II

106TH CONGRESS

1ST SESSION S. 592

To improve the health of children.

IN THE SENATE OF THE UNITED STATES

MARCH 11, 1999

Mr. BOND introduced the following bill; which was read twice and referred to

the Committee on Finance

A BILL

To improve the health of children.

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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Healthy Kids 2000 Act’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—HEALTH CARE ACCESSIBILITY AND ACCOUNTABILITY

FOR MOTHERS AND NEWBORNS

Subtitle A—Accessibility of Mothers and Newborns to Health Insurance

Sec. 101. Short title; references.

Sec. 102. Optional coverage of low-income, uninsured pregnant women under a

State child health plan.
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Sec. 103. Automatic enrollment for children born to women receiving pregnancy-related assistance.

Sec. 104. Expanded availability of funding for administrative costs related to

outreach and eligibility determinations.

Subtitle B—Patient Rights With Respect to Care

Sec. 111. Patient rights with respect to care

‘‘SUBPART C—PATIENT RIGHTS WITH RESPECT TO CARE

‘‘Sec. 721. Patient access to obstetric and gynecological care.

‘‘Sec. 722. Access to pediatric care.

‘‘Sec. 723. Accountability through distribution of information.

‘‘Sec. 724. Generally applicable provision.

Sec. 112. Grievances and appeals with respect to children.

Sec. 113. Amendments to the Internal Revenue Code of 1986.

Sec. 114. Effective date.

TITLE II—PAYMENTS TO CHILDREN’S HOSPITALS THAT

OPERATE GME PROGRAMS

Sec. 201. Short title.

Sec. 202. Program of payments to children’s hospitals that operate graduate

medical education programs.

TITLE III—PEDIATRIC PUBLIC HEALTH PROMOTION

Subtitle A—National Center for Birth Defects Research and Prevention

Sec. 301. National center for birth defects research and prevention.

Subtitle B—Pregnant Mothers and Infants Health Promotion

Sec. 311. Short title.

Sec. 312. Findings.

Sec. 313. Establishment.

Subtitle C—Safe Motherhood Monitoring and Prevention Research

Sec. 321. Short title.

Sec. 322. Amendment to Public Health Service Act.

Subtitle D—Poison Control Center Enhancement

Sec. 331. Short title.

Sec. 332. Findings.

Sec. 333. Definition.

Sec. 334. Establishment of a national toll-free number.

Sec. 335. Establishment of nationwide media campaign.

Sec. 336. Establishment of a grant program.

TITLE IV—PEDIATRIC RESEARCH

Sec. 401. Establishment of a pediatric research initiative.

Sec. 402. Investment in tomorrow’s pediatric researchers.
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1 TITLE I—HEALTH CARE ACCES2 SIBILITY AND ACCOUNTABIL3 ITY FOR MOTHERS AND

4 NEWBORNS

5 Subtitle A—Accessibility of Moth6 ers and Newborns to Health In7 surance

8 SEC. 101. SHORT TITLE; REFERENCES.

9 (a) SHORT TITLE.—This subtitle may be cited as the

10 ‘‘Mothers and Newborns Health Insurance Act of 1999’’.

11 (b) REFERENCES TO SOCIAL SECURITY ACT.—Ex12 cept as otherwise expressly provided, whenever in this sub13 title an amendment or repeal is expressed as an amend14 ment to, or repeal of, a section or other provision, the ref15 erence shall be considered to be made to a section or other

16 provision of the Social Security Act.

17 SEC. 102. OPTIONAL COVERAGE OF LOW-INCOME, UNIN18 SURED PREGNANT WOMEN UNDER A STATE

19 CHILD HEALTH PLAN.

20 (a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et

21 seq.) is amended by adding at the end the following new

22 section:
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1 ‘‘SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNIN2 SURED PREGNANT WOMEN.

3 ‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any

4 other provision of this title, a State child health plan may

5 provide for coverage of pregnancy-related assistance for

6 targeted low-income pregnant women in accordance with

7 this section.

8 ‘‘(b) DEFINITIONS.—For purposes of this section:

9 ‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The

10 term ‘pregnancy-related assistance’ has the meaning

11 given the term ‘child health assistance’ in section

12 2110(a) as if any reference to targeted low-income

13 children were a reference to targeted low-income

14 pregnant women, except that the assistance shall be

15 limited to services related to pregnancy (which in16 clude prenatal, delivery, and postpartum services)

17 and to other conditions that may complicate preg18 nancy and shall not include pre-pregnancy services

19 and supplies.

20 ‘‘(2) TARGETED LOW-INCOME PREGNANT

21 WOMAN.—The term ‘targeted low-income pregnant

22 woman’ has the meaning given the term ‘targeted

23 low-income child’ in section 2110(b) as if any ref24 erence to a child were deemed a reference to a

25 woman during pregnancy and through the end of the
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1 month in which the 60-day period (beginning on the

2 last day of her pregnancy) ends.

3 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

4 RULES.—In the case of, and with respect to, a State pro5 viding for coverage of pregnancy-related assistance to tar6 geted low-income pregnant women under subsection (a),

7 the following special rules apply:

8 ‘‘(1) Any reference in this title (other than sub9 section (b)) to a targeted low-income child is deemed

10 to include a reference to a targeted low-income preg11 nant woman.

12 ‘‘(2) Any such reference to child health assist13 ance with respect to such women is deemed a ref14 erence to pregnancy-related assistance.

15 ‘‘(3) Any such reference to a child is deemed a

16 reference to a woman during pregnancy and the pe17 riod described in subsection (b)(2).

18 ‘‘(4) The medicaid applicable income level is

19 deemed a reference to the income level established

20 under section 1902(l)(2)(A).

21 ‘‘(5) Subsection (a) of section 2103 (relating to

22 required scope of health insurance coverage) shall

23 not apply insofar as a State limits coverage to serv24 ices described in subsection (b)(1) and the reference

25 to such section in section 2105(a)(1) is deemed not
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1 to require, in such case, compliance with the require2 ments of section 2103(a).

3 ‘‘(6) There shall be no exclusion of benefits for

4 services described in subsection (b)(1) based on any

5 pre-existing condition, and no waiting period (includ6 ing a waiting period to carry out section

7 2102(b)(3)(C)) shall apply.

8 ‘‘(d) NO IMPACT ON ALLOTMENTS.—Nothing in this

9 section shall be construed as affecting the amount of any

10 initial allotment provided to a State under section

11 2104(b).

12 ‘‘(e) APPLICATION OF FUNDING RESTRICTIONS.—

13 The coverage under this section (and the funding of such

14 coverage) is subject to the restrictions of section

15 2105(c).’’.

