)(2).

9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For the

10 purpose of carrying out this section, there are authorized

11 to be appropriated such sums as may be necessary for

12 each of the fiscal years 1997 through 1999.’’.

13 Subtitle C—Women and AIDS Re14 search Initiative Amendments

15 of 1996

16 SEC. 1191. SHORT TITLE.

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

18 Research Initiative Amendments of 1996’’.

19 SEC. 1192. ESTABLISHMENT OF GENERAL PROGRAM OF RE20 SEARCH REGARDING WOMEN AND ACQUIRED

21 IMMUNE DEFICIENCY SYNDROME.

22 Part B of title XXIII of the Public Health Service

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

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

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

6 in women, including research on the prevention of such

7 cases. The Secretary may conduct such research directly,

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

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

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

12 on the following:

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

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

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

18 the question of how much human immunodeficiency

19 virus infection can be prevented by finding and

20 treating sexually transmitted diseases in women.

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

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

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

3 women.

4 ‘‘(C) Inexpensive single dose therapy for

5 treatable sexually transmitted diseases.

6 ‘‘(D) The development of methods of pre7 vention for use by women.

8 ‘‘(E) The development and dissemination

9 of prevention programs and materials whose

10 purpose is to reduce the incidence of substance

11 abuse among women.

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

15 as well as breast changes, hormonal changes, and

16 menses and menopause changes, whose occurrence

17 becomes probable as a result of the deterioration of

18 the immune system.

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

20 including clinical research.

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

22 such cases and research on model educational pro23 grams for such prevention.
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1 ‘‘(6) Research leading to an understanding of

2 social, economic, and legal factors whose impact con3 tributes to an increased risk of such infection.

4 ‘‘(7) Research leading to an understanding of

5 social, economic, and legal factors whose impact con6 tributes to—

7 ‘‘(A) low levels of participation by women

8 in clinical trials; or

9 ‘‘(B) inadequate access to health care serv10 ices, or inadequate utilization of such services.

11 ‘‘(c) CLINICAL RESEARCH.—

12 ‘‘(1) GYNECOLOGICAL EVALUATIONS.—In clini13 cal trials regarding the human immunodeficiency

14 virus in which women participate as subjects, the

15 Secretary shall ensure—

16 ‘‘(A) that the designs of the trials include

17 adequate evaluation of prospective subjects

18 prior to enrollment, and adequate evaluation of

19 subjects during the course of the trials, includ20 ing evaluation of the reproductive tract, and ap21 propriate follow-up services regarding such eval22 uations; and

23 ‘‘(B) the conduct of studies related to the

24 propensity for cases of infection with such virus

25 to cause abnormalities in the reproductive tract,
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1 or to alter the natural history of other repro2 ductive-tract infections and diseases.

3 ‘‘(2) STANDARD TREATMENTS FOR GYNECO4 LOGICAL CONDITIONS.—The Secretary shall conduct

5 or support clinical trials under subsection (a) to de6 termine whether standard methods of treating gyne7 cological conditions are effective in the case of such

8 conditions that arise as a result of infection with the

9 human immunodeficiency virus.

10 ‘‘(3) EFFECTIVENESS OF CERTAIN TREATMENT

11 PROTOCOLS.—With respect to cases of infection with

12 the human immunodeficiency virus, the Secretary

13 shall conduct or support clinical research under sub14 section (a) to determine the effectiveness, on such

15 cases in women, of approved treatment protocols.

16 ‘‘(4) SUPPORT SERVICES.—

17 ‘‘(A) In conducting or supporting clinical

18 trials regarding the human immunodeficiency

19 virus in which women participate as subjects,

20 the Secretary shall take into account factors

21 that can facilitate such participation, including

22 consideration of employment schedules and the

23 provision of support services. The Secretary

24 may provide such services accordingly, including

25 transportation services, child care services, med-
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1 ical and mental health services, treatment for

2 drug abuse, social services (including services

3 addressing domestic violence), and other sup4 port services.

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

6 shall include services designed to respond to the

7 particular needs of women with respect to par8 ticipation in the clinical trials involved, includ9 ing, as appropriate, training of the individuals

10 who conduct the trials.

11 ‘‘(d) PREVENTION PROGRAMS.—

12 ‘‘(1) SEXUAL TRANSMISSION.—

13 ‘‘(A) With respect to preventing the sexual

14 transmission of the human immunodeficiency

15 virus and other sexually transmitted diseases,

16 the Secretary shall conduct or support research

17 under subsection (a) on topical microbicide and

18 physical barrier methods of prevention that

19 women can use without their sexual partner’s

20 cooperation or knowledge.

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

22 the Secretary shall—

23 ‘‘(i) give priority to carrying out the

24 topical microbicide research agenda of the

25 National Institutes of Health, including
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1 agendas regarding basic research, product

2 development, and clinical evaluation of new

3 and existing products; and

4 ‘‘(ii) give special consideration to re5 search on topical microbicides that are not

6 spermicides and that otherwise are meth7 ods that do not pose a threat to the ability

8 of women to conceive and bear healthy

9 children.

10 ‘‘(2) EPIDEMIOLOGICAL RESEARCH.—The Sec11 retary shall conduct or support epidemiological re12 search under subsection (a) to determine the factors

13 of risk regarding infection with the human

14 immunodeficiency virus that are particular to

15 women, including research regarding—

16 ‘‘(A) the use of spermicides and other con17 traceptive methods;

18 ‘‘(B) the use of vaginal products, including

19 douches, tampons, and vaginal medications;

20 ‘‘(C) the relationship between such infec21 tion and other sexually transmitted diseases;

22 ‘‘(D) the relationship between such infec23 tion and various forms of substance abuse (in24 cluding use of the form of cocaine commonly

25 known as crack); and
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1 ‘‘(E) the relationship between such infec2 tion and noncoital forms of sexual activity.

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

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

5 that, as of March 1996, is being carried out by the Sec6 retary through various agencies of the Public Health Serv7 ice for the purpose of monitoring the progression in

8 women of infection with the human immunodeficiency

9 virus, and determining whether such progression is dif10 ferent in women than in men, the following applies:

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

12 than 2,500 women with such infection are included

13 in the study, and that the demographic variability of

14 the cohort is maintained.

15 ‘‘(2) The Secretary shall ensure that the study

16 period is extended for a minimum of 5 years.

17 ‘‘(3) With respect to markers of human

18 immunodeficiency virus disease progression and viral

19 activity (including the cells commonly known as CD4

20 cells and including quantitative viral load measures),

21 the Secretary shall ensure that the study adequately

22 addresses the relationship between such markers and

23 the development of serious illnesses in such women.

24 For purposes of the preceding sentence, the study

25 shall address gynecological conditions, and other
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1 conditions particular to women, that are not cur2 rently included in the list of conditions arising from

3 such infection that, for surveillance purposes, is

4 maintained by the Director of the Centers for Dis5 ease Control and Prevention.

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

7 term ‘human immunodeficiency virus’ means the etiologic

8 agent for acquired immune deficiency syndrome.

9 ‘‘(g) AUTHORIZATIONS OF APPROPRIATIONS.—

10 ‘‘(1) CLINICAL RESEARCH.—In addition to any

11 other authorizations of appropriations that are avail12 able for the following purposes:

13 ‘‘(A) For the purpose of carrying out sub14 section (c)(1), there are authorized to be appro15 priated $20,000,000 for fiscal year 1997, and

16 such sums as may be necessary for each of the

17 fiscal years 1998 through 1999.

18 ‘‘(B) For the purpose of carrying out sub19 section (c)(2), there are authorized to be appro20 priated $10,000,000 for fiscal year 1997, and

21 such sums as may be necessary for each of the

22 fiscal years 1998 through 1999.

23 ‘‘(C) For the purpose of carrying out sub24 section (c)(3), there are authorized to be appro25 priated $10,000,000 for fiscal year 1997, and
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1 such sums as may be necessary for each of the

2 fiscal years 1998 through 1999.

3 ‘‘(D) For the purpose of carrying out sub4 section (c)(4), there are authorized to be appro5 priated $15,000,000 for fiscal year 1997, and

6 such sums as may be necessary for each of the

7 fiscal years 1998 and 1999.

8 ‘‘(2) PREVENTION PROGRAMS.—In addition to

9 any other authorizations of appropriations that are

10 available for the following purposes:

11 ‘‘(A) For the purpose of carrying out sub12 section (d)(1), there are authorized to be appro13 priated $10,000,000 for fiscal year 1997, and

14 such sums as may be necessary for each of the

15 fiscal years 1998 through 1999.

16 ‘‘(B) For the purpose of carrying out sub17 section (d)(2), there are authorized to be appro18 priated $10,000,000 for fiscal year 1997, and

19 such sums as may be necessary for each of the

20 fiscal years 1998 through 1999.

21 ‘‘(3) INTERAGENCY STUDY.—In addition to any

22 other authorizations of appropriations that are avail23 able for the purpose of carrying out subsection (e),

24 there are authorized to be appropriated for such

25 purpose $6,000,000 for fiscal year 1997, and such
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1 sums as may be necessary for each of the fiscal

2 years 1998 through 1999.’’.

3 Subtitle D—Women’s Cardio4 vascular Diseases Research and

5 Prevention Act

6 SEC. 1201. SHORT TITLE.

7 This subtitle may be cited as the ‘‘Women’s Cardio8 vascular Diseases Research and Prevention Act’’.

9 SEC. 1202. FINDINGS.

10 The Congress finds as follows with respect to women

11 in the United States:

12 (1) Heart attack, stroke, and other cardio13 vascular diseases are the leading causes of death in

14 women.

15 (2) Heart attacks and strokes are leading

16 causes of disability in women.

17 (3) Cardiovascular diseases claim the lives of

18 more women each year than does cancer. Each year

19 more than 479,000 females die of cardiovascular dis20 eases, while approximately 246,000 females die of

21 cancer. Heart attack kills more than 5 times as

22 many females as breast cancer. Stroke kills twice as

23 many females as breast cancer.

24 (4) One in 5 females has some form of cardio25 vascular disease. Of females under age 65, each year
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1 more than 20,000 die of heart attacks. In the case

2 of African-American women, from ages 35 to 74 the

3 death rate from heart attacks is approximately twice

4 that of white women and 3 times that of women of

5 other races.

6 (5) Each year since 1984, cardiovascular dis7 eases have claimed the lives of more females than

8 males. In 1992, of the number of individuals who

9 died of such diseases, 52 percent were females and

10 48 percent were males.

11 (6) The clinical course of cardiovascular dis12 eases is different in women than in men, and cur13 rent diagnostic capabilities are less accurate in

14 women than in men. Once a woman develops a car15 diovascular disease, she is more likely than a man to

16 have continuing health problems, and she is more

17 likely to die.

18 (7) Of women who have had a heart attack, ap19 proximately 44 percent die within 1 year of the at20 tack. Of men who have had such an attack, 27 per21 cent die within 1 year. At older ages, women who

22 have had a heart attack are twice as likely as men

23 to die from the attack within a few weeks. Women

24 are more likely than men to have a stroke during the

25 first 6 years following a heart attack. More than 60
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1 percent of women who suffer a stroke die within 8

2 years. Long-term survivorship of stroke is better in

3 women than in men. Of individuals who die from

4 a stroke, each year approximately 61 percent are fe5 males. In 1992, 87,124 females died from strokes.

6 Women have unrecognized heart attacks more fre7 quently than men. Of women who died suddenly

8 from heart attack, 63 percent had no previous evi9 dence of disease.

10 (8) More than half of the annual health care

11 costs that are related to cardiovascular diseases are

12 attributable to the occurrence of the diseases in

13 women, each year costing this nation hundreds of

14 billions of dollars in health care costs and lost pro15 ductivity.

16 SEC. 1203. EXPANSION AND INTENSIFICATION OF ACTIVI17 TIES REGARDING HEART ATTACK, STROKE

18 AND OTHER CARDIOVASCULAR DISEASES IN

19 WOMEN.

20 Subpart 2 of part C of title IV of the Public Health

21 Service Act (42 U.S.C. 285b et seq.) is amended by insert22 ing after section 424 the following section:

23 ‘‘HEART ATTACK, STROKE, AND OTHER CARDIOVASCULAR

24 DISEASES IN WOMEN

25 ‘‘SEC. 424A. (a) IN GENERAL.—The Director of the

26 Institute shall expand, intensify, and coordinate research
25

•S 1799 IS

1 and related activities of the Institute with respect to heart

2 attack, stroke, and other cardiovascular diseases in

3 women.

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

5 The Director of the Institute shall coordinate activities

6 under subsection (a) with similar activities conducted by

7 the other national research institutes and agencies of the

8 National Institutes of Health to the extent that such Insti9 tutes and agencies have responsibilities that are related

10 to heart attack, stroke, and other cardiovascular diseases

11 in women.

12 ‘‘(c) CERTAIN PROGRAMS.—In carrying out sub13 section (a), the Director of the Institute shall conduct or

14 support research to expand the understanding of the

15 causes of, and to develop methods for preventing, cardio16 vascular diseases in women. Activities under such sub17 section shall include conducting and supporting the follow18 ing:

19 ‘‘(1) Research to determine the reasons under20 lying the prevalence of heart attack, stroke, and

21 other cardiovascular diseases in women, including

22 African-American women and other women who are

23 members of racial or ethnic minority groups.

24 ‘‘(2) Basic research concerning the etiology and

25 causes of cardiovascular diseases in women.
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•S 1799 IS

1 ‘‘(3) Epidemiological studies to address the fre2 quency and natural history of such diseases and the

3 differences among men and women, and among ra4 cial and ethnic groups, with respect to such diseases.

5 ‘‘(4) The development of safe, efficient, and

6 cost-effective diagnostic approaches to evaluating

7 women with suspected ischemic heart disease.

8 ‘‘(5) Clinical research for the development and

9 evaluation of new treatments for women, including

10 rehabilitation.

11 ‘‘(6) Studies to gain a better understanding of

12 methods of preventing cardiovascular diseases in

13 women, including applications of effective methods

14 for the control of blood pressure, lipids, and obesity.

15 ‘‘(7) Information and education programs for

16 patients and health care providers on risk factors as17 sociated with heart attack, stroke, and other cardio18 vascular diseases in women, and on the importance

19 of the prevention or control of such risk factors and

20 timely referral with appropriate diagnosis and treat21 ment. Such programs shall include information and

22 education on health-related behaviors that can im23 prove such important risk factors as smoking, obe24 sity, high blood cholesterol, and lack of exercise.
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1 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the

2 purpose of carrying out this section, there are authorized

3 to be appropriated $140,000,000 for fiscal year 1997, and

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

5 1998 and 1999. The authorization of appropriations es6 tablished in the preceding sentence is in addition to any

7 other authorization of appropriation that is available for

8 such purpose.’’.

9 Subtitle E—Osteoporosis and Re10 lated Bone Diseases Research

11 Act of 1996

12 SEC. 1251. SHORT TITLE.

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

14 Related Bone Diseases Research Act of 1996’’.

15 SEC. 1252. FINDINGS.

16 The Congress finds that—

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

18 characterized by an excessive loss of bone tissue and

19 an increased susceptibility to fractures of the hip,

20 spine, and wrist;

21 (2) osteoporosis is a threat to an estimated

22 25,000,000 Americans, 80 percent of whom are

23 women, many of whose cases go undiagnosed be24 cause the condition develops without symptoms until

25 a strain, bump, or fall causes a fracture;
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•S 1799 IS

1 (3) between 3 and 4 million Americans have

2 Paget’s disease, osteogenesis imperfecta,

3 hyperparathyroidism, and other related metabolic

4 bone diseases;

5 (4) osteoporosis is responsible for 1,500,000

6 bone fractures annually, including more than

7 250,000 hip fractures, 500,000 vertebral fractures,

8 200,000 fractures of the wrist, and the remaining

9 fractures at other limb sites;

10 (5) 1 of every 2 women and 1 of every 8 men

11 over age 50 will develop fractures associated with

12 osteoporosis;

13 (6) direct medical costs of osteoporosis are esti14 mated to be $10,000,000,000 annually for the Unit15 ed States, not including the costs of family care and

16 lost work for caregivers;

17 (7) direct medical costs of osteoporosis are ex18 pected to increase precipitously because the propor19 tion of the population comprised of older persons is

20 expanding and each generation of older persons

21 tends to have a higher incidence of osteoporosis than

22 preceding generations;

23 (8) technology now exists, and new technology

24 is developing, that will permit early diagnosis and
29

•S 1799 IS

1 prevention of osteoporosis as well as management of

2 the condition once it has developed;

3 (9) funding for research on osteoporosis and re4 lated bone diseases is severely constrained at key re5 search institutes, including the National Institute of

6 Arthritis and Musculoskeletal and Skin Diseases, the

7 National Institute on Aging, the National Institute

8 of Diabetes and Digestive and Kidney Diseases, the

9 National Institute of Dental Research, and the Na10 tional Institute of Child Health and Human Devel11 opment;

12 (10) further research is needed to improve med13 ical knowledge concerning—

14 (A) cellular mechanisms related to the

15 processes of bone resorption and bone forma16 tion, and the effect of different agents on bone

17 remodeling;

18 (B) risk factors for osteoporosis, including

19 newly discovered risk factors, risk factors relat20 ed to groups not ordinarily studied (such as

21 men and minorities), risk factors related to

22 genes that help to control skeletal metabolism,

23 and risk factors relating to the relationship of

24 aging processes to the development of

25 osteoporosis;
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•S 1799 IS

1 (C) bone mass measurement technology,

2 including more widespread and cost-effective

3 techniques for making more precise measure4 ments and for interpreting measurements;

5 (D) calcium (including bioavailability, in6 take requirements, and the role of calcium in

7 building heavier and denser skeletons), and vi8 tamin D and its role as an essential vitamin in

9 adults;

10 (E) prevention and treatment, including

11 the efficacy of current therapies, alternative

12 drug therapies for prevention and treatment,

13 and the role of exercise; and

14 (F) rehabilitation; and

15 (11) further educational efforts are needed to

16 increase public and professional knowledge of the

17 causes of, methods for avoiding, and treatment of

18 osteoporosis.

19 SEC. 1253. OSTEOPOROSIS RESEARCH.

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

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

22 at the end the following new section:
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•S 1799 IS

1 ‘‘SEC. 442A. RESEARCH ON OSTEOPOROSIS AND RELATED

2 DISEASES.

3 ‘‘(a) EXPANSION OF RESEARCH.—The Director of

4 the Institute, the Director of the National Institute on

5 Aging, the Director of the National Institute of Diabetes

6 and Digestive and Kidney Diseases, the Director of the

7 National Institute of Dental Research, and the Director

8 of the National Institute of Child Health and Human De9 velopment shall expand and intensify research on

10 osteoporosis and related bone diseases. The research shall

11 be in addition to research that is authorized under any

12 other provision of law.

13 ‘‘(b) MECHANISMS FOR EXPANSION OF RESEARCH.—

14 Each of the Directors specified in subsection (a) shall, in

15 carrying out such subsection, provide for one or more of

16 the following:

17 ‘‘(1) Investigator-initiated research.

18 ‘‘(2) Funding for investigators beginning their

19 research careers.

20 ‘‘(3) Mentorship research grants.

21 ‘‘(4) Specialized centers.

22 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

23 are authorized to be appropriated to carry out this section

24 $30,000,000 for the National Institute of Arthritis and

25 Musculoskeletal and Skin Diseases, $6,500,000 for the

26 National Institute on Aging, $6,500,000 for the National
32

•S 1799 IS

1 Institute of Diabetes and Digestive and Kidney Diseases,

2 $4,000,000 for the National Institute of Dental Research,

3 and $3,000,000 for the National Institute of Child Health

4 and Human Development for each of the fiscal years 1997

5 through 1999, and such sums as may be necessary for

6 subsequent fiscal years. These funds are in addition to

7 amounts authorized to be appropriated for biomedical re8 search relating to osteoporosis and related bone diseases

9 under any other provision of law.

10 ‘‘(d) RELATED BONE DISEASES DEFINED.—As used

11 in this section, the term ‘related bone diseases’ includes—

12 ‘‘(1) Paget’s disease, a bone disease character13 ized by enlargement and loss of density with bowing

14 and deformity of the bones;

15 ‘‘(2) osteogenesis imperfecta, a familial disease

16 marked by extreme brittleness of the long bones;

17 ‘‘(3) hyperparathyroidism, a condition charac18 terized by the presence of excess parathormone in

19 the body resulting in disturbance of calcium metabo20 lism with loss of calcium from bone and renal dam21 age;

22 ‘‘(4) hypoparathyroidism, a condition character23 ized by the absence of parathormone resulting in

24 disturbances of calcium metabolism;
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•S 1799 IS

1 ‘‘(5) renal bone disease, a disease characterized

2 by metabolic disturbances from dialysis, renal trans3 plants, or other renal disturbances;

4 ‘‘(6) primary or postmenopausal osteoporosis

5 and secondary osteoporosis, such as that induced by

6 corticosteroids; and

7 ‘‘(7) other general diseases of bone and mineral

8 metabolism including abnormalities of vitamin D.’’.

9 Subtitle F—Lupus Research

10 Amendments of 1996

11 SEC. 1291. SHORT TITLE.

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

13 Amendments of 1996’’.

14 SEC. 1292. FINDINGS.

15 The Congress finds that—

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

17 autoimmune disease of particular concern to women;

18 (2) lupus affects women 9 times more often

19 than men;

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

21 lupus, a serious form of the disease that affects

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

23 disease that affects mainly the skin; and drug-in24 duced lupus caused by certain medications;
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•S 1799 IS

1 (4) lupus can be fatal if not detected and treat2 ed early;

3 (5) the disease can simultaneously affect var4 ious areas of the body, such as the skin, joints, kid5 neys, and brain, and can be difficult to diagnose be6 cause the symptoms of lupus are similar to those of

7 many other diseases;

8 (6) lupus disproportionately affects African9 American women, as the prevalence of the disease

10 among such women is 3 times the prevalence among

11 white women, and an estimated 1 in 250 African12 American women between the ages of 15 and 65 de13 velops the disease;

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

15 Americans have been diagnosed with the disease,

16 and that many more have undiagnosed cases;

17 (8) current treatments for the disease can be

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

19 (9) many victims of the disease suffer debilitat20 ing pain and fatigue, making it difficult to maintain

21 employment and lead normal lives.
35

•S 1799 IS

1 SEC. 1293. EXPANSION AND INTENSIFICATION OF ACTIVI2 TIES REGARDING LUPUS.

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

4 Service Act (42 U.S.C. 285d et seq.) is amended by insert5 ing after section 441 the following section:

6 ‘‘LUPUS

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

8 Institute shall expand and intensify research and related

9 activities of the Institute with respect to lupus.

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

11 The Director of the Institute shall coordinate the activities

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

13 conducted by the other national research institutes and

14 agencies of the National Institutes of Health to the extent

15 that such Institutes and agencies have responsibilities that

16 are related to lupus.

17 ‘‘(c) PROGRAMS FOR LUPUS.—In carrying out sub18 section (a), the Director of the Institute shall conduct or

19 support research to expand the understanding of the

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

21 such subsection shall include conducting and supporting

22 the following:

23 ‘‘(1) Research to determine the reasons under24 lying the elevated prevalence of lupus in women, in25 cluding African-American women.
36

•S 1799 IS

1 ‘‘(2) Basic research concerning the etiology and

2 causes of the disease.

3 ‘‘(3) Epidemiological studies to address the fre4 quency and natural history of the disease and the

5 differences among the sexes and among racial and

6 ethnic groups with respect to the disease.

7 ‘‘(4) The development of improved screening

8 techniques.

9 ‘‘(5) Clinical research for the development and

10 evaluation of new treatments, including new biologi11 cal agents.

12 ‘‘(6) Information and education programs for

13 health care professionals and the public.

14 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the

15 purpose of carrying out this section, there are authorized

16 to be appropriated $20,000,000 for fiscal year 1997, and

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

18 1998 and 1999. The authorization of appropriations es19 tablished in the preceding sentence is in addition to any

20 other authorization of appropriations that is available for

21 such purpose.’’.
37

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1 Subtitle G—Ovarian Cancer

2 Research and Information

3 Amendments of 1996

4 SEC. 1301. SHORT TITLE.

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

6 Research and Information Amendments of 1996’’.

7 SEC. 1302. FUNDING FOR RESEARCH ON OVARIAN CANCER.

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

9 is amended—

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

11 of’’ and all that follows through ‘‘417,’’ and insert12 ing the following: ‘‘CANCERS.—

13 ‘‘(A) For the purpose of carrying out sec14 tion 417(d),’’; and

15 (2) by adding at the end the following subpara16 graph:

17 ‘‘(B)(i) For the purpose of carrying out re18 search under section 417(d) on ovarian cancer,

19 there are authorized to be appropriated

20 $90,000,000 for fiscal year 1997, and such

21 sums as may be necessary for each of the fiscal

22 years 1998 and 1999. With respect to such pur23 pose, such authorizations of appropriations are

24 in addition to the authorizations of appropria-
38

•S 1799 IS

1 tions established in subparagraph (A) and in

2 subsection (a).

3 ‘‘(ii) Of the amounts appropriated under

4 clause (i), the Director of the Institute shall re5 serve 50 percent for research described in such

6 clause that does not involve treatment or clini7 cal trials, and 50 percent for research described

8 in such clause that does involve treatment and

9 clinical trials.

10 ‘‘(iii) In expending the amounts reserved

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

12 shall ensure that 1 or more programs of re13 search on ovarian cancer are carried out under

14 the programs designated by the Director as the

15 Specialized Programs of Research Excellence.’’.

16 SEC. 1303. PUBLIC INFORMATION AND EDUCATION ON

17 OVARIAN CANCER.

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

19 is amended by striking ‘‘section 413; and’’ and inserting

20 the following: ‘‘section 413, which programs shall include

21 programs on ovarian cancer that (subject to changes in

22 the applicable facts) provide information and education re23 garding—

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

25 including the fact that there is not a procedure
39

•S 1799 IS

1 that reliably provides for the early detection of

2 such cancer;

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

4 basis to such cancer;

5 ‘‘(C) factors indicating a substantial risk

6 of such cancer; and

7 ‘‘(D) the various treatments for such can8 cer and the extent to which the treatments are

9 effective; and’’.

10 Subtitle H—HPV Infection and Cer11 vical Cancer Research Resolu12 tion of 1996

13 SEC. 1351. SHORT TITLE.

14 This subtitle may be cited as the ‘‘HPV Infection and

15 Cervical Cancer Research Resolution of 1996’’.

16 SEC. 1352. SENSE OF CONGRESS.

17 It is the sense of the Congress that in conducting re18 search relating to the prevention and detection of cervical

19 cancer, the Director of the National Cancer Institute and

20 the Director of the National Institute of Allergy and Infec21 tious Diseases should collaborate in sponsoring basic and

22 clinical research on human papillomavirus diagnosis and

23 prevention as a risk of cervical cancer, and as applicable,

24 develop screening techniques accordingly.
40

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1 Subtitle I—Office for Rare Disease

2 Research Act of 1996

3 SEC. 1391. SHORT TITLE.

4 This subtitle may be cited as the ‘‘Office for Rare

5 Disease Research Act of 1996’’.

6 SEC. 1392. ESTABLISHMENT OF OFFICE FOR RARE DISEASE

7 RESEARCH.

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

9 (42 U.S.C. 281 et seq.) is amended by adding at the end

10 thereof the following new section:

11 ‘‘SEC. 404F. OFFICE FOR RARE DISEASE RESEARCH.

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

13 the Office of the Director of the National Institutes of

14 Health an office to be known as the Office for Rare Dis15 ease Research (in this section referred to as the ‘Office’).

16 The Office shall be headed by a director, who shall be ap17 pointed by the Director of the National Institutes of

18 Health.

19 ‘‘(b) PURPOSE.—The purpose of the Office is to pro20 mote and coordinate the conduct of research on rare dis21 eases through a strategic research plan and to establish

22 and manage a rare disease research clinical database.

23 ‘‘(c) ADVISORY COUNCIL.—The Secretary shall es24 tablish an advisory council for the purpose of providing

25 advice to the director of the Office concerning carrying
41

•S 1799 IS

1 out the strategic research plan and other duties under this

2 section. Section 222 shall apply to such council to the

3 same extent and in the same manner as such section ap4 plies to committees or councils established under such sec5 tion.

6 ‘‘(d) DUTIES.—In carrying out subsection (b), the di7 rector of the Office shall—

8 ‘‘(1) develop a comprehensive plan for the con9 duct and support of research on rare diseases;

10 ‘‘(2) coordinate and disseminate information

11 among the institutes and the public on rare diseases;

12 ‘‘(3) support research training and encourage

13 the participation of a diversity of individuals in the

14 conduct of rare disease research;

15 ‘‘(4) identify projects or research on rare dis16 eases that should be conducted or supported by the

17 National Institutes of Health;

18 ‘‘(5) develop and maintain a central database

19 on current government sponsored clinical research

20 projects for rare diseases;

21 ‘‘(6) determine the need for registries of re22 search subjects and epidemiological studies of rare

23 disease populations; and

24 ‘‘(7) prepare biennial reports on the activities

25 carried out or to be carried out by the Office and
42

•S 1799 IS

1 submit such reports to the Secretary and the Con2 gress.’’.

