I 
108TH CONGRESS 
1ST SESSION 
H. R. 936
To leave no child behind. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 26, 2003
Mr. GEORGE MILLER of California (for himself, Mr. WEXLER, Mr. HOEFFEL, 
Mrs. NAPOLITANO, Mr. PAYNE, Mr. OWENS, Mr. SERRANO, Mr. KEN-
NEDY of Rhode Island, Mr. KILDEE, Mr. ANDREWS, Mr. UDALL of New 
Mexico, Mr. BROWN of Ohio, Mr. ABERCROMBIE, Mrs. DAVIS of Cali-
fornia, Ms. LEE, Ms. WOOLSEY, Ms. SOLIS, Mr. KUCINICH, Ms. 
MILLENDER-MCDONALD, Mr. SCOTT of Virginia, Mr. MORAN of Virginia, 
Mr. TIERNEY, Ms. PELOSI, Mr. STARK, Ms. WATSON, Mr. FARR, and 
Ms. LOFGREN) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committees on 
Energy and Commerce, Education and the Workforce, Agriculture, the 
Judiciary, Government Reform, and Transportation and Infrastructure, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of the 
committee concerned 
A BILL 
To leave no child behind.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Leave No Child Behind 
Act of 2003’’.
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows:
TITLE I—HEALTHY START—CHILDREN’S HEALTH INSURANCE 
Subtitle A—Children’s Health Insurance 
Sec. 1001. Medikids health insurance. 
Sec. 1002. Benefits for all children born after 2002. 
Sec. 1003. Medikids premium. 
Sec. 1004. Refundable credit for cost-sharing expenses under Medikids pro-
gram. 
Sec. 1005. Report on long-term revenues. 
Subtitle B—Children’s Health Insurance Eligibility Expansion and Enrollment 
Improvements 
CHAPTER 1—ELIGIBILITY EXPANSIONS 
SUBCHAPTER A—MEDICAID AND SCHIP 
Sec. 1101. Expansion of children’s eligibility for medicaid and SCHIP. 
Sec. 1102. Optional coverage of legal immigrants under the medicaid program 
and title XXI. 
SUBCHAPTER B—FAMILY OPPORTUNITY ACT 
Sec. 1111. Short title; amendments to Social Security Act. 
Sec. 1112. Opportunity for families of disabled children to purchase medicaid 
coverage for such children. 
Sec. 1113. Treatment of inpatient psychiatric hospital services for individuals 
under age 21 in home or community-based services waivers. 
Sec. 1114. Demonstration of coverage under the medicaid program of children 
with potentially severe disabilities. 
Sec. 1115. Development and support of family-to-family health information cen-
ters. 
Sec. 1116. Restoration of medicaid eligibility for certain SSI beneficiaries. 
CHAPTER 2—ENROLLMENT IMPROVEMENTS 
Sec. 1121. Application of simplified title XXI procedures under the medicaid 
program. 
Sec. 1122. Automatic enrollment of children born to title XXI parents. 
CHAPTER 3—EFFECTIVE DATE 
Sec. 1131. Effective date. 
Subtitle C—Improving Access to Care 
CHAPTER 1—COMMISSION 
Sec. 1201. Commission on Children’s Access To Care. 
CHAPTER 2—CHILDREN’S HEALTH INSURANCE ACCOUNTABILITY 
Sec. 1211. Short title.
Sec. 1212. Findings. 
Sec. 1213. Amendments to the Public Health Service Act. 
Sec. 1214. Amendments to the employee retirement income security act of 
1974. 
Sec. 1215. Studies. 
Sec. 1216. Effective dates. 
CHAPTER 3—EPSDT 
Sec. 1221. Collection of data regarding the delivery of EPSDT services. 
Subtitle D—Reducing Public Health Risks 
CHAPTER 1—ASTHMA TREATMENTS 
Sec. 1301. Findings. 
Sec. 1302. Asthma, vision, and hearing screening for Early Head Start and 
Head Start Programs. 
Sec. 1303. Asthma, vision, and hearing screening and treatment for children 
enrolled in public schools. 
Sec. 1304. General effective date. 
CHAPTER 2—INCREASE IN FUNDING FOR HUD PROGRAMS 
Sec. 1311. Lead-based paint hazard control grants. 
Sec. 1312. Healthy homes initiative program. 
CHAPTER 3—YOUTH SMOKING CESSATION AND EDUCATION 
Sec. 1321. Short title. 
SUBCHAPTER A—PROTECTION OF CHILDREN FROM TOBACCO 
PART I—FOOD AND DRUG ADMINISTRATION JURISDICTION AND GENERAL 
AUTHORITY 
Sec. 1331. Reference. 
Sec. 1332. Statement of general authority. 
Sec. 1333. Nonapplicability to other drugs or devices. 
Sec. 1334. Conforming amendments to confirm jurisdiction. 
Sec. 1335. General rule. 
Sec. 1336. Safety and efficacy standard and recall authority. 
PART II—REGULATION OF TOBACCO PRODUCTS 
Sec. 1341. Performance standards. 
Sec. 1342. Application of Federal Food, Drug, and Cosmetic Act to tobacco 
products. 
Sec. 1343. Funding. 
Sec. 1344. Repeals. 
SUBCHAPTER B—MISCELLANEOUS PROVISIONS 
Sec. 1351. Nonapplication to tobacco producers. 
Sec. 1352. Equal treatment of retail outlets. 
CHAPTER 4—COVERAGE OF CHILDHOOD IMMUNIZATIONS 
Sec. 1361. Short title.
Sec. 1362. Amendments to the Employee Retirement Income Security Act of 
1974. 
Sec. 1363. Amendments to the Public Health Service Act. 
Sec. 1364. Amendments to the Internal Revenue Code of 1986. 
Sec. 1365. Effective dates. 
Subtitle E—Reducing Environmental Health Risks 
CHAPTER 1—ENVIRONMENTAL PROTECTION OF CHILDREN 
Sec. 1401. Short title. 
Sec. 1402. Environmental protection for children and other vulnerable sub-
populations. 
Sec. 1403. Conforming amendment. 
Sec. 1413. Conforming amendment. 
Sec. 1414. Effective date. 
TITLE II—HEALTHY START—SUPPORT FOR HEALTHY 
DEVELOPMENT 
Subtitle A—Promotion of State and Local Support 
Sec. 2001. State and local parenting support and education grant program. 
Subtitle B—Family and Medical Leave Expansion 
Sec. 2101. Short title. 
Sec. 2102. Findings. 
CHAPTER 1—FAMILY INCOME TO RESPOND TO SIGNIFICANT TRANSITIONS 
Sec. 2111. Short title. 
Sec. 2112. Purposes. 
Sec. 2113. Definitions. 
Sec. 2114. Demonstration projects. 
Sec. 2115. Notification. 
Sec. 2116. Evaluations and reports. 
Sec. 2117. Authorization of appropriations. 
Sec. 2118. Technical and conforming amendments. 
CHAPTER 2—FAMILY FRIENDLY WORKPLACES 
Sec. 2121. Short title. 
Sec. 2122. Coverage of employees. 
CHAPTER 3—EMPLOYMENT PROTECTION FOR BATTERED WOMEN 
Sec. 2131. Entitlement to leave for addressing domestic violence for non-Fed-
eral employees. 
Sec. 2132. Entitlement to leave for addressing domestic violence for Federal 
employees. 
Sec. 2133. Existing leave usable for domestic violence. 
CHAPTER 4—FEDERAL EMPLOYEES PAID PARENTAL LEAVE 
Sec. 2141. Short title. 
Sec. 2142. Demonstration project. 
Sec. 2143. Technical and conforming amendments. 
Sec. 2144. Effective date.
CHAPTER 5—TIME FOR SCHOOLS 
Sec. 2151. Short title. 
Sec. 2152. General requirements for leave. 
Sec. 2153. School involvement leave for civil service employees. 
Sec. 2154. Effective date. 
Subtitle C—Health Care for the Uninsured 
Sec. 2201. Familycare coverage of parents under the medicaid program and 
title XXI. 
Subtitle D—Awareness of Environmental Risks to Children 
Sec. 2301. Short title. 
Sec. 2302. Finding. 
CHAPTER 1—CHILDREN’S ENVIRONMENTAL PROTECTION 
SUBCHAPTER A—DISCLOSURE OF INDUSTRIAL RELEASES THAT PRESENT A 
SIGNIFICANT RISK TO CHILDREN 
Sec. 2311. Reporting requirements. 
SUBCHAPTER B—DISCLOSURE OF HIGH HEALTH RISK CHEMICALS IN 
CHILDREN’S CONSUMER PRODUCTS 
Sec. 2321. List of toxic chemicals. 
Sec. 2322. Reporting of toxic chemicals in consumer products. 
Sec. 2323. Exemptions. 
Sec. 2324. Private citizen enforcement. 
CHAPTER 2—PUBLIC RIGHT TO KNOW ABOUT TOXIC CHEMICAL USE 
Sec. 2331. Disclosure of toxic chemical use by comparable facilities. 
Sec. 2332. Disclosure of toxic chemical use. 
Sec. 2333. Streamlined data collection and dissemination. 
Sec. 2334. Trade secret protection. 
Subtitle E—Promoting Responsible Fatherhood 
CHAPTER 1—BLOCK GRANTS 
Sec. 2401. Block grants to States to encourage media campaigns. 
Sec. 2402. Responsible fatherhood block grant. 
CHAPTER 2—NATIONAL CLEARINGHOUSE 
Sec. 2411. National clearinghouse for responsible fatherhood programs. 
TITLE III—HEAD START AND CHILD CARE 
Subtitle A—Infants and Toddlers 
Sec. 3001. Reservation of Head Start Act funds for infants and toddlers. 
Sec. 3002. Reservation of child care and development block grant funds for in-
fants and toddlers. 
Subtitle B—Child Care Access
CHAPTER 1—IMPROVING ACCESS TO CHILD CARE 
Sec. 3011. Incentive grants to States. 
Sec. 3012. Payment rates. 
CHAPTER 2—IMPROVEMENTS IN ACCESS TO CHILD CARE 
Sec. 3111. Goals. 
Sec. 3112. Authorization of appropriations. 
Sec. 3113. State plan requirements. 
Sec. 3114. Funds for indian tribes. 
Sec. 3115. Definitions. 
Subtitle C—Child Care Quality Improvement 
CHAPTER 1—FOCUS ON COMMITTED AND UNDERPAID STAFF FOR 
CHILDREN’S SAKE 
Sec. 3201. Short title. 
Sec. 3202. Findings and purpose. 
Sec. 3203. Definitions. 
Sec. 3204. Funds for child care provider development and retention grants and 
for child care provider scholarships. 
Sec. 3205. Allotments to States. 
Sec. 3206. Application and plan. 
Sec. 3207. Child care provider development and retention grant program. 
Sec. 3208. Child care provider scholarship program. 
Sec. 3209. Annual report. 
Sec. 3210. Authorization of appropriations. 
CHAPTER 2—STRENGTHENING QUALITY THROUGH THE CHILD CARE AND 
DEVELOPMENT BLOCK GRANT 
Sec. 3231. State plan. 
Sec. 3232. Child care quality improvements. 
Sec. 3233. Administration and enforcement. 
CHAPTER 3—CHILD CARE CENTERS IN FEDERAL FACILITIES 
Sec. 3241. Short title. 
Sec. 3242. Definitions. 
Sec. 3243. Providing quality child care in Federal facilities. 
Sec. 3244. Federal child care evaluation. 
Sec. 3245. Child care services for Federal employees. 
Sec. 3246. Miscellaneous provisions relating to child care provided by Federal 
agencies.
CHAPTER 4—EARLY LEARNING 
Sec. 3251. Short title; findings. 
Sec. 3252. Purposes. 
Sec. 3253. Definitions. 
Sec. 3254. Prohibitions. 
Sec. 3255. Authorization and appropriation of funds. 
Sec. 3256. Allotments to States. 
Sec. 3257. Administrative costs. 
Sec. 3258. State requirements.
Sec. 3259. State administration. 
Sec. 3260. Local application. 
Sec. 3261. Local administration. 
Sec. 3262. Use of funds. 
Sec. 3263. Repeal. 
Sec. 3264. Effective date. 
CHAPTER 5—CHILD CARE FACILITIES FINANCING 
Sec. 3271. Short title. 
Sec. 3272. Technical and financial assistance grants. 
Subtitle D—Head Start Access and Improvement 
Sec. 3301. Authorization of appropriations. 
Subtitle E—Education Improvements 
CHAPTER 1—INCREASING ACCESS TO QUALITY PREKINDERGARTEN 
PROGRAMS 
Sec. 3401. Prekindergarten programs. 
CHAPTER 2—INCREASING THE AVAILABILITY OF BOOKS 
Sec. 3411. Short title. 
Sec. 3412. Findings. 
Sec. 3413. Definitions. 
Sec. 3414. Grants to State agencies. 
Sec. 3415. Contracts 
to 
child 
care 
resource 
and
referral agencies. 
Sec. 3416. Use of funds. 
Sec. 3417. Report to Congress. 
Sec. 3418. Special postage stamps for child literacy. 
Sec. 3419. Authorization of appropriations. 
CHAPTER 3—QUALITY TEACHING AND LEADERSHIP 
SUBCHAPTER A—AMENDMENT TO TITLE II OF THE ELEMENTARY AND 
SECONDARY EDUCATION ACT OF 1965
Sec. 3421. Amendments to title II. 
SUBCHAPTER B—NATIONAL BOARD CERTIFICATION PROGRAM 
Sec. 3431. Purpose. 
Sec. 3432. Grants to expand participation in the national board certification 
program. 
SUBCHAPTER C—STUDENT LOAN FORGIVENESS FOR TEACHERS 
Sec. 3441. Student loan forgiveness for teachers. 
CHAPTER 4—SCHOOL CONSTRUCTION 
SUBCHAPTER A—SCHOOL MODERNIZATION BONDS 
Sec. 3451. Short title. 