16 (b) CONFORMING AMENDMENT.—Section

17 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is

18 amended—

19 (1) by striking ‘‘and’’ at the end of clause (i);

20 (2) by striking the period at the end of clause

21 (ii) and inserting ‘‘, and’’; and

22 (3) by adding at the end the following new

23 clause:

24 ‘‘(iii) may not apply a waiting period

25 (including a waiting period to carry out
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1 paragraph (3)(C)) in the case of a targeted

2 low-income child who is pregnant.’’.

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

4 subsections (a) and (b) shall take effect on the date of

5 the enactment of this Act and shall apply to allotments

6 for all fiscal years.

7 SEC. 103. AUTOMATIC ENROLLMENT FOR CHILDREN BORN

8 TO WOMEN RECEIVING PREGNANCY-RELAT9 ED ASSISTANCE.

10 (a) IN GENERAL.—Section 2111, as added by section

11 102, is amended by adding at the end the following new

12 subsection:

13 ‘‘(f) AUTOMATIC ENROLLMENT FOR CHILDREN

14 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS15 SISTANCE.—Notwithstanding any other provision of this

16 title, if a child is born to a targeted low-income pregnant

17 woman who was receiving pregnancy-related assistance

18 under this section on the date of the child’s birth, the child

19 shall be deemed to have applied for child health assistance

20 under the State child health plan on the date of such birth,

21 to have been found eligible for such assistance on such

22 date, and to remain eligible for such assistance until the

23 child attains 1 year of age.’’.

24 (b) EFFECTIVE DATE.—The amendment made by

25 subsection (a) shall take effect on the date of the enact-
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1 ment of this Act and shall apply to allotments for all fiscal

2 years.

3 SEC. 104. EXPANDED AVAILABILITY OF FUNDING FOR AD4 MINISTRATIVE COSTS RELATED TO OUT5 REACH AND ELIGIBILITY DETERMINATIONS.

6 Section 1931(h) (42 U.S.C. 1396u–1(h)) is

7 amended—

8 (1) by striking the subsection heading and in9 serting ‘‘INCREASED FEDERAL MATCHING RATE

10 FOR ADMINISTRATIVE COSTS RELATED TO OUT11 REACH AND ELIGIBILITY DETERMINATIONS’’;

12 (2) in paragraph (2), by striking ‘‘eligibility de13 terminations’’ and all that follows and inserting ‘‘de14 terminations of the eligibility of children and preg15 nant women for benefits under the State plan under

16 this title or title XXI, outreach to children and preg17 nant women likely to be eligible for such benefits,

18 and such other outreach- and eligibility-related ac19 tivities as the Secretary may approve.’’;

20 (3) in paragraph (3), by striking ‘‘and ending

21 with fiscal year 2000’’; and

22 (4) by striking paragraph (4) and inserting the

23 following:

24 ‘‘(4) ENCOURAGING USE OF LOCAL AND COM25 MUNITY-BASED ORGANIZATIONS IN OUTREACH AND
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1 ENROLLMENT ACTIVITIES.—The Secretary shall es2 tablish a procedure under which, if a State does not

3 otherwise obligate the amounts made available under

4 this subsection, local and community-based public or

5 nonprofit private organizations (including local and

6 county governments, public health departments,

7 community health centers, children’s hospitals, and

8 disproportionate share hospitals) may seek to have

9 administrative costs relating to outreach and enroll10 ment of children and pregnant women under this

11 title and title XXI treated as administrative costs of

12 a State described in section 1903(a)(7), if such or13 ganizations have the permission of the State in14 volved. A State may require such an organization to

15 provide payment of such amounts as the State would

16 otherwise be responsible for in order to obtain pay17 ment under this paragraph.’’.

18 Subtitle B—Patient Rights With

19 Respect to Care

20 SEC. 111. PATIENT RIGHTS WITH RESPECT TO CARE.

21 (a) IN GENERAL.—Part 7 of subtitle B of title I of

22 the Employee Retirement Income Security Act of 1974

23 (29 U.S.C. 1181 et seq.) is amended—

24 (1) by redesignating subpart C as subpart D;

25 and
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1 (2) by inserting after subpart B the following:

2 ‘‘Subpart C—Patient Rights With Respect to Care

3 ‘‘SEC. 721. PATIENT ACCESS TO OBSTETRIC AND GYNECO4 LOGICAL CARE.

5 ‘‘(a) IN GENERAL.—In any case in which a group

6 health plan (other than a fully insured group health

7 plan)—

8 ‘‘(1) provides coverage for benefits consisting

9 of—

10 ‘‘(A) gynecological care (such as preventive

11 women’s health examinations); or

12 ‘‘(B) obstetric care (such as pregnancy-re13 lated services);

14 provided by a participating physician who specializes

15 in such care; and

16 ‘‘(2) requires or provides for the designation by

17 a participant or beneficiary of a participating pri18 mary care provider;

19 if the primary care provider designated by such partici20 pant or beneficiary is not such a physician as described

21 in paragraph (1), then the plan shall meet the require22 ments of subsection (b).

23 ‘‘(b) REQUIREMENTS.—A group health plan (other

24 than a fully insured group health plan) that meets the re25 quirements of this subsection, in connection with the cov-
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1 erage of benefits described in subsection (a) consisting of

2 care described in subparagraph (A) or (B) of subsection

3 (a)(1), if the plan—

4 ‘‘(1) does not require authorization or a referral

5 by the primary care provider in order to obtain cov6 erage for such benefits; and

7 ‘‘(2) treats the ordering of other routine care

8 related to the care described in subparagraph (A) or

9 (B) of subsection (a)(1), by the participating physi10 cian providing the care described in either such sub11 paragraph, as the authorization of the primary care

12 provider with respect to such care.

13 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in sub14 section (b)(2) shall be construed as waiving any require15 ments of coverage relating to medical necessity or appro16 priateness with respect to the coverage of the gynecological

17 or obstetric care so ordered. Nothing in subsection (b)

18 shall be construed to preclude the health plan from requir19 ing that the obstetrician or gynecologist notify the primary

20 care provider or the plan of treatment decisions.

21 ‘‘SEC. 722. ACCESS TO PEDIATRIC CARE.

22 ‘‘(a) ACCESS TO APPROPRIATE PEDIATRIC PRIMARY

23 CARE PROVIDERS.—

24 ‘‘(1) IN GENERAL.—If a group health plan

25 (other than a fully insured group health plan) re-
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1 quires or provides for a participant to designate a

2 participating pediatric primary care provider for a

3 child of such participant—

4 ‘‘(A) the plan or issuer shall permit the

5 participant to designate a pediatric primary

6 care provider who specializes in pediatrics as

7 the child’s primary care provider; and

8 ‘‘(B) if such a participant has not des9 ignated such a provider for the child, the plan

10 or issuer shall consider appropriate pediatric ex11 pertise in mandatorily assigning such a partici12 pant to a pediatric primary care provider.