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

5 1996

6 SEC. 1401. SHORT TITLE.

7 This subtitle may be cited as the ‘‘Federal Risk As8 sessment in Women’s Health Act of 1996’’.

9 SEC. 1402. INTERAGENCY REVIEW.

10 The Office of Science and Technology Policy, through

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

13 of Women’s Health of the Public Health Service and with

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

15 Institutes of Health, shall conduct a review of all Federal

16 programs that assess or mitigate the risks to women’s

17 health from environmental exposures, including programs

18 setting standards for exposure to various pollutants, toxic

19 substances, pesticide use, and pesticide residues. The re20 sults of such review, including recommendations for ensur21 ing that women’s health needs are addressed by Federal

22 programs and policies, shall be transmitted to the Con23 gress within 6 months after the date of enactment of this

24 Act.
43

•S 1799 IS

1 SEC. 1403. STUDY OF RESEARCH NEEDS.

2 The National Institute of Environmental Health

3 Sciences shall enter into a contract with the National Re4 search Council of the National Academy of Sciences for

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

6 Office of Women’s Health of the Public Health Service

7 and with the Office of Research on Women’s Health of

8 the National Institutes of Health, for a study to determine

9 the status of the science base and needs of the Federal

10 Government for research relating to the risks to women’s

11 health from environmental exposures, for the purpose of

12 assessing and mitigating such risks. The results of such

13 study shall be transmitted to the Congress within one year

14 after the date of enactment of this Act.

15 Subtitle K—Women’s Health

16 Environmental Factors Act of 1996

17 SEC. 1451. SHORT TITLE.

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

19 Environmental Factors Act of 1996’’.

20 SEC. 1452. REPORT ON EFFECT OF ENVIRONMENTAL FAC21 TORS ON WOMEN’S HEALTH.

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

23 Human Services, acting through the Director of the Na24 tional Institute of Environmental Health Sciences, shall

25 submit to the Congress a report in accordance with the

26 following:
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•S 1799 IS

1 (1) The report shall summarize the body of sci2 entific knowledge on the effects that environmental

3 factors have on women’s health. The report shall in4 clude descriptions of the known effects of environ5 mental factors on breast cancer, on immune dys6 function, and on compounds that mimic human es7 trogen.

8 (2) The report shall specify an agenda for the

9 conduct and support of research by such Director on

10 the effects that environmental factors have on wom11 en’s health. The agenda shall specify the categories

12 of research that should receive priority. In the devel13 opment of the agenda, the summary prepared under

14 paragraph (1) shall be considered, including consid15 eration of areas of research identified by the sum16 mary as having received insufficient study.

17 (b) DATE FOR SUBMISSION OF REPORT.—The report

18 under subsection (a) shall be submitted to the Congress

19 not later than one year after the date of the enactment

20 of this Act.

21 Subtitle L—Consumer Involvement

22 in Breast Cancer Research Act

23 SEC. 1491. SHORT TITLE.

24 This subtitle may be cited as the ‘‘Consumer Involve25 ment in Breast Cancer Research Act’’.
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•S 1799 IS

1 SEC. 1492. INCREASED INVOLVEMENT OF ADVOCATES IN

2 DECISION MAKING REGARDING RESEARCH

3 ON BREAST CANCER.

4 Section 417(c) of the Public Health Service Act (42

5 U.S.C. 285a–6(c)) is amended by adding at the end the

6 following paragraph:

7 ‘‘(3) INVOLVEMENT OF ADVOCATES IN DECI8 SION MAKING.—

9 ‘‘(A) The Director of the Institute shall, to

10 the extent practicable, provide for the increased

11 involvement (relative to fiscal year 1996) of ad12 vocates in decision making at the Institute re13 garding research on breast cancer.

14 ‘‘(B) For purposes of this paragraph, the

15 term ‘advocate’ means an individual who is ac16 countable to, represents, and reports back to

17 organizations that represent those affected by

18 breast cancer.

19 ‘‘(C) The Director of the Institute shall

20 prepare a report on the manner in which sub21 paragraph (A) has been carried out. The report

22 shall be included in the first report under sec23 tion 407 that the Director submits after the ex24 piration of the one-year period beginning on the

25 date of the enactment of the Consumer Involve26 ment in Breast Cancer Research Act.’’.
46

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1 Subtitle M—Women and Alcohol

2 Research Equity Act of 1996

3 SEC. 1501. SHORT TITLE.

4 This subtitle may be cited as the ‘‘Women and Alco5 hol Research Equity Act of 1996’’.

6 SEC. 1502. FINDINGS.

7 The Congress finds as follows with respect to the

8 United States:

9 (1) One of every 4 alcoholics receiving treat10 ment is a woman.

11 (2) In fiscal year 1995, the National Institute

12 on Alcohol Abuse and Alcoholism had a total re13 search budget of $191,186,000, and $43,997,080 of

14 the budget (approximately 23 percent) was available

15 for research on alcohol abuse and alcoholism among

16 women. There are selected areas where alcohol con17 tributes to a more rapid and severe development of

18 disease in women than in men, and research on

19 women exclusively in these areas is important.

20 (3) According to data collected during the years

21 1980 through 1993 (in the survey known as the Na22 tional Drug and Alcoholism Treatment Unit Sur23 vey), women represent approximately 30 percent of

24 the clients presenting for alcohol problems in tradi25 tional public treatment facilities. A recent study has
47

•S 1799 IS

1 shown that women are more likely than men to use

2 nontraditional health care systems for alcohol-related

3 problems. No data exists to count women in non4 traditional treatment settings; therefore, it is not

5 possible to know whether women are overrepresented

6 or underrepresented in all treatment settings in pro7 portion to their numbers (30 percent).

8 (4) Alcohol use by pregnant women is the lead9 ing known cause of mental retardation in newborns.

10 Fetal alcohol syndrome (FAS), which is marked by

11 dysfunction of the central nervous system and by

12 prenatal and postnatal growth deficiency and facial

13 malformations, strikes 1 to 3 out of every 1,000

14 newborns, or 3,600 to 10,000 babies a year, depend15 ing upon the national birth-rate. The incidence of

16 less severe fetal alcohol effects (FAE) is at least 3

17 times that of fetal alcohol syndrome. For Black

18 Americans, the risk of FAS remains about sevenfold

19 higher than for whites, even after adjustment for the

20 frequency of maternal alcohol intake, occurrence of

21 chronic alcohol problems, and parity. Among Native

22 Americans, the incidence of FAS varies among dif23 ferent cultures; some are similar to the overall U.S.

24 population, while a much higher prevalence is re25 ported for others. Research is also needed on the
48

•S 1799 IS

1 male contribution to birth abnormalities related to

2 alcohol.

3 (5) Most treatment programs do not provide

4 child care or adequate alternatives for women enter5 ing treatment.

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

7 100 percent higher than for male alcoholics. Propor8 tionately more alcoholic women die of cirrhosis of

9 the liver than do alcoholic men. Additionally, the

10 combined effects of estrogen and alcohol may impact

11 not only liver damage but osteoporosis as well.

12 (7) The interval between onset of drinking-re13 lated problems and entry into treatment appears to

14 be shorter for women than for men. Further, studies

15 of women alcoholics in treatment suggest that they

16 often experience greater physiological impairment

17 earlier in their drinking careers, despite having

18 consumed less alcohol than men. These findings sug19 gest that the development of consequences associated

20 with heavy drinking may be accelerated or ‘‘tele21 scoped’’ in women.

22 (8) Women become intoxicated faster than men.

23 This may be due to a different enzyme and hor24 monal activity in women than in men.
49

•S 1799 IS

1 (9) Chronic, heavy drinking contributes to men2 strual disorders, fertility problems, and premature

3 menopause.

4 (10) Alcohol use may be associated with an in5 creased risk of breast cancer. Research indicates

6 that the incidence of breast cancer increases when a

7 woman consumes 1 ounce or more of absolute alco8 hol daily.

9 (11) The National Institute on Alcohol Abuse

10 and Alcoholism has identified areas for future re11 search on alcohol abuse and alcoholism among

12 women. As a result of stimulating research applica13 tions during the years 1993 through 1995, such In14 stitute’s portfolio on women and children has in15 creased by $17,997,000, or more than 69 percent,

16 over the fiscal year 1992 base of $26,000,000.

17 SEC. 1503. PROVISIONS REGARDING INCREASE IN AMOUNT

18 OF FUNDS EXPENDED FOR RESEARCH ON AL19 COHOL ABUSE AND ALCOHOLISM AMONG

20 WOMEN.

21 Section 464H(d) of the Public Health Service Act (42

22 U.S.C. 285n(d)) is amended by adding at the end the fol23 lowing paragraph:

24 ‘‘(3) WOMEN’S HEALTH.—
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1 ‘‘(A) For fiscal year 1997, of the first

2 $191,186,000 appropriated under paragraph

3 (1), the Director of the Institute shall obligate

4 not less than $43,997,080 for the purpose of

5 carrying out under this subpart projects of re6 search on alcohol abuse and alcoholism among

7 women.

8 ‘‘(B) In addition to the authorization of

9 appropriations established in paragraph (1),

10 there are authorized to be appropriated for car11 rying out the purpose specified in subparagraph

12 (A) $25,000,000 for fiscal year 1997, and such

13 sums as may be necessary for each of the fiscal

14 years 1998 and 1999.’’.

15 Subtitle N—Breast Cancer

16 Screening

17 SEC. 1601. SHORT TITLE.

18 This subtitle may be cited as the ‘‘Accurate Mam19 mography Guidelines Act of 1996’’.

20 SEC. 1602. SENSE OF CONGRESS REGARDING BREAST CAN21 CER SCREENING.

22 (a) FINDINGS.—Congress finds that—

23 (1) the National Cancer Institute is the lead

24 Federal agency for research on the causes, preven25 tion, diagnosis, and treatment of cancer;
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1 (2) health professionals and consumers

2 throughout the Nation regard the guidelines of the

3 National Cancer Institute as reliable scientific and

4 medical advice;

5 (3) it has been proven that intervention with

6 routine screening for breast cancer through mam7 mography can save women’s lives at a time when

8 medical science is unable to prevent this disease;

9 (4) there are statistical limitations to evaluating

10 the efficacy of mammography in a 5–10 year age

11 range of women, using existing studies designed to

12 test the efficacy of mammography in a 25–30 year

13 age range of women;

14 (5) there were numerous shortcomings identi15 fied in a Canadian study designed to address reduc16 tion of mortality from breast cancer in the 40–49

17 age range;

18 (6) to date, it is not possible to have the same

19 degree of scientific confidence about the benefit of

20 mammography for women ages 40–49 as exists for

21 women ages 50–69 due to inherent limitations in the

22 studies that have been conducted;

23 (7) meta-analysis (combining the results of sev24 eral studies) is sometimes useful, and the studies

25 used to reach the National Cancer Institute’s conclu-
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1 sions were not easily combined because of variations

2 in design, technology, screening interval, the inclu3 sion or exclusion of clinical breast examination, and

4 quality;

5 (8) the existing clinical trial data are inad6 equate to provide a definite answer to the efficacy of

7 early detection in the 40–49 age group and there

8 has been a dramatic change in technology during the

9 30-year period since the initiation of the first study

10 of breast cancer screening;

11 (9) the majority, approximately 80 percent, of

12 women who are diagnosed with breast cancer have

13 no identifiable risk for this disease;

14 (10) breast cancer is the leading cause of can15 cer death among women in the age group 15–54;

16 (11) the American Cancer Society and 21 other

17 national medical organizations and health and

18 consumer groups are at variance with the recently

19 rescinded guideline of the National Cancer Institute

20 for mammography for women ages 40–49; and

21 (12) the statement of scientific fact on breast

22 cancer screening issued by the National Cancer In23 stitute on December 3, 1993, will cause widespread

24 confusion and concern among women and physi25 cians, erode confidence in mammography, and rein-
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1 force barriers and negative attitudes that keep

2 women of all ages from being screened

3 (b) SENSE OF CONGRESS.—It is the sense of Con4 gress that—

5 (1) adequately designed and conducted studies

6 are needed to determine the benefit of screening

7 women ages 40–49 through mammography and

8 other emerging technologies;

9 (2) the National Cancer Institute’s statement of

10 scientific fact on breast cancer screening should

11 clearly state that the uncertainty of evidence for

12 women in this age group is due to the limitations of

13 existing studies (as of the date of issuance of the

14 statement); and

15 (3) the National Cancer Institute should reissue

16 the recently rescinded guideline for mammography

17 for women ages 40–49 or direct the public to con18 sider guidelines issued by other organizations.

19 TITLE II—SERVICES

20 Subtitle A—Women’s Health Office

21 Act of 1996

22 SEC. 2101. SHORT TITLE.

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

24 Office Act of 1996’’.
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1 SEC. 2102. PUBLIC HEALTH SERVICE OFFICE ON WOMEN’S

2 HEALTH.

3 Title XVII of the Public Health Service Act (42

4 U.S.C. 300u et seq.) is amended by adding at the end

5 the following section:

6 ‘‘OFFICE ON WOMEN’S HEALTH

7 ‘‘SEC. 1710. (a) ESTABLISHMENT OF OFFICE.—

8 There is established an Office on Women’s Health (here9 after referred to in this section as the ‘Office’) within the

10 Office of the Assistant Secretary for Health.

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

12 Department of Health and Human Services a Deputy As13 sistant Secretary for Women’s Health, who shall be the

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

15 Deputy Assistant Secretary, shall carry out this section.

16 ‘‘(c) DUTIES.—The Secretary, acting through the Of17 fice, shall, with respect to women’s health conditions—

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

19 concerning scientific, legal, ethical, and policy issues

20 relating to women’s health;

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

22 and objectives and coordinate all other activities

23 within the Department of Health and Human Serv24 ices that relate to disease prevention, health pro25 motion, service delivery, and research concerning

26 women;
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1 ‘‘(3) enter into interagency agreements with

2 other agencies of the Service to increase the partici3 pation of women in health service and promotion

4 programs;

5 ‘‘(4) support research, demonstrations and eval6 uations to test new and innovative models, to in7 crease knowledge and understanding of health risk

8 factors, to develop mechanisms that support better

9 information dissemination, education, prevention,

10 and service delivery for women, and to support ini11 tiatives for the promotion of women with respect to

12 careers in the health professions and research;

13 ‘‘(5) monitor Public Health Service agency and

14 regional activities regarding women’s health, and co15 ordinate activities of such agency Offices of Wom16 en’s Health;

17 ‘‘(6) establish a women’s health resource center

18 to facilitate the exchange of information regarding

19 matters relating to health information and health

20 promotion, preventive health services, and education

21 in the appropriate use of health care, to facilitate ac22 cess to such information, to assist in the analysis of

23 issues and problems relating to such matters, and to

24 provide technical assistance with respect to the ex25 change of such information (including facilitating
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•S 1799 IS

1 the development of materials for such technical as2 sistance); and

3 ‘‘(7) coordinate efforts to promote women’s

4 health programs and policies in the voluntary and

5 corporate sectors.

6 ‘‘(d) COORDINATING COMMITTEE.—The Secretary

7 shall provide for the operation of a committee composed

8 of the heads of the agencies of the Public Health Service

9 (or the designees of the agency heads), which committee

10 shall be chaired by the Deputy Assistant Secretary for

11 Women’s Health. With respect to women’s health condi12 tions, such committee shall assist the Deputy Assistant

13 Secretary in identifying the needs for programs regarding

14 the conditions, and in making an estimate each fiscal year

15 of the funds needed to adequately support the programs;

16 identifying needs regarding the coordination of programs;

17 and encouraging the agencies of the Public Health Service

18 to conduct and support programs.

19 ‘‘(e) ADVISORY COMMITTEE.—The Secretary shall

20 provide for the operation of an advisory committee regard21 ing the duties of the Office. Such committee shall be com22 posed of 15 voting members, appointed from among indi23 viduals who have expertise in women’s health and who are

24 not officers or employees of the Federal Government, and

25 the term of office for such members shall be four years.
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1 The membership of the committee shall include as nonvot2 ing members each of the individuals serving as nonvoting

3 members of the Coordinating Committee under subsection

4 (d), and shall include such other Federal officials or em5 ployees as the Secretary determines to be appropriate. The

6 committee shall be chaired by the Deputy Assistant Sec7 retary for Women’s Health, and shall meet at the call of

8 the Chair, but not less than once each fiscal year.

9 ‘‘(f) REPORTS.—Not later than January 31, 1997,

10 and January 31 of each second year thereafter, the Sec11 retary shall prepare and submit to the appropriate com12 mittees of Congress a report describing the activities car13 ried out under this section during the preceding 2 fiscal

14 years.

15 ‘‘(g) DEFINITION.—For purposes of this section, the

16 term ‘women’s health conditions’, with respect to women

17 of all age, ethnic, and racial groups, means all diseases,

18 disorders, and conditions—

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

20 in women; and

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

22 type of medical intervention are different for women,

23 or for which it is unknown whether such factors or

24 types are different for women.
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1 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the

2 purpose of carrying out this section, there are authorized

3 to be appropriated $6,000,000 for fiscal year 1997, and

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

5 1998 and 1999.’’.

6 SEC. 2103. CENTERS FOR DISEASE CONTROL AND PREVEN7 TION OFFICE OF WOMEN’S HEALTH.

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

9 (42 U.S.C. 243 et seq.) is amended by inserting after sec10 tion 317F the following section:

11 ‘‘CENTERS FOR DISEASE CONTROL AND PREVENTION

12 OFFICE OF WOMEN’S HEALTH

13 ‘‘SEC. 317G. (a) ESTABLISHMENT.—There is estab14 lished within the Office of the Director of the Centers for

15 Disease Control and Prevention an office to be known as

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

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

18 director who shall be appointed by the Director of the

19 Centers.

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

21 ‘‘(1) determine the current level of the Centers

22 activity regarding women’s health conditions, across

23 age, biological, and sociocultural contexts, in all as24 pects of the Centers work, including prevention pro25 grams, public and professional education, services,

26 and treatment;
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1 ‘‘(2) establish short-range and long-range goals

2 and objectives for women’s health and coordinate all

3 other activities within the Centers that relate to pre4 vention, research, education and training, service de5 livery, and policy development;

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

7 should be conducted or supported by the National

8 Centers;

9 ‘‘(4) consult with health professionals, non-gov10 ernmental organizations, consumer organizations,

11 women’s health professionals, and other individuals

12 and groups, as appropriate, on the policy of the Cen13 ters with regard to women; and

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

15 health with the Public Health Service Office on

16 Women’s Health established under section 1710.

17 ‘‘(c) COORDINATING COMMITTEE.—

18 ‘‘(1) ESTABLISHMENT.—In carrying out sub19 section (b), the Director of the Office shall establish

20 a committee to be known as the Coordinating Com21 mittee on Research on Women’s Health (hereafter

22 referred to in this subsection as the ‘Coordinating

23 Committee’).
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1 ‘‘(2) COMPOSITION.—The Coordinating Com2 mittee shall be composed of the Directors of the

3 National Centers.

4 ‘‘(3) CHAIRPERSON.—The Director of the Of5 fice shall serve as the chairperson of the Coordinat6 ing Committee.

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

8 the Coordinating Committee shall assist the Director

9 of the Office in—

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

11 activities that focus on women’s health;

12 ‘‘(B) identifying needs regarding the co13 ordination of activities, including intramural

14 and extramural multidisciplinary activities; and

15 ‘‘(C) making recommendations to the Di16 rector of the Centers for Disease Control and

17 Prevention concerning findings made under

18 subparagraphs (A) and (B).

19 ‘‘(d) REPORTS.—Not later than January 31, 1997,

20 and January 31 of each second year thereafter, the Direc21 tor shall prepare and submit to the Director of the Public

22 Health Service Office of Women’s Health, a report de23 scribing the activities carried out under this section during

24 the preceding 2 fiscal years.
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1 ‘‘(e) DEFINITION.—As used in this section the term

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

3 age, ethnic, and racial groups, means all diseases, dis4 orders, and conditions—

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

6 in women; and

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

8 type of medical intervention are different for women,

9 or for which it is unknown whether such factors or

10 types are different for women.’’.

11 SEC. 2104. AGENCY FOR HEALTH CARE POLICY AND RE12 SEARCH OFFICE OF WOMEN’S HEALTH.

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

14 (42 U.S.C. 299c et seq.) is amended—

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

16 and

17 (2) by inserting after section 926 the following

18 section:

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

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

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

22 Policy and Research an office to be known as the Office

23 of Women’s Health (hereafter referred to in this section

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

25 who shall be appointed by the Director of the Agency.
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1 ‘‘(b) PURPOSE.—The Director of the Office shall—

2 ‘‘(1) determine the current Agency level of ac3 tivity regarding women’s health, across age, biologi4 cal, and sociocultural contexts, in all aspects of

5 Agency work, including drafting clinical practice

6 guidelines, and conducting research into patient out7 comes, delivery of health care services, and access to

8 health care;

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

10 and objectives for research important to women’s

11 health and coordinate all other activities within the

12 Agency that relate to health services and medical

13 effectiveness research;

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

15 should be conducted or supported by the Agency;

16 ‘‘(4) consult with health professionals, non-gov17 ernmental organizations, consumer organizations,

18 women’s health professionals, and other individuals

19 and groups, as appropriate, on Agency policy with

20 regard to women; and

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

22 health with the Public Health Service Office on

23 Women’s Health established under section 1710.

24 ‘‘(c) COORDINATING COMMITTEE.—
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1 ‘‘(1) ESTABLISHMENT.—In carrying out sub2 section (b), the Director of the Office shall establish

3 a committee to be known as the Coordinating Com4 mittee on Research on Women’s Health (hereafter

5 referred to in this subsection as the ‘Coordinating

6 Committee’).

7 ‘‘(2) COMPOSITION.—The Coordinating Com8 mittee shall be composed of the Directors of the

9 Offices.

10 ‘‘(3) CHAIRPERSON.—The Director of the Of11 fice shall serve as the chairperson of the Coordinat12 ing Committee.

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

14 women’s health, the Coordinating Committee shall

15 assist the Director of the Office in—

16 ‘‘(A) identifying the need for such re17 search, and making an estimate each fiscal year

18 of the funds needed to adequately support the

19 research;

20 ‘‘(B) identifying needs regarding the co21 ordination of research activities, including in22 tramural and extramural multidisciplinary ac23 tivities; and

24 ‘‘(C) making recommendations to the Di25 rector of the Agency for Health Care Policy and
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•S 1799 IS

1 Research concerning findings made under sub2 paragraphs (A) and (B).

3 ‘‘(d) REPORTS.—Not later than January 31, 1997,

4 and January 31 of each second year thereafter, the Direc5 tor shall prepare and submit to the Director of the Public

6 Health Service Office of Women’s Health, a report de7 scribing the activities carried out under this section during

8 the preceding 2 fiscal years.’’.

9 SEC. 2105. HEALTH RESOURCES AND SERVICES ADMINIS10 TRATION OFFICE OF WOMEN’S HEALTH.

11 Part D of title III of the Public Health Service Act

12 (42 U.S.C. 254b et seq.) is amended—

13 (1) by redesignating section 340D as section

14 340E; and

15 (2) by inserting before section 340E (as so re16 designated) the following:

17 ‘‘Subpart IX—Miscellaneous Provisions

18 ‘‘OFFICE OF WOMEN’S HEALTH

19 ‘‘SEC. 340D. (a) ESTABLISHMENT.—There is estab20 lished within the Office of the Administrator of the Health

21 Resources and Services Administration an office to be

22 known as the Office of Women’s Health (hereafter re23 ferred to in this section as the ‘Office’). The Office shall

24 be headed by a director who shall be appointed by the Di25 rector of the Administration.
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1 ‘‘(b) PURPOSE.—The Director of the Office shall—

2 ‘‘(1) determine the current agency level of activ3 ity regarding women’s health across age, biological,

4 and sociocultural contexts;

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

6 and objectives for women’s health and coordinate all

7 other activities within the agency that relate to

8 health care provider training, health service delivery,

9 research, and demonstration projects;

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

11 should be conducted or supported by the Bureaus;

12 ‘‘(4) consult with health professionals, non-gov13 ernmental organizations, consumer organizations,

14 women’s health professionals, and other individuals

15 and groups, as appropriate, on agency policy with

16 regard to women; and

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

18 health with the Public Health Service Office on

19 Women’s Health established under section 1710.

20 ‘‘(c) COORDINATING COMMITTEE.—

21 ‘‘(1) ESTABLISHMENT.—In carrying out sub22 section (b), the Director of the Office shall establish

23 a committee to be known as the Coordinating Com24 mittee on Research on Women’s Health (hereafter
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1 referred to in this subsection as the ‘Coordinating

2 Committee’).

3 ‘‘(2) COMPOSITION.—The Coordinating Com4 mittee shall be composed of the Directors of the

5 Bureaus.

6 ‘‘(3) CHAIRPERSON.—The Director of the Of7 fice shall serve as the Chairperson of the Coordinat8 ing Committee.

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

10 women’s health, the Coordinating Committee shall

11 assist the Director of the Office in—

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

13 activities that focus on women’s health;

14 ‘‘(B) identifying needs regarding the co15 ordination of activities, including intramural

16 and extramural multidisciplinary activities; and

17 ‘‘(C) making recommendations to the Di18 rector of the Centers for Disease Control and

19 Prevention concerning findings made under

20 subparagraphs (A) and (B).

21 ‘‘(d) REPORTS.—Not later than January 31, 1997,

22 and January 31 of each second year thereafter, the Direc23 tor of the Office shall prepare and submit to the Director

24 of the Public Health Service Office of Women’s Health,
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1 a report describing the activities carried out under this

2 section during the preceding 2 fiscal years.’’.

3 SEC. 2106. FOOD AND DRUG ADMINISTRATION OFFICE OF

4 WOMEN’S HEALTH.

5 Chapter IX of the Federal Food, Drug, and Cosmetic

6 Act (21 U.S.C. 391 et seq.) is amended by adding at the

7 end the following section:

8 ‘‘SEC. 906. OFFICE OF WOMEN’S HEALTH.

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

10 the Office of the Commissioner of the Food and Drug Ad11 ministration an office to be known as the Office of Wom12 en’s Health (hereafter referred to in this section as the

13 ‘Office’). The Office shall be headed by a Director who

14 shall be appointed by the Commissioner of the Administra15 tion.

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

17 ‘‘(1) determine current Commission levels of ac18 tivity regarding women’s participation in clinical

19 trials the study of gender differences in the testing

20 of drugs, medical devices, and biological products,

21 across, age, sociocultural, and, where deemed appro22 priate, biological contexts;

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

24 and objectives for adequate inclusion of women in all

25 Commission protocols and policies;
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1 ‘‘(3) provide guidance or criteria for drug and

2 device manufacturers to use in determining the ex3 tent and sufficiency of female representation in clini4 cal trials;

5 ‘‘(4) consult with pharmaceutical manufactur6 ers, health professionals with expertise in women’s

7 issues, consumer organizations, and women’s health

8 professionals on Commission policy with regard to

9 women;

10 ‘‘(5) make annual estimates of funds needed to

11 monitor clinical trials in accordance with needs that

12 are identified; and

13 ‘‘(6) coordinate Commission activities on wom14 en’s health with the Public Health Service Office on

15 Women’s Health established under section 1710 of

16 the Public Health Service Act.

17 ‘‘(c) COORDINATING COMMITTEE.—

18 ‘‘(1) ESTABLISHMENT.—In carrying out sub19 section (b), the Director of the Office shall establish

20 a committee to be known as the Coordinating Com21 mittee on Women’s Health (hereafter referred to in

22 this subsection as the ‘Coordinating Committee’).

23 ‘‘(2) COMPOSITION.—The Coordinating Com24 mittee shall be composed of the Directors of the

25 Food and Drug Administration Centers.
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1 ‘‘(3) CHAIRPERSON.—The Director of the Of2 fice shall serve as the Chairperson of the Coordinat3 ing Committee.

4 ‘‘(4) DUTIES.—With respect to studies on wom5 en’s health, the Coordinating Committee shall assist

6 the Director of the Office in—

7 ‘‘(A) identifying the need for further stud8 ies in specific areas of women’s health that fall

9 within the mission of the Commission, and de10 veloping strategies to foster such studies;

11 ‘‘(B) identifying needs regarding the co12 ordination of Commission activities, including

13 intramural and extramural studies;

14 ‘‘(C) maintaining the Commission’s focus

15 in areas of importance to women;

16 ‘‘(D) supporting the development of meth17 odologies to determine the circumstances in

18 which obtaining data specific to women (includ19 ing data relating to the age of women and the

20 membership of women in ethnic or racial

21 groups) is an appropriate function of clinical

22 trials of treatments and therapies;

23 ‘‘(E) supporting the development and ex24 pansion of clinical trials of treatments and

25 therapies for which obtaining such data has
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1 been determined to be an appropriate function;

2 and

3 ‘‘(F) encouraging the Food and Drug Ad4 ministration Centers to conduct and support

5 such studies, including such clinical trials.