Sec. 3452. Expansion of incentives for public schools.
Sec. 3453. Application of certain labor standards on construction projects fi-
nanced under public school modernization program. 
SUBCHAPTER B—SCHOOLS AS CENTERS OF THE COMMUNITY 
Sec. 3461. Findings. 
Sec. 3462. Purpose. 
Sec. 3463. Program authorized. 
Sec. 3464. Use of funds. 
Sec. 3465. Applications. 
Sec. 3466. Authorization of appropriations. 
CHAPTER 5—CHILD OPPORTUNITY ZONE FAMILY CENTERS 
Sec. 3471. Child opportunity zone family centers. 
TITLE IV—FAIR START—LIFTING CHILDREN OUT OF POVERTY 
Subtitle A—Expanding the Child Tax Credit 
Sec. 4001. Expansion of child tax credit; credit made partially refundable. 
Subtitle B—Strengthening the Earned Income Tax Credit 
Sec. 4101. Short title. 
Sec. 4102. Increased earned income tax credit for 2 or more qualifying chil-
dren. 
Sec. 4103. Simplification of definition of earned income. 
Sec. 4104. Simplification of definition of child dependent. 
Sec. 4105. Modification of joint return requirement for earned income tax cred-
it. 
Subtitle C—Expanding the Dependent Care Tax Credit 
Sec. 4201. Dependent care tax credit. 
TITLE V—FAIR START—SUPPORT TO PROMOTE WORK AND 
REDUCE POVERTY 
Subtitle A—Gateways Grant Program 
Sec. 5001. Gateways grant program. 
Subtitle B—Support From Both Parents 
CHAPTER 1—CHILD SUPPORT DISTRIBUTION 
Sec. 5101. Short title. 
SUBCHAPTER A—DISTRIBUTION OF CHILD SUPPORT 
Sec. 5111. Distribution of child support collected by States on behalf of chil-
dren receiving certain welfare benefits. 
SUBCHAPTER B—REVIEW AND ADJUSTMENT OF CHILD SUPPORT ORDERS 
Sec. 5116. Mandatory review and modification of child support orders for 
TANF recipients.
SUBCHAPTER C—DEMONSTRATIONS OF EXPANDED INFORMATION AND 
ENFORCEMENT 
Sec. 5121. Guidelines for involvement of public non-IV-D child support enforce-
ment agencies in child support enforcement. 
Sec. 5122. Demonstrations involving establishment and enforcement of child 
support obligations by public non-IV-D child support enforce-
ment agencies. 
Sec. 5123. GAO report to Congress on private child support enforcement agen-
cies. 
Sec. 5124. Effective date. 
SUBCHAPTER D—EXPANDED ENFORCEMENT 
Sec. 5126. Decrease in amount of child support arrearage triggering passport 
denial. 
Sec. 5127. Use of tax refund intercept program to collect past-due child sup-
port on behalf of children who are not minors. 
Sec. 5128. Garnishment of compensation paid to veterans for service-connected 
disabilities in order to enforce child support obligations. 
SUBCHAPTER E—MISCELLANEOUS 
Sec. 5131. Report on undistributed child support payments. 
Sec. 5132. Use of new hire information to assist in administration of unemploy-
ment compensation programs. 
Sec. 5133. Immigration provisions. 
Sec. 5134. Correction of errors in conforming amendments in the Welfare-to-
Work and Child Support Amendments of 1999. 
Sec. 5135. Increase in payment rate to States for expenditures for short-term 
training of staff of certain child welfare agencies. 
Sec. 5136. Effective date. 
CHAPTER 2—CHILD SUPPORT DEMONSTRATION PROGRAMS 
Sec. 5141. Short title. 
Sec. 5142. Purposes. 
Sec. 5143. Definitions. 
Sec. 5144. Establishment of child support assurance demonstration projects. 
Subtitle C—Fair Wages and Unemployment Insurance 
CHAPTER 1—FAIR MINIMUM WAGE 
Sec. 5201. Short title. 
Sec. 5202. Minimum wage. 
Sec. 5203. Applicability of minimum wage to the commonwealth of the northern 
mariana islands. 
CHAPTER 2—LIVABLE WAGES FOR EMPLOYEES UNDER FEDERAL 
CONTRACTS 
Sec. 5211. Short title. 
Sec. 5212. Findings. 
Sec. 5213. Poverty level wage. 
Sec. 5214. Effective date. 
CHAPTER 3—UNEMPLOYMENT INSURANCE
Sec. 5221. Parity for part-time workers, fair counting of wages, and use of im-
proved technology for making wage data available. 
Sec. 5222. Ensuring unemployment compensation for individuals that are sepa-
rated from employment due to domestic violence. 
Sec. 5223. Loss of child care as good cause for leaving employment. 
Subtitle D—Jobs for Low-Income Parents 
Sec. 5301. Disregard of months engaged in work for purposes of 5-year TANF 
assistance limit. 
Sec. 5302. Replacement of caseload reduction credit with employment credit. 
Sec. 5303. States to receive partial credit toward work participation rate for re-
cipients engaged in part-time work. 
Sec. 5304. TANF recipients who qualify for supplemental security income bene-
fits removed from work participation rate calculation for entire 
year. 
Sec. 5305. Elimination of limit on number of TANF recipients enrolled in voca-
tional education or high school who may be counted towards 
the work participation requirement. 
Sec. 5306. Counting of up to 2 years of vocational or educational training (in-
cluding postsecondary education), work-study, and related in-
ternships as work activities. 
Sec. 5307. Limited counting of certain activities leading to employment as work 
activity. 
Sec. 5308. Elimination of separate work participation rate for 2-parent fami-
lies. 
Sec. 5309. Addition of poverty reduction bonus to TANF. 
Sec. 5310. Participation in workforce investment boards. 
Sec. 5311. Clarification of TANF purpose. 
Sec. 5312. Effective date. 
Subtitle E—Incentives to Serve Families 
Sec. 5401. Development of model caseworker training materials. 
Sec. 5402. Exception to limit on TANF administrative expenditures for case-
worker bonuses and other State initiatives to eliminate barriers 
to work. 
Sec. 5403. Strengthening of TANF individual responsibility plans. 
Sec. 5404. Effective date. 
Subtitle F—Addressing Work Barriers 
Sec. 5501. Funding for access to jobs program. 
Sec. 5502. Requirement to identify and provide services to address barriers to 
employment of TANF recipients. 
Sec. 5503. State option to establish exceptions from time limit for receipt of 
TANF assistance based on severe barriers to employment. 
Sec. 5504. Effective date. 
Subtitle G—Protection for Families in Need 
Sec. 5601. Earn-back of months of TANF assistance. 
Sec. 5602. Establishment of a fair conciliation process for families under 
TANF. 
Sec. 5603. Treatment of aliens under the TANF program. 
Sec. 5604. Effective date.
Subtitle H—TANF Reauthorization 
Sec. 5701. Reauthorization of TANF State family assistance grants. 
Sec. 5702. Prohibition on supplantation of TANF funds. 
TITLE VI—FAIR START 
Subtitle A—Child and Adult Care Food Program 
Sec. 6001. Participation of for-profit care centers in child and adult care food 
program. 
Sec. 6002. Categorical eligibility requirements. 
Sec. 6003. Increase in administrative reimbursement rates. 
Sec. 6004. Program for at-risk school children. 
Subtitle B—Food Stamp Program 
Sec. 6101. Restoration of food stamp benefits for qualified aliens. 
Sec. 6102. Conforming food stamp and medicaid income definitions; simplified 
income calculations. 
Sec. 6103. Prevention of hunger among families with children. 
Sec. 6104. Encouragement of collection of child support. 
Sec. 6105. Elimination of excess shelter expense deduction cap for families with 
high shelter costs. 
Sec. 6106. Periodic redetermination of eligibility. 
Sec. 6107. Transitional benefits option. 
Sec. 6108. Improving State incentives to serve working families. 
TITLE VII—FAIR START HOUSING 
Subtitle A—Section 8 Vouchers 
Sec. 7001. Rental assistance voucher program. 
Sec. 7002. Voucher success fund. 
Subtitle B—National Affordable Housing Trust Fund 
Sec. 7101. Purposes. 
Sec. 7102. National Affordable Housing Trust Fund. 
Sec. 7103. Administration of National Affordable Housing Trust Fund. 
Sec. 7104. Regulations. 
Subtitle C—Housing Preservation Matching Grants 
Sec. 7201. Short title. 
Sec. 7202. Findings and purposes. 
Sec. 7203. Definitions. 
Sec. 7204. Authority. 
Sec. 7205. Applications. 
Sec. 7206. Use of grants. 
Sec. 7207. Grant amount limitation. 
Sec. 7208. Matching requirements. 
Sec. 7209. Treatment of subsidy layering requirements. 
Sec. 7210. Regulations. 
Sec. 7211. Authorization of appropriations. 
TITLE VIII—SAFE START
Subtitle A—Promotion of Permanency for Children 
Sec. 8001. Reimbursement for preventive, protective, crisis, permanency, inde-
pendent living, and post-permanency services and activities. 
Sec. 8002. Child and family service plan and case reviews. 
Sec. 8003. Kinship guardianship assistance payments for children. 
Sec. 8004. Elimination of financial eligibility requirement for foster care main-
tenance and adoption assistance payments. 
Sec. 8005. Establishment of uniform Federal matching rate. 
Sec. 8006. Elimination of disincentive for foster parents to adopt children with 
special needs who have been in their foster care. 
Sec. 8007. Extension of adoption assistance payments. 
Sec. 8008. Reimbursement for room and board in foster family homes, child 
care institutions, or supervised living arrangements for young 
people aging out of foster care. 
Sec. 8009. Additional accountability. 
Sec. 8010. Authority of indian tribes to receive Federal funds for foster care 
and adoption assistance. 
Subtitle B—Social Services Block Grant 
Sec. 8101. Short title. 
Sec. 8102. Findings. 
Sec. 8103. Restoration of authority to transfer up to 10 percent of TANF 
funds to the Social Services Block Grant. 
Sec. 8104. Restoration of funds for the Social Services Block Grant. 
Sec. 8105. Requirement to submit annual report on State activities. 
Subtitle C—Child Protection and Alcohol and Drug Partnerships 
Sec. 8201. Short title. 
Sec. 8202. Child protection/alcohol and drug partnerships for children. 
Subtitle D—Permanency Grants 
Sec. 8301. Establishment of permanency grants program. 
Subtitle E—Addressing the Needs of Children Exposed to Domestic Violence 
Sec. 8401. Findings. 
Sec. 8402. Purpose. 
Sec. 8403. Amendments to Acts addressing the needs of children exposed to do-
mestic violence. 
Subtitle F—Enhancing Healthy Emotional Development in Young Children 
Sec. 8501. Enhancing healthy emotional development. 
TITLE IX—SUCCESSFUL TRANSITION TO ADULTHOOD 
Subtitle A—Youth Development 
CHAPTER 1—SHORT TITLE; POLICY; DEFINITIONS 
Sec. 9001. Short title. 
Sec. 9002. A national youth policy. 
Sec. 9003. Definitions. 
CHAPTER 2—GRANTS FOR STATE AND COMMUNITY PROGRAMS
Sec. 9101. Purpose. 
Sec. 9102. Authorization of appropriations. 
Sec. 9103. Allotments to States. 
Sec. 9104. State youth development agencies and youth development areas. 
Sec. 9105. State youth development plans. 
Sec. 9106. Distribution of funds for State activities and area allocations. 
Sec. 9107. Youth development consortia. 
Sec. 9108. Area youth development plans. 
Sec. 9109. Grants and contracts to eligible entities. 
Sec. 9110. Eligible entities. 
Sec. 9111. Applications. 
Sec. 9112. Youth development programs. 
CHAPTER 3—ACCOUNTABILITY 
Sec. 9201. Purposes. 
Sec. 9202. Federal level accountability. 
Sec. 9203. State level accountability. 
Sec. 9204. Local level accountability. 
Sec. 9205. State audit. 
CHAPTER 4—TRAINING, RESEARCH, AND EVALUATION 
Sec. 9301. Purpose. 
Sec. 9302. Grants and contracts. 
Sec. 9303. Authorization of appropriations. 
Subtitle E—Coordination of National Youth Policy 
Sec. 9401. Coordinating Council for National Youth Policy. 
Subtitle B—Youth Programs 
Sec. 9201. Americorps. 
Sec. 9202. Youthbuild program. 
Sec. 9203. Youth workforce investment activities. 
Sec. 9204. Transition training for reintegrating youth offenders. 
TITLE X—SAFE START—JUVENILE JUSTICE 
Subtitle A—Juvenile Delinquency Prevention and Protection 
Sec. 10001. Definition of juvenile. 
Sec. 10002. State plan allocation. 
Sec. 10003. State plan requirements. 
Subtitle B—Mental Health Juvenile Justice 
Sec. 10101. Short title. 
Sec. 10102. Training of justice system personnel. 
Sec. 10103. Block grant funding for treatment and diversion programs. 
Sec. 10104. Initiative for comprehensive, intersystem programs. 
Sec. 10105. Federal Coordinating Council on the Criminalization of Juveniles 
With Mental Disorders. 
Sec. 10106. Mental health screening and treatment for prisoners. 
Sec. 10107. Inapplicability of amendments. 
Subtitle C—Juvenile Justice and Accountability
Sec. 10201. Increase in funding for title III of the JJDPA. 
Sec. 10202. Funding for the services for youthful offenders. 
TITLE XI—SAFE START—GUN SAFETY 
Subtitle A—Closing the Gun Show Loophole 
Sec. 11001. Extension of Brady background checks to gun shows. 
Subtitle B—Child Safety Locks 
Sec. 11101. Requirement of child handgun safety locks. 
Subtitle C—Unlawful Weapons Transfers 
Sec. 11201. Unlawful weapons transfers to juveniles. 
Subtitle D—Large Capacity Ammunition Feeding Devices 
Sec. 11301. Ban on importing large capacity ammunition feeding devices. 