13 ‘‘(2) CONSTRUCTION.—Nothing in paragraph

14 (1) shall be construed to—

15 ‘‘(A) waive any requirements of coverage

16 relating to medical necessity or appropriateness

17 with respect to coverage of services; or

18 ‘‘(B) preclude the group health plan in19 volved from requiring that the pediatric pro20 vider notify the primary care provider or the

21 plan of treatment decisions.

22 ‘‘(b) REFERRAL TO SPECIALITY CARE FOR CHIL23 DREN REQUIRING TREATMENT BY SPECIALISTS.—

24 ‘‘(1) IN GENERAL.—In the case of a child who

25 is covered under a group health plan (other than a
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1 fully insured group health plan) and who has a men2 tal or physical condition, disability, or disease of suf3 ficient seriousness and complexity to require diag4 nosis, evaluation or treatment by a specialist, the

5 plan shall make or provide for a referral to a special6 ist who has extensive experience or training, and is

7 available and accessible to provide the treatment for

8 such condition or disease, including the choice of a

9 nonprimary care specialist participating in the plan

10 or a referral to a nonparticipating provider as pro11 vided for under paragraph (4) if such a provider is

12 not available within the plan.

13 ‘‘(2) SPECIALIST DEFINED.—For purposes of

14 this subsection, the term ‘specialist’ means, with re15 spect to a condition, disability, or disease, a health

16 care practitioner, facility (such as a children hos17 pital), or center (such as a center of excellence) that

18 has extensive pediatric expertise through appropriate

19 training or experience to provide high quality care in

20 treating the condition, disability, or disease.

21 ‘‘(3) REFERRALS TO PARTICIPATING PROVID22 ERS.—A group health plan (other than a fully in23 sured group health plan) is not required under para24 graph (1) to provide for a referral to a specialist

25 that is not a participating provider, unless the plan
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1 does not have an appropriate specialist that is avail2 able and accessible to treat the participant’s or bene3 ficiary’s condition and that is a participating pro4 vider with respect to such treatment.

5 ‘‘(4) TREATMENT OF NONPARTICIPATING PRO6 VIDERS.—If a group health plan (other than a fully

7 insured group health plan) refers a child beneficiary

8 to a nonparticipating specialist, services provided

9 pursuant to the referral shall be provided at no addi10 tional cost to the participant beyond what the partic11 ipant would otherwise pay for services received by

12 such a specialist who is a participating provider.

13 ‘‘(c) DEFINITION.—In this subpart, the term ‘child’

14 means an individual who is under 19 years of age.

15 ‘‘SEC. 723. ACCOUNTABILITY THROUGH DISTRIBUTION OF

16 INFORMATION.

17 ‘‘(a) IN GENERAL.—A group health plan (other than

18 a fully insured group health plan) shall, with respect to

19 the coverage of children, submit to participants (and pro20 spective participants), and make available to the public,

21 in writing the health-related information described in sub22 section (b).

23 ‘‘(b) INFORMATION.—The information to be provided

24 under subsection (a) shall include information on the

25 structures, processes, and outcomes regarding each health
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1 insurance product offered to participants and beneficiaries

2 in a manner that is separate for both the adult and child

3 participants and beneficiaries, using measures that are

4 specific to each group.

5 ‘‘SEC. 724. GENERALLY APPLICABLE PROVISION.

6 ‘‘In the case of a group health plan that provides ben7 efits under 2 or more coverage options, the requirements

8 of this subpart shall apply separately with respect to each

9 coverage option.’’.

10 (b) DEFINITION.—Section 733(a) of the Employee

11 Retirement Income Security Act of 1974 (29 U.S.C.

12 1191b(a)) is amended by adding at the end the following:

13 ‘‘(3) FULLY INSURED GROUP HEALTH PLAN.—

14 The term ‘fully insured group health plan’ means a

15 group health plan where benefits are provided pursu16 ant to the terms of an arrangement between a group

17 health plan and a health insurance issuer and are

18 guaranteed by the health insurance issuer under a

19 contract or policy of insurance.’’.

20 (c) CONFORMING AMENDMENT.—The table of con21 tents in section 1 of the Employee Retirement Income Se22 curity Act of 1974 is amended—

23 (1) in the item relating to subpart C, by strik24 ing ‘‘Subpart C’’ and inserting ‘‘Subpart D’’; and
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1 (2) by adding at the end of the items relating

2 to subpart B of part 7 of subtitle B of title I of such

3 Act the following new items:

‘‘SUBPART C—PATIENT RIGHTS WITH RESPECT TO CARE

‘‘Sec. 721. Patient access to obstetric and gynecological care.

‘‘Sec. 722. Access to pediatric care.

‘‘Sec. 723. Accountability through distribution of information.

‘‘Sec. 724. Generally applicable provision.’’.

4 SEC. 112. GRIEVANCES AND APPEALS WITH RESPECT TO

5 CHILDREN.

6 (a) IN GENERAL.—Section 503 of the Employee Re7 tirement Income Security Act of 1974 (29 U.S.C. 1133)

8 is amended to read as follows:

9 ‘‘SEC. 503. CLAIMS PROCEDURE, AND GRIEVANCES AND AP10 PEALS WITH RESPECT TO CHILDREN.

11 ‘‘(a) CLAIMS PROCEDURE.—In accordance with regu12 lations of the Secretary, every employee benefit plan

13 shall—

14 ‘‘(1) provide adequate notice in writing to any

15 participant or beneficiary whose claim for benefits

16 under the plan has been denied, setting forth the

17 specific reasons for such denial, written in a manner

18 calculated to be understood by the participant, and

19 ‘‘(2) afford a reasonable opportunity to any

20 participant whose claim for benefits has been denied

21 for a full and fair review by the appropriate named

22 fiduciary of the decision denying the claim.
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1 ‘‘(b) INTERNAL APPEALS PROCESS.—A group health

2 plan, or health insurance issuer in connection with the

3 provisions of health insurance coverage, shall, with respect

4 to the coverage of children, establish and maintain a sys5 tem to provide for the resolution of complaints and appeals

6 regarding all aspects of such coverage. Such a system shall

7 include an expedited procedure for appeals where a stand8 ard appeal would jeopardize the life, health, or develop9 ment of the child.