6 ‘‘(d) REPORTS.—Not later than January 31, 1997,

7 and January 31 of each second year thereafter, the Direc8 tor shall prepare and submit to the Director of the Public

9 Health Service Office of Women’s Health, a report de10 scribing the activities carried out under this section during

11 the preceding 2 fiscal years.’’.

12 Subtitle B—Genetic Information

13 Nondiscrimination in Health In14 surance Act of 1996

15 SEC. 2151. SHORT TITLE.

16 This subtitle may be cited as the ‘‘Genetic Informa17 tion Nondiscrimination in Health Insurance Act of 1996’’.

18 SEC. 2152. PROHIBITION OF HEALTH INSURANCE DISCRIMI19 NATION ON THE BASIS OF GENETIC INFOR20 MATION.

21 (a) IN GENERAL.—An insurance provider may not

22 deny or cancel health insurance coverage, or vary the pre23 miums, terms, or conditions for health insurance coverage,

24 for an individual or a family member of an individual—

25 (1) on the basis of genetic information; or
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1 (2) on the basis that the individual or family

2 member of an individual has requested or received

3 genetic services.

4 (b) LIMITATION ON COLLECTION AND DISCLOSURE

5 OF INFORMATION.—

6 (1) IN GENERAL.—An insurance provider may

7 not request or require an individual to whom the

8 provider provides health insurance coverage, or an

9 individual who desires the provider to provide health

10 insurance coverage, to disclose to the provider ge11 netic information about the individual or family

12 member of the individual.

13 (2) REQUIREMENT OF PRIOR AUTHORIZA14 TION.—An insurance provider may not disclose ge15 netic information about an individual without the

16 prior written authorization of the individual or legal

17 representative of the individual. Such authorization

18 is required for each disclosure and shall include an

19 identification of the person to whom the disclosure

20 would be made.

21 (c) ENFORCEMENT.—

22 (1) PLANS OTHER THAN EMPLOYEE HEALTH

23 BENEFIT PLANS.—The requirements established

24 under subsections (a) and (b) shall be enforced by

25 the State insurance commissioner for the State in-
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•S 1799 IS

1 volved or the official or officials designated by the

2 State, except that in no case shall a State enforce

3 such requirements as they relate to employee health

4 benefit plans.

5 (2) EMPLOYEE HEALTH BENEFIT PLANS.—

6 With respect to employee health benefit plans, the

7 Secretary shall enforce the requirements established

8 under subsections (a) and (b) in the same manner

9 as provided for under sections 502, 504, 506, and

10 510 of the Employee Retirement Income Security

11 Act of 1974 (29 U.S.C. 1132, 1134, 1136, and

12 1140).

13 (3) PRIVATE RIGHT OF ACTION.—A person may

14 bring a civil action—

15 (A) to enjoin any act or practice which vio16 lates subsection (a) or (b),

17 (B) to obtain other appropriate equitable

18 relief (i) to redress such violations, or (ii) to en19 force any such subsections, or

20 (C) to obtain other legal relief, including

21 monetary damages.

22 (4) JURISDICTION.—State courts of competent

23 jurisdiction and district courts of the United States

24 have concurrent jurisdiction of actions under this

25 subsection. The district courts of the United States
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1 shall have jurisdiction, without respect to the

2 amount in controversy or the citizenship of the par3 ties, to grant the relief provided for in paragraph

4 (3) in any action.

5 (5) VENUE.—For purposes of this subsection

6 the venue provisions of section 1391 of title 28,

7 United States Code, shall apply.

8 (6) REGULATIONS.—The Secretary may pro9 mulgate such regulations as may be necessary or ap10 propriate to carry out this section.

11 (d) APPLICABILITY.—

12 (1) PREEMPTION OF STATE LAW.—A State may

13 establish or enforce requirements for insurance pro14 viders or health insurance coverage with respect to

15 the subject matter of this section, but only if such

16 requirements are more restrictive than the require17 ments established under subsections (a) and (b).

18 (2) RULE OF CONSTRUCTION.—Nothing in this

19 section shall be construed to affect or modify the

20 provisions of section 514 of the Employee Retire21 ment Income Security Act of 1974 (29 U.S.C.

22 1144).

23 (3) CONTINUATION.—Nothing in this section

24 shall be construed as requiring a group health plan
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1 or an employee health benefit plan to provide bene2 fits to a particular participant or beneficiary.

3 (e) DEFINITIONS.—For purposes of this subtitle:

4 (1) EMPLOYEE HEALTH BENEFIT PLAN.—The

5 term ‘‘employee health benefit plan’’ means any em6 ployee welfare benefit plan, governmental plan, or

7 church plan (as defined under paragraphs (1), (32),

8 and (33) of section 3 of the Employee Retirement

9 Income Security Act of 1974 (29 U.S.C. 1002)) that

10 provides or pays for health insurance coverage (such

11 as provider and hospital benefits) whether—

12 (A) directly;

13 (B) through a group health plan; or

14 (C) otherwise.

15 (2) FAMILY MEMBER.—The term ‘‘family mem16 ber’’ means, with respect to an individual, another

17 individual related by blood to that individual.

18 (3) GENETIC INFORMATION.—The term ‘‘ge19 netic information’’ means information about genes,

20 gene products, or inherited characteristics.

21 (4) GENETIC SERVICES.—The term ‘‘genetic

22 services’’ means health services to obtain, assess,

23 and interpret genetic information for diagnostic and

24 therapeutic purposes, and for genetic education and

25 counseling.
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1 (5) GROUP HEALTH PLAN.—The term ‘‘group

2 health plan’’ has the meaning given such term in

3 section 607 of the Employee Retirement Income Se4 curity Act of 1974 (29 U.S.C. 1167), and includes

5 a multiple employer welfare arrangement (as defined

6 in section 3(40) of such Act) that provides health in7 surance coverage.

8 (6) HEALTH INSURANCE COVERAGE.—The term

9 ‘‘health insurance coverage’’ means a contractual ar10 rangement for the provision of a payment for health

11 care, including—

12 (A) a group health plan; and

13 (B) any other health insurance arrange14 ment, including any arrangement consisting of

15 a hospital or medical expense incurred policy or

16 certificate, hospital or medical service plan con17 tract, or health maintenance organization sub18 scriber contract.

19 (7) INDIVIDUAL HEALTH PLAN.—The term ‘‘in20 dividual health plan’’ means any health insurance

21 coverage offered to individuals that is not a group

22 health plan.

23 (8) INSURANCE PROVIDER.—The term ‘‘insur24 ance provider’’ means an insurer or other entity pro25 viding health insurance coverage.
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1 (9) PERSON.—The term ‘‘person’’ includes cor2 porations, companies, associations, firms, partner3 ships, societies, and joint stock companies, as well as

4 individuals.

5 (10) SECRETARY.—The term ‘‘Secretary’’

6 means the Secretary of Labor.

7 (11) STATE.—The term ‘‘State’’ means any of

8 the 50 States, the District of Columbia, Puerto Rico,

9 the Northern Mariana Islands, the Virgin Islands,

10 American Samoa, and Guam.

11 (f) TECHNICAL AMENDMENT.—Section 508 of the

12 Employee Retirement Income Security Act of 1974 (29

13 U.S.C. 1138) is amended by inserting ‘‘and under the Ge14 netic Insurance Nondiscrimination in Health Insurance

15 Act of 1995’’ before the period.

16 (g) EFFECTIVE DATE.—This section shall apply to

17 health insurance coverage offered or renewed on or after

18 the end of the 90-day period beginning on the date of the

19 enactment of this Act.

20 Subtitle C—Improved Patient Ac21 cess to Clinical Studies Act of

22 1996

23 SEC. 2191. SHORT TITLE.

24 This subtitle may be cited as the ‘‘Improved Patient

25 Access to Clinical Studies Act of 1996’’.
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1 SEC. 2192. COVERAGE FOR INDIVIDUALS PARTICIPATING

2 IN APPROVED CLINICAL STUDIES.

3 (a) PERMITTING PARTICIPATION IN APPROVED CLIN4 ICAL STUDIES.—A health plan may not deny (or limit or

5 impose additional conditions on) coverage of items and

6 services furnished to an enrollee if—

7 (1) the enrollee is participating in an approved

8 clinical study,

9 (2) the items and services are furnished accord10 ing to the design of the study or to treat conditions

11 resulting from participation in the study, and

12 (3) the items and services would otherwise be

13 covered under the plan except for the fact that they

14 are provided in connection with participation in such

15 a study.

16 A health plan may not discriminate against an enrollee

17 on the basis of the enrollee’s participation in such a study.

18 (b) CONSTRUCTION.—Nothing in subsection (a) shall

19 be construed as requiring a health plan to provide for pay20 ment for items and services normally paid for as part of

21 an approved clinical study.

22 (c) APPROVED CLINICAL STUDY DEFINED.—In this

23 section, the term ‘‘approved clinical study’’ means—

24 (1) a research study approved by the Secretary

25 of Health and Human Services, the Director of the

26 National Institutes of Health, the Commissioner of
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•S 1799 IS

1 the Food and Drug Administration, the Secretary of

2 Veterans Affairs, the Secretary of Defense, or a

3 qualified nongovernmental research entity (as de4 fined in guidelines of the National Institutes of

5 Health), or

6 (2) a peer-reviewed and approved research pro7 gram, as defined by the Secretary of Health and

8 Human Services, conducted for the primary purpose

9 of determining whether or not a treatment is safe,

10 efficacious, or having any other characteristic of a

11 treatment which must be demonstrated in order for

12 the treatment to be medically necessary or appro13 priate.

14 Subtitle D—Equitable Health Care

15 for Neurobiological Disorders

16 Act of 1996

17 SEC. 2201. SHORT TITLE.

18 This subtitle may be cited as the ‘‘Equitable Health

19 Care for Neurobiological Disorders Act of 1996’’.

20 SEC. 2202. FINDINGS.

21 Congress finds that—

22 (1) there are sufficient neuroscientific data to

23 document that many severe ‘‘mental’’ illnesses are

24 actually physical illnesses known as neurobiological
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1 disorders that are characterized by significant

2 neuroanatomical and neurochemical abnormalities;

3 (2) American families should have adequate

4 health insurance protection for the costs of treating

5 neurobiological disorders that is commensurate with

6 the protections provided for other illnesses;

7 (3) currently, many public and private health

8 insurance programs discriminate against persons

9 with neurobiological disorders by providing more re10 strictive coverage for treatments of those illnesses in

11 comparison to coverage provided for treatments of

12 other medical problems;

13 (4) unequal health insurance coverage contrib14 utes to the destructive and unfair stigmatization of

15 persons with neurobiological disorders that are as

16 beyond the control of the individuals as are cancer,

17 diabetes, and other serious physical health problems;

18 (5) about 95 percent of what is known about

19 both normal and abnormal structure and function of

20 the brain has been learned in the last 10 years, but

21 millions of severely mentally ill people have yet to

22 benefit from these startling research advances in

23 clinical and basic neuroscience; and

24 (6) according to the National Institutes of Men25 tal Health, equitable insurance coverage for severe
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•S 1799 IS

1 mental disorders will yield $2.2 billion annually in

2 net savings through decreased use of general medical

3 services and a substantial decrease in social costs.

4 SEC. 2203. STANDARDS FOR NONDISCRIMINATORY TREAT5 MENT OF NEUROBIOLOGICAL DISORDERS

6 FOR EMPLOYER HEALTH BENEFIT PLANS.

7 (a) IN GENERAL.—The standards for the nondiscrim8 inatory and equitable treatment by employer health bene9 fit plans of individuals with neurobiological disorders are

10 requirements that such plans (and carriers offering such

11 plans) provide for coverage of services that are essential

12 to the effective treatment of neurobiological disorders in

13 a manner that—

14 (1) is not more restrictive than coverage pro15 vided for other major physical illnesses;

16 (2) provides adequate financial protection to the

17 person requiring the medical treatment for a

18 neurobiological disorder; and

19 (3) is consistent with effective and common

20 methods of controlling health care costs for other

21 major physical illnesses.

22 (b) PLAN DEEMED TO MEET STANDARDS.—An em23 ployer health benefit plan shall be deemed to meet the

24 standards described in subsection (a) if the plan provides

25 for the following:
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1 (1) Stop-loss protection for catastrophic ex2 penses.

3 (2) Coverage of facility-based care.

4 (3) Coverage of outpatient medical management

5 on a par with other medical procedures to encourage

6 the use of cost-effective ambulatory treatment, in7 cluding treatment in non-traditional settings.

8 (4) Coverage of visits for psychological support9 ive, therapeutic, and rehabilitative services, with co10 insurance and fees set to ensure effective cost con11 trol of high demand services.

12 (5) Coverage of prescription drugs essential to

13 the cost effective treatment of neurobiological dis14 orders.

15 (6) Coverage of medically necessary services for

16 comorbidity of other disorders.

17 SEC. 2204. ENFORCEMENT THROUGH EXCISE TAX.

18 (a) IN GENERAL.—Chapter 43 of the Internal Reve19 nue Code of 1986 (relating to qualified pension, etc.,

20 plans) is amended by adding at the end thereof the follow21 ing new section:
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1 ‘‘SEC. 4980C. FAILURE TO COMPLY WITH EMPLOYER

2 HEALTH BENEFIT PLAN STANDARDS FOR

3 NONDISCRIMINATORY TREATMENT FOR

4 NEUROBIOLOGICAL DISORDERS.

5 ‘‘(a) IMPOSITION OF TAX.—There is hereby imposed

6 a tax on the failure of a carrier or an employer health

7 benefit plan to comply with the standards relating to the

8 nondiscriminatory treatment of neurobiological disorders

9 under section 3 of the Equitable Health Care for

10 Neurobiological Disorders Act of 1996.

11 ‘‘(b) AMOUNT OF TAX.—

12 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

13 the tax imposed by subsection (a) shall be an

14 amount not to exceed 25 percent of the amounts re15 ceived by the carrier or under the plan for coverage

16 during the period such failure persists.

17 ‘‘(2) LIMITATION IN CASE OF INDIVIDUAL FAIL18 URES.—In the case of a failure that only relates to

19 specified individuals or employers (and not to the

20 plan generally), the amount of the tax imposed by

21 subsection (a) shall not exceed the aggregate of

22 $100 for each day during which such failure persists

23 for each individual to which such failure relates. A

24 rule similar to the rule of section 4980B(b)(3) shall

25 apply for purposes of this section.
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1 ‘‘(c) LIABILITY FOR TAX.—The tax imposed by this

2 section shall be paid by the carrier.

3 ‘‘(d) EXCEPTIONS.—

4 ‘‘(1) CORRECTIONS WITHIN 30 DAYS.—No tax

5 shall be imposed by subsection (a) by reason of any

6 failure if—

7 ‘‘(A) such failure was due to reasonable

8 cause and not to willful neglect, and

9 ‘‘(B) such failure is corrected within the

10 30-day period beginning on earliest date the

11 carrier knew, or exercising reasonable diligence

12 would have known, that such failure existed.

13 ‘‘(2) WAIVER BY SECRETARY.—In the case of a

14 failure which is due to reasonable cause and not to

15 willful neglect, the Secretary may waive part or all

16 of the tax imposed by subsection (a) to the extent

17 that payment of such tax would be excessive relative

18 to the failure involved.

19 ‘‘(e) DEFINITIONS.—For purposes of this section, the

20 terms ‘carrier’ and ‘employer health benefit plan’ have the

21 respective meanings given such terms in section 5 of the

22 Equitable Health Care for Neurobiological Disorders Act

23 of 1996.’’
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1 (b) CLERICAL AMENDMENT.—The table of sections

2 for chapter 43 of such Code is amended by adding at the

3 end thereof the following new item:

‘‘Sec. 4980C. Failure to comply with employer health benefit plan

standards for nondiscriminatory treatment for

neurobiological disorders.’’.

4 (c) EFFECTIVE DATE.—The amendments made by

5 this subsection shall apply to plan years beginning after

6 December 31, 1996.

7 SEC. 2205. DEFINITIONS.

8 In this subtitle, the following definitions shall apply:

9 (1) CARRIER.—The term ‘‘carrier’’ means any

10 entity which provides health insurance or health ben11 efits in a State, and includes a licensed insurance

12 company, a prepaid hospital or medical service plan,

13 a health maintenance organization, the plan sponsor

14 of a multiple employer welfare arrangement or an

15 employee benefit plan (as defined under the Em16 ployee Retirement Income Security Act of 1974), or

17 any other entity providing a plan of health insurance

18 subject to State insurance regulation.

19 (2) EMPLOYER HEALTH BENEFIT PLAN.—The

20 term ‘‘employer health benefit plan’’ means a health

21 benefit plan (including an employee welfare benefit

22 plan, as defined in section 3(1) of the Employee Re23 tirement Income Security Act of 1974) which is of24 fered to employees through an employer and for
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•S 1799 IS

1 which the employer provides for any contribution to

2 such plan or any premium for such plan are de3 ducted by the employer from compensation to the

4 employee.

5 (3) HEALTH BENEFIT PLAN.—The term

6 ‘‘health benefit plan’’ means any hospital or medical

7 expense incurred policy or certificate, hospital or

8 medical service plan contract, or health maintenance

9 subscriber contract, or a multiple employer welfare

10 arrangement or employee benefit plan (as defined

11 under the Employee Retirement Income Security Act

12 of 1974) which provides benefits with respect to

13 health care services, but does not include—

14 (A) coverage only for accident, dental, vi15 sion, disability income, or long-term care insur16 ance, or any combination thereof,

17 (B) medicare supplemental health insur18 ance,

19 (C) coverage issued as a supplement to li20 ability insurance,

21 (D) worker’s compensation or similar in22 surance, or

23 (E) automobile medical-payment insurance,

24 or any combination thereof.

25 (4) NEUROBIOLOGICAL DISORDER.—
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1 (A) IN GENERAL.—An individual with a

2 ‘‘neurobiological disorder’’ is an individual diag3 nosed with one or more of the following condi4 tions:

5 (i) Affective disorders, including bipo6 lar disorder and major depressive disorder.

7 (ii) Anxiety disorders, including obses8 sive-compulsive disorder and panic dis9 order.

10 (iii) Attention deficit disorders.

11 (iv) Autism and other pervasive devel12 opmental disorders.

13 (v) Psychotic disorders, including

14 schizophrenia spectrum disorders.

15 (vi) Tourette’s disorder.

16 (B) PERIODIC REVIEW OF DEFINITION.—

17 (i) IN GENERAL.—Not later than 6

18 months after the date of the enactment of

19 this subtitle, the Secretary of Health and

20 Human Services shall promulgate regula21 tions directing the National Institute of

22 Mental Health to conduct a biannual re23 view of the definition of neurobiological

24 disorders under subparagraph (A). In con25 ducting such review, the National Institute
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•S 1799 IS

1 of Mental Health shall consult with extra2 mural researchers to review such definition

3 and make recommendations for necessary

4 revisions.

5 (ii) REVIEW BY ADVISORY COUNCIL

6 REQUIRED.—The Secretary may not pro7 mulgate any regulation modifying the defi8 nition of neurobiological disorders under

9 subsection (a) until the recommendations

10 of the National Institute of Mental Health

11 under clause (i) have been reviewed by the

12 National Advisory Mental Health Council.

13 Subtitle E—Victims of Abuse

14 Insurance Protection Act

15 SEC. 2251. SHORT TITLE.

16 This subtitle may be cited as the ‘‘Victims of Abuse

17 Insurance Protection Act’’.

18 SEC. 2252. DEFINITIONS.

19 As used in this subtitle:

20 (1) The term ‘‘abuse’’ means the occurrence of

21 one or more of the following acts between household

22 or family (including in-laws or extended family)

23 members, spouses or former spouses, or individuals

24 engaged in or formerly engaged in a sexually inti25 mate relationship:
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•S 1799 IS

1 (A) Attempting to cause or intentionally,

2 knowingly, or recklessly causing another person

3 bodily injury, physical harm, substantial emo4 tional distress, psychological trauma, rape, sex5 ual assault, or involuntary sexual intercourse.

6 (B) Engaging in a course of conduct or re7 peatedly committing acts toward another per8 son, including following the person without

9 proper authority and under circumstances that

10 place the person in reasonable fear of bodily in11 jury or physical harm.

12 (C) Subjecting another person to false im13 prisonment or kidnapping.

14 (D) Attempting to cause or intentionally,

15 knowingly, or recklessly causing damage to

16 property so as to intimidate or attempt to con17 trol the behavior of another person.

18 (2) The term ‘‘abuse-related medical condition’’

19 means a medical condition which arises in whole or

20 in part out of an action or pattern of abuse.

21 (3) The term ‘‘abuse status’’ means the fact or

22 perception that a person is, has been, or may be a

23 subject of abuse, irrespective of whether the person

24 has sustained abuse-related medical conditions or

25 has incurred abuse-related claims.
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•S 1799 IS

1 (4) The term ‘‘health benefit plan’’ means any

2 public or private entity or program that provides for

3 payments for health care, including—

4 (A) a group health plan (as defined in sec5 tion 607 of the Employee Retirement Income

6 Security Act of 1974) or a multiple employer

7 welfare arrangement (as defined in section

8 3(40) of such Act) that provides health bene9 fits;

10 (B) any other health insurance arrange11 ment, including any arrangement consisting of

12 a hospital or medical expense incurred policy or

13 certificate, hospital or medical service plan con14 tract, or health maintenance organization sub15 scriber contract;

16 (C) workers’ compensation or similar in17 surance to the extent that it relates to workers’

18 compensation medical benefits (as defined by

19 the Federal Trade Commission); and

20 (D) automobile medical insurance to the

21 extent that it relates to medical benefits (as de22 fined by the Federal Trade Commission).

23 (5) The term ‘‘health carrier’’ means a person

24 that contracts or offers to contract on a risk-assum25 ing basis to provide, deliver, arrange for, pay for or
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•S 1799 IS

1 reimburse any of the cost of health care services un2 less the person assuming the risk is accepting the

3 risk from a duly licensed health carrier.

4 (6) The term ‘‘insured’’ means a party named

5 on a policy, certificate, or health benefit plan as the

6 person with legal rights to the benefits provided by

7 the policy, certificate, or health benefit plan. For

8 group insurance, such term includes a person who is

9 a beneficiary covered by a group policy, certificate,

10 or health benefit plan.

11 (7) The term ‘‘insurer’’ means any person, re12 ciprocal exchange, interinsurer, Lloyds insurer, fra13 ternal benefit society, or other legal entity engaged

14 in the business of insurance, including agents, bro15 kers, adjusters, and third party administrators. The

16 term also includes health carriers, health benefit

17 plans, and life, disability, and property and casualty

18 insurers.

19 (8) The term ‘‘policy’’ means a contract of in20 surance, certificate, indemnity, suretyship, or annu21 ity issued, proposed for issuance or intended for is22 suance by an insurer, including endorsements or rid23 ers to an insurance policy or contract.

24 (9) The term ‘‘subject of abuse’’ means a per25 son to whom an act of abuse is directed, a person
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•S 1799 IS

1 who has had prior or current injuries, illnesses, or

2 disorders that resulted from abuse, or a person who

3 seeks, may have sought, or should have sought medi4 cal or psychological treatment for abuse, protection,

5 court-ordered protection, or shelter from abuse.

6 SEC. 2253. DISCRIMINATORY ACTS PROHIBITED.

7 (a) IN GENERAL.—No insurer or health carrier may,

8 directly or indirectly, engage in any of the following acts

9 or practices on the basis that the applicant or insured,

10 or any person employed by the applicant or insured or

11 with whom the applicant or insured is known to have a

12 relationship or association, is, has been, or may be the

13 subject of abuse:

14 (1) Denying, refusing to issue, renew or reissue,

15 or canceling or otherwise terminating an insurance

16 policy or health benefit plan.

17 (2) Restricting, excluding, or limiting insurance

18 or health benefit plan coverage for losses as a result

19 of abuse or denying a claim incurred by an insured

20 as a result of abuse, except as otherwise permitted

21 or required by State laws relating to life insurance

22 beneficiaries.

23 (3) Adding a premium differential to any insur24 ance policy or health benefit plan.
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•S 1799 IS

1 (4) Terminating health coverage for a subject

2 of abuse because coverage was originally issued in

3 the name of the abuser and the abuser has divorced,

4 separated from, or lost custody of the subject of

5 abuse or the abuser’s coverage has terminated volun6 tarily or involuntarily and the subject of abuse does

7 not qualify for extension of coverage under part 6 of

8 subtitle B of title I or the Employee Retirement In9 come Security Act of 1974 (29 U.S.C. 1161 et seq.)

10 or 4980B of the Internal Revenue Code of 1986.

11 Nothing in this paragraph prohibits the insurer from

12 requiring the subject of abuse to pay the full pre13 mium for the subject’s coverage under the health

14 plan. The insurer may terminate group coverage

15 after the continuation coverage required by this

16 paragraph has been in force for 18 months if it of17 fers conversion to an equivalent individual plan. The

18 continuation of health coverage required by this

19 paragraph shall be satisfied by any extension of cov20 erage under part 6 of subtitle B of title I or the Em21 ployee Retirement Income Security Act of 1974 (29

22 U.S.C. 1161 et seq.) or 4980B of the Internal Reve23 nue Code of 1986 provided to a subject of abuse and

24 is not intended to be in addition to any extension of

25 coverage provided under part 6 of subtitle B of title
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•S 1799 IS

1 I or the Employee Retirement Income Security Act

2 of 1974 (29 U.S.C. 1161 et seq.) or 4980B of the

3 Internal Revenue Code of 1986.

4 (b) USE OF INFORMATION.—

5 (1) IN GENERAL.—No insurer may use, dis6 close, or transfer information relating to an appli7 cant’s or insured’s abuse status or abuse-related

8 medical condition or the applicant’s or insured’s sta9 tus as a family member, employer or associate, per10 son in a relationship with a subject of abuse for any

11 purpose unrelated to the direct provision of health

12 care services unless such use, disclosure, or transfer

13 is required by an order of an entity with authority

14 to regulate insurance or an order of a court of com15 petent jurisdiction or by abuse reporting laws. Noth16 ing in this paragraph shall be construed as limiting

17 or precluding a subject of abuse from obtaining the

18 subject’s own medical records from an insurer.

19 (2) AUTHORITY OF SUBJECT OF ABUSE.—A

20 subject of abuse, at the absolute discretion of the

21 subject of abuse, may provide evidence of abuse to

22 an insurer for the limited purpose of facilitating

23 treatment of an abuse-related condition or dem24 onstrating that a condition is abuse-related. Nothing

25 in this paragraph shall be construed as authorizing
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•S 1799 IS

1 an insurer or health carrier to disregard such pro2 vided evidence.

3 SEC. 2254. REASONS FOR ADVERSE ACTIONS.

4 An insurer that takes any adverse action relating to

5 any plan or policy of a subject of abuse, shall advise the

6 subject of abuse applicant or insured of the specific rea7 sons for the action in writing. Reference to general under8 writing practices or guidelines does not constitute a spe9 cific reason.

10 SEC. 2255. LIFE INSURANCE.

11 Nothing in this subtitle shall be construed to prohibit

12 a life insurer from declining to issue a life insurance policy

13 if the applicant or prospective owner of the policy is or

14 would be designated as a beneficiary of the policy, and

15 if—

16 (1) the applicant or prospective owner of the

17 policy lacks an insurable interest in the insured; or

18 (2) the applicant or prospective owner of the

19 policy is known, on the basis of police or court

20 records, to have committed an act of abuse.

21 SEC. 2256. SUBROGATION WITHOUT CONSENT PROHIBITED.

22 Except where the subject of abuse has already recov23 ered damages, subrogation of claims resulting from abuse

24 is prohibited with the informed consent of the subject of

25 abuse.
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•S 1799 IS

1 SEC. 2257. ENFORCEMENT.

2 (a) FEDERAL TRADE COMMISSION.—The Federal

3 Trade Commission shall have the power to examine and

4 investigate any insurer to determine whether such insurer

5 has been or is engaged in any act or practice prohibited

6 by this subtitle. If the Federal Trade Commission deter7 mines an insurer has been or is engaged in any act or

8 practice prohibited by this subtitle, the Commission may

9 take action against such insurer by the issuance of a cease

10 and desist order as if the insurer was in violation of sec11 tion 5 of the Federal Trade Commission Act. Such cease

12 and desist order may include any individual relief war13 ranted under the circumstances, including temporary, pre14 liminary, and permanent injunctive and compensatory re15 lief.