Subtitle E—Enforcement of Gun Laws 
Sec. 11401. Enhance enforcement of gun violence laws.
Subtitle F—Miscellaneous 
Sec. 11501. Study of marketing practices of the firearms industry. 
Sec. 11502. Regulation of internet firearms transfers. 
Sec. 11503. Reduction of gun trafficking. 
TITLE XII—MISCELLANEOUS 
Sec. 12001. Advisory Committee on Private Sector Support for Children and 
Families. 
Sec. 12002. Improvement of data collection and reporting regarding children 
and families.
TITLE 
I—HEALTHY 
START—
CHILDREN’S HEALTH INSUR-
ANCE 
Subtitle A—Children’s Health 
Insurance 
SEC. 1001. MEDIKIDS HEALTH INSURANCE. 
(a) SHORT TITLE OF SUBTITLE.—This subtitle may 
be cited as the ‘‘MediKids Health Insurance Act of 2003’’.
(b) FINDINGS.—Congress finds the following:
(1) More than 11 million American children are 
uninsured. 
(2) Children who are uninsured receive less 
medical care and less preventive care and have a 
poorer level of health, which result in lifetime costs 
to themselves and to the entire American economy. 
(3) Although SCHIP and Medicaid are success-
fully extending a health coverage safety net to a 
growing portion of the vulnerable low-income popu-
lation of uninsured children, we now see that they 
alone cannot achieve 100 percent health insurance 
coverage for our nation’s children due to inevitable 
gaps during outreach and enrollment, fluctuations in 
eligibility, and variations in access to private insur-
ance at all income levels. 
(4) As all segments of our society continue to 
become more and more transient, with many 
changes in employment over the working lifetime of 
parents, the need for a reliable safety net of health 
insurance which follows children across State lines, 
already a major problem for the children of migrant 
and seasonal farmworkers, will become a major con-
cern for all families in the United States. 
(5) The Medicare program has successfully 
evolved over the years to provide a stable, universal
source of health insurance for the nation’s disabled 
and those over age 65, and therefore provides a test-
ed model for designing a program to reach out to 
America’s children. 
(6) The problem of insuring 100 percent of all 
American children could be gradually solved by auto-
matically enrolling all children born after December 
31, 2004, in a program modeled after Medicare (and 
to be known as ‘‘MediKids’’), and allowing those 
children to be transferred into other equivalent or 
better insurance programs, including either private 
insurance, SCHIP, or Medicaid, if they are eligible 
to do so, but maintaining the child’s default enroll-
ment in MediKids for any times when the child’s ac-
cess to other sources of insurance is lost. 
(7) A family’s freedom of choice to use other in-
surers to cover children would not be interfered with 
in any way, and children eligible for SCHIP and 
Medicaid would continue to be enrolled in those pro-
grams, but the underlying safety net of MediKids 
would always be available to cover any gaps in insur-
ance due to changes in medical condition, employ-
ment, income, or marital status, or other changes af-
fecting a child’s access to alternate forms of insur-
ance.
(8) The MediKids program can be administered 
without impacting the finances or status of the exist-
ing Medicare program. 
(9) The MediKids benefit package can be tai-
lored to the special needs of children and updated 
over time. 
(10) The financing of the program can be ad-
ministered without difficulty by a yearly payment of 
affordable premiums through a family’s tax filing (or 
adjustment of a family’s earned income tax credit). 
(11) The cost of the program will gradually rise 
as the number of children using MediKids as the in-
surer of last resort increases, and a future Congress 
always can accelerate or slow down the enrollment 
process as desired, while the societal costs for emer-
gency room usage, lost productivity and work days, 
and poor health status for the next generation of 
Americans will decline. 
(12) Over time 100 percent of American chil-
dren will always have basic health insurance, and we 
can therefore expect a healthier, more equitable, and 
more productive society.
SEC. 1002. BENEFITS FOR ALL CHILDREN BORN AFTER 
2002. 
(a) IN GENERAL.—The Social Security Act is amend-
ed by adding at the end the following new title: 
‘‘TITLE XXII—MEDIKIDS PROGRAM 
‘‘SEC. 2201. ELIGIBILITY. 
‘‘(a) ELIGIBILITY OF INDIVIDUALS BORN AFTER DE-
CEMBER 31, 2004; ALL CHILDREN UNDER 23 YEARS OF 
AGE IN SIXTH YEAR.—An individual who meets the fol-
lowing requirements with respect to a month is eligible to 
enroll under this title with respect to such month: 
‘‘(1) AGE.—
‘‘(A) FIRST YEAR.—During the first year 
in which this title is effective, the individual has 
not attained 6 years of age.
‘‘(B) SECOND YEAR.—During the second 
year in which this title is effective, the indi-
vidual has not attained 11 years of age. 
‘‘(C) THIRD YEAR.—During the third year 
in which this title is effective, the individual has 
not attained 16 years of age. 
‘‘(D) FOURTH YEAR.—During the fourth 
year in which this title is effective, the indi-
vidual has not attained 21 years of age. 
‘‘(E) FIFTH AND SUBSEQUENT YEARS.—
During the fifth year in which this title is effec-
tive and each subsequent year, the individual 
has not attained 23 years of age. 
‘‘(2) CITIZENSHIP.—The individual is a citizen 
or national of the United States or is lawfully resid-
ing in the United States. 
‘‘(b) ENROLLMENT PROCESS.—An individual may 
enroll in the program established under this title only in 
such manner and form as may be prescribed by regula-
tions, and only during an enrollment period prescribed by 
the Secretary consistent with the provisions of this section. 
Such regulations shall provide a process under which—
‘‘(1) individuals who are born in the United 
States after December 31, 2002, are deemed to be 
enrolled at the time of birth and a parent or guard-
ian of such an individual is permitted to pre-enroll 
in the month prior to the expected month of birth; 
‘‘(2) individuals who are born outside the 
United States after such date and who become eligi-
ble to enroll by virtue of immigration into (or an ad-
justment of immigration status in) the United 
States are deemed enrolled at the time of entry or 
adjustment of status; 
‘‘(3) eligible individuals may otherwise be en-
rolled at such other times and manner as the Sec-
retary shall specify, including the use of outstationed
eligibility 
sites 
as 
described 
in 
section 
1902(a)(55)(A) and the use of presumptive eligi-
bility provisions like those described in section 
1920A; and 
‘‘(4) at the time of automatic enrollment of a 
child, the Secretary provides for issuance to a parent 
or custodian of the individual a card evidencing cov-
erage under this title and for a description of such 
coverage. 
The provisions of section 1837(h) apply with respect to 
enrollment under this title in the same manner as they 
apply to enrollment under part B of title XVIII. 
‘‘(c) DATE COVERAGE BEGINS.—
‘‘(1) IN GENERAL.—The period during which 
an individual is entitled to benefits under this title 
shall begin as follows, but in no case earlier than 
January 1, 2005: 
‘‘(A) In the case of an individual who is 
enrolled under paragraph (1) or (2) of sub-
section (b), the date of birth or date of obtain-
ing appropriate citizenship or immigration sta-
tus, as the case may be. 
‘‘(B) In the case of an another individual 
who enrolls (including pre-enrolls) before the 
month in which the individual satisfies eligi-
bility for enrollment under subsection (a), the 
first day of such month of eligibility. 
‘‘(C) In the case of an another individual 
who enrolls during or after the month in which 
the individual first satisfies eligibility for enroll-
ment under such subsection, the first day of the 
following month. 
‘‘(2) AUTHORITY
TO
PROVIDE
FOR
PARTIAL 
MONTHS
OF
COVERAGE.—Under regulations, the 
Secretary may, in the Secretary’s discretion, provide 
for coverage periods that include portions of a 
month in order to avoid lapses of coverage. 
‘‘(3) LIMITATION ON PAYMENTS.—No payments 
may be made under this title with respect to the ex-
penses of an individual enrolled under this title un-
less such expenses were incurred by such individual 
during a period which, with respect to the individual, 
is a coverage period under this section. 
‘‘(d) EXPIRATION OF ELIGIBILITY.—An individual’s 
coverage period under this part shall continue until the 
individual’s enrollment has been terminated because the 
individual no longer meets the requirements of subsection 
(a) (whether because of age or change in immigration sta-
tus).
‘‘(e) ENTITLEMENT TO MEDIKIDS BENEFITS FOR 
ENROLLED INDIVIDUALS.—An individual enrolled under 
this section is entitled to the benefits described in section 
2202. 
‘‘(f) LOW-INCOME INFORMATION.—At the time of en-
rollment of a child under this title, the Secretary shall 
make an inquiry as to whether or not the family income 
of the family that includes the child is less than 150 per-
cent of the poverty line for a family of the size involved. 
If the family income is below such level, the Secretary shall 
encode in the identification card issued in connection with 
eligibility under this title a code indicating such fact. The 
Secretary also shall provide for a toll-free telephone line 
at which providers can verify whether or not such a child 
is in a family the income of which is below such level. 
‘‘(g) CONSTRUCTION.—Nothing in this title shall be 
construed as requiring (or preventing) an individual who 
is enrolled under this section from seeking medical assist-
ance under a State medicaid plan under title XIX or child 
health assistance under a State child health plan under 
title XXI. 
‘‘SEC. 2202. BENEFITS. 
‘‘(a) SECRETARIAL
SPECIFICATION
OF
BENEFIT 
PACKAGE.—
provisions of this section) at least the same benefits 
(including coverage, access, availability, duration, 
and beneficiary rights) that are available under 
parts A and B of title XVIII. 
‘‘(2) ALL
REQUIRED
MEDICAID
BENEFITS.—
Such benefits shall also include all items and serv-
ices for which medical assistance is required to be 
provided under section 1902(a)(10)(A) to individuals 
described in such section, including early and peri-
odic screening, diagnostic services, and treatment 
services. 
‘‘(3) INCLUSION
OF
PRESCRIPTION
DRUGS.—
Such benefits also shall include (as specified by the 
Secretary) prescription drugs and biologicals. 
‘‘(4) COST-SHARING.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), such benefits also shall include the 
cost-sharing (in the form of deductibles, coin-
surance, and copayments) applicable under title 
XVIII with respect to comparable items and 
services, except that no cost-sharing shall be 
imposed with respect to early and periodic 
screening and diagnostic services included 
under paragraph (2).
‘‘(B) NO COST-SHARING FOR LOWEST IN-
COME CHILDREN.—Such benefits shall not in-
clude any cost-sharing for children in families 
the income of which (as determined for pur-
poses of section 1905(p)) does not exceed 150 
percent of the official income poverty line (re-
ferred to in such section) applicable to a family 
of the size involved. 
‘‘(C) REFUNDABLE
CREDIT
FOR
COST-
SHARING
FOR
OTHER
LOW-INCOME
CHIL-
DREN.—For a refundable credit for cost-shar-
ing in the case of children in certain families, 
see section 35A of the Internal Revenue Code 
of 1986. 
‘‘(c) PAYMENT SCHEDULE.—The Secretary, with the 
assistance of the Medicare Payment Advisory Commission, 
shall develop and implement a payment schedule for bene-
fits covered under this title. To the extent feasible, such 
payment schedule shall be consistent with comparable pay-
ment schedules and reimbursement methodologies applied 
under parts A and B of title XVIII. 
‘‘(d) INPUT.—The Secretary shall specify such bene-
fits and payment schedules only after obtaining input from 
appropriate child health providers and experts.
‘‘(e) ENROLLMENT IN HEALTH PLANS.—The Sec-
retary shall provide for the offering of benefits under this 
title through enrollment in a health benefit plan that 
meets the same (or similar) requirements as the require-
ments that apply to Medicare+Choice plans under part 
C of title XVIII. In the case of individuals enrolled under 
this title in such a plan, the Medicare+Choice capitation 
rate described in section 1853(c) shall be adjusted in an 
appropriate manner to reflect differences between the pop-
ulation served under this title and the population under 
title XVIII. 
‘‘SEC. 2203. PREMIUMS. 
‘‘(a) AMOUNT OF MONTHLY PREMIUMS.—
‘‘(1) IN GENERAL.—The Secretary shall, during 
September of each year (beginning with 2004), es-
tablish a monthly MediKids premium. Subject to 
paragraph (2), the monthly MediKids premium for 
a year is equal to 1⁄12 of the annual premium rate 
computed under subsection (b). 
‘‘(2) ELIMINATION OF MONTHLY PREMIUM FOR 
DEMONSTRATION
OF
EQUIVALENT
COVERAGE
(IN-
CLUDING
COVERAGE
UNDER
LOW-INCOME
PRO-
GRAMS).—The amount of the monthly premium im-
posed under this section for an individual for a 
month shall be zero in the case of an individual who
demonstrates to the satisfaction of the Secretary 
that the individual has basic health insurance cov-
erage for that month the actuarial value of which, 
as determined by the Secretary, is at least actuari-
ally equivalent to the benefits available under this 
title. For purposes of the previous sentence enroll-
ment in a medicaid plan under title XIX, a State 
child health insurance plan under title XXI, or 
under the medicare program under title XVIII is 
deemed to constitute basic health insurance coverage 
described in such sentence.
‘‘(b) ANNUAL PREMIUM.—
‘‘(1) NATIONAL, PER
CAPITA
AVERAGE.—The 
Secretary shall estimate the average, annual per 
capita amount that would be payable under this title 
with respect to individuals residing in the United 
States who meet the requirement of section 
2201(a)(1) as if all such individuals were eligible for 
(and enrolled) under this title during the entire year 
(and assuming that section 1862(b)(2)(A)(i) did not 
apply). 
‘‘(2) ANNUAL PREMIUM.—Subject to subsection 
(d), the annual premium under this subsection for 
months in a year is equal to 25 percent of the aver-
age, annual per capita amount estimated under 
paragraph (1) for the year. 
‘‘(c) PAYMENT OF MONTHLY PREMIUM.—
‘‘(1) PERIOD OF PAYMENT.—In the case of an 
individual who participates in the program estab-
lished by this title, subject to subsection (d), the 
monthly premium shall be payable for the period 
commencing with the first month of the individual’s 
coverage period and ending with the month in which 
the individual’s coverage under this title terminates. 