10 ‘‘(c) EXTERNAL APPEALS PROCESS.—A group health

11 plan, or health insurance issuer in connection with the

12 provision of health insurance coverage, shall, with respect

13 to the coverage of children, provide for an independent ex14 ternal review process that meets the following require15 ments:

16 ‘‘(1) External appeal activities shall be con17 ducted through clinical peers, including a physician

18 or other health care professional who is appro19 priately credentialed in pediatrics who has the same

20 or similar specialty as the speciality involved in the

21 appeal and who has experience managing the condi22 tion, procedure, or treatment under review or ap23 peal.

24 ‘‘(2) External appeal activities shall be con25 ducted through an entity that has sufficient pedi-
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1 atric expertise, including subspeciality expertise, and

2 staffing to conduct external appeal activities on a

3 timely basis.

4 ‘‘(3) Such a review process shall include an ex5 pedited procedure for appeals on behalf of a child

6 enrollee in which the time frame of a standard ap7 peal would jeopardize the life, health, or development

8 of the child.’’.

9 (b) CONFORMING AMENDMENT.—The table of con10 tents in section 1 of the Employee Retirement Income Se11 curity Act of 1974 is amended by striking the item relat12 ing to section 503 and inserting the following new item:

‘‘Sec. 503. Claims procedures and grievances and appeals with respect to children.’’.

13 SEC. 113. AMENDMENTS TO THE INTERNAL REVENUE CODE

14 OF 1986.

15 Subchapter B of chapter 100 of the Internal Revenue

16 Code of 1986 is amended—

17 (1) in the table of sections, by inserting after

18 the item relating to section 9812 the following new

19 item:

‘‘Sec. 9813. Standard relating to Patients’ bill of rights.’’; and

20 (2) by inserting after section 9812 the follow21 ing:
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1 ‘‘SEC. 9813. STANDARD RELATING TO PATIENTS’ RIGHTS.

2 ‘‘A group health plan shall comply with the require3 ments of subpart C of part 7 of subtitle B of title I of

4 the Employee Retirement Income Security Act of 1974 (as

5 in effect as of the date of the enactment of the Healthy

6 Kids 2000 Act), and such requirements shall be deemed

7 to be incorporated into this section.’’.

8 SEC. 114. EFFECTIVE DATE.

9 (a) IN GENERAL.—The amendments made by this

10 subtitle shall apply with respect to plan years beginning

11 on or after January 1 of the second calendar year follow12 ing the date of the enactment of this Act. The Secretary

13 shall issue all regulations necessary to carry out the

14 amendments made by this section before the effective date

15 thereof.

16 (b) LIMITATION ON ENFORCEMENT ACTIONS.—No

17 enforcement action shall be taken, pursuant to the amend18 ments made by this subtitle, against a group health plan

19 with respect to a violation of a requirement imposed by

20 such amendments before the date of issuance of regula21 tions issued in connection with such requirement.
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1 TITLE II—PAYMENTS TO CHIL2 DREN’S HOSPITALS THAT OP3 ERATE GME PROGRAMS

4 SEC. 201. SHORT TITLE.

5 This title may be cited as the ‘‘Pediatric Medical

6 Education, Training, and Research Act of 1999’’.

7 SEC. 202. PROGRAM OF PAYMENTS TO CHILDREN’S HOS8 PITALS THAT OPERATE GRADUATE MEDICAL

9 EDUCATION PROGRAMS.

10 (a) PAYMENTS.—

11 (1) IN GENERAL.—The Secretary shall make

12 payment under this section to each children’s hos13 pital for each hospital cost reporting period begin14 ning after fiscal year 1999 and before fiscal year

15 2004 for the direct and indirect expenses associated

16 with operating approved medical residency training

17 programs.

18 (2) PAYMENT AMOUNT.—Subject to paragraph

19 (3), the amount payable under this section to a chil20 dren’s hospital for direct and indirect expenses relat21 ing to approved medical residency training programs

22 for a cost reporting period ending in a fiscal year is

23 equal to the sum of the amount determined under

24 subsection (b) and the amount determined under

25 subsection (c) for such hospital for such fiscal year.
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1 (3) CAPPED AMOUNT.—

2 (A) IN GENERAL.—The payments to chil3 dren’s hospitals established in this subsection

4 for cost reporting periods ending in any fiscal

5 year shall not exceed the funds appropriated

6 under subsection (e) for that fiscal year.

7 (B) PRO RATA REDUCTIONS.—If the Sec8 retary determines that the amount of funds ap9 propriated under subsection (e) for cost report10 ing periods ending in any fiscal year is insuffi11 cient to provide the total amount of payments

12 otherwise due for such periods, the Secretary

13 shall reduce each of the amounts payable under

14 this section for such period on a pro rata basis

15 to reflect such shortfall.

16 (b) AMOUNT OF PAYMENT FOR DIRECT MEDICAL

17 EDUCATION.—

18 (1) IN GENERAL.—The amount determined

19 under this subsection for payments to a children’s

20 hospital for direct expenses relating to approved

21 medical residency training programs for a cost re22 porting period ending in fiscal years 2000 through

23 2003 is equal to the product of—
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1 (A) the per resident rate for direct medical

2 education, as determined under paragraph (2),

3 for the cost reporting period; and

4 (B) the weighted average number of full5 time equivalent residents in the hospital’s ap6 proved medical residency training programs (as

7 determined under section 1886(h)(4) of the So8 cial Security Act (42 U.S.C. 1395ww(h)(4)))

9 for the cost reporting period.

10 (2) PER RESIDENT RATE FOR DIRECT MEDICAL

11 EDUCATION.—

12 (A) IN GENERAL.—The per resident rate

13 for direct medical education for a hospital for

14 a cost reporting period is the updated rate de15 termined under subparagraph (B).

16 (B) COMPUTATION UPDATED RATE.—The

17 updated rate determined under this subpara18 graph is equal to the lesser of—

19 (i) a rate equal to the weighted aver20 age of the per resident rates computed

21 under section 1886(h)(2) of the Social Se22 curity Act (42 U.S.C. 1395ww(h)(2)) for

23 cost reporting periods ending during fiscal

24 year 1999 for all hospitals located in the
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1 Metropolitan Statistical Area in which the

2 hospital involved is located; or

3 (ii) the per resident rate for cost re4 porting periods ending during fiscal year

5 1999 for the hospital involved (as deter6 mined by the Secretary using the meth7 odology described in section

8 1886(h)(2)(E)) of such Act (42 U.S.C.

9 1395ww(h)(2)(E)));

10 each such rate updated by the hospital market

11 basket increase percentage from fiscal year

12 1999 through the fiscal year involved.