16 (b) PRIVATE CAUSE OF ACTION.—An applicant or in17 sured claiming to be adversely affected by an act or prac18 tice of an insurer in violation of this subtitle may maintain

19 an action against the insurer in a Federal or State court

20 of original jurisdiction. Upon proof of such conduct by a

21 preponderance of the evidence, the court may award ap22 propriate relief, including temporary, preliminary, and

23 permanent injunctive relief and compensatory and puni24 tive damages, as well as the costs of suit and reasonable

25 fees for the aggrieved individual’s attorneys and expert

26 witnesses. With respect to compensatory damages, the ag-
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•S 1799 IS

1 grieved individual may elect, at any time prior to the ren2 dering of final judgment, to recover in lieu of actual dam3 ages, an award of statutory damages in the amount of

4 $5,000 for each violation.

5 Subtitle F—Insurance Protection

6 for Victims of Domestic Violence

7 Act

8 SEC. 2291. SHORT TITLE.

9 This subtitle may be cited as the ‘‘Insurance Protec10 tion for Victims of Domestic Violence Act’’.

11 SEC. 2292. PROHIBITION OF HEALTH INSURANCE DISCRIMI12 NATION WITH RESPECT TO VICTIMS OF DO13 MESTIC VIOLENCE.

14 The Public Health Service Act (42 U.S.C. 201 et

15 seq.) is amended by adding at the end the following new

16 title:

17 ‘‘TITLE XXVII—PROHIBITION OF

18 HEALTH INSURANCE DIS19 CRIMINATION WITH RESPECT

20 TO VICTIMS OF DOMESTIC VI21 OLENCE

22 ‘‘SEC. 2701. LIMITATIONS ON UNDERWRITING.

23 ‘‘No insurer may engage in a practice that has the

24 effect of denying, canceling, or not renewing health insur25 ance coverage or health benefits, or establishing, increas-
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•S 1799 IS

1 ing, or varying the premium charged for the coverage or

2 benefits or excluding health coverage with respect to

3 health care items or services related to treatment of a con4 dition—

5 ‘‘(1) to an individual on the basis that the indi6 vidual or family member is, has been, or may be the

7 subject of abuse, has had prior injuries that resulted

8 from abuse, or seeks, has sought, or should have

9 sought medical or psychological treatment for pro10 tection against abuse, or shelter from abuse; or

11 ‘‘(2) to or for a group or employer on the basis

12 that the group includes or the employer employs, or

13 provides or subsidizes insurance for, an individual

14 described in paragraph (1).

15 ‘‘SEC. 2702. ESTABLISHMENT OF STANDARDS.

16 ‘‘(a) ROLE OF NATIONAL ASSOCIATION OF INSUR17 ANCE COMMISSIONERS.—

18 ‘‘(1) IN GENERAL.—The Secretary shall request

19 the National Association of Insurance Commis20 sioners to develop, in consultation with nonprofit do21 mestic violence victim advocacy organizations, within

22 9 months after the date of the enactment of this

23 title, model standards that incorporate the limita24 tions on underwriting set forth in section 2701, and
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•S 1799 IS

1 provide procedures for enforcement for such provi2 sions, including a private right of action.

3 ‘‘(2) REVIEW OF STANDARDS.—If the Associa4 tion develops recommended regulations specifying

5 the standards within the period, the Secretary shall

6 review the standards. The review shall be completed

7 within 90 days after the date the regulations are de8 veloped. Unless the Secretary determines within the

9 period that such standards do not meet the require10 ments, such standards shall serve as the standards

11 under this title, with such amendments as the Sec12 retary determines to be necessary.

13 ‘‘(b) CONTINGENCY.—If the Association does not de14 velop the model regulations within the 9 month period be15 ginning on the date of the enactment of this title, or the

16 Secretary determines that the regulations do not specify

17 standards that meet the requirements described in sub18 section (a), the Secretary shall specify, within 15 months

19 after the date of the enactment of this title, standards to

20 carry out the requirements.

21 ‘‘(c) APPLICATION OF STANDARDS.—

22 ‘‘(1) IN GENERAL.—Each State shall submit to

23 the Secretary, by the deadline specified in paragraph

24 (2), a report on actions the State is taking to imple25 ment and enforce the standards established under
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•S 1799 IS

1 this section with respect to insurers and health in2 surance coverage offered or renewed not later than

3 such deadline.

4 ‘‘(2) DEADLINE FOR REPORT.—Each State

5 shall file the report described in paragraph (1) not

6 later than 1 year after the date that standards are

7 established under subsection (a) or, in the event of

8 the failure of the Association to develop timely model

9 regulations, under subsection (b).

10 ‘‘(d) FEDERAL ROLE.—

11 ‘‘(1) NOTICE OF DEFICIENCY.—If the Secretary

12 determines that a State has failed to submit a report

13 by the deadline specified by subsection (c), or finds

14 that the State has not implemented and provided

15 adequate enforcement of the standards established

16 under subsection (a) or (b), the Secretary shall no17 tify the State and provide the State a period of 60

18 days in which to submit the report.

19 ‘‘(2) IMPLEMENTATION OF ALTERNATIVE EN20 FORCEMENT MECHANISM.—

21 ‘‘(A) IN GENERAL.—If, after the 60-day

22 period, the Secretary finds that such a failure

23 has not been corrected, the Secretary shall

24 within 30 days provide for a mechanism for the

25 implementation and enforcement of such stand-
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1 ards in the State as the Secretary determines to

2 be appropriate.

3 ‘‘(B) CIVIL PENALTY.—Under any imple4 mentation and enforcement mechanism estab5 lished by the Secretary pursuant to this para6 graph, the Secretary shall have the authority to

7 impose on an insurer a civil monetary penalty

8 in the amount of $10,000 for each day during

9 which such insurer violates the requirements

10 described in section 2701, or the standards de11 veloped under this section. Liability for such

12 penalty shall begin to accrue on the 30th day

13 after the Secretary has provided such insurer

14 with notice of its noncompliance, if the insurer

15 has failed to correct the deficiency by such date.

16 ‘‘(C) EFFECTIVE PERIOD.—Any such im17 plementation and enforcement mechanism es18 tablished by the Secretary shall take effect with

19 respect to insurers, and health insurance cov20 erage offered or renewed, on or after 3 months

21 after the date of the Secretary’s finding under

22 paragraph (1), and until the date the Secretary

23 finds that such a failure has been corrected.

24 ‘‘(3) FEDERAL CIVIL RIGHT OF ACTION.—
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1 ‘‘(A) IN GENERAL.—Any individual

2 aggrieved as a result of conduct prohibited

3 by section 2701 may bring a civil action in

4 the appropriate United States district

5 court against the insurer.

6 ‘‘(B) RELIEF.—Upon proof of such

7 conduct by a preponderance of the evi8 dence, the insurer shall be subject to a civil

9 penalty that may include temporary, pre10 liminary, or permanent injunctive relief

11 and compensatory and punitive damages,

12 as well as the costs of suit and reasonable

13 fees for the aggrieved individual’s attor14 neys. With respect to compensatory dam15 ages, the aggrieved individual may elect, at

16 any time prior to the rendering of final

17 judgment, to recover in lieu of actual dam18 ages, an award of statutory damages in the

19 amount of $5,000 for each violation.

20 ‘‘SEC. 2703. APPLICATION TO GROUP HEALTH PLANS AND

21 ENFORCEMENT.

22 ‘‘(a) APPLICATION.—Subject to subsection (b), the

23 prohibitions in section 2701 and the standards developed

24 under section 2702 shall apply to group health plans pro25 viding health coverage in the same manner as they apply
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1 to insurers providing health insurance coverage. The pen2 alty described in section 2702(d)(2)(B) may be imposed

3 by the Secretary of Labor on group health plans that are

4 not in compliance with the requirements of sections 2701

5 and 2702.

6 ‘‘(b) SUBSTITUTION OF FEDERAL OFFICIALS.—For

7 purposes of subsection (a), any reference in section 2702

8 to—

9 ‘‘(1) a State or the Secretary of Health and

10 Human Services is deemed to be a reference to the

11 Secretary of Labor; and

12 ‘‘(2) an insurer or health insurance coverage is

13 deemed to be a reference to a group health plan and

14 health coverage, respectively.

15 ‘‘(c) ENFORCEMENT.—For purposes of part 5 of sub16 title B of title I of the Employee Retirement Income Secu17 rity Act of 1974 (29 U.S.C. 1131 et seq.) the provisions

18 of this title insofar as they relate to group health plans

19 shall be deemed to be provisions of title I of such Act irre20 spective of exclusions under section 4(b) of such Act.

21 ‘‘(d) REGULATORY AUTHORITY.—With respect to the

22 regulatory authority of the Secretary of Labor under this

23 title pursuant to subsection (c), section 505 of the Em24 ployee Retirement Income Security Act of 1974 (29

25 U.S.C. 1135) shall apply.
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1 ‘‘SEC. 2704. DEFINITIONS.

2 ‘‘For purposes of this title:

3 ‘‘(1) ASSOCIATION.—The term ‘Association’

4 means the National Association of Insurance Com5 missioners.

6 ‘‘(2) INSURER.—

7 ‘‘(A) IN GENERAL.—The term ‘insurer’

8 means a health benefit plan or a health care

9 provider that conducts activities related to the

10 protection of public health.

11 ‘‘(B) HEALTH BENEFIT PLAN.—The term

12 ‘health benefit plan’ means any public or pri13 vate entity or program that provides for pay14 ments for health care, including—

15 ‘‘(i) a group health plan (as defined in

16 section 607 of the Employee Retirement

17 Income Security Act of 1974 (29 U.S.C.

18 1167)) or a multiple employer welfare ar19 rangement (as defined in section 3(40) of

20 such Act) that provides health benefits;

21 and

22 ‘‘(ii) any other health insurance ar23 rangement, including any arrangement

24 consisting of a hospital or medical expense

25 incurred policy or certificate, hospital or

26 medical service plan contract, or health
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1 maintenance organization subscriber con2 tract.

3 ‘‘(C) HEALTH CARE PROVIDER.—The term

4 ‘health care provider’ means a provider of serv5 ices (as defined in section 1861(u) of the Social

6 Security Act (42 U.S.C. 1395u)), a physician,

7 a supplier, or any other person furnishing

8 health care, including a Federal or State pro9 gram that provides directly for the provision of

10 health care to beneficiaries.

11 ‘‘(3) VICTIM OF ABUSE.—The term ‘victim of

12 abuse’ means the occurrence of one or more of the

13 following acts between family or household members,

14 current or former sexual or intimate partners, or

15 persons sharing biological parenthood—

16 ‘‘(A) attempting to cause or intentionally,

17 knowingly, or recklessly causing bodily injury,

18 rape, or sexual abuse as such term is defined in

19 section 2242 of title 18, United States Code.

20 ‘‘(B) placing, by physical menace, another

21 individual in reasonable fear of imminent seri22 ous bodily injury;

23 ‘‘(C) infliction of false imprisonment; or

24 ‘‘(D) physically or sexually abusing minor

25 children.’’.
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1 Subtitle G—Domestic Violence Vic2 tims Insurance Protection Act

3 of 1996

4 SEC. 2301. SHORT TITLE.

5 This subtitle may be cited as the ‘‘Domestic Violence

6 Victims Insurance Protection Act of 1996’’.

7 SEC. 2302. PROTECTION OF DOMESTIC VIOLENCE VICTIMS

8 FROM HEALTH INSURANCE DISCRIMINATION.

9 (a) IN GENERAL.—An insurer may not deny or can10 cel health insurance coverage for an individual solely on

11 the basis that the individual is or has been the subject

12 of an act of domestic violence.

13 (b) INTERPRETATION.— Nothing in this section shall

14 prevent an insurer from underwriting, issuing, or renewing

15 health insurance coverage on the basis of the physical or

16 mental history of an individual so long as the insurer does

17 not take into consideration whether such individual’s con18 dition was caused by an act of domestic violence.

19 (c) STANDARDS.—

20 (1) IN GENERAL.—The Secretary of Health and

21 Human Services shall request the National Associa22 tion of Insurance Commissioners to develop, within

23 9 months after the date of the enactment of the Act,

24 model regulations that specify standards with re-
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1 spect to the requirements of this subtitle as applica2 ble to carriers and health insurance coverage.

3 (2) REVIEW OF STANDARDS.—If the National

4 Association of Insurance Commissioners develops

5 recommended regulations specifying such standards

6 within such period, the Secretary shall review the

7 standards. Such review shall be completed within 60

8 days after the date the regulations are developed.

9 Unless the Secretary determines within such period

10 that the standards do not meet the requirements,

11 such standards shall serve as the standards under

12 this section, with such amendments as the Secretary

13 deems necessary.

14 (3) APPLICATION OF STANDARDS.—Each State

15 shall submit to the Secretary a report on steps the

16 State is taking to implement and enforce the stand17 ards established under paragraph (1) with respect to

18 carriers and health insurance coverage offered or re19 newed.

20 (d) DEFINITIONS.—For purposes of this section:

21 (1) ACT OF DOMESTIC VIOLENCE.—The term

22 ‘‘act of domestic violence’’ means, with respect to an

23 individual, the occurrence of one or more acts of

24 harassment, menacing, reckless endangerment, kid25 napping, assault, attempted assault, or attempted
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1 murder, in violation of Federal or State law, between

2 household or family members (including in-laws or

3 extended family), spouses or former spouses, or indi4 viduals engaged in or formerly engaged in a sexually

5 intimate relationship, where such an act has resulted

6 in actual physical or emotional injury, or has created

7 a substantial risk of physical or emotional harm to

8 such individual or such individual’s child.

9 (2) HEALTH INSURANCE COVERAGE.—

10 (A) IN GENERAL.—Except as provided in

11 subparagraph (B), the term ‘‘health insurance

12 coverage’’ means any hospital or medical service

13 policy or certificate, hospital or medical service

14 plan contract, or health maintenance organiza15 tion contract offered by an insurer.

16 (B) EXCEPTION.—Such term does not in17 clude any of the following:

18 (i) Coverage for accident only, dental

19 only, vision only, disability income, or long20 term care insurance.

21 (ii) Medical supplemental health in22 surance.

23 (iii) Coverage issued as a supplement

24 to liability insurance.
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1 (iv) Liability insurance, including gen2 eral liability insurance and automobile li3 ability insurance.

4 (v) Worker’s compensation or similar

5 insurance.

6 (vi) Automobile medical-payment in7 surance.

8 (vii) Coverage for a specified disease

9 or illness.

10 (3) INSURER.—The term ‘‘insurer’’ means an

11 insurance company, insurance service, or insurance

12 organization licensed to engage in the business of in13 surance in a State, and health maintenance organi14 zation.

15 (4) STATE.—The term ‘‘State’’ means any

16 State, the District of Columbia, Puerto Rico, the

17 Northern Mariana Islands, the Virgin Islands,

18 American Samoa, and Guam.

19 Subtitle H—Fairness to Minority

20 Women Health Act

21 SEC. 2351. SHORT TITLE.

22 This subtitle may be cited as the ‘‘Fairness to Minor23 ity Women Health Act’’.
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1 SEC. 2352. EXCEPTION TO AFDC INCOME AND RESOURCES

2 ATTRIBUTION RULE FOR CERTAIN BATTERED

3 ALIENS.

4 (a) IN GENERAL.—Section 415(f) of the Social Secu5 rity Act (42 U.S.C. 615(f)) is amended—

6 (1) in the matter preceding paragraph (1), by

7 striking ‘‘who is—’’ and inserting ‘‘who—’’;

8 (2) in each of paragraphs (1) and (2), by in9 serting ‘‘is’’ before ‘‘admitted’’;

10 (3) in paragraph (3), by inserting ‘‘is’’ before

11 ‘‘paroled’’;

12 (4) in paragraph (4)—

13 (A) by inserting ‘‘is’’ before ‘‘granted’’;

14 and

15 (B) by striking ‘‘or’’ at the end;

16 (5) in paragraph (5)—

17 (A) by inserting ‘‘is’’ before ‘‘a Cuban’’;

18 and

19 (B) by striking the period at the end and

20 inserting a semicolon; and

21 (6) by adding at the end the following:

22 ‘‘(6) is battered by, or is the subject of extreme

23 cruelty (including physical acts resulting in physical

24 injury or a threat of physical injury, sexual abuse,

25 rape, or mental abuse) perpetrated by, the spouse or

26 other person who executed the affidavit of support
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1 or similar agreement referred to in subsection (a)

2 with respect to the alien, but only after the first day

3 on which the battery or cruelty occurs after the alien

4 enters into the United States; or

5 ‘‘(7) is a dependent child, and a relative with

6 whom the child is living is battered by, or is the sub7 ject of extreme cruelty (including physical acts re8 sulting in physical injury or a threat of physical in9 jury, sexual abuse, rape, or mental abuse) per10 petrated by, the parent or other person who executed

11 the affidavit of support or similar agreement re12 ferred to in subsection (a) with respect to the alien,

13 but only after the first day on which the battery or

14 cruelty occurs after the alien enters into the United

15 States.’’.

16 (b) EFFECTIVE DATE.—The amendment made by

17 subsection (a) shall take effect 90 days after the date of

18 the enactment of this Act.

19 SEC. 2353. AMENDMENT TO THE FOOD STAMP ACT OF 1977.

20 (a) IN GENERAL.—Section 5(i) of the Food Stamp

21 Act of 1977 (7 U.S.C. 2014(i)) is amended by adding at

22 the end the following:

23 ‘‘(F) If an alien is battered by the alien’s sponsor,

24 or is the subject of extreme cruelty perpetrated by the

25 sponsor, after such alien enters the United States, then
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1 after the date the battery or cruelty occurs, this subsection

2 (other than subparagraph (E) of paragraph (2)) shall not

3 apply with respect to such alien and to any child of such

4 alien less than 18 years of age and residing with such

5 alien.’’.

6 (b) The amendment made by subsection (a) shall take

7 effect 90 days after the date of the enactment of this Act.

8 SEC. 2354. REQUIRING CERTAIN RECIPIENTS OF FEDERAL

9 FINANCIAL ASSISTANCE TO HAVE PERSON10 NEL AVAILABLE WHO SPEAK PREDOMINANT

11 LANGUAGE USED IN AREA.

12 (a) PROVIDERS OF OBSTETRICAL AND GYNECO13 LOGICAL SERVICES.—

14 (1) MEDICAID.—Section 1903(i) of the Social

15 Security Act (42 U.S.C. 1396b(i)) is amended—

16 (A) by striking ‘‘or’’ at the end of para17 graph (14);

18 (B) by striking the period at the end of

19 paragraph (15) and inserting ‘‘; or’’; and

20 (C) by inserting after paragraph (15) the

21 following new paragraph:

22 ‘‘(16) with respect to any amount expended for

23 obstetrical or gynecological services furnished by or

24 through a hospital, clinic, or other institutional pro25 vider, unless the hospital, clinic, or provider has
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1 available at least one individual who is able to com2 municate in the predominant language used by resi3 dents of the area in which the hospital, clinic, or

4 provider is located (as determined by the Secretary

5 on the basis of information provided by the Sec6 retary of Commerce pursuant to the most recent de7 cennial census).’’.

8 (2) FAMILY PLANNING SERVICES.—Section

9 1001 of the Public Health Service Act (42 U.S.C.

10 300) is amended—

11 (A) by redesignating subsections (c) and

12 (d) as subsections (d) and (e), respectively; and

13 (B) by inserting after subsection (b) the

14 following subsection:

15 ‘‘(c) The Secretary may make a grant under this sec16 tion only if the applicant involved agrees to ensure that,

17 of the individuals providing services under the grant, at

18 least one will be an individual who is able to communicate

19 in the predominant language used by residents of the area

20 in which the family planning project involved is located

21 (as determined by the Secretary on the basis of informa22 tion provided by the Secretary of Commerce pursuant to

23 the most recent decennial census).’’.
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1 (3) EFFECTIVE DATE.—The amendments made

2 by this subsection shall apply to services furnished

3 on or after October 1, 1996.

4 (b) DOMESTIC VIOLENCE SHELTERS.—

5 (1) IN GENERAL.—The Family Violence Pre6 vention and Services Act (42 U.S.C. 10401 et seq.)

7 is amended by adding at the end the following new

8 section:

9 ‘‘SEC. 319. AVAILABILITY OF BILINGUAL SERVICES.

10 ‘‘No funds may be made available under this title for

11 any provider of shelter or related assistance unless the

12 provider has available at least one individual who is able

13 to communicate in the predominant language used by resi14 dents of the area in which the provider is located (as deter15 mined by the Secretary on the basis of information pro16 vided by the Secretary of Commerce pursuant to the most

17 recent decennial census).’’.

18 (2) EFFECTIVE DATE.—The amendment made

19 by paragraph (1) shall apply to funds made available

20 on or after October 1, 1996.

21 SEC. 2355. STUDY REGARDING DOMESTIC VIOLENCE AND

22 LATINA WOMEN.

23 (a) IN GENERAL.—With respect to cases of domestic

24 violence in which Latina women are the victims, the Sec25 retary of Health and Human Services, in consultation with
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1 the Attorney General of the United States, shall conduct

2 a study for the following purposes:

3 (1) To determine the incidence of such cases,

4 and to provide a comparison of such estimate with

5 the relevant incidence for other populations of

6 women (utilizing existing data regarding such other

7 populations).

8 (2) To determine whether and to what extent

9 the causes and effects for such cases are different

10 than for cases of domestic violence in which other

11 populations of women are the victims (utilizing exist12 ing data regarding such other populations).

13 (b) REPORT.—Not later than 3 years after the date

14 of the enactment of this Act, the Secretary of Health and

15 Human Services shall submit to the Congress a report de16 scribing the findings made in the study under subsection

17 (a).

18 Subtitle I—Adolescent Health

19 Demonstration Projects Act

20 SEC. 2391. SHORT TITLE.

21 This subtitle may be cited as the ‘‘Adolescent Health

22 Demonstration Projects Act’’.
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1 SEC. 2392. ESTABLISHMENT OR SUPPORT OF DEMONSTRA2 TION PROJECTS.

3 The Secretary of Health and Human Services (here4 inafter in this subtitle referred to as the ‘‘Secretary’’) shall

5 make grants in fiscal years 1997 through 2001 to public

6 and nonprofit private entities to establish or support ado7 lescent health demonstration projects in secondary schools

8 or entities associated with secondary schools for the pur9 pose of demonstrating how such projects may be estab10 lished throughout the United States.

11 SEC. 2393. PROJECT REQUIREMENTS.

12 An adolescent health demonstration project estab13 lished or supported under section 2392 shall (1) provide

14 nutrition and hygiene counseling, health care related to

15 sports, family planning information and services, prenatal

16 and postpartum care, family life and parenting counseling,

17 and alcohol and drug abuse education and treatment, (2)

18 serve adolescents before their graduation from high school,

19 (3) encourage family participation, to the extent practical,

20 (4) obtain the approval of the school board in the locality

21 to be served by the project before the project is imple22 mented, (5) furnish such reports and data as the Sec23 retary may require, including, at a minimum, the number

24 and characteristics of individuals served, the services pro25 vided, and the results achieved, and (6) establish a com26 munity advisory committee to oversee the establishment
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1 and implementation of such project. Such community ad2 visory committee shall include students, parents, school

3 personnel, physicians, religious and business leaders, and

4 other community representatives and shall establish poli5 cies for the project with respect to the services to be pro6 vided under the project, the populations to be served, the

7 personnel who will provide services, fees to be charged, and

8 other policy issues.

9 SEC. 2394. AREAS TO BE SERVED.

10 In making grants under section 2392, the Secretary

11 shall give priority to applications for projects which will

12 serve areas with low-income residents or minority popu13 lations.

14 SEC. 2395. ABORTION RESTRICTION.

15 None of the funds provided under a grant under sec16 tion 2392 may be used to perform or pay for abortions.

17 SEC. 2396. REPORT.

18 The Secretary shall, in each fiscal year, set aside not

19 more than 5 percent of the amount appropriated for

20 grants under section 2392 to evaluate the operations of

21 the projects for which grants were made under such sec22 tion. Not later than December 1, 2002, the Secretary shall

23 report to the Congress the result of such evaluation to24 gether with such recommendations as the Secretary may

25 have respecting the extension of the grant authority under
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1 section 2392 or the establishment of a continuing service

2 program.

3 Subtitle J—Eating Disorders Infor4 mation and Education Act of

5 1996

6 SEC. 2401. SHORT TITLE.

7 This subtitle may be cited as the ‘‘Eating Disorders

8 Information and Education Act of 1996’’.

9 SEC. 2402. FINDINGS.

10 The Congress finds the following:

11 (1) Eating disorders include anorexia nervosa,

12 bulimia nervosa, and binge eating disorder, as well

13 as eating disorders not otherwise defined.

14 (2) Anorexia nervosa and bulimia each can re15 sult in death, cardiac impairments, depression, sub16 stance abuse, osteoporosis, infertility, amenorrhea,

17 anemia, and other medical conditions.

18 (3) Medical authorities are uncertain to what

19 extent eating disorders are caused by physiological

20 factors, by psychosocial factors, or by both.

21 (4) Such disorders primarily affect women. As

22 many as 7 percent of women may be experiencing

23 eating disorders, and the rate of new cases is in24 creasing. As many as 80 percent of women may dur-
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1 ing their lifetimes display symptoms of eating dis2 orders.

3 (5) There are effective treatments for some eat4 ing disorders.

5 SEC. 2403. PUBLIC INFORMATION AND EDUCATION ON EAT6 ING DISORDERS.

7 Subpart 3 of part B of title V of the Public Health

8 Service Act (42 U.S.C. 290bb–31 et seq.) is amended by

9 adding at the end the following section:

10 ‘‘EATING DISORDERS

11 ‘‘SEC. 520C. (a) INFORMATION AND EDUCATION.—

12 The Secretary, acting through the Director of the Center

13 for Mental Health Services, shall carry out a program to

14 provide information and education to the public on the

15 prevention and treatment of eating disorders.

16 ‘‘(b) TOLL-FREE TELEPHONE COMMUNICATIONS.—

17 In carrying out subsection (a), the Secretary shall provide

18 for the operation of toll-free telephone communications to

19 provide information to the public on eating disorders, in20 cluding referrals for services for the prevention and treat21 ment of such disorders. Such communications shall be

22 available on a 24-hour, 7-day basis.

23 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

24 purpose of carrying out this section, there are authorized

25 to be appropriated $2,000,000 for fiscal year 1997, and
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1 such sums as may be necessary for each of the fiscal years

2 1998 and 1999.’’.

3 Subtitle K—Women’s Choice and

4 Reproductive Health Protection

5 Act of 1996

6 SEC. 2451. SHORT TITLE.

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

8 and Reproductive Health Protection Act of 1996’’.

9 SEC. 2452. FINDINGS.

10 The Congress finds that—

11 (1) reproductive rights are central to women’s

12 ability to exercise full enjoyment of rights secured to

13 them by Federal and State law;

14 (2) abortion has been a legal and constitu15 tionally protected medical procedure throughout the

16 United States since 1973 and has become part of

17 mainstream medical practice as is evidenced by the

18 positions of medical institutions including the Amer19 ican Medical Association, the American College of

20 Obstetricians and Gynecologists, and the American

21 Medical Women’s Association;

22 (3) the availability of abortion services is dimin23 ishing throughout the United States: 84 percent of

24 counties have no abortion provider and between
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1 1982 and 1992 the number of providers decreased

2 in 45 States; and

3 (4) at a minimum, Congress must retain the

4 following policies, which currently preserve women’s

5 choice and reproductive health:

6 (A) Funding for abortion services for vic7 tims of rape and incest.

8 (B) Protection from clinic violence.

9 (C) The implementation of breast cancer,

10 cervical cancer and chlamydia screening pro11 grams in all 50 States.

12 (D) Full implementation of legislation to

13 establish contraceptive and infertility research

14 programs.

15 (E) Authorization of family planning pro16 grams.

17 (F) The prohibition of a ‘‘gag’’ rule on in18 formation pertaining to reproductive medical

19 services.

20 (G) The evaluation of RU–486.

21 (H) The fundamental right to choose, as

22 stated by the Supreme Court in Roe v. Wade.

23 (I) Fairness in insurance.
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1 (J) The ability of military personnel over2 seas to purchase abortion services at military

3 facilities with private funds.

4 SEC. 2453. SENSE OF CONGRESS WITH RESPECT TO CER5 TAIN REPRODUCTIVE HEALTH ISSUES.

6 (a) RAPE AND INCEST VICTIM PROTECTION.—It is

7 the sense of Congress that the current provisions requiring

8 funding of abortion services in cases of life endangerment,

9 rape or incest for women eligible for medical assistance

10 are essential to their health and well-being and therefore

11 Federal and State governments must provide funding in

12 these cases.

13 (b) CLINIC VIOLENCE.—It is the sense of Congress

14 that—

15 (1) Federal resources are necessary to ensure

16 that women have safe access to reproductive health

17 facilities and that health professionals can deliver

18 services in a secure environment free from violence

19 and threats of force; and

20 (2) it is necessary and appropriate to use Fed21 eral resources to combat the nationwide campaign of

22 violence and harassment against reproductive health

23 centers.