‘‘(2) COLLECTION
THROUGH
TAX
RETURN.—
For provisions providing for the payment of monthly 
premiums under this subsection, see section 59B of 
the Internal Revenue Code of 1986. 
‘‘(3) 
PROTECTIONS
AGAINST
FRAUD
AND 
ABUSE.—The Secretary shall develop, in coordina-
tion with States and other health insurance issuers, 
administrative systems to ensure that claims which 
are submitted to more than one payor are coordi-
nated and duplicate payments are not made. 
‘‘(d) REDUCTION IN PREMIUM FOR CERTAIN LOW-
INCOME FAMILIES.—For provisions reducing the premium 
under this section for certain low-income families, see sec-
tion 59B(c) of the Internal Revenue Code of 1986.
‘‘SEC. 2204. MEDIKIDS TRUST FUND. 
‘‘(a) ESTABLISHMENT OF TRUST FUND.—
‘‘(1) IN GENERAL.—There is hereby created on 
the books of the Treasury of the United States a 
trust fund to be known as the ‘MediKids Trust 
Fund’ (in this section referred to as the ‘Trust 
Fund’). The Trust Fund shall consist of such gifts 
and bequests as may be made as provided in section 
201(i)(1) and such amounts as may be deposited in, 
or appropriated to, such fund as provided in this 
title. 
‘‘(2) PREMIUMS.—Premiums collected under 
section 2203 shall be transferred to the Trust Fund. 
‘‘(b) INCORPORATION OF PROVISIONS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
subsections (b) through (i) of section 1841 shall 
apply with respect to the Trust Fund and this title 
in the same manner as they apply with respect to 
the Federal Supplementary Medical Insurance Trust 
Fund and part B, respectively. 
‘‘(2) MISCELLANEOUS REFERENCES.—In apply-
ing provisions of section 1841 under paragraph 
(1)—
‘‘(A) any reference in such section to ‘this 
part’ is construed to refer to title XXII;
‘‘(B) any reference in section 1841(h) to 
section 1840(d) and in section 1841(i) to sec-
tions 1840(b)(1) and 1842(g) are deemed ref-
erences to comparable authority exercised under 
this title; 
‘‘(C) payments may be made under section 
1841(g) to the Trust Funds under sections 
1817 and 1841 as reimbursement to such funds 
for payments they made for benefits provided 
under this title; and 
‘‘(D) the Board of Trustees of the 
MediKids Trust Fund shall be the same as the 
Board of Trustees of the Federal Supple-
mentary Medical Insurance Trust Fund. 
‘‘SEC. 2205. OVERSIGHT AND ACCOUNTABILITY. 
‘‘(a) THROUGH ANNUAL REPORTS OF TRUSTEES.—
The Board of Trustees of the MediKids Trust Fund under 
section 2204(b)(1) shall report on an annual basis to Con-
gress concerning the status of the Trust Fund and the 
need for adjustments in the program under this title to 
maintain financial solvency of the program under this 
title. 
‘‘(b) PERIODIC GAO REPORTS.—The Comptroller 
General of the United States shall periodically submit to 
Congress reports on the adequacy of the financing of cov-
erage provided under this title. The Comptroller General 
shall include in such report such recommendations for ad-
justments in such financing and coverage as the Comp-
troller General deems appropriate in order to maintain fi-
nancial solvency of the program under this title. 
‘‘SEC. 2206. INCLUSION OF CARE COORDINATION SERVICES. 
‘‘(a) IN GENERAL.—
‘‘(1) PROGRAM
AUTHORITY.—The Secretary, 
beginning in 2004, may implement a care coordina-
tion services program in accordance with the provi-
sions of this section under which, in appropriate cir-
cumstances, eligible individuals may elect to have 
health care services covered under this title managed 
and coordinated by a designated care coordinator. 
‘‘(2) ADMINISTRATION
BY
CONTRACT.—The 
Secretary may administer the program under this 
section through a contract with an appropriate pro-
gram administrator. 
‘‘(3) COVERAGE.—Care coordination services 
furnished in accordance with this section shall be 
treated under this title as if they were included in 
the definition of medical and other health services 
under section 1861(s) and benefits shall be available 
under this title with respect to such services without 
the application of any deductible or coinsurance.
‘‘(b) ELIGIBILITY CRITERIA; IDENTIFICATION AND 
NOTIFICATION OF ELIGIBLE INDIVIDUALS.—
‘‘(1) INDIVIDUAL ELIGIBILITY CRITERIA.—The 
Secretary shall specify criteria to be used in making 
a determination as to whether an individual may ap-
propriately be enrolled in the care coordination serv-
ices program under this section, which shall include 
at least a finding by the Secretary that for cohorts 
of individuals with characteristics identified by the 
Secretary, professional management and coordina-
tion of care can reasonably be expected to improve 
processes or outcomes of health care and to reduce 
aggregate costs to the programs under this title.
‘‘(2) PROCEDURES
TO
FACILITATE
ENROLL-
MENT.—The Secretary shall develop and implement 
procedures designed to facilitate enrollment of eligi-
ble individuals in the program under this section. 
‘‘(c) ENROLLMENT OF INDIVIDUALS.—
‘‘(1) SECRETARY’S DETERMINATION OF ELIGI-
BILITY.—The Secretary shall determine the eligi-
bility for services under this section of individuals 
who are enrolled in the program under this section 
and who make application for such services in such 
form and manner as the Secretary may prescribe. 
‘‘(2) ENROLLMENT PERIOD.—
‘‘(A) EFFECTIVE DATE AND DURATION.—
Enrollment of an individual in the program 
under this section shall be effective as of the 
first day of the month following the month in 
which the Secretary approves the individual’s 
application under paragraph (1), shall remain 
in effect for one month (or such longer period 
as the Secretary may specify), and shall be 
automatically renewed for additional periods, 
unless terminated in accordance with such pro-
cedures as the Secretary shall establish by regu-
lation. Such procedures shall permit an indi-
vidual to disenroll for cause at any time and 
without cause at re-enrollment intervals. 
‘‘(B) LIMITATION
ON
REENROLLMENT.—
The Secretary may establish limits on an indi-
vidual’s eligibility to reenroll in the program 
under this section if the individual has 
disenrolled from the program more than once 
during a specified time period. 
‘‘(d) PROGRAM.—The care coordination services pro-
gram under this section shall include the following ele-
ments: 
‘‘(1) BASIC CARE COORDINATION SERVICES.—
‘‘(A) IN GENERAL.—Subject to the cost-ef-
fectiveness criteria specified in subsection 
(b)(1), except as otherwise provided in this sec-
tion, enrolled individuals shall receive services 
described in section 1905(t)(1) and may receive 
additional items and services as described in 
subparagraph (B). 
‘‘(B) ADDITIONAL
BENEFITS.—The Sec-
retary may specify additional benefits for which 
payment would not otherwise be made under 
this title that may be available to individuals 
enrolled in the program under this section (sub-
ject to an assessment by the care coordinator of 
an individual’s circumstance and need for such 
benefits) in order to encourage enrollment in, or 
to improve the effectiveness of, such program. 
‘‘(2) CARE
COORDINATION
REQUIREMENT.—
Notwithstanding any other provision of this title, the 
Secretary may provide that an individual enrolled in 
the program under this section may be entitled to 
payment under this title for any specified health 
care items or services only if the items or services 
have been furnished by the care coordinator, or co-
ordinated through the care coordination services pro-
gram. Under such provision, the Secretary shall pre-
scribe exceptions for emergency medical services as 
described in section 1852(d)(3), and other excep-
tions determined by the Secretary for the delivery of 
timely and needed care. 
‘‘(e) CARE COORDINATORS.—
‘‘(1) CONDITIONS OF PARTICIPATION.—In order 
to be qualified to furnish care coordination services 
under this section, an individual or entity shall—
‘‘(A) be a health care professional or entity 
(which may include physicians, physician group 
practices, or other health care professionals or 
entities the Secretary may find appropriate) 
meeting such conditions as the Secretary may 
specify; 
‘‘(B) have entered into a care coordination 
agreement; and 
‘‘(C) meet such criteria as the Secretary 
may establish (which may include experience in 
the provision of care coordination or primary 
care physician’s services). 
‘‘(2) AGREEMENT TERM; PAYMENT.—
‘‘(A) DURATION AND RENEWAL.—A care 
coordination agreement under this subsection 
shall be for one year and may be renewed if the 
Secretary is satisfied that the care coordinator
continues to meet the conditions of participa-
tion specified in paragraph (1). 
‘‘(B) PAYMENT FOR SERVICES.—The Sec-
retary may negotiate or otherwise establish pay-
ment terms and rates for services described in 
subsection (d)(1). 
‘‘(C) LIABILITY.—Case coordinators shall 
be subject to liability for actual health damages 
which may be suffered by recipients as a result 
of the care coordinator’s decisions, failure or 
delay in making decisions, or other actions as 
a care coordinator. 
‘‘(D) TERMS.—In addition to such other 
terms as the Secretary may require, an agree-
ment under this section shall include the terms 
specified in subparagraphs (A) through (C) of 
section 1905(t)(3). 
‘‘SEC. 2207. ADMINISTRATION AND MISCELLANEOUS. 
‘‘(a) IN GENERAL.—Except as otherwise provided in 
this title—
‘‘(1) the Secretary shall enter into appropriate 
contracts with providers of services, other health 
care providers, carriers, and fiscal intermediaries, 
taking into account the types of contracts used
under title XVIII with respect to such entities, to 
administer the program under this title; 
‘‘(2) individuals enrolled under this title shall 
be treated for purposes of title XVIII as though the 
individual were entitled to benefits under part A and 
enrolled under part B of such title; 
‘‘(3) benefits described in section 2202 that are 
payable under this title to such individuals shall be 
paid in a manner specified by the Secretary (taking 
into account, and based to the greatest extent prac-
ticable upon, the manner in which they are provided 
under title XVIII);
‘‘(4) provider participation agreements under 
title XVIII shall apply to enrollees and benefits 
under this title in the same manner as they apply 
to enrollees and benefits under title XVIII; and 
‘‘(5) individuals entitled to benefits under this 
title may elect to receive such benefits under health 
plans in a manner, specified by the Secretary, simi-
lar to the manner provided under part C of title 
XVIII. 
‘‘(b) 
COORDINATION
WITH
MEDICAID
AND 
SCHIP.—Notwithstanding any other provision of law, in-
dividuals entitled to benefits for items and services under 
this title who also qualify for benefits under title XIX or
XXI or any other Federally funded program may continue 
to qualify and obtain benefits under such other title or 
program, and in such case such an individual shall elect 
either—
‘‘(1) such other title or program to be primary 
payor to benefits under this title, in which case no 
benefits shall be payable under this title and the 
monthly premium under section 2203 shall be $0; or 
‘‘(2) benefits under this title shall be primary 
payor to benefits provided under such program or 
title, in which case the Secretary shall enter into 
agreements with States as may be appropriate to 
provide that, in the case of such individuals, the ben-
efits under titles XIX and XXI or such other pro-
gram (including reduction of cost-sharing) are pro-
vided on a ‘wrap-around’ basis to the benefits under 
this title.’’.
(b) CONFORMING AMENDMENTS TO SOCIAL SECU-
RITY ACT PROVISIONS.—
(1) Section 201(i)(1) of the Social Security Act 
(42 U.S.C. 401(i)(1)) is amended by striking ‘‘or the 
Federal Supplementary Medical Insurance Trust 
Fund’’ and inserting ‘‘the Federal Supplementary 
Medical Insurance Trust Fund, or the MediKids 
Trust Fund’’.
(2) Section 201(g)(1)(A) of such Act (42 
U.S.C. 401(g)(1)(A)) is amended by striking ‘‘ and 
the Federal Supplementary Medical Insurance Trust 
Fund established by title XVIII’’ and inserting ‘‘, 
the Federal Supplementary Medical Insurance Trust 
Fund, and the MediKids Trust Fund established by 
title XVIII’’.
(3) Section 1853(c) of such Act (42 U.S.C. 
1395w–23(c)) is amended—
(A) in paragraph (1), by striking ‘‘and 
(7)’’ and inserting ‘‘, (7), and (8)’’, and 
(B) by adding at the end the following: 
‘‘(8) ADJUSTMENT FOR MEDIKIDS.—In apply-
ing this subsection with respect to individuals enti-
tled to benefits under title XXII, the Secretary shall 
provide for an appropriate adjustment in the 
Medicare+Choice capitation rate as may be appro-
priate to reflect differences between the population 
served under such title and the population under 
parts A and B.’’. 
(c) MAINTENANCE OF MEDICAID ELIGIBILITY AND 
BENEFITS FOR CHILDREN.—
(1) IN GENERAL.—In order for a State to con-
tinue to be eligible for payments under section
1903(a) of the Social Security Act (42 U.S.C. 
1396b(a))—
(A) the State may not reduce standards of 
eligibility, or benefits, provided under its State 
medicaid plan under title XIX of the Social Se-
curity Act or under its State child health plan 
under title XXI of such Act for individuals 
under 23 years of age below such standards of 
eligibility, and benefits, in effect on the date of 
the enactment of this Act; and 
(B) the State shall demonstrate to the sat-
isfaction of the Secretary of Health and Human 
Services that any savings in State expenditures 
under title XIX or XXI of the Social Security 
Act that results from children from enrolling 
under title XXII of such Act shall be used in 
a manner that improves services to beneficiaries 
under title XIX of such Act, such as through 
increases in provider payment rates, expansion 
of eligibility, improved nurse and nurse aide 
staffing and improved inspections of nursing fa-
cilities, and coverage of additional services.
(2) MEDIKIDS AS PRIMARY PAYOR.—In apply-
ing title XIX of the Social Security Act, the 
MediKids program under title XXII of such Act
shall be treated as a primary payor in cases in which 
the election described in section 2207(b)(2) of such 
Act, as added by subsection (a), has been made. 