13 (c) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL

14 EDUCATION.—

15 (1) IN GENERAL.—The amount determined

16 under this subsection for payments to a children’s

17 hospital for indirect expenses relating to approved

18 medical residency training programs for a cost re19 porting period ending in fiscal years 2000 through

20 2003 is equal to an amount determined appropriate

21 by the Secretary.

22 (2) FACTORS.—In determining the amount

23 under paragraph (1), the Secretary shall—

24 (A) take into account variations in case

25 mix among children’s hospitals and the weight-
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1 ed average number of full-time equivalent resi2 dents in the hospitals’ approved medical resi3 dency training programs (as determined under

4 section 1886(h)(4) of the Social Security Act

5 (42 U.S.C. 1395ww(h)(4))) for the cost report6 ing period; and

7 (B) assure that the aggregate of the pay8 ments for indirect expenses relating to approved

9 medical residency training programs under this

10 section in a fiscal year are equal to the amount

11 appropriated for such expenses in such year

12 under subsection (e)(2).

13 (d) MAKING OF PAYMENTS.—

14 (1) INTERIM PAYMENTS.—The Secretary shall

15 estimate, before the beginning of each cost reporting

16 period for a hospital for which a payment may be

17 made under this section, the amount of the payment

18 for such period and shall (subject to paragraph (2))

19 make payment of such amount in 26 equal interim

20 installments during such period.

21 (2) WITHHOLDING.—The Secretary shall with22 hold up to 25 percent from each interim installment

23 paid under paragraph (1).

24 (3) RECONCILIATION.—At the end of each such

25 period, the hospital shall submit to the Secretary
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1 such information as the Secretary determines to be

2 necessary to determine the percent (if any) of the

3 amount withheld under paragraph (2) that is due

4 under this section for the hospital for the period.

5 Based on such determination, the Secretary shall re6 coup any overpayments made, or pay any balance

7 due. The amount so determined shall be considered

8 a final intermediary determination for purposes of

9 applying section 1878 of the Social Security Act (42

10 U.S.C. 1395oo) and shall be subject to review under

11 that section in the same manner as the amount of

12 payment under section 1886(d) of such Act (42

13 U.S.C. 1395ww(d)) is subject to review under such

14 section.

15 (e) LIMITATION ON EXPENDITURES.—

16 (1) PAYMENT FOR DIRECT MEDICAL EDU17 CATION EXPENSES REPRESENTING MEDICARE’S

18 SHARE OF SUCH EXPENSES.—

19 (A) IN GENERAL.—Subject to subpara20 graph (B), there are hereby appropriated, out

21 of any money in the Treasury not otherwise ap22 propriated, for payments under this section for

23 direct expenses relating to approved medical

24 residency training programs for a cost reporting

25 period for cost reporting periods beginning in—
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1 (i) fiscal year 2000, $35,000,000;

2 (ii) fiscal year 2001, $95,000,000;

3 (iii) fiscal year 2002, $95,000,000;

4 and

5 (iv) fiscal year 2003, $95,000,000.

6 (B) CARRYOVER OF EXCESS.—If the

7 amount of payments under this section for cost

8 reporting periods ending in fiscal year 2000,

9 2001, or 2002 is less than the amount provided

10 under this paragraph for such payments for

11 such periods, then the amount available under

12 this paragraph for cost reporting periods ending

13 in the following fiscal year shall be increased by

14 the amount of such difference.

15 (2) PAYMENT FOR INDIRECT MEDICAL EDU16 CATION EXPENSES REPRESENTING MEDICARE’S

17 SHARE OF SUCH EXPENSES.—There are hereby ap18 propriated, out of any money in the Treasury not

19 otherwise appropriated, for payments under this sec20 tion for indirect expenses relating to approved medi21 cal residency training programs for a cost reporting

22 period for cost reporting periods beginning in—

23 (A) fiscal year 2000, $65,000,000;

24 (B) fiscal year 2001, $190,000,000;

25 (C) fiscal year 2002, $190,000,000; and
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1 (D) fiscal year 2003, $190,000,000.

2 (f) RELATION TO MEDICARE AND MEDICAID PAY3 MENTS.—Notwithstanding any other provision of law,

4 payments under this section to a hospital for a cost report5 ing period—

6 (1) are in lieu of any amounts otherwise pay7 able to the hospital under section 1886(h) or

8 1886(d)(5)(B) of the Social Security Act (42 U.S.C.

9 1395ww(h); 1395ww(d)(5)B)) to the hospital for

10 such cost reporting period, but

11 (2) shall not affect the amounts otherwise pay12 able to such hospitals under a State Medicaid plan

13 under title XIX of the Social Security Act (42

14 U.S.C. 1396 et seq.).

15 (g) DEFINITIONS.—In this section:

16 (1) APPROVED MEDICAL RESIDENCY TRAINING

17 PROGRAM.—The term ‘‘approved medical residency

18 training program’’ has the meaning given such term

19 in section 1886(h)(5)(A) of the Social Security Act

20 (42 U.S.C. 1395ww(h)(5)(A)).

21 (2) CHILDREN’S HOSPITAL.—The term ‘‘chil22 dren’s hospital’’ means a hospital described in sec23 tion 1886(d)(1)(B)(iii) of the Social Security Act

24 (42 U.S.C. 1395ww(d)(1)(B)(iii)).
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1 (3) DIRECT GRADUATE MEDICAL EDUCATION

2 COSTS.—The term ‘‘direct graduate medical edu3 cation costs’’ has the meaning given such term in

4 section 1886(h)(5)(C) of the Social Security Act (42

5 U.S.C. 1395ww(h)(5)(C)).

6 (4) SECRETARY.—The term ‘‘Secretary’’ means

7 the Secretary of Health and Human Services.

8 TITLE III—PEDIATRIC PUBLIC

9 HEALTH PROMOTION

10 Subtitle A—National Center for

11 Birth Defects Research and Pre12 vention

13 SEC. 301. NATIONAL CENTER FOR BIRTH DEFECTS RE14 SEARCH AND PREVENTION.

15 Title III of the Public Health Service Act (42 U.S.C.

16 241 et seq.) is amended by adding at the end the follow17 ing:

18 ‘‘PART Q—PEDIATRIC PUBLIC HEALTH

19 PROMOTION

20 ‘‘SEC. 399L. NATIONAL CENTER FOR BIRTH DEFECTS RE21 SEARCH AND PREVENTION.

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

23 the Centers for Disease Control and Prevention a center

24 to be known as the National Center for Birth Defects Re25 search and Prevention.
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1 ‘‘(b) PURPOSE.—The general purpose of the National

2 Center established under subsection (a) shall be to—

3 ‘‘(1) collect, analyze, and make available data

4 on birth defects, including data on the causes of

5 such defects and on the incidence and prevalence of

6 such defects;

7 ‘‘(2) conduct applied epidemiological research

8 on the prevention of such defects; and

9 ‘‘(3) provide information and education to the

10 public on the prevention of such defects.