24 (c) PREVENTIVE HEALTH MEASURES REGARDING

25 BREAST AND CERVICAL CANCER.—It is the sense of the
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1 Congress that the program of grants under title XV of

2 the Public Health Service Act should receive a level of

3 funding that is adequate for all States to receive grants

4 under such title.

5 (d) PROGRAMS REGARDING CONTRACEPTION AND

6 INFERTILITY.—

7 (1) RESEARCH CENTERS.—It is the sense of the

8 Congress that the program of research centers under

9 section 452A of the Public Health Service Act

10 should receive a level of funding that is adequate for

11 a reasonable number of research centers to be oper12 ated under the program.

13 (2) LOAN REPAYMENT PROGRAM REGARDING

14 CONDUCT OF RESEARCH.—It is the sense of the

15 Congress that the program of loan-repayment con16 tracts under section 487B of the Public Health

17 Service Act should receive a level of funding that is

18 adequate for a reasonable number of individuals to

19 conduct research under the program.

20 (3) SCREENINGS FOR INFERTILITY-RELATED

21 SEXUALLY TRANSMITTED DISEASES.—It is the sense

22 of the Congress that the program of grants under

23 section 318A of the Public Health Service Act

24 should receive a level of funding that is adequate for
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1 screenings under such section to be available in all

2 States.

3 SEC. 2454. FAMILY PLANNING AMENDMENTS.

4 Section 1001(d) of the Public Health Service Act (42

5 U.S.C. 300(d)) is amended to read as follows:

6 ‘‘(d) For the purpose of grants and contracts under

7 this section, there are authorized to be appropriated

8 $220,000,000 for fiscal year 1997, $250,000,000 for fis9 cal year 1998, and such sums as may be necessary for

10 each of the fiscal years 1999 through 2001.’’.

11 SEC. 2455. FREEDOM OF FULL DISCLOSURE.

12 Title XI of the Civil Rights Act of 1964 is amended

13 by adding at the end the following:

14 ‘‘SEC. 1107. (a) Notwithstanding any other provision

15 of law, no governmental authority shall, in or through any

16 program or activity that provides health care services or

17 information, administered or assisted by such authority,

18 limit the right of any person to provide, or the right of

19 any person to receive, nonfraudulent information about

20 the availability of reproductive health care services, includ21 ing family planning, prenatal care, adoption, and abortion

22 services.

23 ‘‘(b) As used in this section the term ‘governmental

24 authority’ means any authority of the United States.’’.
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1 SEC. 2456. FAIRNESS IN EVALUATION OF RU–486.

2 The Secretary of Health and Human Services shall—

3 (1) assure that the Food and Drug Administra4 tion evaluates the drug called Mifepristone or RU–

5 486 only on the basis provided by law; and

6 (2) assess initiatives by which the Department

7 of Health and Human Services can promote the

8 testing, licensing, and manufacturing in the United

9 States of this drug or other antiprogestins.

10 SEC. 2457. FREEDOM OF CHOICE.

11 (a) FINDINGS.—Congress finds the following:

12 (1) The 1973 Supreme Court decision in Roe v.

13 Wade established constitutionally based limits on the

14 power of States to restrict the right of a woman to

15 choose to terminate a pregnancy. Under the strict

16 scrutiny standard enunciated in Roe v. Wade, States

17 were required to demonstrate that laws restricting

18 the right of a woman to choose to terminate a preg19 nancy were the least restrictive means available to

20 achieve a compelling State interest. Since 1989, the

21 Supreme Court has no longer applied the strict scru22 tiny standard in reviewing challenges to the constitu23 tionality of State laws restricting such rights.

24 (2) As a result of the Supreme Court’s recent

25 modification of the strict scrutiny standard enun26 ciated in Roe v. Wade, certain States have restricted
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1 the right of women to choose to terminate a preg2 nancy or to utilize some forms of contraception, and

3 these restrictions operate cumulatively to—

4 (A)(i) increase the number of illegal or

5 medically less safe abortions, often resulting in

6 physical impairment, loss of reproductive capac7 ity or death to the women involved;

8 (ii) burden interstate commerce by forcing

9 women to travel from States in which legal bar10 riers render contraception or abortion unavail11 able or unsafe to other States or foreign na12 tions;

13 (iii) interfere with freedom of travel be14 tween and among the various States;

15 (iv) burden the medical and economic re16 sources of States that continue to provide

17 women with access to safe and legal abortion;

18 and

19 (v) interfere with the ability of medical

20 professionals to provide health services;

21 (B) obstruct access to and use of contra22 ceptive and other medical techniques that are

23 part of interstate and international commerce;

24 (C) discriminate between women who are

25 able to afford interstate and international travel
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1 and women who are not, a disproportionate

2 number of whom belong to racial or ethnic mi3 norities; and

4 (D) infringe upon women’s ability to exer5 cise full enjoyment of rights secured to them by

6 Federal and State law, both statutory and con7 stitutional.

8 (3) Although Congress may not by legislation

9 create constitutional rights, it may, where authorized

10 by its enumerated powers and not prohibited by a

11 constitutional provision, enact legislation to create

12 and secure statutory rights in areas of legitimate na13 tional concern.

14 (4) Congress has the affirmative power both

15 under section 8 of article I of the Constitution of the

16 United States and under section 5 of the Fourteenth

17 Amendment of the Constitution to enact legislation

18 to prohibit State interference with interstate com19 merce, liberty or equal protection of the laws.

20 (b) PURPOSE.—It is the purpose of this section to

21 establish, as a statutory matter, limitations upon the

22 power of States to restrict the freedom of a woman to ter23 minate a pregnancy in order to achieve the same limita24 tions as provided, as a constitutional matter, under the
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1 strict scrutiny standard of review enunciated in Roe v.

2 Wade and applied in subsequent cases from 1973 to 1988.

3 (c) IN GENERAL.—A State—

4 (1) may not restrict the freedom of a woman to

5 choose whether or not to terminate a pregnancy be6 fore fetal viability;

7 (2) may restrict the freedom of a woman to

8 choose whether or not to terminate a pregnancy

9 after fetal viability unless such a termination is nec10 essary to preserve the life or health of the woman;

11 and

12 (3) may impose requirements on the perform13 ance of abortion procedures if such requirements are

14 medically necessary to protect the health of women

15 undergoing such procedures.

16 (d) DEFINITION.—As used in this section, the term

17 ‘‘State’’ includes the District of Columbia, the Common18 wealth of Puerto Rico, and each other territory or posses19 sion of the United States.

20 SEC. 2458. FAIRNESS IN INSURANCE.

21 Notwithstanding any other provision of law no Fed22 eral law shall be construed to prohibit a provider of health

23 insurance from offering coverage for the full range of re24 productive health care, including abortion services.
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1 SEC. 2459. ABORTIONS IN FACILITIES OF THE UNIFORMED

2 SERVICES NOT PROHIBITED IF NOT FEDER3 ALLY FUNDED.

4 Section 1093 of title 10, United States Code, is

5 amended—

6 (1) by inserting ‘‘(a) LIMITATION.—’’ before

7 ‘‘Funds’’; and

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

9 ‘‘(b) ABORTIONS IN FACILITIES OVERSEAS.—Sub10 section (a) does not limit the performing of an abortion

11 in a facility of the uniformed services located outside the

12 48 contiguous States of the United States if—

13 ‘‘(1) the cost of performing the abortion is fully

14 paid from a source or sources other than funds

15 available to the Department of Defense;

16 ‘‘(2) abortions are not prohibited by the laws of

17 the jurisdiction where the facility is located; and

18 ‘‘(3) the abortion would otherwise be permitted

19 under the laws applicable to the provision of health

20 care to members and former members of the uni21 formed services and their dependents in such facil22 ity.’’.
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1 Subtitle L—Women’s Right To

2 Know Act of 1996

3 SEC. 2491. SHORT TITLE.

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

5 To Know Act of 1996’’.

6 SEC. 2492. FIRST AMENDMENT RIGHTS.

7 Title XI of the Civil Rights Act of 1964 is amended

8 by adding at the end the following:

9 ‘‘SEC. 1107. (a) Notwithstanding any other provision

10 of law, no governmental authority shall in or through any

11 program or activity, administered or assisted by such au12 thority, that provides health care services or information,

13 limit the right of any person to provide, or the right of

14 any person to receive, nonfraudulent information about

15 the availability of reproductive health care services, includ16 ing family planning, prenatal care, adoption, and abortion

17 services.

18 ‘‘(b) As used in this section—

19 ‘‘(1) the term ‘governmental authority’ means

20 any authority of any State or of the United States;

21 and

22 ‘‘(2) the term ‘State’ includes the District of

23 Columbia, Puerto Rico, and any other territory or

24 possession of the United States.’’.
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1 Subtitle M—International Popu2 lation Stabilization and Repro3 ductive Health Act

4 SEC. 2501. SHORT TITLE.

5 This subtitle may be cited as the ‘‘International Pop6 ulation Stabilization and Reproductive Health Act’’.

7 SEC. 2502. AUTHORITIES RELATING TO UNITED STATES

8 POPULATION ASSISTANCE.

9 Part I of the Foreign Assistance Act of 1961 is

10 amended—

11 (1) in section 104(b), by striking ‘‘on such

12 terms and conditions as he may determine’’ and in13 serting ‘‘in accordance with the provisions of chapter

14 12’’; and

15 (2) by adding at the end the following new

16 chapter:

17 ‘‘CHAPTER 12—UNITED STATES

18 POPULATION ASSISTANCE

19 ‘‘SEC. 499. DEFINITION.—For purposes of this chap20 ter, the term ‘United States population assistance’ means

21 assistance provided under section 104(b) of this Act.

22 ‘‘SEC. 499A. CONGRESSIONAL FINDINGS.—The Con23 gress makes the following findings:

24 ‘‘(1) Throughout much of the developing world,

25 the inability of women and couples to exercise choice
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1 over childbearing undermines the role of women in

2 economic development, contributes to death and suf3 fering among women and their children, puts pres4 sure on the environment and the natural resources

5 on which many poor families depend for their sur6 vival, and in other ways vitiates the efforts of fami7 lies to lift themselves out of the poverty in which

8 more than one billion of the world’s 5.6 billion peo9 ple live.

10 ‘‘(2) Through 2015, the world’s population will

11 continue to grow, with annual population increments

12 predicted to be above 86 million. This will lead to a

13 tripling of the world’s population before stabilization

14 can occur.

15 ‘‘(3) As the population within individual coun16 tries grows, cities grow rapidly, movement in and be17 tween countries increases, and regional distributions

18 of population become unbalanced.

19 ‘‘(4) After more than a quarter century of expe20 rience and research, a global consensus is emerging

21 on the need for increased international cooperation

22 in regard to population in the context of sustainable

23 development.

24 ‘‘(5) To act effectively on this consensus, the

25 ability to exercise reproductive choice should be ex-
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1 panded through broader dissemination of fertility

2 regulation services that involve women, couples, and

3 the community and which are competent in meeting

4 individual, family, and community needs and values.

5 ‘‘(6) Although a number of barriers to family

6 planning remain, in many countries a large and

7 growing unmet desire exists for fertility regulation

8 among women and men who are too poor to pay the

9 full cost of services or for whom services are other10 wise inaccessible. Worldwide, estimates are that

11 more than 350 million couples want to space or pre12 vent another pregnancy, but lack access to family

13 planning methods.

14 ‘‘(7) Millions of women, most of them mothers,

15 are killed or injured each year as a result of unsafe

16 abortions. The availability of safe and effective fer17 tility regulation methods and services and increased

18 access to quality reproductive health care can help

19 prevent many of these tragedies.

20 ‘‘(8) In addition to the personal toll on families,

21 the impact of human population growth and wide22 spread poverty is evident in mounting signs of stress

23 on the world’s environment, particularly in tropical

24 deforestation, erosion of arable land and watersheds,

25 extinction of plant and animal species, global climate
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1 change, waste management, and air and water pollu2 tion.

3 ‘‘(9) Traditionally, United States population as4 sistance has not focused on achieving specific goals

5 with respect to international population stabilization

6 or the expansion of reproductive choice. The absence

7 of clear goals in those areas has led to a lack of cri8 teria for allocating funds and evaluating program

9 success.

10 ‘‘DECLARATION OF POLICY

11 ‘‘SEC. 499B. (a) IN GENERAL.—Congress declares

12 that to reduce population growth and stabilize world popu13 lation at the lowest level feasible and thereby improve the

14 health and well-being of the world’s families, to ensure the

15 role of women in the development process, and to protect

16 the global environment, an important objective of the for17 eign policy of the United States shall be to assist the inter18 national community to achieve universal availability of

19 quality fertility regulation services through a wide choice

20 of safe and effective means of family planning, including

21 programs of public education and other health and devel22 opment efforts in support of smaller families.

23 ‘‘(b) FINANCIAL TARGETS.—The Congress endorses

24 a target for global expenditures in developing countries of

25 at least $17,000,000,000 by the year 2000 for population

26 programs described in section 499C, and establishes a goal
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1 for United States population assistance by the year 2000

2 of $1,850,000,000 in constant 1993 dollars.

3 ‘‘SEC. 499C. AUTHORIZED ACTIVITIES.—United

4 States population assistance is authorized to provide—

5 ‘‘(1) support for the expansion of quality, af6 fordable, voluntary family planning services, which

7 emphasize informed choice among a variety of safe

8 and effective fertility regulation methods and closely

9 related reproductive health care services, including

10 the prevention and control of HIV–AIDS, sexually

11 transmitted diseases, and reproductive tract infec12 tions;

13 ‘‘(2) support for adequate and regular supplies

14 of quality contraceptives, quality family planning

15 counseling, information, education, communication,

16 and services emphasizing the use of the mass media

17 to improve public knowledge of fertility regulation

18 and related disease prevention methods and where

19 they may be obtained and to promote the benefits of

20 family planning and reproductive health to individ21 uals, families, and communities;

22 ‘‘(3) support to United States and foreign re23 search institutions and other appropriate entities for

24 biomedical research to develop and evaluate im25 proved methods of safe fertility regulation and relat-
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1 ed disease control, with particular emphasis on

2 methods which—

3 ‘‘(A) are likely to be safer, easier to use,

4 easier to make available in developing country

5 settings, and less expensive than current meth6 ods;

7 ‘‘(B) are controlled by women, including

8 barrier methods and vaginal microbicides;

9 ‘‘(C) are likely to prevent the spread of

10 sexually transmitted diseases; and

11 ‘‘(D) encourage and allow men to take

12 greater responsibility for their own fertility;

13 ‘‘(4) support for field research on the character14 istics of programs most likely to result in sustained

15 use of effective family planning in meeting each indi16 vidual’s lifetime reproductive goals, with particular

17 emphasis on the perspectives of family planning

18 users, including support for relevant social and be19 havioral research focusing on such factors as the

20 use, nonuse, and unsafe or ineffective use of various

21 fertility regulation and related-disease control meth22 ods;

23 ‘‘(5) support for the development of new evalua24 tion techniques and performance criteria for family
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1 planning programs, emphasizing the family planning

2 user’s perspective and reproductive goals;

3 ‘‘(6) support for research and research dissemi4 nation related to population policy development, in5 cluding demographic and health surveys to assess

6 population trends, measure unmet needs, and evalu7 ate program impact, and support for policy-relevant

8 research on the relationships between population

9 trends, poverty, and environmental management, in10 cluding implications for sustainable agriculture,

11 agroforestry, biodiversity, water resources, energy

12 use, and local and global climate change;

13 ‘‘(7) support for prevention of unsafe abortions

14 and management of complications of unsafe abor15 tions, including research and public information dis16 semination on the health and welfare consequences;

17 ‘‘(8) support for special programs to reach ado18 lescents and young adults before they begin child19 bearing, including health education programs which

20 stress responsible parenthood and the health risks of

21 unprotected sexual intercourse, as well as service

22 programs designed to meet the information and con23 traception needs of adolescents;
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1 ‘‘(9) support for a broad array of governmental

2 and nongovernmental communication strategies de3 signed—

4 ‘‘(A) to create public awareness worldwide;

5 ‘‘(B) to generate a consensus on the need

6 to address reproductive health issues and the

7 problems associated with continued world popu8 lation growth;

9 ‘‘(C) to emphasize the need to educate men

10 as well as women and mobilize their support for

11 reproductive rights and responsibilities; and

12 ‘‘(D) to remove all major remaining bar13 riers to family planning use, including unneces14 sary legal, medical, clinical, and regulatory bar15 riers to information and methods, and to make

16 family planning an established community

17 norm;

18 ‘‘(10) support for programs and strategies that

19 actively discourage harmful practices such as female

20 genital mutilation; and

21 ‘‘(11) support for prenatal, safe delivery pro22 grams and postnatal care programs that include

23 breastfeeding as a child survival strategy and means

24 for enhancing birth spacing.
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1 ‘‘SEC. 499D. TERMS AND CONDITIONS.—United

2 States population assistance is authorized to be provided

3 subject to the following conditions:

4 ‘‘(1) Such assistance may only support, directly

5 or through referral, those activities which provide a

6 broad range of fertility regulation methods permitted

7 by individual country policy and a broad choice of

8 public and private family planning services, includ9 ing networks for community-based and subsidized

10 commercial distribution of high quality contracep11 tives.

12 ‘‘(2) No program supported by United States

13 population assistance may deny an individual family

14 planning services because of such individual’s inabil15 ity to pay all or part of the cost of such services.

16 ‘‘(3) In each recipient country, programs sup17 ported by United States population assistance shall,

18 to the extent possible, support an integrated ap19 proach, consistent with respect for the rights of

20 women as decisionmakers in matters of reproduction

21 and sexuality, for the provision of public and private

22 reproductive health services.

23 ‘‘(4) Family planning services and related re24 productive health care services supported by United

25 States population assistance shall ensure—
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1 ‘‘(A) privacy and confidentiality and main2 tain the highest medical standards possible

3 under local conditions; and

4 ‘‘(B) regular oversight of the quality of

5 medical care and other services offered, includ6 ing followup care such as care for the side ef7 fects of contraceptive use.

8 ‘‘(5) United States population assistance pro9 grams shall furnish only those contraceptive drugs

10 and devices which have received approval for mar11 keting in the United States by the Food and Drug

12 Administration or which have been tested and deter13 mined to be safe and effective under research proto14 cols comparable to those required by the Food and

15 Drug Administration or have been determined to be

16 safe by an appropriate international organization or

17 the relevant health authority in the country to which

18 they are provided.

19 ‘‘(6) Family planning services supported by

20 United States population assistance shall be de21 signed to take into account the needs of the family

22 planning user, including the constraints on women’s

23 time, by involving members of the community, in24 cluding both men and women, in the design, man25 agement, and ongoing evaluation of the services
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1 through appropriate training and recruitment ef2 forts. The design of services shall stress easy acces3 sibility, by locating services as close as possible to

4 potential users, by keeping hours of service conven5 ient, and by improving communications between

6 users and providers through community outreach

7 and involvement. Related services shall be included,

8 either on site or through referral.

9 ‘‘(7) United States population assistance to ad10 olescent fertility programs shall be provided in the

11 context of prevailing norms and customs in the re12 cipient country.

13 ‘‘(8)(A) Programs supported by United States

14 population assistance shall—

15 ‘‘(i) support the prevention of the spread

16 of HIV–AIDS infection;

17 ‘‘(ii) raise awareness regarding HIV–AIDS

18 prevention and consequences; and

19 ‘‘(iii) provide quality counselling, medical

20 care and support services to HIV–AIDS in21 fected individuals in a manner which respects

22 individual rights and confidentiality.

23 ‘‘(B) Responsible sexual behavior, including vol24 untary abstinence, for the prevention of HIV infec-
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1 tion should be promoted and included in education

2 and information programs.

3 ‘‘(9) None of the funds made available by the

4 United States Government to foreign governments,

5 international organizations, or nongovernmental or6 ganizations may be used to coerce any person to un7 dergo contraceptive sterilization or involuntary abor8 tion or to accept any other method of fertility regu9 lation.

10 ‘‘ELIGIBILITY FOR POPULATION ASSISTANCE

11 ‘‘SEC. 499E. (a) ELIGIBLE COUNTRIES.—Notwith12 standing any other provision of law, United States popu13 lation assistance shall be available, directly or through

14 intermediary organizations, to any country which the

15 President determines has met one or more of the following

16 criteria:

17 ‘‘(1) The country accounts for a significant pro18 portion of the world’s annual population increment.

19 ‘‘(2) The country has significant unmet needs

20 for fertility regulation and requires foreign assist21 ance to implement, expand, or sustain quality family

22 planning services for all its people.

23 ‘‘(3) The country demonstrates a strong policy

24 commitment to population stabilization through the

25 expansion of reproductive choice.
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1 ‘‘(b) ELIGIBILITY OF NONGOVERNMENTAL AND MUL2 TILATERAL ORGANIZATIONS.—In determining eligibility

3 for United States population assistance, the President

4 shall not subject nongovernmental and multilateral organi5 zations to requirements which are more restrictive than

6 requirements applicable to foreign governments for such

7 assistance.

8 ‘‘PARTICIPATION IN MULTILATERAL ORGANIZATIONS

9 ‘‘SEC. 499F. (a) FINDING.—The Congress recognizes

10 that the recent attention, in government policies toward

11 population stabilization owes much to the efforts of the

12 United Nations and its specialized agencies and organiza13 tions, particularly the United Nations Population Fund.

14 ‘‘(b) AVAILABILITY OF FUNDS.—United States popu15 lation assistance shall be available for contributions to the

16 United Nations Population Fund in such amounts as the

17 President determines would be commensurate with United

18 States contributions to other multilateral organizations

19 and with the contributions of other donor countries.

20 ‘‘(c) PROHIBITIONS.—(1) The prohibitions contained

21 in section 104(f) of this Act shall apply to the funds made

22 available for the United Nations Population Fund.

23 ‘‘(2) No United States population assistance may be

24 available to the United Nations Population Fund unless

25 such assistance is held in a separate account and not com26 mingled with any other funds.
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1 ‘‘(3) No funds may be available for the United Na2 tions Population Fund unless the Fund agrees to prohibit

3 the use of those funds to carry out any program, project,

4 or activity that involves the use of coerced abortion or in5 voluntary sterilization.

6 ‘‘(d) ALLOCATION OF FUNDS.—Of the funds made

7 available for United States population assistance, the

8 President shall make available for the Special Programme

9 of Research, Development and Research Training in

10 Human Reproduction for each of the fiscal years 1996 and

11 1997 an amount commensurate with the contributions of

12 the other donor countries for the purpose of furthering

13 international cooperation in the development and evalua14 tion of fertility regulation technology.

15 ‘‘SUPPORT FOR NONGOVERNMENTAL ORGANIZATIONS

16 ‘‘SEC. 499G. (a) FINDING.—Congress finds that in

17 many developing countries, nongovernmental entities, in18 cluding private and voluntary organizations and private

19 sector entities, such as the International Planned Parent20 hood Federation and the Planned Parenthood Federation

21 of America, are the most appropriate and effective provid22 ers of United States assistance to population and family

23 planning activities.

24 ‘‘(b) PROCEDURES.—The President shall establish

25 simplified procedures for the development and approval of
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1 programs to be carried out by nongovernmental organiza2 tions that have demonstrated—

3 ‘‘(1) a capacity to undertake effective popu4 lation and family planning activities which encourage

5 significant involvement by private health practition6 ers, employer-based health services, unions, and co7 operative health organizations; and

8 ‘‘(2) a commitment to quality reproductive

9 health care for women.

10 ‘‘(c) PRIORITY FOR NONGOVERNMENTAL ORGANIZA11 TIONS.—The largest share of United States population as12 sistance made available for any fiscal year shall be made

13 available through United States and foreign nongovern14 mental organizations.

15 ‘‘SEC. 499H. REPORTS TO CONGRESS.—The Presi16 dent shall prepare and submit to the Congress, as part

17 of the annual presentation materials on foreign assistance,

18 a report on world progress toward population stabilization

19 and universal reproductive choice. The report shall in20 clude—

21 ‘‘(1) estimates of expenditures on the popu22 lation activities described in section 499C by na23 tional governments, donor agencies, and private sec24 tor entities;
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1 ‘‘(2) an assessment by country, of the availabil2 ity and use of all methods of fertility regulation and

3 abortion, whether lawful or unlawful in that country;

4 ‘‘(3) an analysis by country and region of the

5 impact of population trends on a set of key social,

6 economic, political, and environment indicators,

7 which shall be identified by the President in the first

8 report submitted pursuant to this section and ana9 lyzed in that report and each subsequent report; and

10 ‘‘(4) a detailed statement of prior year and pro11 posed direct and indirect allocations of population

12 assistance, by country, which describes how each

13 country allocation meets the criteria set forth in this

14 section.’’.

15 SEC. 2503. AUTHORIZATIONS OF APPROPRIATIONS.

16 Section 104(g)(1) of the Foreign Assistance Act of

17 1961 (22 U.S.C. 2151b(g)(1) is amended by amending

18 subparagraph (A) to read as follows:

19 ‘‘(A) $635,000,000 for fiscal year 1997 and

20 $695,000,000 for fiscal year 1998 to carry out sub21 section (b) of this section; and’’.

22 SEC. 2504. OVERSIGHT OF MULTILATERAL DEVELOPMENT

23 BANKS.

24 (a) FINDINGS.—The Congress finds that—
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1 (1) multilateral development banks have an im2 portant role to play in global population efforts;

3 (2) although the increased commitment by mul4 tilateral development banks to population-related ac5 tivities is encouraging, together the banks provided

6 less than $200,000,000 in 1994 in assistance for

7 core population programs, and their overall lending

8 for population, health, and nutrition decreased by

9 more than one-half between 1993 and 1994; and

10 (3) the banks themselves have recognized a

11 need to improve oversight of programs, strengthen

12 the technical skills of their personnel, and improve

13 their capacity to work with borrowers, other donors,

14 and nongovernmental organizations in formulating

15 creative population projects to meet diverse borrower

16 needs.

17 (b) SENSE OF CONGRESS.—It is the sense of the

18 Congress that the multilateral development banks should

19 increase their annual support for the population activities

20 described in section 499C of the Foreign Assistance Act

21 of 1961, as added by this Act, to not less than a total

22 of $1,000,000,000 by December 31, 2001.

23 (c) REPORT REQUIRED.—Not later than July 31 of

24 each year, the Secretary of the Treasury shall prepare and
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•S 1799 IS

1 transmit to Congress a report which includes, with respect

2 to the preceding calendar year—

3 (1) information on the resources made available

4 by each multilateral development bank for the popu5 lation activities described in section 499C of the

6 Foreign Assistance Act of 1961, as added by this

7 Act;

8 (2) if such resources total less than

9 $1,000,000,000, any specific actions taken by the

10 United States executive directors to the banks to en11 courage increases in such resources and in policy12 level discussions with donor and developing country

13 governments; and

14 (3) an analysis of the progress made by the

15 banks towards—

16 (A) meeting the objectives of the popu17 lation activities which are supported by the

18 banks;

19 (B) increasing their in-country manage20 ment staff;

21 (C) improving the technical skills of their

22 personnel; and

23 (D) assuring their responsiveness to bor24 rower needs.
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1 (d) DEFINITION.—As used in this section, the term

2 ‘‘multilateral development banks’’ means the International

3 Bank for Reconstruction and Development, the Inter4 national Development Association, the African Develop5 ment Bank, the Asian Development Bank, the Inter6 American Development Bank, and the European Bank for

7 Reconstruction and Development.

8 SEC. 2505. ECONOMIC AND SOCIAL DEVELOPMENT INITIA9 TIVES TO STABILIZE WORLD POPULATION.

10 (a) CONGRESSIONAL FINDINGS.—The Congress

11 makes the following findings:

12 (1) Women represent 50 percent of the world’s

13 human resource potential. Therefore, improving the

14 health, social, and economic status of women and in15 creasing their productivity are essential for economic

16 progress in all countries. Improving the status of

17 women also enhances their decisionmaking capacity

18 at all levels in all spheres of life, including in the

19 area of reproductive health.

20 (2) Throughout the world, women who partici21 pate in the social, economic, and political affairs of

22 their communities are more likely to exercise their

23 choice about childbearing than women who do not

24 participate in such activities.
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1 (3) Effective economic development strategies

2 address issues such as infant and child survival

3 rates, educational opportunities for girls and women,

4 and gender equality in development.

5 (4) Comprehensive population stabilization ef6 forts which include both family planning services

7 and economic development activities achieve lower

8 birth rates and stimulate more development than

9 those which pursue these objectives independently.

10 (5) The most powerful, long-term influence on

11 birthrates is education, especially educational attain12 ment among women. Education is one of the most

13 important means of empowering women with the

14 knowledge, skills and self confidence necessary to

15 participate in their communities.

16 (6) In most societies, men traditionally have ex17 ercised preponderant power in nearly all spheres of

18 life. Therefore, improving communication between

19 men and women on reproductive health issues and

20 increasing their understanding of joint responsibil21 ities are essential to ensuring that men and women

22 are equal partners in public and private life.