(d) EXPANSION OF MEDPAC MEMBERSHIP TO 19.—
(1) IN GENERAL.—Section 1805(c) of the So-
cial Security Act (42 U.S.C. 1395b–6(c)) is amend-
ed—
(A) in paragraph (1), by striking ‘‘17’’ and 
inserting ‘‘19’’; and 
(B) in paragraph (2)(B), by inserting ‘‘ex-
perts in children’s health,’’ after ‘‘other health 
professionals,’’. 
(2) INITIAL
TERMS
OF
ADDITIONAL
MEM-
BERS.—
(A) IN GENERAL.—For purposes of stag-
gering the initial terms of members of the 
Medicare Payment Advisory Commission under 
section 1805(c)(3) of the Social Security Act 
(42 U.S.C. 1395b–6(c)(3)), the initial terms of 
the 2 additional members of the Commission 
provided for by the amendment under sub-
section (a)(1) are as follows: 
(i) One member shall be appointed for 
1 year.
(ii) One member shall be appointed 
for 2 years. 
(B) COMMENCEMENT
OF
TERMS.—Such 
terms shall begin on January 1, 2004. 
SEC. 1003. MEDIKIDS PREMIUM. 
(a) GENERAL RULE.—Subchapter A of chapter 1 of 
the Internal Revenue Code of 1986 (relating to determina-
tion of tax liability) is amended by adding at the end the 
following new part: 
‘‘PART VIII—MEDIKIDS PREMIUM
‘‘Sec. 59B. MediKids premium.
‘‘SEC. 59B. MEDIKIDS PREMIUM. 
‘‘(a) IMPOSITION OF TAX.—In the case of an indi-
vidual to whom this section applies, there is hereby im-
posed (in addition to any other tax imposed by this sub-
title) a MediKids premium for the taxable year. 
‘‘(b) INDIVIDUALS SUBJECT TO PREMIUM.—
‘‘(1) IN GENERAL.—This section shall apply to 
an individual if the taxpayer has a MediKid at any 
time during the taxable year. 
‘‘(2) MEDIKID.—For purposes of this section, 
the term ‘MediKid’ means, with respect to a tax-
payer, any individual with respect to whom the tax-
payer is required to pay a premium under section
2203(c) of the Social Security Act for any month of 
the taxable year. 
‘‘(c) AMOUNT OF PREMIUM.—For purposes of this 
section, the MediKids premium for a taxable year is the 
sum of the monthly premiums under section 2203 of the 
Social Security Act for months in the taxable year. 
‘‘(d) EXCEPTIONS BASED ON ADJUSTED GROSS IN-
COME.—
‘‘(1) EXEMPTION FOR VERY LOW-INCOME TAX-
PAYERS.—
‘‘(A) IN GENERAL.—No premium shall be 
imposed by this section on any taxpayer having 
an adjusted gross income not in excess of the 
exemption amount. 
‘‘(B) EXEMPTION AMOUNT.—For purposes 
of this paragraph, with respect to a family, the 
exemption amount is the amount equal to 150 
percent of the income official poverty line (as 
defined by the Office of Management and 
Budget, and revised annually in accordance 
with section 673(2) of the Omnibus Budget 
Reconciliation Act of 1981) applicable to a fam-
ily of the size involved. 
‘‘(C) PHASEOUT OF EXEMPTION.—In the 
case of a taxpayer having an adjusted gross in-
come which exceeds the exemption amount but 
does not exceed twice the exemption amount, 
the premium shall be the amount which bears 
the same ratio to the premium which would 
(but for this subparagraph) apply to the tax-
payer as such excess bears to the exemption 
amount. 
‘‘(2) PREMIUM LIMITED TO 5 PERCENT OF AD-
JUSTED GROSS INCOME.—In no event shall any tax-
payer be required to pay a premium under this sec-
tion in excess of an amount equal to 5 percent of the 
taxpayer’s adjusted gross income. 
‘‘(e) COORDINATION WITH OTHER PROVISIONS.—
‘‘(1) NOT TREATED AS MEDICAL EXPENSE.—
For purposes of this chapter, any premium paid 
under this section shall not be treated as expense for 
medical care. 
‘‘(2) NOT TREATED AS TAX FOR CERTAIN PUR-
POSES.—The premium paid under this section shall 
not be treated as a tax imposed by this chapter for 
purposes of determining—
‘‘(A) the amount of any credit allowable 
under this chapter, or 
‘‘(B) the amount of the minimum tax im-
posed by section 55.
‘‘(3) TREATMENT
UNDER
SUBTITLE
F.—For 
purposes of subtitle F, the premium paid under this 
section shall be treated as if it were a tax imposed 
by section 1.’’. 
(b) TECHNICAL AMENDMENTS.—
(1) Subsection (a) of section 6012 of such Code 
is amended by inserting after paragraph (9) the fol-
lowing new paragraph: 
‘‘(10) Every individual liable for a premium 
under section 59B.’’. 
(2) The table of parts for subchapter A of chap-
ter 1 of such Code is amended by adding at the end 
the following new item:
‘‘Part VIII. MediKids premium.’’.
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to months beginning after Decem-
ber 2004, in taxable years ending after such date. 
SEC. 1004. REFUNDABLE CREDIT FOR COST-SHARING EX-
PENSES UNDER MEDIKIDS PROGRAM. 
(a) IN GENERAL.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to refundable credits) is amended by insert-
ing after section 35 the following new section:
‘‘SEC. 35A. COST-SHARING EXPENSES UNDER MEDIKIDS 
PROGRAM. 
‘‘(a) ALLOWANCE OF CREDIT.—In the case of an in-
dividual who has a MediKid (as defined in section 59B) 
at any time during the taxable year, there shall be allowed 
as a credit against the tax imposed by this subtitle an 
amount equal to 50 percent of the amount paid by the 
taxpayer during the taxable year as cost-sharing under 
section 2202(b)(4) of the Social Security Act. 
‘‘(b) LIMITATION BASED ON ADJUSTED GROSS IN-
COME.—The amount of the credit which would (but for 
this subsection) be allowed under this section for the tax-
able year shall be reduced (but not below zero) by an 
amount which bears the same ratio to such amount of 
credit as the excess of the taxpayer’s adjusted gross in-
come for such taxable year over the exemption amount (as 
defined in section 59B(d)) bears to such exemption 
amount.’’. 
(b) TECHNICAL AMENDMENTS.—
(1) Paragraph (2) of section 1324(b) of title 
31, United States Code, is amended by inserting ‘‘or 
35A’’ after ‘‘35’’. 
(2) The table of sections for subpart C of part 
IV of subchapter A of chapter 1 of such Code is
amended by inserting after the item relating to sec-
tion 25 the following new item:
‘‘Sec. 35A. Cost-sharing expenses under MediKids program.’’.
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2004. 
SEC. 1005. REPORT ON LONG-TERM REVENUES. 
Within 1 year after the date of enactment of this 
title, the Secretary of the Treasury shall propose a gradual 
schedule of progressive tax changes to fund the program 
under title XXII of the Social Security Act, as the number 
of enrollees grows in the out-years.
Subtitle B—Children’s Health In-
surance 
Eligibility 
Expansion 
and Enrollment Improvements 
CHAPTER 1—ELIGIBILITY EXPANSIONS 
Subchapter A—Medicaid and SCHIP 
SEC. 1101. EXPANSION OF CHILDREN’S ELIGIBILITY FOR 
MEDICAID AND SCHIP. 
(a) EXPANSION
OF INCOME ELIGIBILITY UNDER 
SCHIP.—Section 2110(c)(4) of the Social Security Act 
(42 U.S.C. 42 U.S.C. 1397jj(c)(4)) is amended by striking 
‘‘200’’ and inserting ‘‘300’’. 
(b) MANDATORY BUY-IN COVERAGE.—
(1) MEDICAID.—
(A) 
IN
GENERAL.—Section 
1902(a)(10)(A)(i) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(A)(i)) is amended—
(i) by striking ‘‘or’’ at the end of sub-
clause (VI); 
(ii) by striking the semicolon at the 
end of subclause (VII) and insert ‘‘, or’’; 
and 
(iii) by adding at the end the fol-
lowing: 
‘‘(VIII) who are children in fami-
lies whose income exceeds 300 percent 
of the income official poverty line (as 
defined by the Office of Management 
and Budget, and revised annually in 
accordance with section 673(2) of the 
Omnibus Budget Reconciliation Act of 
1981) applicable to a family of the 
size involved subject, notwithstanding 
section 1916, to payment of premiums 
or other cost-sharing charges (set on 
a sliding scale based on income) that 
the State may determine;’’. 
(B) CONFORMING
AMENDMENT.—Section 
1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4))
is 
amended 
by 
inserting 
‘‘1902(a)(10)(A)(i)(VIII),’’ 
after 
‘‘1902(a)(10)(A)(i)(VII),’’. 
(2) SCHIP.—Section 2107(e)(1) of such Act 
(42 U.S.C. 1397gg(e)(1)) is amended by adding at 
the end the following new subparagraph: 
‘‘(E) Section 1902(a)(10)(A)(i)(VIII) (re-
lating to buy-in coverage for children whose 
family income exceeds 300 percent of the pov-
erty line).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section apply to medical assistance and child health 
assistance provided on or after October 1, 2003. 
SEC. 1102. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 
UNDER THE MEDICAID PROGRAM AND TITLE 
XXI. 
(a) MEDICAID PROGRAM.—Section 1903(v) of the 
Social Security Act (42 U.S.C. 1396b(v)) is amended—
(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 
(2) by adding at the end the following: 
‘‘(4)(A) A State may elect (in a plan amendment 
under this title) to provide medical assistance under this 
title for aliens who are lawfully residing in the United 
States (including battered aliens described in section
431(c) of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996) and who are otherwise 
eligible for such assistance, within any of the following eli-
gibility categories: 
‘‘(i) PREGNANT WOMEN.—Women during preg-
nancy (and during the 60-day period beginning on 
the last day of the pregnancy). 
‘‘(ii) CHILDREN.—Children (as defined under 
such plan), including optional targeted low-income 
children described in section 1905(u)(2)(B). 
‘‘(B)(i) In the case of a State that has elected to pro-
vide medical assistance to a category of aliens under sub-
paragraph (A), no debt shall accrue under an affidavit of 
support against any sponsor of such an alien on the basis 
of provision of assistance to such category and the cost 
of such assistance shall not be considered as an unreim-
bursed cost. 
‘‘(ii) The provisions of sections 401(a), 402(b), 403, 
and 421 of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996 shall not apply to a 
State that makes an election under subparagraph (A).’’. 
(b) TITLE XXI.—Section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended by add-
ing at the end the following:
‘‘(E) Section 1903(v)(4) (relating to op-
tional coverage of permanent resident alien chil-
dren), but only if the State has elected to apply 
such section to that category of children under 
title XIX.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2003, and apply to 
medical assistance and child health assistance furnished 
on or after such date. 
Subchapter B—Family Opportunity Act 
SEC. 1111. SHORT TITLE; AMENDMENTS TO SOCIAL SECU-
RITY ACT. 
(a) SHORT TITLE.—This subchapter may be cited as 
the ‘‘Family Opportunity Act of 2003’’ or the ‘‘Dylan Lee 
James Act’’. 
(b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex-
cept as otherwise specifically provided, whenever in this 
Act an amendment is expressed in terms of an amendment 
to or repeal of a section or other provision, the reference 
shall be considered to be made to that section or other 
provision of the Social Security Act.
SEC. 1112. OPPORTUNITY FOR FAMILIES OF DISABLED 
CHILDREN TO PURCHASE MEDICAID COV-
ERAGE FOR SUCH CHILDREN. 
(a) STATE OPTION TO ALLOW FAMILIES OF DIS-
ABLED CHILDREN TO PURCHASE MEDICAID COVERAGE 
FOR SUCH CHILDREN.—
(1) IN
GENERAL.—Section 1902 (42 U.S.C. 
1396a) is amended—
(A) in subsection (a)(10)(A)(ii)—
(i) by striking ‘‘or’’ at the end of sub-
clause (XVII); 
(ii) by adding ‘‘or’’ at the end of sub-
clause (XVIII); and 
(iii) by adding at the end the fol-
lowing new subclause:
‘‘(XIX) who are disabled children 
described in subsection (cc)(1);’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(cc)(1) Individuals described in this paragraph are 
individuals—
‘‘(A) who have not attained 18 years of age; 
‘‘(B) who would be considered disabled under 
section 1614(a)(3)(C) (determined without regard to 
the reference to age in that section) but for having 
earnings or deemed income or resources (as deter-
mined under title XVI for children) that exceed the 
requirements for receipt of supplemental security in-
come benefits; and 
‘‘(C) whose family income does not exceed such 
income level as the State establishes and does not 
exceed—
‘‘(i) 300 percent of the income official pov-
erty line (as defined by the Office of Manage-
ment and Budget, and revised annually in ac-
cordance with section 673(2) of the Omnibus 
Budget Reconciliation Act of 1981) applicable 
to a family of the size involved; or 
‘‘(ii) such higher percent of such poverty 
line as a State may establish, except that no 
Federal financial participation shall be provided 
under section 1903(a) for any medical assist-
ance provided to an individual who would not be 
described in this subsection but for this 
clause.’’. 
(2) INTERACTION WITH EMPLOYER-SPONSORED 
FAMILY
COVERAGE.—Section 1902(cc) (42 U.S.C. 