11 ‘‘(c) DIRECTOR.—The National Center established

12 under subsection (a) shall be headed by a director to be

13 appointed by the Secretary.

14 ‘‘(d) TRANSFERS.—There shall be transferred to the

15 National Center established under subsection (a) all activi16 ties, budgets and personnel of the National Center for En17 vironmental Health that relate to birth defects, folic acid,

18 cerebral palsy, mental retardation, child development,

19 newborn screening, autism, fragile X syndrome, fetal alco20 hol syndrome, pediatric genetics, and disability prevention.

21 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There

22 are authorized to be appropriated such sums as may be

23 necessary to carry out this section.’’.
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1 Subtitle B—Pregnant Mothers and

2 Infants Health Promotion

3 SEC. 311. SHORT TITLE.

4 This subtitle may be cited as the ‘‘Pregnant Mothers

5 and Infants Health Protection Act’’.

6 SEC. 312. FINDINGS.

7 Congress makes the following findings:

8 (1) Alcohol consumption by a woman during

9 her pregnancy can cause the woman to have a mis10 carriage and otherwise cause serious harm to her

11 baby, including low birth weight, birth defects, and

12 behavioral problems.

13 (2) Illegal drug usage can cause problems such

14 as miscarriage, early birth, or high or low blood

15 pressure for the mother.

16 (3) Exposure to illegal drugs often causes ba17 bies to die before or after they are born. If a baby

18 is born alive, the newborn might be addicted to

19 drugs and have painful withdrawal. Drug exposure

20 may also cause severe damage to the newborn’s or21 gans, such as the brain, eyes, ears, heart, kidneys,

22 or genitals.

23 (4) Smoking tobacco products during pregnancy

24 significantly increases maternal and fetal risk and

25 accounts for 20 to 30 percent of the low birth weight
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1 rate and 10 percent of the fetal and infant death

2 rate in the United States.

3 (5) Infants of mothers who smoke during and

4 after pregnancy have nearly a 3 fold increase in the

5 risk of Sudden Infant Death Syndrome (referred to

6 in this section as ‘‘SIDS’’) as compared to infants

7 of mothers who do not smoke.

8 (6) Smoking during pregnancy has been associ9 ated with certain childhood cancers and birth de10 fects, and it increases the risk of spontaneous abor11 tion, premature rupture of membranes, and delivery

12 of a stillborn infant.

13 (7) Smoking during pregnancy may impede the

14 growth of the fetus and increase the likelihood of

15 mental retardation by 50 percent.

16 (8) The proportion of women who quit smoking

17 during pregnancy but relapse within 6 months is

18 nearly 63 percent, thereby exposing their infants to

19 passive smoke and increasing their risk of SIDS and

20 other health related problems.

21 (9) Effective prenatal smoking, alcohol, and il22 legal drug cessation methods increase the rate of

23 cessation during pregnancy.
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1 SEC. 313. ESTABLISHMENT.

2 Part Q of title III of the Public Health Service Act

3 (as added by section 301) is amended by adding at the

4 end the following:

5 ‘‘SEC. 399M. PROGRAMS REGARDING PRENATAL AND POST6 NATAL HEALTH.

7 ‘‘(a) IN GENERAL.—The Secretary, acting through

8 the Director of the Centers for Disease Control and Pre9 vention, shall carry out programs—

10 ‘‘(1) to collect, analyze, and make available data

11 on prenatal smoking, alcohol and illegal drug usage,

12 including data on the implications of such activities

13 and on the incidence and prevalence of such activi14 ties and their implications;

15 ‘‘(2) to conduct applied epidemiological research

16 on the prevention of prenatal and postnatal smoking,

17 alcohol and illegal drug usage;

18 ‘‘(3) to support, conduct, and evaluate the ef19 fectiveness of educational and cessation programs;

20 and

21 ‘‘(4) to provide information and education to

22 the public on the prevention and implications of pre23 natal and postnatal smoking, alcohol and illegal drug

24 usage.

25 ‘‘(b) GRANTS.—In carrying out subsection (a), the

26 Secretary may award grants to and enter into contracts
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1 with States, local governments, scientific and academic in2 stitutions, Federally qualified health centers, and other

3 public and nonprofit entities, and may provide technical

4 and consultative assistance to such entities.

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

6 is authorized to be appropriated to carry out this section,

7 $15,000,000 for each of the fiscal years 2000 and 2001,

8 and such sums as may be necessary for each of the fiscal

9 years 2002 and 2003.’’.

10 Subtitle C—Safe Motherhood Mon11 itoring and Prevention Re12 search

13 SEC. 321. SHORT TITLE.

14 This Act may be cited as the ‘‘Safe Motherhood Mon15 itoring and Prevention Research Act’’.

16 SEC. 322. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.

17 Part Q of title III of the Public Health Service Act

18 (as added by section 301 and amended by section 311)

19 is further amended by adding at the end the following:

20 ‘‘SEC. 399N. SAFE MOTHERHOOD MONITORING.

21 ‘‘(a) PURPOSE.—It is the purpose of this section to

22 develop monitoring systems at the local, State, and na23 tional level to better understand the burden of maternal

24 complications and mortality and to decrease the disparities
34

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1 among population at risk of death and complications from

2 pregnancy.

3 ‘‘(b) ACTIVITIES.—For the purpose described in sub4 section (a), the Secretary may carry out the following ac5 tivities:

6 ‘‘(1) The Secretary, acting through the Centers

7 for Disease Control and Prevention, may establish

8 and implement a national monitoring and surveil9 lance program to identify and promote the investiga10 tion of deaths and severe complications that occur

11 during pregnancy.

12 ‘‘(2) The Secretary, acting through the Centers

13 for Disease Control and Prevention, may expand the

14 Pregnancy Risk Assessment Monitoring System to

15 provide surveillance and collect data in each of the

16 50 States.

17 ‘‘(3) The Secretary, acting through the Centers

18 for Disease Control and Prevention, may expand the

19 Maternal and Child Health Epidemiology Program

20 to provide technical support, financial assistance, or

21 the time-limited assignment of senior epidemiologists

22 to maternal and child health programs in each of the

23 50 States.
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1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

2 is authorized to be appropriated to carry out this section,

3 $25,000,000 for each fiscal year.’’.