23 (7) In addition to enabling women to partici24 pate in the development of their societies, edu25 cational attainment has a strong influence on all
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1 other aspects of family welfare, including child sur2 vival. However, of the world’s 130 million children

3 who are not enrolled in primary school, 70 percent

4 are girls.

5 (8) In a number of countries, lower rates of

6 school enrollment among girls, the practice of pre7 natal sex selection, and higher rates of mortality

8 among very young girls suggest that ‘‘son pref9 erence’’ is curtailing the access of girl children to

10 food, health care, and education.

11 (9) Each year, nearly 15 million children under

12 the age of 5 die, most from preventable causes.

13 Wider availability of vaccines, simple treatments for

14 diarrheal disease and respiratory infections, and im15 proved nutrition could prevent many of these deaths.

16 (10) Each year, 500,000 or more women world17 wide die from complications related to pregnancy,

18 childbirth, illegal abortion, or inadequate or inacces19 sible reproductive health care services. Another 10

20 million women annually suffer long-term illness or

21 permanent physical impairment from such causes.

22 (11) Malnutrition and anemia are widespread

23 among poor women in their childbearing years, yet

24 the worldwide campaign to encourage breastfeeding
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1 has devoted little attention to the nutritional needs

2 of nursing mothers.

3 (12) By mid-1993, the cumulative number of

4 AIDS cases since the pandemic began was estimated

5 at 2.5 million, and an estimated 14 million people

6 had been infected with HIV. By year 2000, esti7 mates are that 40 million people will be HIV in8 fected.

9 (13) As of mid-1993, four-fifths of all persons

10 ever infected with HIV lived in developing countries.

11 Women are the fastest growing group of new cases.

12 (b) DECLARATION OF POLICY.—Congress declares

13 that, to further the United States foreign policy objective

14 of assisting the international community in achieving uni15 versal availability of quality fertility regulation services

16 and stabilizing world population, additional objectives of

17 the foreign policy of the United States shall be—

18 (1) to help achieve universal access to basic

19 education for women and men, with particular prior20 ity being given to primary and technical education

21 and job training;

22 (2) to increase understanding of the con23 sequences of population growth through effective

24 education strategies that begin in primary school

25 and continue through all levels of formal and nonfor-
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1 mal education and which take into account the

2 rights and responsibilities of parents and the needs

3 of children and adolescents;

4 (3) to reduce the gap between male and female

5 levels of literacy and between male and female levels

6 of primary and secondary school enrollment;

7 (4) to help ensure that women worldwide have

8 the opportunity to become equal partners with men

9 in the development of their societies;

10 (5) to help eliminate all forms of discrimination

11 against girl children and the root causes of son pref12 erence, which result in harmful and unethical prac13 tice such as female infanticide and prenatal sex se14 lection;

15 (6) to increase public awareness of the value of

16 girl children through public education that promotes

17 equal treatment of girls and boys in health, nutri18 tion, education, socioeconomic and political activity,

19 and equitable inheritance rights;

20 (7) to promote gender equality in all spheres of

21 life, including family and community life, and to en22 courage and enable men to take responsibility for

23 their sexual and reproductive behavior and their so24 cial and family roles;
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1 (8) to help ensure that women and men have

2 the information and means needed to achieve good

3 reproductive health and to exercise their reproduc4 tive rights through responsible sexual behavior and

5 equity in gender relations;

6 (9) to reduce global maternal and infant mor7 tality rates; and

8 (10) to improve worldwide maternal and child

9 health status and quality of life.

10 (c) AUTHORIZED ACTIVITIES.—United States devel11 opment assistance shall be available, on a priority basis,

12 for—

13 (1) countries which either have adopted and im14 plemented, or have agreed to adopt and implement,

15 strategies to help ensure—

16 (A) before 2015, the achievement of the

17 goal of universal primary education for girls

18 and boys in all countries and access to second19 ary and higher levels of education, including vo20 cational education and technical training, for

21 girls and women;

22 (B) by 2005, the reduction of adult illit23 eracy by at least one-half the country’s 1990

24 level;
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1 (C) by 2005, the elimination of the gap be2 tween male and female levels of literacy and be3 tween male and female levels of primary and

4 secondary school enrollment; and

5 (D) the establishment of programs de6 signed to meet adolescent health needs, which

7 include services and information on responsible

8 sexual behavior, family planning practice, repro9 ductive health and sexually transmitted dis10 eases, and HIV–AIDS prevention;

11 (2) governmental and nongovernmental pro12 grams which, with respect to a targeted country, are

13 intended—

14 (A) by 2005, to increase life expectancy at

15 birth to greater than 70 years of age and by

16 2015, to 75 years of age;

17 (B) by 2005, to reduce by one-third the

18 country’s mortality rates for infants and chil19 dren under 5 years of age, or to 50 per 1,000

20 live births for infants and 70 per 1,000 for chil21 dren under 5 years of age, whichever is less;

22 and by 2015, to reduce the country’s infant

23 mortality rate below 35 per 1,000 births and

24 the under-5 mortality rate below 45 per 1,000;
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1 (C) by 2005, to reduce maternal mortality

2 by one-half of the 1990 level and by a further

3 one-half by 2015;

4 (D) by 2005, to reduce significantly mal5 nutrition among the country’s children under 5

6 years of age;

7 (E) to maintain immunizations against

8 childhood diseases for significant segments of

9 the country’s children; and

10 (F) to reduce the number of childhood

11 deaths in the country which result from diar12 rheal disease and acute respiratory infections;

13 (3) governmental and nongovernmental pro14 grams which are intended to increase women’s pro15 ductivity and ensure equal participation and equi16 table representation at all levels of the political proc17 ess and public life in each community and society

18 through—

19 (A) improved access to appropriate labor20 saving technology, vocational training, and ex21 tension services and access to credit and child

22 care;

23 (B) equal participation of women and men

24 in all areas of family and household responsibil25 ities, including family planning, financial sup-
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1 port, child rearing, children’s education, and

2 maternal and child health and nutrition;

3 (C) fulfillment of the potential of women

4 through education, skill development and em5 ployment, with the elimination of poverty, illit6 eracy and poor health among women being of

7 paramount importance; and

8 (D) recognition and promotion of the equal

9 value of children of both sexes;

10 (4) governmental and nongovernmental pro11 grams which are intended to increase the access of

12 girls and women to comprehensive reproductive

13 health care services pursuant to subsection (d); and

14 (5) governmental and nongovernmental pro15 grams which are intended to eliminate all forms of

16 exploitation, abuse, harassment, and violence against

17 women, adolescents, and children.

18 (d) SAFE MOTHERHOOD INITIATIVE.—(1)(A) The

19 President is authorized to establish a grant program, to

20 be known as the Safe Motherhood Initiative, to help im21 prove the access of girls and women worldwide to com22 prehensive reproductive health care services.

23 (B) Such program shall be carried out in accordance

24 with this section and shall be subject to the same terms,

25 conditions, prohibitions, and restrictions as are applicable
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1 to assistance made available under sections 499D, 499E,

2 and 499F of the Foreign Assistance Act of 1961, as added

3 by this Act.

4 (2) Comprehensive reproductive health care programs

5 which are eligible for assistance under this section in6 clude—

7 (A) fertility regulation services;

8 (B) prenatal care and screening for high risk

9 pregnancies and improved access to safe delivery

10 services for women with high risk pregnancies;

11 (C) supplemental food programs for pregnant

12 and nursing women;

13 (D) child survival and other programs that pro14 mote birth spacing through breastfeeding;

15 (E) expanded and coordinated programs that

16 support responsible sexual behavior, including vol17 untary abstinence, and which prevent, detect, and

18 treat sexually transmitted diseases, including HIV–

19 AIDS, reproductive tract infections, and other

20 chronic reproductive health problems;

21 (F) programs intended to eliminate traditional

22 practices injurious to women’s health, including fe23 male genital mutilation;
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1 (G) improvements in the practice of midwifery,

2 including outreach to traditional birth attendants;

3 and

4 (H) expanded and coordinated programs to pre5 vent, detect, and treat cancers of the reproductive

6 system.

7 (e) REPORTS TO CONGRESS.—(1) Not later than De8 cember 31, 1996, the President shall prepare and submit

9 to Congress a report which includes—

10 (A) estimates of the total financial resources

11 needed to achieve, by the year 2005, the specific ob12 jectives set forth in subsection (c) with respect to

13 education, rates of illiteracy, malnutrition, immuni14 zation, maternal and child mortality and morbidity,

15 and improvements in the economic productivity of

16 women;

17 (B) an analysis of such estimates which sepa18 rately lists the total financial resources needed from

19 the United States, other donor nations, and non20 governmental organizations;

21 (C) an analysis, by country, which—

22 (i) identifies the legal, social, economic,

23 and cultural barriers to women’s self-determina24 tion and to improvements in the economic pro-
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1 ductivity of women in traditional and modern

2 labor sectors; and

3 (ii) describes initiatives needed to develop

4 appropriate technologies for use by women,

5 credit programs for low-income women, ex6 panded child care, vocational training, and ex7 tension services for women; and

8 (D) a comprehensive description of—

9 (i) new and expanded initiatives to ensure

10 safe motherhood worldwide;

11 (ii) findings on the major causes of mortal12 ity and morbidity among women of childbearing

13 age in various regions of the world;

14 (iii) actions needed to reduce, by the year

15 2005, world maternal mortality by one-half of

16 the worldwide 1990 level and a further one-half

17 by 2015; and

18 (iv) the financial resources needed to meet

19 this goal from the United States, other donor

20 nations, and nongovernmental organizations.

21 (2) In each annual country human rights report, the

22 Secretary of State shall include—

23 (A) information on any patterns within the

24 country of discrimination against women in inherit25 ance laws, property rights, family law, access to
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1 credit and technology, hiring practices, formal edu2 cation, and vocational training; and

3 (B) an assessment which makes reference to all

4 significant forms of violence against women, includ5 ing rape, domestic violence, and female genital muti6 lation, the extent of involuntary marriage and child7 bearing, and the prevalence of marriage among

8 women under 18 years of age.

9 (f) AUTHORIZATION OF APPROPRIATIONS.—(1) Of

10 the aggregate amounts available for United States devel11 opment and economic assistance programs for education

12 activities, $165,000,000 for fiscal year 1997 and

13 $200,000,000 for fiscal year 1998 shall be available only

14 for programs in support of increasing primary and second15 ary school enrollment and equalizing levels of male and

16 female enrollment.

17 (2) There are authorized to be appropriated

18 $330,000,000 for fiscal year 1997 and $380,000,000 for

19 fiscal year 1998 to the Child Survival Fund under section

20 104(c)(2) of the Foreign Assistance Act of 1961, which

21 amounts shall be available for child survival activities only,

22 including the Children’s Vaccine Initiative, the worldwide

23 immunization effort, and oral rehydration programs.
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1 (3) There are authorized to be appropriated

2 $100,000,000 for the Safe Motherhood Initiative for each

3 of fiscal years 1996 and 1997.

4 (g) DEFINITIONS.—For purposes of this section—

5 (1) the term ‘‘annual country human rights re6 port’’ refers to the report required to be submitted

7 pursuant to section 502B(b) of the Foreign Assist8 ance Act of 1961 (22 U.S.C. 2304(b)); and

9 (2) the term ‘‘United States development and

10 economic assistance’’ means assistance made avail11 able under chapter 1 of part I and chapter 4 of part

12 II of the Foreign Assistance Act of 1961.

13 SEC. 2506. AIDS PREVENTION AND CONTROL FUND.

14 (a) IN GENERAL.—Section 104(c) of the Foreign As15 sistance Act of 1961 (22 U.S.C. 2151b(c)) is amended by

16 adding at the end the following new paragraph:

17 ‘‘(4)(A)(i) The President is authorized to provide as18 sistance, under such terms and conditions as he may de19 termine, with respect to activities relating to research on,

20 and the treatment and control of, acquired immune defi21 ciency syndrome (AIDS) in developing countries.

22 ‘‘(ii) Assistance provided under clause (i) shall in23 clude—

24 ‘‘(I) funds made available directly to the World

25 Health Organization for its use in financing the
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1 Global Program on AIDS (including activities imple2 mented by the Pan American Health Organization);

3 and

4 ‘‘(II) funds made available to the United Na5 tions Children’s Fund (UNICEF) for AIDS-related

6 activities.

7 ‘‘(B) Appropriations pursuant to subparagraph (A)

8 may be referred to as the ‘AIDS Prevention and Control

9 Fund’.’’.

10 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

11 104(g)(1) of the Foreign Assistance Act of 1961 (22

12 U.S.C. 2151b(g)) is amended—

13 (1) by striking ‘‘and’’ at the end of subpara14 graph (A);

15 (2) in subparagraph (B), by striking ‘‘sub16 section (c) of this section.’’ and inserting ‘‘sub17 section (c) of this section (other than paragraph (4)

18 thereof); and’’; and

19 (3) by adding at the end thereof the following

20 new subparagraph:

21 ‘‘(C) $125,000,000 for fiscal year 1997

22 and $145,000,000 for fiscal year 1998 to carry

23 out subsection (c)(4) of this section.’’.

24 (c) EFFECTIVE DATE.—The amendments made by

25 this section shall take effect October 1, 1996.
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1 SEC. 2507. SUPPORT FOR UNITED NATIONS FORWARD

2 LOOKING STRATEGIES FOR THE ADVANCE3 MENT OF WOMEN.

4 (a) IN GENERAL.—The President shall direct the

5 United States representatives to the United Nations Com6 mission on the Status of Women to take all actions nec7 essary to ensure the rapid implementation of the United

8 Nations Forward Looking Strategies for the Advancement

9 of Women, as adopted in 1985 at the United Nations Con10 ference ending the Decade for Women.

11 (b) REVIEW AND ANNUAL REPORTS.—Not later than

12 December 31, 1996, the Secretary of State shall submit

13 the 5-year review of the status of United States women,

14 as called for at the conference, and shall submit such an15 nual reports as are requested by the United Nations Com16 mission on the Status of Women.

17 SEC. 2508. SUPPORT FOR THE CONVENTION ON THE ELIMI18 NATION OF ALL FORMS OF DISCRIMINATION

19 AGAINST WOMEN.

20 The President shall promptly complete the review of

21 the United Nations Convention on the Elimination of All

22 Forms of Discrimination Against Women, which was

23 signed by the United States on July 17, 1980, and submit

24 to the Senate any reservations, understandings, or dec25 larations that the President considers necessary in order

26 that the Senate may give its advice and consent to ratifica-
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1 tion, or report to the Congress why he is unable or unwill2 ing to do so.

3 Subtitle N—Federal Prohibition of

4 Female Genital Mutilation Act

5 of 1996

6 SEC. 2551. SHORT TITLE.

7 This subtitle may be cited as the ‘‘Federal Prohibi8 tion of Female Genital Mutilation Act of 1996’’.

9 SEC. 2552. TITLE 18 AMENDMENT.

10 (a) IN GENERAL.—Chapter 7 of title 18, United

11 States Code, is amended by adding at the end the follow12 ing new section:

13 ‘‘§ 116. Female genital mutilation

14 ‘‘(a) Except as provided in subsection (b), whoever

15 knowingly circumcises, excises, or infibulates the whole or

16 any part of the labia majora or labia minora or clitoris

17 of another person who has not attained the age of 18 years

18 shall be fined under this title or imprisoned not more than

19 5 years, or both.

20 ‘‘(b) A surgical operation is not a violation of this

21 section if the operation is—

22 ‘‘(1) necessary to the health of the person on

23 whom it is performed, and is performed by a person

24 licensed in the place of its performance as a medical

25 practitioner; or
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1 ‘‘(2) performed on a person in labor or who has

2 just given birth and is performed for medical pur3 poses connected with that labor or birth by a person

4 licensed in the place it is performed as a medical

5 practitioner, midwife, or person in training to be6 come such a practitioner or midwife.

7 ‘‘(c) In applying subsection (b)(1), no account shall

8 be taken of the effect on the person on whom the operation

9 is to be performed of any belief on the part of that or

10 any other person that the operation is required as a mat11 ter of custom or ritual.

12 ‘‘(d) Whoever knowingly denies to any person medical

13 care or services or otherwise discriminates against any

14 person in the provision of medical care or services, be15 cause—

16 ‘‘(1) that person has undergone female cir17 cumcision, excision, or infibulation; or

18 ‘‘(2) that person has requested that female cir19 cumcision, excision, or infibulation be performed on

20 any person;

21 shall be fined under this title or imprisoned not more than

22 one year, or both.’’.

23 (b) CLERICAL AMENDMENT.—The table of sections

24 at the beginning of chapter 7 of title 18, United States
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1 Code, is amended by adding at the end the following new

2 item:

‘‘116. Female genital mutilation.’’.

3 SEC. 2553. INFORMATION AND EDUCATION REGARDING FE4 MALE GENITAL MUTILATION.

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

6 Human Services shall do the following:

7 (1) Compile data on the number of females liv8 ing in the United States who have been subjected to

9 female genital mutilation (whether in the United

10 States or in their countries of origin), including a

11 specification of the number of girls under the age of

12 18 who have been subjected to such mutilation.

13 (2) Identify communities in the United States

14 that practice female genital mutilation, and design

15 and carry out outreach activities to educate individ16 uals in the communities on the physical and psycho17 logical health effects of such practice. Such outreach

18 activities shall be designed and implemented in col19 laboration with representatives of the ethnic groups

20 practicing such mutilation and with representatives

21 of organizations with expertise in preventing such

22 practice.

23 (3) Develop recommendations for the education

24 of students of schools of medicine and osteopathic

25 medicine regarding female genital mutilation and
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1 complications arising from such mutilation. Such

2 recommendations shall be disseminated to such

3 schools.

4 (b) DEFINITION.—For purposes of this section, the

5 term ‘‘female genital mutilation’’ means the removal or

6 infibulation (or both) of the whole or part of the clitoris,

7 the labia minora, or the labia majora.

8 SEC. 2554. EFFECTIVE DATES.

9 Section 2553 of this Act shall take effect imme10 diately, and the Secretary of Health and Human Services

11 shall commence carrying it out not later than 90 days

12 after the date of the enactment of this Act. Section 2552

13 of this Act shall take effect 180 days after the date of

14 the enactment of this Act.

15 Subtitle O—Women and HIV

16 Outreach and Prevention Act

17 SEC. 2591. SHORT TITLE.

18 This subtitle may be cited as the ‘‘Women and HIV

19 Outreach and Prevention Act’’.

20 SEC. 2592. PREVENTIVE HEALTH PROGRAMS REGARDING

21 WOMEN AND HUMAN IMMUNODEFICIENCY

22 VIRUS.

23 Title XXV of the Public Health Service Act (42

24 U.S.C. 300ee et seq.) is amended by adding at the end

25 the following part:
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1 ‘‘PART C—PROGRAMS FOR WOMEN

2 ‘‘SEC. 2531. PREVENTIVE HEALTH SERVICES.

3 ‘‘(a) IN GENERAL.—The Secretary may make grants

4 for the following purposes:

5 ‘‘(1) Providing to women preventive health serv6 ices that are related to acquired immune deficiency

7 syndrome, including—

8 ‘‘(A) providing prevention education on the

9 human immunodeficiency virus (in this part re10 ferred to as ‘HIV’), including counseling on all

11 modes of transmission between individuals, in12 cluding sexual contact, the use of IV drugs, and

13 maternal-fetal transmission;

14 ‘‘(B) making available voluntary HIV test15 ing services to women; and

16 ‘‘(C) providing effective and close linkages

17 between testing and care services for women.

18 ‘‘(2) Providing appropriate referrals regarding

19 the provision of other services to women who are re20 ceiving services pursuant to paragraph (1), includ21 ing, as appropriate, referrals regarding the follow22 ing: treatment for HIV infection; treatment for sub23 stance abuse; mental health services; pregnancy and

24 childbirth; pediatric care; housing services; public as-
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1 sistance; job training; child care; respite care; repro2 ductive health care; and domestic violence.

3 ‘‘(3) Providing follow-up services regarding

4 such referrals, to the extent practicable.

5 ‘‘(4) Improving referral arrangements for pur6 poses of paragraph (2).

7 ‘‘(5) In the case of a woman receiving services

8 pursuant to any of paragraphs (1) through (3), pro9 viding to the partner of the woman the services de10 scribed in such paragraphs, as appropriate.

11 ‘‘(6) With respect to the services specified in

12 paragraphs (1) through (5)—

13 ‘‘(A) providing outreach services to inform

14 women of the availability of such services; and

15 ‘‘(B) providing training regarding the ef16 fective provision of such services.

17 ‘‘(b) MINIMUM QUALIFICATIONS OF GRANTEES.—

18 The Secretary may make a grant under subsection (a)

19 only if the applicant for the grant is a grantee under sec20 tion 329, section 330, or section 1001, or is another public

21 or nonprofit private entity that provides health or vol22 untary family planning services to a significant number

23 of low-income women in a culturally sensitive and lan24 guage-appropriate manner.
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1 ‘‘(c) CONFIDENTIALITY.—The Secretary may make a

2 grant under subsection (a) only if the applicant for the

3 grant agrees to maintain the confidentiality of information

4 on individuals regarding screenings pursuant to subsection

5 (a), subject to complying with applicable law.

6 ‘‘(d) APPLICATION FOR GRANT.—The Secretary may

7 make a grant under subsection (a) only if an application

8 for the grant is submitted to the Secretary and the appli9 cation is in such form, is made in such manner, and con10 tains such agreements, assurances, and information as the

11 Secretary determines to be necessary to carry out such

12 subsection.

13 ‘‘(e) EVALUATIONS AND REPORTS.—

14 ‘‘(1) EVALUATIONS.—The Secretary shall, di15 rectly or through contracts with public or private en16 tities, provide for evaluations of projects carried out

17 pursuant to subsection (a).

18 ‘‘(2) REPORTS.—Not later than 1 year after the

19 date on which amounts are first appropriated under

20 subsection (f), and annually thereafter, the Sec21 retary shall submit to the Congress a report summa22 rizing evaluations carried out under paragraph (1)

23 during the preceding fiscal year.

24 ‘‘(f) AUTHORIZATIONS OF APPROPRIATIONS.—
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1 ‘‘(1) TITLE X CLINICS.—For the purpose of

2 making grants under subsection (a) to entities that

3 are grantees under section 1001, and for the pur4 pose of otherwise carrying out this section with re5 spect to such grants, there are authorized to be ap6 propriated $30,000,000 for fiscal year 1997, and

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

8 years 1998 and 1999.

9 ‘‘(2) COMMUNITY AND MIGRANT HEALTH CEN10 TERS; OTHER PROVIDERS.—For the purpose of mak11 ing grants under subsection (a) to entities that are

12 grantees under section 329 or 330, and to other en13 tities described in subsection (b) that are not grant14 ees under section 1001, and for the purpose of oth15 erwise carrying out this section with respect to such

16 grants, there are authorized to be appropriated

17 $20,000,000 for fiscal year 1997, and such sums as

18 may be necessary for each of the fiscal years 1998

19 and 1999.

20 ‘‘SEC. 2532. PUBLIC EDUCATION.

21 ‘‘(a) IN GENERAL.—The Secretary may make grants

22 for the purpose of developing and carrying out programs

23 to provide HIV prevention education to women, including

24 education on all modes of transmission between individ-
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1 uals, including sexual contact, the use of IV drugs, and

2 maternal-fetal transmission.

3 ‘‘(b) MINIMUM QUALIFICATIONS OF GRANTEES.—

4 The Secretary may make a grant under subsection (a)

5 only if the applicant involved is a public or nonprofit pri6 vate entity that is experienced in carrying out health-relat7 ed activities for women, with a priority given to such enti8 ties that have successfully targeted women of color.

9 ‘‘(c) APPLICATION FOR GRANT.—The Secretary may

10 make a grant under subsection (a) only if an application

11 for the grant is submitted to the Secretary and the appli12 cation is in such form, is made in such manner, and con13 tains such agreements, assurances, and information as the

14 Secretary determines to be necessary to carry out such

15 subsection.

16 ‘‘(d) PROVISIONS REGARDING PLANNING COUN17 CILS.—In carrying out the mission of the Community HIV

18 Planning Process, the Secretary shall ensure that women

19 who represent women’s interests and have expertise on

20 women’s health, HIV positive women, and their advocates

21 are included on the Planning Councils, that financial re22 sources are allocated to ensure such representation, and

23 that Planning Councils use qualitative data based on wom24 en’s experiences.

25 ‘‘(e) EVALUATIONS AND REPORTS.—
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1 ‘‘(1) EVALUATIONS.—The Secretary shall, di2 rectly or through contracts with public or private en3 tities, provide for evaluations of projects carried out

4 pursuant to subsection (a).

5 ‘‘(2) REPORTS.—Not later than 1 year after the

6 date on which amounts are first appropriated under

7 subsection (e), and annually thereafter, the Sec8 retary shall submit to the Congress a report summa9 rizing evaluations carried out under paragraph (1)

10 during the preceding fiscal year.

11 ‘‘(f) AUTHORIZATIONS OF APPROPRIATIONS.—For

12 the purpose of carrying out this section, there are author13 ized to be appropriated $30,000,000 for fiscal year 1997,

14 and such sums as may be necessary for each of the fiscal

15 years 1998 and 1999.’’.

16 SEC. 2593. TREATMENT OF WOMEN FOR SUBSTANCE

17 ABUSE.

18 Subpart 1 of part B of title V of the Public Health

19 Service Act (42 U.S.C. 290bb et seq.), as amended by sec20 tion 108 of Public Law 102–321 (106 Stat. 336), is

21 amended by inserting after section 509 the following sec22 tion:

23 ‘‘TREATMENT OF WOMEN FOR SUBSTANCE ABUSE

24 ‘‘SEC. 509A. (a) IN GENERAL.—The Director of the

25 Center for Substance Abuse Treatment may make awards
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1 of grants, cooperative agreements, and contracts for the

2 purpose of carrying out programs—

3 ‘‘(1) to provide treatment for substance abuse

4 to women, including but not limited to, women with

5 dependent children;

6 ‘‘(2) to provide to women who engage in such

7 abuse counseling on the prevention of infection with,

8 and the transmission of, the etiologic agent for ac9 quired immune deficiency syndrome; and

10 ‘‘(3) to provide such counseling to women who

11 are the partners of individuals who engage in such

12 abuse.

13 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—For the

14 purpose of carrying out subsection (a), there are author15 ized to be appropriated $20,000,000 for fiscal year 1997,

16 and such sums as may be necessary for each of the fiscal

17 years 1998 and 1999.’’.

18 SEC. 2594. EARLY INTERVENTION SERVICES FOR WOMEN.

19 Section 2655 of the Public Health Service Act (42

20 U.S.C. 300ff–55) is amended—

21 (1) by striking ‘‘For the purpose of’’ and insert22 ing ‘‘(a) IN GENERAL.—For the purpose of’’; and

23 (2) by adding at the end the following sub24 section:
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1 ‘‘(b) PROGRAMS FOR WOMEN.—For the purpose of

2 making grants under section 2651 to provide to women

3 early intervention services described in such section, and

4 for the purpose of providing technical assistance under

5 section 2654(b) with respect to such grants, there are au6 thorized to be appropriated $20,000,000 for fiscal year

7 1997, and such sums as may be necessary for each of the

8 fiscal years 1998 and 1999.’’.

9 Subtitle P—Smoking Prevention

10 and Cessation in WIC Clinics Act

11 SEC. 2601. SHORT TITLE.

12 This subtitle may be cited as the ‘‘Smoking Preven13 tion and Cessation in WIC Clinics Act’’.

14 SEC. 2602. SMOKING CESSATION DEMONSTRATION PRO15 GRAMS FOR WIC PARTICIPANTS.

16 Section 17(e) of the Child Nutrition Act of 1966 (42

17 U.S.C. 1786(e)) is amended—

18 (1) by redesignating paragraphs (3) (the second

19 place it appears), (4), and (5) as paragraphs (4)

20 through (6), respectively; and

21 (2) by adding at the end the following new

22 paragraph:

23 ‘‘(7)(A) The State agency shall ensure that each local

24 agency operating the program under this section—
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1 ‘‘(i) establishes and carries out an on-site smok2 ing cessation demonstration program for pregnant

3 participants on a voluntary basis; and

4 ‘‘(ii) educates all participants about the adverse

5 health effects of cigarette smoking.

6 ‘‘(B) The program described in subparagraph (A)(i)

7 shall—

8 ‘‘(i) be provided to participants during regular

9 visits to the clinic;

10 ‘‘(ii) be incorporated into the program under

11 this section;

12 ‘‘(iii) include a public information and edu13 cation component, which shall include the dissemina14 tion of risk information and materials relating to the

15 adverse health effects of cigarette smoking during

16 pregnancy; and

17 ‘‘(iv) include a self-monitoring component,

18 which shall include—

19 ‘‘(I) one-on-one counseling designed to help

20 participants quit smoking; and

21 ‘‘(II) the utilization of a process whereby

22 the participant develops and signs, and a rep23 resentative from the local agency and an indi24 vidual chosen by the participant also sign, a

25 written statement containing a promise by the
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1 participant to quit smoking beginning on a cer2 tain date.