1396a(cc)), as added by paragraph (1), is amended 
by adding at the end the following new paragraph: 
‘‘(2)(A) If an employer of a parent of an individual 
described in paragraph (1) offers family coverage under
a group health plan (as defined in section 2791(a) of the 
Public Health Service Act), the State may—
‘‘(i) require such parent to apply for, enroll in, 
and pay premiums for, such coverage as a condition 
of such parent’s child being or remaining eligible for 
medical 
assistance 
under 
subsection 
(a)(10)(A)(ii)(XIX) if the parent is determined eligi-
ble for such coverage and the employer contributes 
at least 50 percent of the total cost of annual pre-
miums for such coverage; and 
‘‘(ii) if such coverage is obtained—
‘‘(I) subject to paragraph (2) of section 
1916(h), reduce the premium imposed by the 
State under that section (if any) in an amount 
that reasonably reflects the premium contribu-
tion made by the parent for private coverage on 
behalf of a child with a disability; and 
‘‘(II) treat such coverage as a third party 
liability under subsection (a)(25). 
‘‘(B) In the case of a parent to which subparagraph 
(A) applies, if the family income of such parent does not 
exceed 300 percent of the income official poverty line (re-
ferred to in paragraph (1)(C)(i)), a State may provide for 
payment of any portion of the annual premium for such 
family coverage that the parent is required to pay. Any
payments made by the State under this subparagraph 
shall be considered, for purposes of section 1903(a), to 
be payments for medical assistance.’’. 
(b) STATE OPTION TO IMPOSE INCOME-RELATED 
PREMIUMS.—Section 1916 (42 U.S.C. 1396o) is amend-
ed—
(1) in subsection (a), by striking ‘‘subsection 
(g)’’ and inserting ‘‘subsections (g) and (h)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h)(1) With respect to disabled children provided 
medical assistance under section 1902(a)(10)(A)(ii)(XIX), 
subject to paragraph (2), a State may (in a uniform man-
ner for such children) require the families of such children 
to pay monthly premiums set on a sliding scale based on 
family income. 
‘‘(2) A premium requirement imposed under para-
graph (1) may only apply to the extent that—
‘‘(A) the aggregate amount of such premium 
and any premium that the parent is required to pay 
for family coverage under section 1902(cc)(2)(A)(i) 
does not exceed 5 percent of the family’s income; 
and 
‘‘(B) the requirement is imposed consistent with 
section 1902(cc)(2)(A)(ii)(I).
‘‘(3) A State shall not require prepayment of a pre-
mium imposed pursuant to paragraph (1) and shall not 
terminate 
eligibility 
of 
a 
child 
under 
section 
1902(a)(10)(A)(ii)(XIX) for medical assistance under this 
title on the basis of failure to pay any such premium until 
such failure continues for a period of not less than 60 days 
from the date on which the premium became past due. 
The State may waive payment of any such premium in 
any case where the State determines that requiring such 
payment would create an undue hardship.’’. 
(c) CONFORMING AMENDMENT.—Section 1903(f)(4) 
(42 U.S.C. 1396b(f)(4)) is amended in the matter pre-
ceding 
subparagraph 
(A) 
by 
inserting 
‘‘1902(a)(10)(A)(ii)(XIX),’’ 
after 
‘‘1902(a)(10)(A)(ii)(XVIII),’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to medical assistance for items and 
services furnished on or after January 1, 2004. 
SEC. 1113. TREATMENT OF INPATIENT PSYCHIATRIC HOS-
PITAL SERVICES FOR INDIVIDUALS UNDER 
AGE 21 IN HOME OR COMMUNITY-BASED 
SERVICES WAIVERS. 
(a) IN
GENERAL.—Section 1915(c) (42 U.S.C. 
1396n(c)) is amended—
(1) in paragraph (1)—
(A) in the first sentence, by inserting ‘‘, or 
inpatient psychiatric hospital services for indi-
viduals under age 21,’’ after ‘‘intermediate care 
facility for the mentally retarded’’; and 
(B) in the second sentence, by inserting ‘‘, 
or inpatient psychiatric hospital services for in-
dividuals under age 21’’ before the period; 
(2) in paragraph (2)(B), by striking ‘‘or serv-
ices in an intermediate care facility for the mentally 
retarded’’ each place it appears and inserting ‘‘, 
services in an intermediate care facility for the men-
tally retarded, or inpatient psychiatric hospital serv-
ices for individuals under age 21’’; 
(3) by striking paragraph (2)(C) and inserting 
the following: 
‘‘(C) such individuals who are determined to be 
likely to require the level of care provided in a hos-
pital, nursing facility, or intermediate care facility 
for the mentally retarded, or inpatient psychiatric 
hospital services for individuals under age 21, are 
informed of the feasible alternatives, if available 
under the waiver, at the choice of such individuals, 
to the provision of inpatient hospital services, nurs-
ing facility services, services in an intermediate care 
facility for the mentally retarded, or inpatient psy-
chiatric hospital services for individuals under age 
21;’’; and 
(4) in paragraph (7)(A)—
(A) by inserting ‘‘, or inpatient psychiatric 
hospital services for individuals under age 21,’’ 
after ‘‘intermediate care facility for the men-
tally retarded’’; and 
(B) by inserting ‘‘, or who would require 
inpatient psychiatric hospital services for indi-
viduals under age 21’’ before the period. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) apply with respect to medical assistance 
provided on or after January 1, 2003. 
SEC. 1114. DEMONSTRATION OF COVERAGE UNDER THE 
MEDICAID PROGRAM OF CHILDREN WITH PO-
TENTIALLY SEVERE DISABILITIES. 
(a) STATE APPLICATION.—A State may apply to the 
Secretary of Health and Human Services (in this section 
referred to as the ‘‘Secretary’’) for approval of a dem-
onstration project (in this section referred to as a ‘‘dem-
onstration project’’) under which up to a specified max-
imum number of children with a potentially severe dis-
ability (as defined in subsection (b)) are provided medical 
assistance under the State medicaid plan under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.).
(b) CHILD WITH
A POTENTIALLY SEVERE DIS-
ABILITY DEFINED.—
(1) IN
GENERAL.—In this section, the term 
‘‘child with a potentially severe disability’’ means, 
with respect to a demonstration project, an indi-
vidual who—
(A) has not attained 21 years of age; 
(B) has a physical or mental condition, 
disease, disorder (including a congenital birth 
defect or a metabolic condition), injury, or de-
velopmental disability that was incurred before 
the individual attained such age; and 
(C) is reasonably expected, but for the re-
ceipt of medical assistance under the State 
medicaid plan, to reach the level of disability 
defined under section 1614(a)(3) of the Social 
Security Act (42 U.S.C. 1382c(a)(3)), (deter-
mined without regard to the reference to age in 
subparagraph (C) of that section).
(2) EXCEPTION.—Such term does not include 
an individual who would be considered disabled 
under section 1614(a)(3)(C) of the Social Security 
Act (42 U.S.C. 1382c(a)(3)(C)) (determined without 
regard to the reference to age in that section). 
(c) APPROVAL OF DEMONSTRATION PROJECTS.—
(1) IN GENERAL.—Subject to paragraph (3), 
the Secretary shall approve applications under sub-
section (a) that meet the requirements of paragraph 
(2) and such additional terms and conditions as the 
Secretary may require. The Secretary may waive the 
requirement of section 1902(a)(1) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(1)) to allow for sub-
State demonstrations. 
(2) TERMS AND CONDITIONS OF DEMONSTRA-
TION PROJECTS.—The Secretary may not approve a 
demonstration project under this section unless the 
State provides assurances satisfactory to the Sec-
retary that the following conditions are or will be 
met: 
(A) 
INDEPENDENT
EVALUATION.—The 
State provides for an independent evaluation of 
the project to be conducted during fiscal year 
2006. 
(B) CONSULTATION
FOR
DEVELOPMENT 
OF CRITERIA.—The State consults with appro-
priate pediatric health professionals in estab-
lishing the criteria for determining whether a 
child has a potentially severe disability. 
(C) ANNUAL REPORT.—The State submits 
an annual report to the Secretary (in a uniform
form and manner established by the Secretary) 
on the use of funds provided under the grant 
that includes the following: 
(i) Enrollment and financial statistics 
on—
(I) the total number of children 
with a potentially severe disability en-
rolled in the demonstration project, 
disaggregated by disability; 
(II) the services provided by cat-
egory or code and the cost of each 
service so categorized or coded; and 
(III) the number of children en-
rolled in the demonstration project 
who also receive services through pri-
vate insurance. 
(ii) With respect to the report sub-
mitted for fiscal year 2008, the results of 
the 
independent 
evaluation 
conducted 
under subparagraph (A). 
(iii) Such additional information as 
the Secretary may require. 
(3) LIMITATIONS ON FEDERAL FUNDING.—
(A) APPROPRIATION.—
(i) IN GENERAL.—Out of any funds in 
the Treasury not otherwise appropriated, 
there is appropriated to carry out this sec-
tion—
(I) $16,666,000 for each of fiscal 
years 2004 and 2005; and 
(II) $16,667,000 for each of fis-
cal years 2006 through 2009. 
(ii) BUDGET AUTHORITY.—Clause (i) 
constitutes budget authority in advance of 
appropriations Acts and represents the ob-
ligation of the Federal Government to pro-
vide for the payment of the amounts ap-
propriated under clause (i). 
(B) LIMITATION
ON
PAYMENTS.—In no 
case may—
(i) the aggregate amount of payments 
made by the Secretary to States under this 
section exceed $100,000,000; 
(ii) the aggregate amount of payments 
made by the Secretary to States for ad-
ministrative expenses relating to the eval-
uations and annual reports required under 
subparagraphs (A) and (C) of paragraph
(2) 
exceed 
$2,000,000 
of 
such 
$100,000,000; or 
(iii) payments be provided by the Sec-
retary for a fiscal year after fiscal year 
2010. 
(C) FUNDS ALLOCATED TO STATES.—
(i) IN GENERAL.—The Secretary shall 
allocate funds to States based on their ap-
plications and the availability of funds. In 
making such allocations, the Secretary 
shall ensure an equitable distribution of 
funds among States with large populations 
and States with small populations. 
(ii) AVAILABILITY.—Funds allocated 
to a State under a grant made under this 
section for a fiscal year shall remain avail-
able until expended. 
(D) FUNDS NOT ALLOCATED TO STATES.—
Funds not allocated to States in the fiscal year 
for which they are appropriated shall remain 
available in succeeding fiscal years for alloca-
tion by the Secretary using the allocation for-
mula established under this section. 
(E) PAYMENTS
TO
STATES.—The Sec-
retary shall pay to each State with a dem-
onstration project approved under this section, 
from its allocation under subparagraph (C), an 
amount for each quarter equal to the Federal 
medical assistance percentage (as defined in 
section 1905(b) of the Social Security Act (42 
U.S.C. 1395d(b))) of expenditures in the quar-
ter for medical assistance provided to children 
with a potentially severe disability. 
(d) RECOMMENDATION.—Not later than October 1, 
2007, the Secretary shall submit a recommendation to the 
Committee on Commerce of the House of Representatives 
and the Committee on Finance of the Senate regarding 
whether the demonstration project established under this 
section should be continued after fiscal year 2009. 
(e) STATE DEFINED.—In this section, the term 
‘‘State’’ has the meaning given such term for purposes of 
title XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.).
SEC. 1115. DEVELOPMENT AND SUPPORT OF FAMILY-TO-
FAMILY HEALTH INFORMATION CENTERS. 
Section 501 (42 U.S.C. 701) is amended by adding 
at the end the following new subsection: 
‘‘(c)(1) In addition to amounts appropriated under 
subsection (a) and retained under section 502(a)(1) for 
the purpose of carrying out activities described in sub-
section (a)(2), there is appropriated to the Secretary, out 
of any money in the Treasury not otherwise appropriated, 
for the purpose of enabling the Secretary (through grants, 
contracts, or otherwise) to provide for special projects of 
regional and national significance for the development and 
support of family-to-family health information centers de-
scribed in paragraph (2), $10,000,000 for each of fiscal 
years 2004 through 2009. Funds appropriated under this 
paragraph shall remain available until expended. 
‘‘(2) The family-to-family health information centers 
described in this paragraph are centers that—
‘‘(A) assist families of children with disabilities 
or special health care needs to make informed 
choices about health care in order to promote good 
treatment decisions, cost-effectiveness, and improved 
health outcomes for such children; 
‘‘(B) provide information regarding the health 
care needs of, and resources available for, children 
with disabilities or special health care needs; 
‘‘(C) identify successful health delivery models 
for such children; 
‘‘(D) develop with representatives of health care 
providers, managed care organizations, health care 
purchasers, and appropriate State agencies a model
for collaboration between families of such children 
and health professionals; 
‘‘(E) provide training and guidance regarding 
caring for such children; 
‘‘(F) conduct outreach activities to the families 
of such children, health professionals, schools, and 
other appropriate entities and individuals; and
‘‘(G) are staffed by families of children with 
disabilities or special health care needs who have ex-
pertise in Federal and State public and private 
health care systems and health professionals. 
‘‘(3) The provisions of this title that are applicable 
to the funds made available to the Secretary under section 
502(a)(1) apply in the same manner to funds made avail-
able to the Secretary under paragraph (1).’’. 
SEC. 1116. RESTORATION OF MEDICAID ELIGIBILITY FOR 
CERTAIN SSI BENEFICIARIES. 
(a) IN GENERAL.—Section 1902(a)(10)(A)(i)(II) (42 
U.S.C. 1396a(a)(10)(A)(i)(II)) is amended—
(1) by inserting ‘‘(aa)’’ after ‘‘(II)’’; 
(2) by striking ‘‘or who are’’ and inserting ‘‘, 
(bb) who are’’; and 
(3) by inserting before the comma at the end 
the following: ‘‘, or (cc) who are under 21 years of 
age and with respect to whom supplemental security
income benefits would be paid under title XVI if 
subparagraphs (A) and (B) of section 1611(c)(7) 
were applied without regard to the phrase ‘the first 
day of the month following’ ’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to medical assistance for items 
and services furnished on or after the first day of the first 
calendar quarter that begins after the date of enactment 
of this Act. 
CHAPTER 2—ENROLLMENT 
IMPROVEMENTS 
SEC. 1121. APPLICATION OF SIMPLIFIED TITLE XXI PROCE-
DURES UNDER THE MEDICAID PROGRAM. 