4 ‘‘SEC. 399O. PREVENTION RESEARCH TO ENSURE SAFE

5 MOTHERHOOD.

6 ‘‘(a) PURPOSE.—It is the purpose of this section to

7 provide the Centers for Disease Control and Prevention

8 with the authority to further expand research concerning

9 risk factors, prevention strategies, and the roles of the

10 family, health care providers and the community in safe

11 motherhood.

12 ‘‘(b) RESEARCH.—The Secretary, acting through the

13 Centers for Disease Control and Prevention, may carry

14 out activities to expand research relating to—

15 ‘‘(1) encouraging preconception counseling, es16 pecially for at risk populations such as diabetics;

17 ‘‘(2) the identification of critical components of

18 prenatal delivery and postpartum care;

19 ‘‘(3) the identification of outreach and support

20 services, such as folic acid education, that are avail21 able for pregnant women;

22 ‘‘(4) the identification of women who are at

23 high risk for complications;

24 ‘‘(5) preventing preterm delivery;

25 ‘‘(6) preventing urinary tract infections;
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1 ‘‘(7) preventing unnecessary caesarean sections;

2 ‘‘(8) an examination of the higher rates of ma3 ternal mortality among African American women;

4 ‘‘(9) an examination of the relationship between

5 domestic violence and maternal complications and

6 mortality;

7 ‘‘(10) preventing smoking, alcohol and illegal

8 drug usage before, during and after pregnancy;

9 ‘‘(11) preventing infections that cause maternal

10 and infant complications; and

11 ‘‘(12) other areas determined appropriate by

12 the Secretary.

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

14 is authorized to be appropriated to carry out this section,

15 $20,000,000 for each fiscal year.

16 ‘‘SEC. 399P. PREVENTION PROGRAMS TO ENSURE SAFE

17 MOTHERHOOD.

18 ‘‘(a) IN GENERAL.—The Secretary, acting through

19 the Centers for Disease Control and Prevention may carry

20 out activities to promote safe motherhood, including—

21 ‘‘(1) public education campaigns on healthy

22 pregnancies and the building of partnerships with

23 outside organizations concerned about safe mother24 hood;
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1 ‘‘(2) education programs for physicians, nurses

2 and other health care providers; and

3 ‘‘(3) activities to promote community support

4 services for pregnant women.

5 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There

6 is authorized to be appropriated to carry out this section,

7 $20,000,000 for each fiscal year.’’.

8 Subtitle D—Poison Control Center

9 Enhancement

10 SEC. 331. SHORT TITLE.

11 This subtitle may be cited as the ‘‘Poison Control

12 Center Enhancement and Awareness Act’’.

13 SEC. 332. FINDINGS.

14 Congress makes the following findings:

15 (1) Each year more than 2,000,000 poisonings

16 are reported to poison control centers throughout

17 the United States. More than 90 percent of these

18 poisonings happen in the home. Fifty-three percent

19 of poisoning victims are children younger than 6

20 years of age.

21 (2) Poison centers are life-saving and cost-effec22 tive public health services. For every dollar spent on

23 poison control centers, $7 in medical costs are saved.

24 The average cost of a poisoning exposure call is

25 $31.28, while the average cost if other parts of the
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1 medical system are involved is $932. Over the last

2 2 decades, the instability and lack of funding has re3 sulted in a steady decline in the number of poison

4 control centers in the United States. Currently,

5 there are 75 such centers.

6 (3) Stabilizing the funding structure and in7 creasing accessibility to poison control centers will

8 increase the number of United States residents who

9 have access to a certified poison control center, and

10 reduce the inappropriate use of emergency medical

11 services and other more costly health care services.

12 SEC. 333. DEFINITION.

13 In this subtitle, the term ‘‘Secretary’’ means the Sec14 retary of Health and Human Services.

15 SEC. 334. ESTABLISHMENT OF A NATIONAL TOLL-FREE

16 NUMBER.

17 (a) IN GENERAL.—The Secretary shall provide co18 ordination and assistance to regional poison control cen19 ters for the establishment of a nationwide toll-free phone

20 number to be used to access such centers.

21 (b) AUTHORIZATION OF APPROPRIATIONS.—There is

22 authorized to be appropriated to carry out this section,

23 $2,000,000 for each of the fiscal years 2000 through

24 2004.
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1 SEC. 335. ESTABLISHMENT OF NATIONWIDE MEDIA CAM2 PAIGN.

3 (a) IN GENERAL.—The Secretary shall establish a

4 national media campaign to educate the public and health

5 care providers about poison prevention and the availability

6 of poison control resources in local communities and to

7 conduct advertising campaigns concerning the nationwide

8 toll-free number established under section 334.

9 (b) CONTRACT WITH ENTITY.—The Secretary may

10 carry out subsection (a) by entering into contracts with

11 1 or more nationally recognized media firms for the devel12 opment and distribution of monthly television, radio, and

13 newspaper public service announcements.

14 (c) AUTHORIZATION OF APPROPRIATIONS.—There is

15 authorized to be appropriated to carry out this section,

16 $600,000 for each of the fiscal years 2000 through 2004.

17 SEC. 336. ESTABLISHMENT OF A GRANT PROGRAM.

18 (a) REGIONAL POISON CONTROL CENTERS.—The

19 Secretary shall award grants to certified regional poison

20 control centers for the purposes of achieving the financial

21 stability of such centers, and for preventing and providing

22 treatment recommendations for poisonings.

23 (b) OTHER IMPROVEMENTS.—The Secretary shall

24 also use amounts received under this section to—

25 (1) develop standard education programs;
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1 (2) develop standard patient management pro2 tocols for commonly encountered toxic exposures;

3 (3) improve and expand the poison control data

4 collection systems; and

5 (4) improve national toxic exposure surveillance.

6 (c) CERTIFICATION.—Except as provided in sub7 section (d), the Secretary may make a grant to a center

8 under subsection (a) only if the center has been certified

9 by a professional organization in the field of poison con10 trol, and the Secretary has approved the organization as

11 having in effect standards for certification that reasonably

12 provide for the protection of the public health with respect

13 to poisoning.

14 (d) WAIVER OF CERTIFICATION REQUIREMENTS.—

15 (1) IN GENERAL.—The Secretary may grant a

16 waiver of the certification requirement of subsection

17 (a) with respect to a noncertified poison control cen18 ter that applies for a grant under this section if such

19 center can reasonably demonstrate that the center

20 will obtain such a certification within a reasonable

21 period of time as determined appropriate by the Sec22 retary.