3 ‘‘(C)(i) The State agency shall ensure that each local

4 agency operating the program under this section submits

5 to such State agency an annual report containing a de6 scription and evaluation of the program established and

7 carried out by such local agency, including a description

8 of the total number of participants receiving services

9 under such program and the success rate of such partici10 pants in quitting smoking. The State agency shall compile

11 such reports into 1 annual report and submit such report

12 to the Secretary.

13 ‘‘(ii) The Secretary shall submit to the Congress an

14 annual report containing—

15 ‘‘(I) a compilation of the information contained

16 in the reports received by the Secretary from each

17 State agency under clause (i); and

18 ‘‘(II) an evaluation of the effectiveness of the

19 smoking cessation demonstration programs.’’.

20 Subtitle Q—Comprehensive Fetal

21 Alcohol Syndrome Prevention Act

22 SEC. 2651. SHORT TITLE.

23 This subtitle may be cited as the ‘‘Comprehensive

24 Fetal Alcohol Syndrome Prevention Act’’.
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1 SEC. 2652. PREVENTION OF FETAL ALCOHOL SYNDROME;

2 PROGRAM OF NATIONAL INSTITUTE ON AL3 COHOL ABUSE AND ALCOHOLISM.

4 Subpart 14 of part C of title IV of the Public Health

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

6 at the end the following section:

7 ‘‘FETAL ALCOHOL SYNDROME

8 ‘‘SEC. 464K. (a) IN GENERAL.—The Director of the

9 Institute shall establish a program for the conduct and

10 support of research and training, the dissemination of

11 health information, and other programs with respect to

12 the cause, diagnosis, prevention, and treatment of fetal al13 cohol syndrome and the related condition known as fetal

14 alcohol effects (which syndrome and effects are referred

15 to collectively in this section as ‘fetal alcohol conditions’).

16 ‘‘(b) INTERAGENCY COORDINATING COMMITTEE.—

17 ‘‘(1) IN GENERAL.—Subject to paragraph (6),

18 the Secretary shall establish a committee to be

19 known as the Interagency Coordinating Committee

20 on Fetal Alcohol Syndrome (in this subsection re21 ferred to as the ‘Coordinating Committee’).

22 ‘‘(2) DUTIES.—With respect to fetal alcohol

23 conditions, the Coordinating Committee shall—

24 ‘‘(A) coordinate the activities of the Na25 tional Institutes of Health; and
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1 ‘‘(B) coordinate the aspects of all Federal

2 health programs and activities relating to such

3 conditions in order to assure the adequacy and

4 technical soundness of such programs and ac5 tivities, and in order to provide for the full com6 munication and exchange of information nec7 essary to maintain adequate coordination of

8 such programs and activities.

9 ‘‘(3) COMPOSITION.—The Coordinating Com10 mittee shall be composed of—

11 ‘‘(A) the directors of each of the national

12 research institutes, and the heads of other

13 agencies of the National Institutes of Health,

14 that are involved in research on fetal alcohol

15 conditions; and

16 ‘‘(B) representatives of all other Federal

17 departments and agencies whose programs in18 volve health functions or responsibilities rel19 evant to such conditions.

20 ‘‘(4) CHAIR.—The Secretary shall designate a

21 member of the Coordinating Committee to serve as

22 the chair of the Committee. The Committee shall

23 meet at the call of the Chair, but not less than four

24 times a year.

25 ‘‘(5) ANNUAL REPORT.—
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1 ‘‘(A) In carrying out paragraph (2), the

2 Coordinating Committee shall comply with the

3 following:

4 ‘‘(i) Identify and monitor all activities

5 regarding fetal alcohol conditions that are

6 conducted or supported by the Department

7 of Health and Human Services and other

8 Federal departments or agencies.

9 ‘‘(ii) Identify the goals expected to be

10 achieved through the activities.

11 ‘‘(iii) Conduct evaluations of the ex12 tent to which the activities have been effec13 tive in achieving such goals.

14 ‘‘(iv) Determine the extent to which

15 the activities have been coordinated with

16 each other.

17 ‘‘(v) Make recommendations on the

18 activities that should be carried out, on

19 priorities among the activities, and on the

20 coordination of the activities.

21 ‘‘(B) Subject to paragraph (6)(B), the Co22 ordinating Committee shall, for each fiscal year,

23 prepare and submit to the Congress a report

24 detailing the activities of the Committee in car25 rying out the duties of the Committee for the
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1 fiscal year. The Coordinating Committee shall

2 submit copies of each such report to the Sec3 retary, the Director of NIH, the officials speci4 fied in paragraph (3)(A), and the advisory

5 council for the Institute. Except as provided in

6 paragraph (6)(B), each such report shall be

7 submitted not later than February 1 of the fis8 cal year following the fiscal year for which the

9 report is prepared.

10 ‘‘(6) INITIAL INTRADEPARTMENTAL STATUS OF

11 COMMITTEE.—

12 ‘‘(A) During fiscal years 1997 and 1998,

13 the Secretary shall ensure that individuals ap14 pointed to the Coordinating Committee under

15 paragraph (3)(B) include only officers or em16 ployees of the Department of Health and

17 Human Services, and that the duties of the Co18 ordinating Committee are carried out only with

19 respect to such Department.

20 ‘‘(B) The first report under subparagraph

21 (B) of paragraph (5) shall concern fiscal years

22 1997 and 1998, and shall consist of the find23 ings and recommendations made by the Coordi24 nating Committee in applying subparagraph (A)

25 of such paragraph to the Department of Health
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1 and Human Services. Such report shall be sub2 mitted not later than February 1, 1999.

3 ‘‘(7) PREVENTION ACTIVITIES.—With respect

4 to activities for the prevention of fetal alcohol condi5 tions—

6 ‘‘(A) the Coordinating Committee shall, as

7 soon as is practicable after the date on which

8 this section takes effect, develop recommenda9 tions under paragraph (5)(A) regarding the De10 partment of Health and Human Services; and

11 ‘‘(B) such Committee shall, as soon as is

12 practicable after October 1, 1998, develop rec13 ommendations under such paragraph regarding

14 other departments and agencies of the Federal

15 Government.

16 ‘‘(c) CERTAIN ACTIVITIES.—

17 ‘‘(1) IN GENERAL.—Activities under subsection

18 (a) regarding fetal alcohol conditions shall include

19 conducting and supporting basic and applied re20 search, including epidemiological research; dem21 onstrations; the training of health professionals, in22 cluding the development of professional practice

23 standards for detecting and preventing such condi24 tions in pregnant women and for counseling such

25 women; the evaluation of programs, including train-
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1 ing programs; and the dissemination of diagnostic

2 criteria. Activities under such subsection shall in3 clude the provision of technical assistance to public

4 and nonprofit private entities that carry out such

5 programs.

6 ‘‘(2) PREVENTION; PUBLIC AWARENESS.—

7 ‘‘(A) With respect to the prevention of

8 fetal alcohol conditions, each of the require9 ments of paragraph (1) regarding the conduct

10 and support of various types of activities shall

11 be carried out, except to the extent inapplicable

12 to prevention activities. Activities conducted or

13 supported pursuant to the preceding sentence

14 shall include carrying out a comprehensive pro15 gram to educate health professionals and the

16 general public, and shall include programs di17 rected toward at-risk populations. Programs

18 under this paragraph that are directed toward

19 particular populations shall be provided in the

20 language and cultural context most appropriate

21 for the population involved.

22 ‘‘(B) In the conduct and support of activi23 ties under subparagraph (A), special emphasis

24 shall be placed upon the utilization of collabo-
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1 rative efforts with both the public and private

2 sectors for the purpose of—

3 ‘‘(i) increasing the awareness and

4 knowledge of health professionals and the

5 public regarding the prevention of fetal al6 cohol conditions; and

7 ‘‘(ii) developing and disseminating to

8 health professionals, patients and patient

9 families, and the public information de10 signed to encourage individuals to adopt

11 healthful practices concerning the preven12 tion of such conditions.

13 ‘‘(d) UNIFORM CRITERIA FOR COLLECTION AND RE14 PORTING OF DATA.—In order to provide for the com15 parability of data on fetal alcohol conditions, the Secretary

16 shall, to the extent practicable, develop uniform criteria

17 for the collection and reporting of such data by or through

18 the National Institutes of Health and the other agencies

19 of the Department of Health and Human Services. The

20 Secretary shall encourage the States to utilize such cri21 teria.

22 ‘‘(e) COLLABORATIVE ACTIVITIES.—The Secretary

23 may require that an activity under this section be carried

24 out in collaboration with or through one or more of the

25 other agencies of the Department of Health and Human
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1 Services, and amounts made available under subsection (f)

2 are available to the Secretary for such purpose.

3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For the

4 purpose of carrying out this section, there are authorized

5 to be appropriated such sums as may be necessary for

6 each of the fiscal years 1997 through 2001.’’.

7 Subtitle R—Postreproductive

8 Health Care Act

9 SEC. 2691. SHORT TITLE.

10 This subtitle may be cited as the ‘‘Postreproductive

11 Health Care Act’’.

12 SEC. 2692. ESTABLISHMENT OF PROGRAM FOR

13 POSTREPRODUCTIVE HEALTH CARE.

14 Part D of title III of the Public Health Service Act

15 (42 U.S.C. 254b et seq.) is amended by adding at the end

16 the following new subpart:

17 ‘‘Subpart IX—Postreproductive Health Care

18 ‘‘POSTREPRODUCTIVE HEALTH CARE

19 ‘‘SEC. 340D. (a) IN GENERAL.—The Secretary shall

20 make grants for the purpose of providing the services de21 scribed in subsection (b) to women who are of menopausal

22 age or older. Such grants may be made only to public or

23 nonprofit private entities that provide health services to

24 a significant number of low-income women.
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1 ‘‘(b) AUTHORIZED SERVICES.—The services referred

2 to in subsection (a) are as follows:

3 ‘‘(1) The prevention and outpatient treatment

4 of health conditions—

5 ‘‘(A) unique to, more serious, or more

6 prevalent for eligible women; or

7 ‘‘(B) for which, in the case of such women,

8 the factors of medical risk or types of medical

9 intervention are different.

10 ‘‘(2) Counseling on the conditions described in

11 paragraph (1).

12 ‘‘(3) The education and training of health pro13 fessionals (including allied health professionals) on

14 the prevention and treatment of such conditions and

15 on the provision of such counseling.

16 ‘‘(c) PRIORITY IN PROVISION OF SERVICES.—The

17 Secretary may make a grant under subsection (a) only if

18 the applicant involved agrees that, in expending the grant

19 to provide authorized services to eligible women, the appli20 cant will give priority to providing the services for meno21 pausal health conditions.

22 ‘‘(d) OUTREACH.—The Secretary may make a grant

23 under subsection (a) only if the applicant involved

24 agrees—
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1 ‘‘(1) to conduct outreach services to inform

2 women in the community involved of the fact that

3 authorized services are available from the applicant;

4 and

5 ‘‘(2) to give priority to providing the outreach

6 services to low-income women.

7 ‘‘(e) LIMITATION ON IMPOSITION OF FEES FOR

8 SERVICES.—The Secretary may make a grant under sub9 section (a) only if the applicant involved agrees that, if

10 a charge is imposed for the provision of services or activi11 ties under the grant, such charge—

12 ‘‘(1) will be made according to a schedule of

13 charges that is made available to the public;

14 ‘‘(2) will be adjusted to reflect the income of

15 the woman involved; and

16 ‘‘(3) will not be imposed on any woman with an

17 income equal to or less than 100 percent of the offi18 cial poverty line, as established by the Director of

19 the Office of Management and Budget and revised

20 by the Secretary in accordance with section 673(2)

21 of the Omnibus Budget Reconciliation Act of 1981.

22 ‘‘(f) REPORTS TO SECRETARY.—The Secretary may

23 make a grant under subsection (a) only if the applicant

24 involved agrees to submit to the Secretary, for each fiscal

25 year for which such a grant is made to the applicant, a
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•S 1799 IS

1 report describing the purposes for which the grant has

2 been expended.

3 ‘‘(g) REQUIREMENT OF APPLICATION.—The Sec4 retary may make a grant under subsection (a) only if the

5 applicant involved makes an agreement that the grant will

6 not be expended for any purpose other than the purpose

7 described in such subsection and for compliance with any

8 other agreements required in this section. Such a grant

9 may be made only if an application for the grant is sub10 mitted to the Secretary containing such agreements, and

11 the application is in such form, is made in such manner,

12 and contains such other agreements, and such assurances

13 and information, as the Secretary determines to be nec14 essary to carry out this section.

15 ‘‘(h) DEFINITIONS.—For purposes of this section:

16 ‘‘(1) The term ‘authorized services’ means the

17 services described in subsection (b).

18 ‘‘(2) The term ‘eligible women’ means women

19 described in subsection (a).

20 ‘‘(3) The term ‘health conditions’ includes dis21 eases and disorders.

22 ‘‘(4) The term ‘health’ includes mental health.

23 ‘‘(5) The term ‘menopausal age’, with respect

24 to a woman, includes the age at which the woman

25 is nearing menopause and includes any age at which
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1 the woman experiences menopausal health condi2 tions.

3 ‘‘(6) The term ‘menopausal health conditions’

4 means conditions arising from the diminished or

5 complete cessation of the functioning of the ovaries,

6 whether occurring naturally or otherwise.

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

8 purpose of carrying out this section, there are authorized

9 to be appropriated $25,000,000 for fiscal year 1997, and

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

11 1998 and 1999.’’.

12 Subtitle S—Family Caregiver

13 Support and Protection Act of 1996

14 SEC. 2701. SHORT TITLE.

15 This subtitle may be cited as the ‘‘Family Caregiver

16 Support and Protection Act of 1996’’.

17 SEC. 2702. COVERAGE OF RESPITE CARE SERVICES UNDER

18 MEDICARE.

19 (a) IN GENERAL.—Section 1861(s)(2) of the Social

20 Security Act (42 U.S.C. 1395x(s)(2)) is amended—

21 (1) by striking ‘‘and’’ at the end of subpara22 graph (N);

23 (2) by striking ‘‘and’’ at the end of subpara24 graph (O); and
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•S 1799 IS

1 (3) by inserting after subparagraph (O) the fol2 lowing new subparagraph:

3 ‘‘(P) respite care services (as defined in sub4 section (oo)); and’’.

5 (b) SERVICES DESCRIBED.—Section 1861 of such

6 Act (42 U.S.C. 1395x) is amended by adding at the end

7 the following new subsection:

8 ‘‘Respite Care Services

9 ‘‘(oo)(1)(A) Subject to subparagraph (C), the term

10 ‘respite care services’ means any of the services described

11 in subparagraph (B) which are furnished to an eligible in12 dividual (as described in paragraph (2)) for the support

13 of a caregiver described in paragraph (2) at the individ14 ual’s home or in the community on a short-term, intermit15 tent, or emergency basis by an individual or entity who

16 meets such standards as the Secretary may establish.

17 ‘‘(B) The services described in this subparagraph are

18 as follows:

19 ‘‘(i) Companion services.

20 ‘‘(ii) Homemaker services.

21 ‘‘(iii) Personal assistance.

22 ‘‘(iv) Community day services.

23 ‘‘(v) Temporary care in an accredited or li24 censed residential facility.
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1 ‘‘(C) In establishing standards pursuant to subpara2 graph (A) for individuals and entities providing respite

3 care services, the Secretary shall consult with organiza4 tions representing providers of the services described in

5 such paragraph and organizations representing individuals

6 who typically receive such services.

7 ‘‘(D) The term ‘respite care services’ does not include

8 any services furnished to an individual during a 12-month

9 period after the individual has been furnished 120 hours

10 of such services during such period.

11 ‘‘(2) An ‘eligible individual’ described in this para12 graph is an individual with functional limitations (as de13 scribed in paragraph (3)) who is dependent on a daily

14 basis on a caregiver who—

15 ‘‘(A) has primary responsibility for providing

16 care to the individual;

17 ‘‘(B) does not receive financial remuneration for

18 providing such care; and

19 ‘‘(C) has provided such care for a period of not

20 less than 3 consecutive months.

21 ‘‘(3)(A) In paragraph (2), an ‘individual with func22 tional limitations’ is an individual who is certified (in ac23 cordance with such criteria as the Secretary may establish

24 consistent with subparagraph (C)) as—
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1 ‘‘(i) being unable to perform without substantial

2 assistance from another individual (including assist3 ance involving verbal reminding or physical cueing)

4 at least 2 of the activities of daily living described

5 in subparagraph (B) for a period of at least 90 days

6 due to a loss of functional capacity or to cognitive

7 or other mental impairment;

8 ‘‘(ii) requiring substantial supervision to protect

9 the individual from threats to the individual’s health

10 or safety due to substantial cognitive or other men11 tal impairment; or

12 ‘‘(iii) having a level of disability similar (as de13 termined by the Secretary) to the level of disability

14 described in clause (i) or (ii).

15 ‘‘(B) The activities of daily living described in this

16 subparagraph are as follows:

17 ‘‘(i) Eating.

18 ‘‘(ii) Toileting.

19 ‘‘(iii) Transferring.

20 ‘‘(iv) Bathing.

21 ‘‘(v) Dressing.

22 ‘‘(vi) Continence.

23 ‘‘(C) In establishing criteria pursuant to subpara24 graph (A) for the certification of individuals with func-
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1 tional limitations, the Secretary may not require that such

2 certification be performed only by a physician.’’.

3 (c) PAYMENT ON HOURLY BASIS.—Section 1833 of

4 such Act (42 U.S.C. 1395l) is amended by inserting after

5 subsection (o) the following new subsection:

6 ‘‘(p) Payment for respite care services shall be paid

7 on the basis of an hour of such services provided.’’.

8 (d) CONFORMING AMENDMENT.—Section 1862(a) of

9 such Act (42 U.S.C. 1395y(a)) is amended—

10 (1) by striking ‘‘or’’ at the end of paragraph

11 (14);

12 (2) by striking the period at the end of para13 graph (15) and inserting ‘‘; or’’; and

14 (3) by inserting after paragraph (15) the fol15 lowing new paragraph:

16 ‘‘(16) in the case of respite care services, which

17 are furnished to an individual during a 12-month pe18 riod after the individual has been furnished 120

19 hours of such services during such period.’’.

20 (e) EFFECTIVE DATE.—The amendments made by

21 this section shall apply to services furnished on or after

22 January 1, 1997.
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1 SEC. 2703. TREATMENT OF LONG-TERM CARE SERVICES AS

2 MEDICAL CARE.

3 (a) GENERAL RULE.—Paragraph (1) of section

4 213(d) (defining medical care) is amended by striking

5 ‘‘or’’ at the end of subparagraph (B), by striking the pe6 riod at the end of subparagraph (C) and inserting ‘‘, or’’,

7 and by adding at the end the following new subparagraph:

8 ‘‘(D) for qualified long-term care services

9 (as defined in subsection (f)).’’

10 (b) DEFINITION OF QUALIFIED LONG-TERM CARE

11 SERVICES.—Section 213 of such Code is amended by add12 ing at the end the following new subsection:

13 ‘‘(f) QUALIFIED LONG-TERM CARE SERVICES.—For

14 purposes of this section—

15 ‘‘(1) IN GENERAL.—The term ‘qualified long16 term care services’ means necessary diagnostic, pre17 ventive, therapeutic, curing, treating, mitigating, and

18 rehabilitative services, and maintenance or personal

19 care services, which—

20 ‘‘(A) are required by a chronically ill indi21 vidual, and

22 ‘‘(B) are provided pursuant to a plan of

23 care prescribed by a licensed health care practi24 tioner.

25 ‘‘(2) CHRONICALLY ILL INDIVIDUAL.—
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1 ‘‘(A) IN GENERAL.—The term ‘chronically

2 ill individual’ means any individual who has

3 been certified by a licensed health care practi4 tioner as—

5 ‘‘(i) being unable to perform (without

6 substantial assistance from another indi7 vidual) at least 2 activities of daily living

8 for a period of at least 90 days due to a

9 loss of functional capacity or to cognitive

10 impairment,

11 ‘‘(ii) requiring substantial supervision

12 to protect such individual from threats to

13 health or safety due to substantial cog14 nitive impairment, or

15 ‘‘(iii) having a level of disability simi16 lar (as determined by the Secretary in con17 sultation with the Secretary of Health and

18 Human Services) to the level of disability

19 described in clause (i) or (ii).

20 Such term shall not include any individual oth21 erwise meeting the requirements of the preced22 ing sentence unless within the preceding 12-

23 month period a licensed health care practitioner

24 has certified that such individual meets such re25 quirements.
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1 ‘‘(B) ACTIVITIES OF DAILY LIVING.—For

2 purposes of subparagraph (A), each of the fol3 lowing is an activity of daily living:

4 ‘‘(i) Eating.

5 ‘‘(ii) Toileting.

6 ‘‘(iii) Transferring.

7 ‘‘(iv) Bathing.

8 ‘‘(v) Dressing.

9 ‘‘(vi) Continence.

10 ‘‘(C) SUBSTANTIAL ASSISTANCE.—For

11 purposes of subparagraph (A)(i), the term ‘sub12 stantial assistance’ includes verbal reminding or

13 physical cuing.

14 ‘‘(3) MAINTENANCE OR PERSONAL CARE SERV15 ICES.—The term ‘maintenance or personal care serv16 ices’ means any care the primary purpose of which

17 is the provision of needed assistance with any of the

18 disabilities as a result of which the individual is a

19 chronically ill individual (including the protection

20 from threats to health and safety due to severe cog21 nitive impairment).

22 ‘‘(4) LICENSED HEALTH CARE PRACTI23 TIONER.—The term ‘licensed health care practi24 tioner’ means any physician (as defined in section

25 1861(r)(1) of the Social Security Act) and any reg-
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1 istered professional nurse, licensed social worker, or

2 other individual who meets such requirements as

3 may be prescribed by the Secretary.’’

4 (c) EFFECTIVE DATE.—The amendments made by

5 this section shall apply to taxable years beginning after

6 December 31, 1995.

7 Subtitle T—Medicare Mammog8 raphy Enhancement Act of 1996

9 SEC. 2751. SHORT TITLE.

10 This subtitle may be cited as the ‘‘Medicare Mam11 mography Enhancement Act of 1996’’.

12 SEC. 2752. EXPANDING SCREENING MAMMOGRAPHY UNDER

13 THE MEDICARE PROGRAM.

14 (a) PROVIDING ANNUAL SCREENING MAMMOGRAPHY

15 FOR WOMEN OVER AGE 49.—Section 1834(c)(2)(A) of

16 the Social Security Act (42 U.S.C. 1395m(c)(2)(A)) is

17 amended—

18 (1) in clause (iv), by striking ‘‘but under 65

19 years of age,’’, and

20 (2) by striking clause (v).

21 (b) WAIVER OF DEDUCTIBLE.—

22 (1) IN GENERAL.—The first sentence of section

23 1833(b) of such Act (42 U.S.C. 1395l(b)) is amend24 ed—
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1 (A) by striking ‘‘and (4)’’ and inserting

2 ‘‘(4)’’, and

3 (B) by striking the period at the end and

4 inserting the following: ‘‘, and (5) such deduct5 ible shall not apply with respect to screening

6 mammography (as described in section

7 1861(jj)).’’.

8 (2) CONFORMING AMENDMENT.—Section

9 1834(c)(1)(C) of such Act (42 U.S.C.

10 1395m(c)(1)(C)) is amended by striking ‘‘, subject

11 to the deductible established under section

12 1833(b),’’.

13 (c) WAIVER OF COINSURANCE.—

14 (1) IN GENERAL.—Section 1834(c)(1)(C) of

15 such Act (42 U.S.C. 1395m(c)(1)(C)) is amended by

16 striking ‘‘80 percent of’’.

17 (2) WAIVER OF COINSURANCE IN OUTPATIENT

18 HOSPITAL SETTINGS.—The third sentence of section

19 1866(a)(2)(A) of such Act (42 U.S.C.

20 1395cc(a)(2)(A)) is amended by inserting after

21 ‘‘1861(s)(10)(A)’’ the following: ‘‘, with respect to

22 screening mammography (as defined in section

23 1861(jj)),’’.
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1 (d) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to screening mammography per3 formed on or after January 1, 1997.

4 Subtitle U—Medicare Bone Mass

5 Measurement Standardization

6 Act of 1996

7 SEC. 2791. SHORT TITLE.

8 This subtitle may be cited as the ‘‘Medicare Bone

9 Mass Measurement Standardization Act of 1996’’.

10 SEC. 2792. MEDICARE COVERAGE OF BONE MASS MEASURE11 MENTS.

12 (a) IN GENERAL.—

13 (1) COVERAGE.—Section 1861(s)(2) of the So14 cial Security Act (42 U.S.C. 1395x(s)(2)), as

15 amended by section 147(f)(6)(B)(iii) of the Social

16 Security Act Amendments of 1994, is amended—

17 (A) in subparagraph (N), by striking

18 ‘‘and’’ at the end;

19 (B) in subparagraph (O), by striking

20 ‘‘and’’ at the end; and

21 (C) by inserting after subparagraph (O)

22 the following new subparagraph:

23 ‘‘(P) bone mass measurement (as defined in

24 subsection (oo)); and’’.
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1 (2) BONE MASS MEASUREMENTS DESCRIBED.—

2 Section 1861 of such Act (42 U.S.C. 1395x), as

3 amended by section 146(a) of the Social Security

4 Act Amendments of 1994, is amended by adding at

5 the end the following new subsection:

6 ‘‘Bone Mass Measurement

7 ‘‘(oo)(1) The term ‘bone mass measurement’ means

8 a radiologic or radioisotopic procedure or other scientif9 ically proven technology performed on a qualified individ10 ual (as defined in paragraph (2)) for the purpose of identi11 fying bone mass or detecting bone loss, and includes a

12 physician’s interpretation of the results of the procedure.

13 ‘‘(2) For purposes of paragraph (1), the term ‘quali14 fied individual’ means (in accordance with regulations pre15 scribed by the Secretary)—

16 ‘‘(A) an estrogen-deficient woman at clinical

17 risk for osteoporosis;

18 ‘‘(B) an individual with vertebral abnormalities;

19 ‘‘(C) an individual receiving long-term

20 glucocorticoid steroid therapy;

21 ‘‘(D) an individual with primary

22 hyperparathyroidism; or

23 ‘‘(E) an individual who is monitored to assess

24 the individual’s response to or the efficacy of ap25 proved osteoporosis drug therapies.’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 subsection (a) shall apply to bone mass measurements per3 formed on or after January 1, 1997.

4 Subtitle V—Osteoporosis and Re5 lated Bone Disorders Resource

6 Center Act of 1996

7 SEC. 2801. SHORT TITLE.

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

9 Related Bone Disorders Resource Center Act of 1996’’.

10 SEC. 2802. FUNDING FOR INFORMATION CLEARINGHOUSE

11 ON OSTEOPOROSIS, PAGET’S DISEASE, AND

12 RELATED BONE DISORDERS.

13 Section 409A(d) of the Public Health Service Act (42

14 U.S.C. 284e(d)) is amended by adding at the end the fol15 lowing sentence: ‘‘In addition to other authorizations of

16 appropriations available for the purpose of the establish17 ment and operation of the information clearinghouse

18 under subsection (c), there are authorized to be appro19 priated for such purpose $500,000 for fiscal year 1997,

20 and such sums as may be necessary for each of the fiscal

21 years 1998 and 1999.’’.
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1 Subtitle W—Women Veterans

2 Health Improvement Act of 1996

3 SEC. 2851. SHORT TITLE.

4 This subtitle may be cited as the ‘‘Women Veterans

5 Health Improvement Act of 1996’’.

6 SEC. 2852. WOMEN’S HEALTH SERVICES.

7 (a) WOMEN’S HEALTH SERVICES.—Section 1701 of

8 title 38, United States Code, is amended—

9 (1) in paragraph (6)(A)(i), by inserting ‘‘wom10 en’s health services,’’ after ‘‘preventive health serv11 ices,’’; and

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

13 ‘‘(10) The term ‘women’s health services’ means

14 health care services provided to women, including counsel15 ing and services relating to the following:

16 ‘‘(A) Papanicolaou tests (pap smear).

17 ‘‘(B) Breast examinations and mammography.

18 ‘‘(C) The management and prevention of sexu19 ally transmitted diseases.

20 ‘‘(D) Menopause, osteoporosis, and other condi21 tions relating to aging.

22 ‘‘(E) Cardiac care.

23 ‘‘(F) Physical and psychological conditions aris24 ing out of acts of sexual violence.
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1 ‘‘(G) Physical and psychological conditions that

2 result from homelessness.’’.