(a) APPLICATION UNDER MEDICAID.—
(1) IN GENERAL.—Section 1902(l) of the Social 
Security Act (42 U.S.C. 1396a(l)) is amended—
(A) in paragraph (3), by inserting ‘‘subject 
to paragraph (5)’’, after ‘‘Notwithstanding sub-
section (a)(17),’’; and 
(B) by adding at the end the following: 
‘‘(5) With respect to determining the eligibility of in-
dividuals under 19 years of age (or such higher age as 
the State has elected under paragraph (1)(D)) for medical 
assistance under subsection (a)(10)(A) notwithstanding
any other provision of this title, if the State has estab-
lished a State child health plan under title XXI—
‘‘(A) the State may not apply a resource stand-
ard; 
‘‘(B) the State shall use the same simplified eli-
gibility form (that in no case shall be more than 4 
pages and that permits application other than in 
person) as the State uses under such State child 
health plan with respect to such individuals; 
‘‘(C) the State shall provide for initial eligibility 
determinations and redeterminations of eligibility 
using the same verification policies, forms, and fre-
quency as the State uses for such purposes under 
such State child health plan with respect to such in-
dividuals; 
‘‘(D) the State shall not require a face-to-face 
interview for purposes of initial eligibility determina-
tions and redeterminations and shall allow for self-
declaration of initial eligibility and recertification in-
formation; and 
‘‘(E) the State shall coordinate the enrollment 
of children under this title and title XXI with the 
enrollment of such children and their families in 
other Federal means-tested public assistance pro-
grams, including child care programs, free or re-
duced price lunches or breakfasts under the Richard 
B. Russell National School Lunch Act (42 U.S.C. 
1751 et seq.), assistance under the special supple-
mental nutrition program for women, infants, and 
children (WIC) under section 17 of the Child Nutri-
tion Act of 1966 (42 U.S.C. 1786), and benefits 
under the Food Stamp Act of 1977.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) apply to determinations of eligi-
bility made on or after the date that is 1 year after 
the date of the enactment of this Act, whether or 
not regulations implementing such amendments have 
been issued. 
(3) DEVELOPMENT
OF
UNIFORM
APPLICA-
TION.—Not later than 1 year after the date of en-
actment of this Act, the Secretary of Health and 
Human Services, in consultation with States and or-
ganizations with expertise in outreach to, and enroll-
ment of, children without health insurance, shall de-
velop a uniform application that meets the require-
ments of section 1902(l)(5) of the Social Security 
Act, as added by paragraph (1), and may be used 
in any State. 
(b) PRESUMPTIVE ELIGIBILITY.—
(1) IN GENERAL.—Section 1920A(b)(3)(A)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396r–
1a(b)(3)(A)(i)) is amended by inserting ‘‘a child care 
resource and referral agency,’’ after ‘‘a State or trib-
al child support enforcement agency,’’. 
(2) APPLICATION TO PRESUMPTIVE ELIGIBILITY 
FOR PREGNANT WOMEN UNDER MEDICAID.—Section 
1920(b) of the Social Security Act (42 U.S.C. 
1396r–1(b)) is amended by adding at the end after 
and below paragraph (2) the following flush sen-
tence: 
‘‘The term ‘qualified provider’ includes a qualified entity 
as defined in section 1920A(b)(3).’’. 
(3) APPLICATION UNDER TITLE XXI.—
(A) IN GENERAL.—Section 2107(e)(1)(D) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397gg(e)(1)) is amended to read as follows: 
‘‘(D) Sections 1920 and 1920A (relating to 
presumptive eligibility).’’. 
(B) EXCEPTION FROM LIMITATION ON AD-
MINISTRATIVE EXPENSES.—Section 2105(c)(2) 
of such Act (42 U.S.C. 1397ee(c)(2)) is amend-
ed by adding at the end the following:
‘‘(C) EXCEPTION FOR PRESUMPTIVE ELI-
GIBILITY
EXPENDITURES.—The 
limitation
under subparagraph (A) on expenditures shall 
not apply to expenditures attributable to the 
application of section 1920 or 1920A (pursuant 
to section 2107(e)(1)(D)), regardless of whether 
the child is determined to be ineligible for the 
program under this title or title XIX.’’. 
(C) CONFORMING
ELIMINATION
OF
RE-
SOURCE TEST.—Section 2102(b)(1)(A) of such 
Act (42 U.S.C. 1397bb(b)(1)(A)) is amended—
(i) by striking ‘‘and resources (includ-
ing any standards relating to spenddowns 
and disposition of resources)’’; and 
(ii) by adding at the end the fol-
lowing: ‘‘Effective 1 year after the date of 
the enactment of the Leave No Child Be-
hind Act of 2003, such standards may not 
include the application of a resource stand-
ard or test.’’. 
(c) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR 
TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN 
LOSING MEDICAID OR TITLE XXI ELIGIBILITY.—
(1) LOSS OF MEDICAID ELIGIBILITY.—Section 
1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)) is amended—
(A) by striking the period at the end of 
paragraph (65) and inserting ‘‘; and’’; and 
(B) by inserting after paragraph (65) the 
following: 
‘‘(66) provide, in the case of a State with a 
State child health plan under title XXI, that before 
medical assistance to a child (or a parent of a child) 
is discontinued under this title, a determination of 
whether the child (or parent) is eligible for benefits 
under title XXI shall be made and, if determined to 
be so eligible, the child (or parent) shall be auto-
matically enrolled in the program under such title 
without the need for a new application.’’. 
(2) LOSS OF TITLE XXI ELIGIBILITY.—Section 
2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by 
redesignating subparagraphs (D) and (E) as sub-
paragraphs (E) and (F), respectively, and by insert-
ing after subparagraph (C) the following: 
‘‘(D) that before health assistance to a 
child (or a parent of a child) is discontinued 
under this title, a determination of whether the 
child (or parent) is eligible for benefits under 
title XIX is made and, if determined to be so 
eligible, the child (or parent) is automatically
enrolled in the program under such title with-
out the need for a new application;’’. 
(3) EFFECTIVE DATE.—The amendments made 
by paragraphs (1) and (2) apply to individuals who 
lose eligibility under the medicaid program under 
title XIX, or under a State child health insurance 
plan under title XXI, respectively, of the Social Se-
curity Act on or after the date that is 60 days after 
the date of the enactment of this Act. 
(d) PROVISION OF MEDICAID AND SCHIP APPLICA-
TIONS AND INFORMATION UNDER THE SCHOOL LUNCH 
PROGRAM.—Section 9(b)(2)(B) of the Richard B. Russell 
National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is 
amended—
(1) by striking ‘‘(B) Applications’’ and inserting 
‘‘(B)(i) Applications’’; and 
(2) by adding at the end the following: 
‘‘(ii)(I) Applications for free and reduced price 
lunches that are distributed pursuant to clause (i) to par-
ents or guardians of children in attendance at schools par-
ticipating in the school lunch program under this Act shall 
also contain information on the availability of medical as-
sistance under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) (commonly referred to as the ‘med-
icaid program’) and of child health assistance under title
XXI of such Act (commonly referred to as ‘SCHIP’), in-
cluding information on how to obtain an application for 
assistance under such program. 
‘‘(II) Information on the medicaid program and 
SCHIP under subclause (I) shall be provided on a form 
separate from the application form for free and reduced 
price lunches under clause (i).’’. 
(e) 12-MONTHS CONTINUOUS ELIGIBILITY.—
(1) MEDICAID.—Section 1902(e)(12) of the So-
cial Security Act (42 U.S.C. 1396a(e)(12)) is 
amended—
(A) by striking ‘‘At the option of the State, 
the plan may’’ and inserting ‘‘The plan shall’’; 
(B) by striking ‘‘an age specified by the 
State (not to exceed 19 years of age)’’ and in-
serting ‘‘19 years of age (or such higher age as 
the 
State 
has 
elected 
under 
subsection 
(l)(1)(D)) or who is eligible for medical assist-
ance as the parent of such a child’’; 
(C) in subparagraph (A), by striking ‘‘a 
period (not to exceed 12 months)’’ and insert-
ing ‘‘the 12-month period beginning on the 
date’’; and
CHAPTER 3—EFFECTIVE DATE 
SEC. 1131. EFFECTIVE DATE. 
(a) IN GENERAL.—Subject to subsection (b), the 
amendments made by this subtitle take effect on the date 
of enactment of this Act. 
(b) EXTENSION OF EFFECTIVE DATE FOR STATE 
LAW AMENDMENT.—In the case of a State plan under 
title XIX or XXI of the Social Security Act which the Sec-
retary of Health and Human Services determines requires 
State legislation in order for the plan to meet the addi-
tional requirements imposed by the amendments made by 
this subtitle, such State plan shall not be regarded as fail-
ing to comply with such requirements solely on the basis 
of its failure to meet the additional requirements before 
the first day of the first calendar quarter beginning after 
the close of the first regular session of the State legisla-
ture that begins after the date of enactment of this Act. 
For purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year of 
the session is considered to be a separate regular session 
of the State legislature.
Subtitle C—Improving Access to 
Care 
CHAPTER 1—COMMISSION 
SEC. 1201. COMMISSION ON CHILDREN’S ACCESS TO CARE. 
(a) ESTABLISHMENT.—There is established a Com-
mission on Children’s Access to Care (in this section re-
ferred to as the ‘‘Commission’’). 
(b) MEMBERSHIP.—
(1) COMPOSITION.—The Commission shall be 
composed of 11 members of whom—
(A) 3 members shall be appointed by the 
President; 
(B) 2 members shall be appointed by the 
Majority Leader of the Senate; 
(C) 2 members shall be appointed by the 
Speaker of the House of Representatives; 
(D) 2 members shall be appointed by the 
Minority Leader of the Senate; and 
(E) 2 members shall be appointed by the 
Minority Leader of the House of Representa-
tives. 
(2) QUALIFICATIONS.—Members of the Com-
mission shall be appointed from among representa-
tives of children’s advocacy groups and children’s 
health care providers.
(3) TIMING OF APPOINTMENTS.—Members of 
the Commission shall be appointed not later than 6 
months after the date of enactment of this Act. 
(4) CHAIR.—
(A) IN GENERAL.—The Commission shall 
select a Chair from among its members. 
(B) DUTIES.—The Chair of the Commis-
sion shall be responsible for—
(i) the assignment of duties and re-
sponsibilities among staff personnel and 
their continuing supervision; and 
(ii) the use and expenditure of funds 
available to the Commission. 
(5) VACANCIES.—Any vacancy on the Commis-
sion shall be filled in the same manner as the origi-
nal incumbent was appointed. 
(6) TRAVEL EXPENSES.—The members of the 
Commission shall be allowed travel expenses, includ-
ing per diem in lieu of subsistence, at rates author-
ized for employees of agencies under subchapter I of 
chapter 57 of title 5, United States Code, while 
away from their homes or regular places of business 
in the performance of services for the Commission. 
(c) MEETINGS.—
(1) INITIAL MEETING.—Not later than 30 days 
after the date on which all members of the Commis-
sion have been appointed, the Commission shall hold 
its first meeting. 
(2) TIME.—The Commission shall meet at the 
call of the Chair. 
(3) QUORUM.—A majority of the members of 
the Commission shall constitute a quorum, but a 
lesser number of members may hold hearings. 
(d) DUTIES.—
(1) IN GENERAL.—The Commission shall con-
duct annual studies of children’s access to health 
care. 
(2) MATTERS STUDIED.—Each year the Com-
mission shall study—
(A) the impact of payment rates under the 
medicaid and the State children’s health insur-
ance programs on access to health care and 
provider participation in the delivery of health 
care to children; 
(B) the access to health care of children 
with special health care needs, particularly 
those in managed care delivery systems; 
(C) the access to, and delivery of, preven-
tive health care to children;
(D) Federal and State government efforts 
to collect data, report, evaluate, and monitor 
children’s access to health care, including Fed-
eral and State government deficiencies in as-
sessing children’s access to health care; 
(E) the needs for supplemental and ena-
bling services to improve children’s access to 
health care, including translation and transpor-
tation services; and 
(F) other factors that impact the ability of 
families with children to gain access to health 
care services. 
(3) REPORTS.—
(A) IN GENERAL.—Not later than 1 year 
after the date of the initial meeting of the Com-
mission, and annually thereafter, the Commis-
sion shall submit to Congress and the President 
a report. 
(B) CONTENTS.—Each report shall contain 
the results of the study conducted for that year 
and the Commission’s recommendations to im-
prove children’s—
(i) health status; and 
(ii) access to health care. 
(e) POWERS OF THE COMMISSION.—
(1) HEARINGS.—The Commission may hold 
hearings, sit and act at times and places, take testi-
mony, and receive evidence as the Commission con-
siders advisable to carry out this section. 
(2) INFORMATION FROM FEDERAL AGENCIES.—
The Commission may secure directly from any Fed-
eral department or agency such information as the 
Commission considers necessary to carry out this 
section. Upon request of the Chair of the Commis-
sion, the head of such department or agency shall 
furnish such information to the Commission. 
(3) POSTAL SERVICES.—The Commission may 
use the United States mails in the same manner and 
under the same conditions as other departments and 
agencies of the Federal Government. 
(4) GIFTS.—The Commission may accept, use, 
and dispose of gifts or donations of services or prop-
erty. 
(f) STAFF AND ADMINISTRATIVE SUPPORT.—
(1) IN GENERAL.—The Chair of the Commis-
sion may, without regard to the civil service laws 
and regulations, appoint and terminate an executive 
director and such other additional personnel as may 
be necessary to enable the Commission to perform
its duties. The employment of an executive director 
shall be subject to confirmation by the Commission. 
(2) COMPENSATION.—The Chair of the Com-
mission may fix the compensation of the executive 
director and other personnel without regard to chap-
ter 51 and subchapter III of chapter 53 of title 5, 
United States Code, relating to classification of posi-
tions and General Schedule pay rates, except that 
the rate of pay for the executive director and other 
personnel may not exceed the rate payable for level 
V of the Executive Schedule under section 5316 of 
title 5, United States Code. 