23 (2) RENEWAL.—The Secretary may only renew

24 a waiver under paragraph (1) for a period of 3

25 years.
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1 (e) SUPPLEMENT NOT SUPPLANT.—Amounts made

2 available to a poison control center under this section shall

3 be used to supplement and not supplant other Federal,

4 State, local or private funds provided for such center.

5 (f) MAINTENANCE OF EFFORT.—A poison control

6 center, in utilizing the proceeds of a grant under this sec7 tion, shall maintain the expenditures of the center for ac8 tivities of the center at a level that is equal to not less

9 than the level of such expenditures maintained by the cen10 ter for the fiscal year preceding the fiscal year for which

11 the grant is received.

12 (g) MATCHING REQUIREMENT.—The Secretary may

13 impose a matching requirement with respect to amounts

14 provided under a grant under this section if the Secretary

15 determines appropriate.

16 (h) AUTHORIZATION OF APPROPRIATIONS.—There is

17 authorized to be appropriated to carry out this section,

18 $25,000,000 for each of the fiscal years 2000 through

19 2004.
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1 TITLE IV—PEDIATRIC

2 RESEARCH

3 SEC. 401. ESTABLISHMENT OF A PEDIATRIC RESEARCH INI4 TIATIVE.

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

6 (42 U.S.C. 281 et seq.) is amended by adding at the end

7 the following:

8 ‘‘SEC. 404F. PEDIATRIC RESEARCH INITIATIVE.

9 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab10 lish within the Office of the Director of NIH a Pediatric

11 Research Initiative (hereafter in this section referred to

12 as the ‘Initiative’). The Initiative shall be headed by the

13 Director of NIH.

14 ‘‘(b) PURPOSE.—The purpose of the Initiative is to

15 provide funds to enable the Director of NIH to

16 encourage—

17 ‘‘(1) increased support for pediatric biomedical

18 research within the National Institutes of Health to

19 ensure that the expanding opportunities for advance20 ment in scientific investigations and care for chil21 dren are realized;

22 ‘‘(2) expanded clinical pharmacology and exper23 imental therapeutics research, to—
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1 ‘‘(A) better understand maturational

2 changes in drug metabolism and drug actions

3 from birth through puberty;

4 ‘‘(B) apply the insights gained to address

5 specific therapeutic and drug toxicity problems

6 relevant to children;

7 ‘‘(C) conduct pediatric clinical trials which

8 will lead to approval of important therapeutic

9 drugs for use by children; and

10 ‘‘(D) serve as an educational resource for

11 patients, practitioners and students;

12 ‘‘(3) enhanced collaborative efforts among the

13 Institutes to support multidisciplinary research in

14 the areas that the Director deems most promising;

15 ‘‘(4) increased support for pediatric outcomes

16 and medical effectiveness research to demonstrate

17 how to improve the quality of children’s health care

18 while reducing cost; and

19 ‘‘(5) recognition of the special attention pedi20 atric research deserves.

21 ‘‘(c) DUTIES.—In carrying out subsection (b), the Di22 rector of NIH shall—

23 ‘‘(1) consult with the Institutes and other advi24 sors as the Director determines appropriate in the
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1 allocation of Initiative funds, including the Institute

2 for Child Health and Human Development;

3 ‘‘(2) have broad discretion in the allocation of

4 any Initiative assistance among the Institutes,

5 among types of grants, and between basic and clini6 cal research so long as the—

7 ‘‘(A) assistance is directly related to the ill8 nesses and diseases of children; and

9 ‘‘(B) assistance is extramural in nature;

10 and

11 ‘‘(3) be responsible for the oversight of any

12 newly appropriated Initiative funds and be account13 able with respect to such funds to Congress and to

14 the public.

15 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There

16 is authorized to be appropriated to carry out this section,

17 $100,000,000 for each of the fiscal years 2000 and 2001,

18 and such sums as may be necessary for each fiscal year

19 thereafter.

20 ‘‘(e) TRANSFER OF FUNDS.—The Director of NIH

21 may transfer amounts appropriated under this section to

22 any of the Institutes for a fiscal year to carry out the pur23 poses of the Initiative under this section.’’.
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1 SEC. 402. INVESTMENT IN TOMORROW’S PEDIATRIC RE2 SEARCHERS.

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

4 Human Services, acting through the National Institute of

5 Child Health and Human Development, shall provide en6 hanced support for extramural activities relating to the

7 training and career development of pediatric researchers.

8 (b) PURPOSE.—In carrying out subsection (a), the

9 Secretary of Health and Human Services shall ensure that

10 enhanced support is designed to ensure the future supply

11 of researchers who are dedicated to the care and research

12 needs of children by providing for—

13 (1) an increase in the number and size of insti14 tutional training grants to medical school pediatric

15 departments and children’s hospitals; and

16 (2) an increase in the number of career develop17 ment awards for pediatric providers building careers

18 in pediatric clinical research.

19 (c) PEDIATRIC RESEARCH LOAN REPAYMENT PRO20 GRAM.—

21 (1) IN GENERAL.—The Secretary of Health and

22 Human Services, in consultation with the Director of

23 the National Institute of Child Health and Human

24 Development, may establish a pediatric research

25 loan repayment program. Through such program—
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1 (A) the Secretary shall enter into contracts

2 with qualified pediatricians under which such

3 pediatricians will agree to conduct pediatric re4 search in consideration of the Federal Govern5 ment agreeing to repay, for each year of such

6 service, not more than $35,000 of the principal

7 and interest of the educational loans of such pe8 diatricians; and

9 (B) the Secretary shall, for the purpose of

10 providing reimbursements for tax liability re11 sulting from payments made under paragraph

12 (1) on behalf of an individual, make payments,

13 in addition to payments under such paragraph,

14 to the individual in an amount equal to 39 per15 cent of the total amount of loan repayments

16 made for the taxable year involved.

17 (2) APPLICATION OF OTHER PROVISIONS.—The

18 provisions of sections 338B, 338C, and 338E of the

19 Public Health Service Act (42 U.S.C. 254l–1, 254m,

20 and 254o) shall, except as inconsistent with para21 graph (1), apply to the program established under

22 such paragraph to the same extent and in the same

23 manner as such provisions apply to the National

24 Health Service Corps Loan Repayment Program es-
47

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1 tablished under subpart III of part D of title III of

2 such Act (42 U.S.C. 245l et seq.).

3 (3) AVAILABILITY OF FUNDS.—Amounts made

4 available to carry out this subsection shall remain

5 available until the expiration of the second fiscal

6 year beginning after the fiscal year for which such

7 amounts were made available.

8 (d) AUTHORIZATION OF APPROPRIATIONS.—There is

9 authorized to be appropriated to carry out this section,

10 $20,000,000 for fiscal year 2000, $25,000,000 for fiscal

11 year 2001, $30,000,000 for fiscal year 2002, and such

12 sums as may be necessary for each fiscal year thereafter.

Æ