3 (b) CONTRACTS FOR WOMEN’S HEALTH SERVICES.—

4 Section 1703(a) of such title is amended by adding at the

5 end the following:

6 ‘‘(9) Women’s health services for veterans on

7 an ambulatory or outpatient basis.’’.

8 (c) REPEAL OF SUPERSEDED AUTHORITY.—Section

9 106 of the Veterans Health Care Act of 1992 (Public Law

10 102–585; 38 U.S.C. 1710 note) is amended—

11 (1) by striking out subsection (a); and

12 (2) by striking out ‘‘(b) RESPONSIBILITIES OF

13 DIRECTORS OF FACILITIES.—’’ before ‘‘The Sec14 retary’’.

15 SEC. 2853. REPORT ON WOMEN’S HEALTH CARE AND RE16 SEARCH.

17 (a) IN GENERAL.—Not later than January 1, 1999,

18 the Secretary of Veterans Affairs shall submit to the Com19 mittees on Veterans’ Affairs of the Senate and House of

20 Representatives a report on the provision of health care

21 services and the conduct of research carried out by, or

22 under the jurisdiction of, the Secretary relating to women

23 veterans. The report shall be prepared through the Center

24 for Women Veterans established under section 318 of title

25 38, United States Code, which shall prepare the report
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1 in consultation with the Advisory Committee on Women

2 Veterans established under section 542 of that title.

3 (b) CONTENTS.—The report under subsection (a)

4 shall include the following information:

5 (1) The number of women veterans who have

6 received women’s health services (as such term is de7 fined in section 1701(10) of title 38, United States

8 Code) in facilities under the jurisdiction of the Sec9 retary (or the Secretary of Defense), shown by ref10 erence to the Department facility which provided

11 (or, in the case of Department of Defense facilities,

12 arranged for) those services.

13 (2) A description of—

14 (A) the services provided at each such fa15 cility;

16 (B) the type and amount of services pro17 vided by such personnel, including information

18 on the numbers of inpatient stays and the num19 ber of outpatient visits through which such

20 services were provided; and

21 (C) the extent to which each such facility

22 relies on contractual arrangements under sec23 tion 1703 or 8153 of title 38, United States

24 Code, to furnish care to women veterans in fa25 cilities which are not under the jurisdiction of
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1 the Secretary where the provision of such care

2 is not furnished in a medical emergency.

3 (3) The steps taken by each such facility to ex4 pand the provision of services at such facility (or

5 under arrangements with the Department of De6 fense facility) to women veterans.

7 (4) A description of the personnel of the De8 partment who provided such services to women vet9 erans, including the number of employees (including

10 both the number of individual employees and the

11 number of full-time employee equivalents) and the

12 professional qualifications or specialty training of

13 such employees and the Department facilities to

14 which such personnel were assigned.

15 (5) A description of any actions taken by the

16 Secretary to ensure the retention of the personnel

17 described in paragraph (4) and any actions under18 taken to recruit additional such personnel or person19 nel to replace such personnel.

20 (6) An assessment by the Secretary of any dif21 ficulties experienced by the Secretary in the furnish22 ing of such services and the actions taken by the

23 Secretary to resolve such difficulties.

24 (7) A description (as of October 1 of the year

25 preceding the year in which the report is submitted)
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1 of the status of any research relating to women vet2 erans being carried out by or under the jurisdiction

3 of the Secretary.

4 (8) A description of the actions taken by the

5 Secretary to foster and encourage the expansion of

6 such research.

7 SEC. 2854. EXPANSION OF RESEARCH RELATING TO WOMEN

8 VETERANS.

9 (a) INCLUSION OF WOMEN AND MINORITIES IN

10 HEALTH RESEARCH.—Section 7303(c) of title 38, United

11 States Code, is amended—

12 (1) in paragraph (1), by striking out ‘‘that,

13 whenever possible and appropriate—’’ and inserting

14 in lieu thereof ‘‘that—’’; and

15 (2) by adding at the end the following new

16 paragraph:

17 ‘‘(3) The requirement in paragraph (1) regarding

18 women and members of minority groups who are veterans

19 may be waived by the Secretary of Veterans Affairs with

20 respect to a project of clinical research if the Secretary

21 determines that the inclusion, as subjects in the project,

22 of women and members of minority groups, respectively—

23 ‘‘(A) is inappropriate with respect to the health

24 of the subjects;
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1 ‘‘(B) is inappropriate with respect to the pur2 pose of the research; or

3 ‘‘(C) is inappropriate under such other cir4 cumstances as the Secretary may designate.’’.

5 (b) HEALTH RESEARCH RELATING TO WOMEN.—

6 Section 7303(d) of such title is amended by adding at the

7 end the following new paragraphs:

8 ‘‘(3) The Secretary shall foster and encourage re9 search under this section on the following matters as they

10 relate to women:

11 ‘‘(A) Breast cancer.

12 ‘‘(B) Gynecological and reproductive health, in13 cluding gynecological cancer, infertility, sexually14 transmitted diseases, and pregnancy.

15 ‘‘(C) Human Immunodeficiency Virus and Ac16 quired Immune Deficiency Syndrome.

17 ‘‘(D) Mental health, including post-traumatic

18 stress disorder, depression, combat related stress,

19 and trauma.

20 ‘‘(E) Diseases related to aging, including meno21 pause, osteoporosis, and Alzheimer’s Disease.

22 ‘‘(F) Substance abuse.

23 ‘‘(G) Sexual violence and related trauma.

24 ‘‘(H) Exposure to toxic chemicals and other en25 vironmental hazards.
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1 ‘‘(I) Cardiac care.

2 ‘‘(4) The Secretary shall, to the maximum extent

3 practicable, ensure that personnel of the Department of

4 Veterans Affairs engaged in the research referred to in

5 paragraph (1) include the following:

6 ‘‘(A) Personnel of the geriatric research, edu7 cation, and clinical centers designated pursuant to

8 section 7314 of this title.

9 ‘‘(B) Personnel of the National Center for Post10 Traumatic Stress Disorder established pursuant to

11 section 110(c) of the Veterans Health Care Act of

12 1984 (Public Law 98–528; 98 Stat. 2692).

13 ‘‘(5) The Secretary shall ensure that personnel of the

14 Department engaged in research relating to the health of

15 women veterans are advised and informed of such research

16 engaged in by other personnel of the Department.’’.

17 SEC. 2855. POPULATION STUDY.

18 (a) STUDY.—The Secretary of Veterans Affairs, sub19 ject to subsection (f), shall conduct a study to determine

20 the needs of veterans who are women for health-care serv21 ices. The study shall be carried out through the Center

22 for Women Veterans.

23 (b) CONSULTATION.—Before carrying out the study,

24 the Secretary shall request the advice of the Advisory
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1 Committee on Women Veterans on the conduct of the

2 study.

3 (c) PERSONS TO BE INCLUDED IN SAMPLE OF VET4 ERANS STUDIED.—(1) Subject to paragraph (2), the study

5 shall be based on—

6 (A) an appropriate sample of veterans who are

7 women; and

8 (B) an examination of the medical and demo9 graphic histories of the women comprising such sam10 ple.

11 (2) The sample referred to in paragraph (1) shall

12 constitute a representative sampling (as determined by the

13 Secretary) of the ages, the ethnic, social and economic

14 backgrounds, the enlisted and officer grades, and the

15 branches of service of all veterans who are women. The

16 Secretary shall ensure that homeless Women Veterans are

17 included in the sample.

18 (3) In carrying out the examination referred to in

19 paragraph (1)(B), the Secretary shall determine the num20 ber of women of the sample who have used medical facili21 ties of the Department, nursing home facilities of or under

22 the jurisdiction of the Department, and outpatient care

23 facilities of or under the jurisdiction of the Department.
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1 (d) REPORTS.—The Secretary shall submit to the

2 Committees on Veterans’ Affairs of the Senate and House

3 of Representatives reports relating to the study as follows:

4 (1) Not later than nine months after the date

5 of the enactment of this Act, an interim report de6 scribing (A) the information and advice obtained by

7 the Secretary from the Advisory Committee on

8 Women Veterans, and (B) the status of the study.

9 (2) Not later than December 31, 1999, a final

10 report describing the results of the study.

11 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

12 authorized to be appropriated to the General Operating

13 Expenses account of the Department of Veterans Affairs

14 $2,000,000 to carry out the purposes of this section.

15 Amounts appropriated pursuant to this authorization of

16 appropriations shall be available for obligation without fis17 cal year limitation.

18 (f) LIMITATION.—No funds may be used to conduct

19 the study described in subsection (a) unless expressly pro20 vided for in an appropriation Act.

21 SEC. 2856. OUTREACH SERVICES FOR HOMELESS WOMEN

22 VETERANS.

23 Section 7722(e) of title 38, United States Code, is

24 amended by adding at the end the following new sentence:

25 ‘‘In carrying out this subsection, the Secretary shall take
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1 such steps as may be necessary to ensure that homeless

2 women veterans are included in such outreach programs

3 and outreach services.’’.

4 SEC. 2857. SAFE AND EFFECTIVE TREATMENT FOR WOMEN

5 PSYCHIATRIC PATIENTS.

6 The Secretary of Veterans Affairs shall ensure that

7 women veterans who are receiving psychiatric treatment

8 from the Secretary, particularly in the case of women who

9 are sexually traumatized, receive such treatment (on both

10 an inpatient and outpatient basis) in a safe and effective

11 manner that recognizes the privacy needs of such women.

12 SEC. 2858. MAMMOGRAPHY QUALITY STANDARDS.

13 (a) APPLICABILITY TO DEPARTMENT OF VETERANS

14 AFFAIRS OF MAMMOGRAPHY QUALITY STANDARDS ACT

15 OF 1992.—Subsections (a) through (k) of section 354 of

16 the Public Health Service Act (42 U.S.C. 263b) shall

17 apply with respect to facilities of the Department of Veter18 ans Affairs without regard to the last sentence of subpara19 graph (A) of subsection (a)(3) of such section.

20 (b) EXTENSION OF DEADLINES.—Any deadline for

21 the completion of any action prescribed under any provi22 sion referred to in subsection (a) shall be applied with re23 spect to facilities of the Department of Veterans Affairs

24 by extending such deadline so as to be two years after

25 the date of the enactment of this Act or two years after
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1 the date which would otherwise be applicable under such

2 provision, whichever is later.

3 (c) INTERAGENCY COOPERATION.—The Secretary of

4 Veterans Affairs shall take appropriate steps to cooperate

5 with the Secretary of Health and Human Services in the

6 implementation of this section.

7 Subtitle X—Newborns’ and

8 Mothers’ Health Protection

9 SEC. 2901. SHORT TITLE.

10 This subtitle may be cited as the ‘‘Newborns’ and

11 Mothers’ Health Protection Act of 1996’’.

12 SEC. 2902. FINDING.

13 Congress finds that—

14 (1) the length of post-delivery inpatient care

15 should be based on the unique characteristics of

16 each mother and her newborn child, taking into con17 sideration the health of the mother, the health and

18 stability of the infant, the ability and confidence of

19 the mother to care for her infant, the adequacy of

20 support systems at home, and the access of the

21 mother and infant to appropriate follow-up health

22 care; and

23 (2) the timing of the discharge of a mother and

24 her newborn child from the hospital should be made
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1 by the attending provider in consultation with the

2 mother.

3 SEC. 2903. REQUIRED COVERAGE FOR MINIMUM HOSPITAL

4 STAY FOLLOWING BIRTH.

5 (a) IN GENERAL.—Except as provided in subsection

6 (b), a health plan or an employee health benefit plan that

7 provides maternity benefits, including benefits for child8 birth, shall ensure that coverage is provided with respect

9 to a mother who is a participant, beneficiary, or policy10 holder under such plan and her newborn child for a mini11 mum of 48 hours of in-patient care following a normal

12 vaginal delivery, and a minimum of 96 hours of in-patient

13 care following a caesarean section, without requiring the

14 attending provider to obtain authorization from the health

15 plan or employee health benefit plan in order to keep a

16 mother and her newborn child in the inpatient setting for

17 such period of time.

18 (b) EXCEPTION.—Notwithstanding subsection (a), a

19 health plan or an employee health benefit plan shall not

20 be required to provide coverage for post-delivery in-patient

21 care for a mother who is a participant, beneficiary, or pol22 icyholder under such plan and her newborn child during

23 the period referred to in subsection (a) if—

24 (1) a decision to discharge the mother and her

25 newborn child prior to the expiration of such period
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1 is made by the attending provider in consultation

2 with the mother; and

3 (2) the health plan or employee health benefit

4 plan provides coverage for post-delivery follow-up

5 care as described in section 2904.

6 SEC. 2904. POST-DELIVERY FOLLOW-UP CARE.

7 (a) IN GENERAL.—In the case of a decision to dis8 charge a mother and her newborn child from the inpatient

9 setting prior to the expiration of 48 hours in the case of

10 a normal vaginal delivery or 96 hours in the case of a

11 caesarean section, the health plan or employee health ben12 efit plan shall provide coverage for timely post-delivery

13 care. Such health care shall be provided to a mother and

14 her newborn child by a registered nurse, physician, nurse

15 practitioner, nurse midwife or physician assistant experi16 enced in maternal and child health in—

17 (1) the home, a provider’s office, a hospital, a

18 federally qualified health center, a federally qualified

19 rural health clinic, or a State health department ma20 ternity clinic; or

21 (2) another setting determined appropriate

22 under regulations promulgated by the Secretary, in

23 consultation with the Secretary of Health and

24 Human Services, (including a birthing center or an

25 intermediate care facility);
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1 except that such coverage shall ensure that the mother has

2 the option to be provided with such care in the home.

3 (b) TIMELY CARE.—As used in subsection (a), the

4 term ‘‘timely post-delivery care’’ means health care that

5 is provided—

6 (1) following the discharge of a mother and her

7 newborn child from the inpatient setting; and

8 (2) in a manner that meets the health care

9 needs of the mother and her newborn child, that

10 provides for the appropriate monitoring of the condi11 tions of the mother and child, and that occurs within

12 the 24- to 72-hour period immediately following dis13 charge.

14 (c) CONSISTENCY WITH STATE LAW.—The Secretary

15 shall, with respect to regulations promulgated under sub16 section (a) concerning appropriate post-delivery care set17 tings, ensure that, to the extent practicable, such regula18 tions are consistent with State licensing and practice laws.

19 SEC. 2905. PROHIBITIONS.

20 (a) TERMS AND CONDITIONS.—In implementing the

21 requirements of this subtitle, a health plan or an employee

22 health benefit plan may not—

23 (1) deny enrollment, renewal, or continued cov24 erage to a mother and her newborn child who are
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•S 1799 IS

1 participants, beneficiaries or policyholders based on

2 compliance with this subtitle;

3 (2) provide monetary incentives to mothers to

4 encourage such mothers to request less than the

5 minimum coverage required under this subtitle; or

6 (3) provide incentives (monetary or otherwise)

7 to an attending provider to induce such provider to

8 provide treatment in a manner inconsistent with this

9 subtitle.

10 (b) PROVIDERS.—In implementing the requirements

11 of this section, a health plan or an employee health benefit

12 plan may not penalize or otherwise reduce or limit the re13 imbursement of an attending provider because such pro14 vider provided treatment in accordance with this subtitle.

15 (c) RULE OF CONSTRUCTION.—Nothing in this sub16 title shall be construed to require that a mother who is

17 a participant, beneficiary, or policyholder covered under

18 this subtitle—

19 (1) give birth in a hospital; or

20 (2) stay in the hospital for a fixed period of

21 time following the birth of her child.

22 SEC. 2906. NOTICE.

23 (a) EMPLOYEE HEALTH BENEFIT PLAN.—An em24 ployee health benefit plan shall provide notice to each par-
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1 ticipant regarding coverage required under this subtitle in

2 accordance with regulations promulgated by the Secretary.

3 (b) HEALTH PLAN.—A health plan shall provide no4 tice to each policyholder regarding coverage required

5 under this subtitle.

6 (c) REQUIREMENTS.—Notice required under this sec7 tion shall be in writing, prominently positioned in, and be

8 transmitted—

9 (1) in a mailing made within 120 days of the

10 date of enactment of this Act by such plan to the

11 participant or policyholder; and

12 (2) as part of the annual informational packet

13 sent to the participant or policyholder.

14 SEC. 2907. APPLICABILITY.

15 (a) CONSTRUCTION.—

16 (1) IN GENERAL.—A requirement or standard

17 imposed under this subtitle on a health plan shall be

18 deemed to be a requirement or standard imposed on

19 the health plan issuer. Such requirements or stand20 ards shall be enforced by the State insurance com21 missioner for the State involved or the official or of22 ficials designated by the State to enforce the re23 quirements of this subtitle. In the case of a health

24 plan offered by a health plan issuer in connection

25 with an employee health benefit plan, the require-
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•S 1799 IS

1 ments or standards imposed under this subtitle shall

2 be enforced with respect to the health plan issuer by

3 the State insurance commissioner for the State in4 volved or the official or officials designated by the

5 State to enforce the requirements of this subtitle.

6 (2) LIMITATION.—Except as provided in section

7 2908(c), the Secretary shall not enforce the require8 ments or standards of this subtitle as they relate to

9 health plan issuers or health plans. In no case shall

10 a State enforce the requirements or standards of

11 this subtitle as they relate to employee health benefit

12 plans.

13 (b) RULE OF CONSTRUCTION.—Nothing in this sub14 title shall be construed to affect or modify the provisions

15 of section 514 of the Employee Retirement Income Secu16 rity Act of 1974 (29 U.S.C. 1144).

17 SEC. 2908. ENFORCEMENT.

18 (a) HEALTH PLAN ISSUERS.—Each State shall re19 quire that each health plan issued, sold, renewed, offered

20 for sale or operated in such State by a health plan issuer

21 meet the standards established under this subtitle. A State

22 shall submit such information as required by the Secretary

23 demonstrating effective implementation of the require24 ments of this subtitle.
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1 (b) EMPLOYEE HEALTH BENEFIT PLANS.—With re2 spect to employee health benefit plans, the standards es3 tablished under this subtitle shall be enforced in the same

4 manner as provided for under sections 502, 504, 506, and

5 510 of the Employee Retirement Income Security Act of

6 1974 (29 U.S.C. 1132, 1134, 1136, and 1140). The civil

7 penalties contained in paragraphs (1) and (2) of section

8 502(c) of such Act (29 U.S.C. 1132(c) (1) and (2)) shall

9 apply to any information required by the Secretary to be

10 disclosed and reported under this section.

11 (c) FAILURE TO ENFORCE.—In the case of the fail12 ure of a State to substantially enforce the standards and

13 requirements set forth in this subtitle with respect to

14 health plans, the Secretary, in consultation with the Sec15 retary of Health and Human Services, shall enforce the

16 standards of this subtitle in such State. In the case of

17 a State that fails to substantially enforce the standards

18 set forth in this subtitle, each health plan issuer operating

19 in such State shall be subject to civil enforcement as pro20 vided for under sections 502, 504, 506, and 510 of the

21 Employee Retirement Income Security Act of 1974 (29

22 U.S.C. 1132, 1134, 1136, and 1140). The civil penalties

23 contained in paragraphs (1) and (2) of section 502(c) of

24 such Act (29 U.S.C. 1132(c) (1) and (2)) shall apply to
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•S 1799 IS

1 any information required by the Secretary to be disclosed

2 and reported under this section.

3 (d) REGULATIONS.—The Secretary, in consultation

4 with the Secretary of Health and Human Services, may

5 promulgate such regulations as may be necessary or ap6 propriate to carry out this subtitle.

7 SEC. 2909. DEFINITIONS.

8 As used in this subtitle:

9 (1) ATTENDING PROVIDER.—The term ‘‘attend10 ing provider’’ shall include the obstetrician-gyne11 cologists, pediatrician, family physician, or other

12 physician attending the mother or newly born child.

13 Such term shall also include any other health care

14 provider who, in accordance with applicable State

15 law, may be primarily responsible for the care of a

16 mother and her newborn child (including nurse mid17 wives and nurse practitioners).

18 (2) BENEFICIARY.—The term ‘‘beneficiary’’ has

19 the meaning given such term under section 3(8) of

20 the Employee Retirement Income Security Act of

21 1974 (29 U.S.C. 1002(8)).

22 (3) EMPLOYEE HEALTH BENEFIT PLAN.—

23 (A) IN GENERAL.—The term ‘‘employee

24 health benefit plan’’ means any employee wel25 fare benefit plan, governmental plan, or church
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•S 1799 IS

1 plan (as defined under paragraphs (1), (32),

2 and (33) of section 3 of the Employee Retire3 ment Income Security Act of 1974 (29 U.S.C.

4 1002 (1), (32), and (33))) that provides or pays

5 for health benefits (such as provider and hos6 pital benefits) for participants and beneficiaries

7 whether—

8 (i) directly;

9 (ii) through a health plan offered by

10 a health plan issuer as defined in para11 graph (4); or

12 (iii) otherwise.

13 (B) RULE OF CONSTRUCTION.—An em14 ployee health benefit plan shall not be con15 strued to be a health plan or a health plan is16 suer.

17 (C) ARRANGEMENTS NOT INCLUDED.—

18 Such term does not include the following, or

19 any combination thereof:

20 (i) Coverage only for accident, or dis21 ability income insurance, or any combina22 tion thereof.

23 (ii) Medicare supplemental health in24 surance (as defined under section

25 1882(g)(1) of the Social Security Act).
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1 (iii) Coverage issued as a supplement

2 to liability insurance.

3 (iv) Liability insurance, including gen4 eral liability insurance and automobile li5 ability insurance.

6 (v) Workers compensation or similar

7 insurance.

8 (vi) Automobile medical payment in9 surance.

10 (vii) Coverage for a specified disease

11 or illness.

12 (viii) Hospital or fixed indemnity in13 surance.

14 (ix) Short-term limited duration in15 surance.

16 (x) Credit-only, dental-only, or vision17 only insurance.

18 (xi) A health insurance policy provid19 ing benefits only for long-term care, nurs20 ing home care, home health care, commu21 nity-based care, or any combination there22 of.

23 (4) GROUP PURCHASER.—The term ‘‘group

24 purchaser’’ means any person (as defined under

25 paragraph (9) of section 3 of the Employee Retire-
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•S 1799 IS

1 ment Income Security Act of 1974 (29 U.S.C.

2 1002(9)) or entity that purchases or pays for health

3 benefits (such as provider or hospital benefits) on

4 behalf of participants or beneficiaries in connection

5 with an employee health benefit plan.

6 (5) HEALTH PLAN.—

7 (A) IN GENERAL.—The term ‘‘health plan’’

8 means any group health plan or individual

9 health plan.

10 (B) GROUP HEALTH PLAN.—The term

11 ‘‘group health plan’’ means any contract, policy,

12 certificate or other arrangement offered by a

13 health plan issuer to a group purchaser that

14 provides or pays for health benefits (such as

15 provider and hospital benefits) in connection

16 with an employee health benefit plan.

17 (C) INDIVIDUAL HEALTH PLAN.—The term

18 ‘‘individual health plan’’ means any contract,

19 policy, certificate or other arrangement offered

20 to individuals by a health plan issuer that pro21 vides or pays for health benefits (such as pro22 vider and hospital benefits) and that is not a

23 group health plan.
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1 (D) ARRANGEMENTS NOT INCLUDED.—

2 Such term does not include the following, or

3 any combination thereof:

4 (i) Coverage only for accident, or dis5 ability income insurance, or any combina6 tion thereof.

7 (ii) Medicare supplemental health in8 surance (as defined under section

9 1882(g)(1) of the Social Security Act).

10 (iii) Coverage issued as a supplement

11 to liability insurance.

12 (iv) Liability insurance, including gen13 eral liability insurance and automobile li14 ability insurance.

15 (v) Workers compensation or similar

16 insurance.

17 (vi) Automobile medical payment in18 surance.

19 (vii) Coverage for a specified disease

20 or illness.

21 (viii) Hospital or fixed indemnity in22 surance.

23 (ix) Short-term limited duration in24 surance.
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1 (x) Credit-only, dental-only, or vision2 only insurance.

3 (xi) A health insurance policy provid4 ing benefits only for long-term care, nurs5 ing home care, home health care, commu6 nity-based care, or any combination there7 of.

8 (E) CERTAIN PLANS INCLUDED.—Such

9 term includes any plan or arrangement not de10 scribed in any clause of subparagraph (D)

11 which provides for benefit payments, on a peri12 odic basis, for—

13 (i) a specified disease or illness, or

14 (ii) a period of hospitalization,

15 without regard to the costs incurred or services

16 rendered during the period to which the pay17 ments relate.

18 (6) HEALTH PLAN ISSUER.—The term ‘‘health

19 plan issuer’’ means any entity that is licensed (prior

20 to or after the date of enactment of this Act) by a

21 State to offer a health plan.

22 (7) PARTICIPANT.—The term ‘‘participant’’ has

23 the meaning given such term under section 3(7) of

24 the Employee Retirement Income Security Act of

25 1974 (29 U.S.C. 1002(7)).
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1 (8) SECRETARY.—The term ‘‘Secretary’’ unless

2 otherwise specified means the Secretary of Labor.

3 SEC. 2910. PREEMPTION.

4 The provisions of this subtitle shall not preempt those

5 provisions of State law that require health plans to provide

6 a minimum of 48 hours of in-patient care in the case of

7 a normal vaginal delivery, and 96 hours of in-patient care

8 in the case of a caesarean section, or that require health

9 plans to provide for maternity and pediatric care that is

10 in accordance with guidelines established by the American

11 College of Obstetricians and Gynecologists and the Amer12 ican Academy of Pediatrics, and to provide follow-up care

13 consistent with this subtitle.

14 SEC. 2911. EFFECTIVE DATE.

15 Except as otherwise provided for in this subtitle, the

16 provisions of this subtitle shall apply as follows:

17 (1) With respect to health plans, such provi18 sions shall apply to plans offered, sold, issued, re19 newed, in effect, or operated on or after January 1,

20 1997.

21 (2) With respect to employee health benefit

22 plans, such provisions shall apply to such plans on

23 the first day of the first plan year beginning on or

24 after January 1, 1997.
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1 Subtitle Y—Obstetrician-Gyne2 cologists as Primary Care Pro3 viders

4 SEC. 2951. SENSE OF THE SENATE REGARDING OBSTETRI5 CIAN-GYNECOLOGISTS

6 (a) FINDINGS.—Congress finds that—

7 (1) women constitute more than 50 percent of

8 the population of the United States;

9 (2) because women’s health historically has re10 ceived little attention in terms of Federal funding

11 and in terms of research priorities, there should be

12 an increased emphasis on the needs and preferences

13 of women in such areas;

14 (3) the Federal Government should increase its

15 support for women’s health and can make a signifi16 cant difference in improving the status of women’s

17 health;

18 (4) increased funding for research is insignifi19 cant if women’s health care services are restricted;

20 (5) many women view their obstetrician-gyne21 cologist as their primary or sole physician;

22 (6) approximately 70 percent of women would

23 be unwilling to change their obstetrician-gynecologist

24 to save money;
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1 (7) an obstetrician-gynecologist improves the

2 access to health care of a woman by providing pri3 mary and preventive health care throughout the

4 woman’s lifetime, encompassing care of the whole

5 patient in addition to focusing on the processes of

6 the female reproductive system;

7 (8) preventive and primary care provided by an

8 obstetrician-gynecologist includes instruction in

9 breast self-examination, cervical cancer screening,

10 health education, instruction in health promotion,

11 hypertension and cardiovascular surveillance,

12 osteoporosis counseling, sexually transmitted dis13 eases counseling, and identification of victims of do14 mestic violence;

15 (9) the most effective way to treat health prob16 lems is to prevent such problems from occurring or

17 to catch such problems in the early stages, when

18 such problems are most treatable;

19 (10) 60 percent of all office visits to obstetri20 cian-gynecologists are for preventive care;

21 (11) obstetrician-gynecologists refer their pa22 tients to other physicians less frequently than other

23 primary care providers, thus avoiding costly and

24 time-consuming referrals;
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1 (12) more than two-thirds of all visits to obste2 trician-gynecologists were by established patients of

3 the physician who were returning for care of a medi4 cal condition;

5 (13) obstetrician-gynecologists manage the

6 health of women beyond the reproductive system,

7 and are uniquely qualified on the basis of education

8 and experience to provide such health care services

9 to women;

10 (14) obstetrician-gynecologists provide health

11 care to women with an awareness of the relationship

12 of disease to family history;

13 (15) over two-thirds of general family practice

14 physicians do not deliver newborns and will not be

15 able to address this need of women; and

16 (16) 80 percent of maternity care services in

17 the United States are provided by obstetrician-gyne18 cologists.

19 (b) SENSE OF THE SENATE.—It is the sense of the

20 Senate that—

21 (1) obstetrician-gynecologists should be included

22 as primary care providers for women in Federal laws

23 relating to the provision of health care; and
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1 (2) legislative proposals that define primary

2 care should include primary care services performed

3 by obstetrician-gynecologists in such definition.

Æ