(3) DETAIL
OF
GOVERNMENT
EMPLOYEES.—
Any Federal Government employee may be detailed 
to the Commission without reimbursement, and such 
detail shall be without interruption or loss of civil 
service status or privilege. 
(4) PROCUREMENT OF TEMPORARY AND INTER-
MITTENT SERVICES.—The Chair of the Commission 
may procure temporary and intermittent services 
under section 3109(b) of title 5, United States Code, 
at rates for individuals which do not exceed the daily 
equivalent of the annual rate of basic pay prescribed 
for level V of the Executive Schedule under section 
5316 of title 5, United States Code.
CHAPTER 2—CHILDREN’S HEALTH 
INSURANCE ACCOUNTABILITY 
SEC. 1211. SHORT TITLE. 
This chapter may be cited as the ‘‘Children’s Health 
Insurance Accountability Act of 2003’’. 
SEC. 1212. FINDINGS. 
Congress makes the following findings: 
(1) Children have health and development needs 
that are markedly different than those for the adult 
population. 
(2) Children experience complex and continuing 
changes during the continuum from birth to adult-
hood in which appropriate health care is essential 
for optimal development. 
(3) The vast majority of work done on develop-
ment methods to assess the effectiveness of health 
care services and the impact of medical care on pa-
tient outcomes and patient satisfaction has been fo-
cused on adults. 
(4) Health outcome measures need to be age, 
gender, and developmentally appropriate to be useful 
to families and children. 
(5) Costly disorders of adulthood often have 
their origins in childhood, making early access to ef-
fective health services in childhood essential.
(6) More than 200 chronic conditions, disabil-
ities and diseases affect children, including asthma, 
diabetes, sickle cell anemia, spina bifida, epilepsy, 
autism, cerebral palsy, congenital heart disease, 
mental retardation, and cystic fibrosis. These chil-
dren need the services of specialists who have in 
depth knowledge about their particular condition. 
(7) Children’s patterns of illness, disability and 
injury differ dramatically from adults. 
SEC. 1213. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 
ACT. 
(a) 
PATIENT
PROTECTION
STANDARDS.—Title 
XXVII of the Public Health Service Act (42 U.S.C. 300gg 
et seq.) is amended—
(1) by redesignating part C as part D; and 
(2) by inserting after part B the following new 
part: 
‘‘PART C—CHILDREN’S HEALTH PROTECTION 
STANDARDS 
‘‘SEC. 2770. ACCESS TO CARE. 
‘‘(a) ACCESS TO APPROPRIATE PRIMARY CARE PRO-
VIDERS.—
‘‘(1) IN GENERAL.—If a group health plan, or 
a health insurance issuer in connection with the pro-
vision of health insurance coverage, requires or pro-
vides for an enrollee to designate a participating pri-
mary care provider for a child of such enrollee—
‘‘(A) the plan or issuer shall permit the en-
rollee to designate a physician who specializes 
in pediatrics as the child’s primary care pro-
vider; and
‘‘(B) if such an enrollee has not designated 
such a provider for the child, the plan or issuer 
shall consider appropriate pediatric expertise in 
mandatorily assigning such an enrollee to a pri-
mary care provider. 
‘‘(2) CONSTRUCTION.—Nothing in paragraph 
(1) shall waive any requirements of coverage relating 
to medical necessity or appropriateness with respect 
to coverage of services. 
‘‘(b) ACCESS TO PEDIATRIC SPECIALTY SERVICES.—
‘‘(1) REFERRAL TO SPECIALTY CARE FOR CHIL-
DREN REQUIRING TREATMENT BY SPECIALISTS.—
‘‘(A) IN GENERAL.—In the case of a child 
who is covered under a group health plan, or 
health insurance coverage offered by a health 
insurance issuer and who has a mental or phys-
ical condition, disability, or disease of sufficient 
seriousness and complexity to require diagnosis, 
evaluation or treatment by a specialist, the plan
or issuer shall make or provide for a referral 
to a specialist who has extensive experience or 
training, and is available and accessible to pro-
vide the treatment for such condition or dis-
ease, including the choice of a nonprimary care 
physician specialist participating in the plan or 
a referral to a nonparticipating provider as pro-
vided for under subparagraph (D) if such a pro-
vider is not available within the plan. 
‘‘(B) SPECIALIST DEFINED.—For purposes 
of this subsection, the term ‘specialist’ means, 
with respect to a condition, disability, or dis-
ease, a health care practitioner, facility, or cen-
ter (such as a center of excellence) that has ex-
tensive pediatric expertise through appropriate 
training or experience to provide high quality 
care in treating the condition, disability or dis-
ease. 
‘‘(C) REFERRALS TO PARTICIPATING PRO-
VIDERS.—A plan or issuer is not required under 
subparagraph (A) to provide for a referral to a 
specialist that is not a participating provider, 
unless the plan or issuer does not have an ap-
propriate specialist that is available and acces-
sible to treat the enrollee’s condition and that
is a participating provider with respect to such 
treatment. 
‘‘(D) TREATMENT OF NONPARTICIPATING 
PROVIDERS.—If a plan or issuer refers a child 
enrollee to a nonparticipating specialist, services 
provided pursuant to the referral shall be pro-
vided at no additional cost to the enrollee be-
yond what the enrollee would otherwise pay for 
services received by such a specialist that is a 
participating provider. 
‘‘(E) SPECIALISTS AS PRIMARY CARE PRO-
VIDERS.—A plan or issuer shall have in place a 
procedure under which a child who is covered 
under health insurance coverage provided by 
the plan or issuer who has a condition or dis-
ease that requires specialized medical care over 
a prolonged period of time shall receive a refer-
ral to a pediatric specialist affiliated with the 
plan, or if not available within the plan, to a 
nonparticipating provider for such condition 
and such specialist may be responsible for and 
capable of providing and coordinating the 
child’s primary and specialty care. 
‘‘(2) STANDING REFERRALS.—
‘‘(A) IN GENERAL.—A group health plan, 
or health insurance issuer in connection with 
the provision of health insurance coverage of a 
child, shall have a procedure by which a child 
who has a condition, disability, or disease that 
requires ongoing care from a specialist may re-
quest and obtain a standing referral to such 
specialist for treatment of such condition. If the 
primary care provider in consultation with the 
medical director of the plan or issuer and the 
specialist (if any), determines that such a 
standing referral is appropriate, the plan or 
issuer shall authorize such a referral to such a 
specialist. Such standing referral shall be con-
sistent with a treatment plan. 
‘‘(B) TREATMENT PLANS.—A group health 
plan, or health insurance issuer, with the par-
ticipation of the family and the health care pro-
viders of the child, shall develop a treatment 
plan for a child who requires ongoing care that 
covers a specified period of time (but in no 
event less than a 6-month period). Services pro-
vided for under the treatment plan shall not re-
quire additional approvals or referrals through 
a gatekeeper.
‘‘(C) TERMS
OF
REFERRAL.—The provi-
sions of subparagraph (C) and (D) of para-
graph (1) shall apply with respect to referrals 
under subparagraph (A) in the same manner as 
they apply to referrals under paragraph (1)(A). 
‘‘(c) ADEQUACY OF ACCESS.—For purposes of sub-
sections (a) and (b), a group health plan or health insur-
ance issuer in connection with health insurance coverage 
shall ensure that a sufficient number, distribution, and va-
riety of qualified participating health care providers are 
available so as to ensure that all covered health care serv-
ices, including specialty services, are available and acces-
sible to all enrollees in a timely manner. 
‘‘(d) COVERAGE OF EMERGENCY SERVICES.— 
‘‘(1) IN GENERAL.—If a group health plan, or 
health insurance coverage offered by a health insur-
ance issuer, provides any benefits for children with 
respect to emergency services (as defined in para-
graph (2)(A)), the plan or issuer shall cover emer-
gency services furnished under the plan or cov-
erage— 
‘‘(A) without the need for any prior au-
thorization determination; 
‘‘(B) whether or not the physician or pro-
vider furnishing such services is a participating
physician or provider with respect to such serv-
ices; and 
‘‘(C) without regard to any other term or 
condition of such coverage (other than exclusion 
of benefits, or an affiliation or waiting period, 
permitted under section 2701). 
‘‘(2) DEFINITIONS.—In this subsection:
‘‘(A) EMERGENCY
MEDICAL
CONDITION 
BASED ON PRUDENT LAYPERSON STANDARD.—
The term ‘emergency medical condition’ means 
a medical condition manifesting itself by acute 
symptoms of sufficient severity (including se-
vere pain) such that a prudent layperson, who 
possesses an average knowledge of health and 
medicine, could reasonably expect the absence 
of immediate medical attention to result in a 
condition described in clause (i), (ii), or (iii) of 
section 1867(e)(1)(A) of the Social Security 
Act. 
‘‘(B) EMERGENCY
SERVICES.—The term 
‘emergency services’ means— 
‘‘(i) a medical screening examination 
(as required under section 1867 of the So-
cial Security Act) that is within the capa-
bility of the emergency department of a
hospital, including ancillary services rou-
tinely available to the emergency depart-
ment to evaluate an emergency medical 
condition (as defined in subparagraph 
(A)); and 
‘‘(ii) within the capabilities of the 
staff and facilities available at the hospital, 
such further medical examination and 
treatment as are required under section 
1867 of such Act to stabilize the patient. 
‘‘(3) 
REIMBURSEMENT
FOR
MAINTENANCE 
CARE
AND
POST-STABILIZATION
CARE.—A group 
health plan, and health insurance issuer offering 
health insurance coverage, shall provide, in covering 
services other than emergency services, for reim-
bursement with respect to services which are other-
wise covered and which are provided to an enrollee 
other than through the plan or issuer if the services 
are maintenance care or post-stabilization care cov-
ered under the guidelines established under section 
1852(d) of the Social Security Act (relating to pro-
moting efficient and timely coordination of appro-
priate maintenance and post-stabilization care of an 
enrollee after an enrollee has been determined to be 
stable).
‘‘(e) PROHIBITION
ON FINANCIAL BARRIERS.—A 
health insurance issuer in connection with the provision 
of health insurance coverage may not impose any cost 
sharing for pediatric specialty services provided under 
such coverage to enrollee children in amounts that exceed 
the cost-sharing required for other specialty care under 
such coverage.
‘‘(f) CHILDREN
WITH
SPECIAL
HEALTH
CARE 
NEEDS.—A health insurance issuer in connection with the 
provision of health insurance coverage shall ensure that 
such coverage provides special consideration for the provi-
sion of services to enrollee children with special health care 
needs. Appropriate procedures shall be implemented to 
provide care for children with special health care needs. 
The development of such procedures shall include partici-
pation by the families of such children. 
‘‘(g) DEFINITIONS.—In this part: 
‘‘(1) CHILD.—The term ‘child’ means an indi-
vidual who is under 19 years of age. 
‘‘(2) CHILDREN WITH SPECIAL HEALTH CARE 
NEEDS.—The term ‘children with special health care 
needs’ means those children who have or are at ele-
vated risk for chronic physical, developmental, be-
havioral or emotional conditions and who also re-
quire health and related services of a type and 
amount not usually required by children. 
‘‘SEC. 2771. CONTINUITY OF CARE. 
‘‘(a) IN GENERAL.—If a contract between a health 
insurance issuer, in connection with the provision of health 
insurance coverage, and a health care provider is termi-
nated (other than by the issuer for failure to meet applica-
ble quality standards or for fraud) and an enrollee is un-
dergoing a course of treatment from the provider at the 
time of such termination, the issuer shall—
‘‘(1) notify the enrollee of such termination, 
and 
‘‘(2) subject to subsection (c), permit the en-
rollee to continue the course of treatment with the 
provider during a transitional period (provided under 
subsection (b)). 
‘‘(b) TRANSITIONAL PERIOD.—
‘‘(1) IN GENERAL.—Except as provided in para-
graphs (2) through (4), the transitional period under 
this subsection shall extend for at least—
‘‘(A) 60 days from the date of the notice 
to the enrollee of the provider’s termination in 
the case of a primary care provider, or 
‘‘(B) 120 days from such date in the case 
of another provider.
‘‘(2) INSTITUTIONAL
CARE.—The transitional 
period under this subsection for institutional or in-
patient care from a provider shall extend until the 
discharge or termination of the period of institu-
tionalization and shall include reasonable follow-up 
care related to the institutionalization and shall also 
include institutional care scheduled prior to the date 
of termination of the provider status.
‘‘(3) PREGNANCY.—If— 
‘‘(A) an enrollee has entered the second 
trimester of pregnancy at the time of a pro-
vider’s termination of participation, and 
‘‘(B) the provider was treating the preg-
nancy before date of the termination, 
the transitional period under this subsection with re-
spect to provider’s treatment of the pregnancy shall 
extend through the provision of post-partum care di-
rectly related to the delivery. 
‘‘(4) TERMINAL ILLNESS.— 
‘‘(A) IN GENERAL.—If— 
‘‘(i) an enrollee was determined to be 
terminally ill (as defined in subparagraph 
(B)) at the time of a provider’s termi-
nation of participation, and
‘‘(ii) the provider was treating the ter-
minal illness before the date of termi-
nation, 
the transitional period under this subsection 
shall extend for the remainder of the enrollee’s 
life for care directly related to the treatment of 
the terminal illness. 
‘‘(B) DEFINITION.—In subparagraph (A), 
an enrollee is considered to be ‘terminally ill’ if 
the enrollee has a medical prognosis that the 
enrollee’s life expectancy is 6 months or less. 
‘‘(c) PERMISSIBLE TERMS
AND CONDITIONS.—An 
issuer may condition coverage of continued treatment by 
a provider under subsection (a)(2) upon the provider 
agreeing to the following terms and conditions: 
‘‘(1) The provider agrees to continue to accept 
reimbursement from the issuer at the rates applica-
ble prior to the start of the transitional period as 
payment in full. 
‘‘(2) The provider agrees to adhere to the 
issuer’s quality assurance standards and to provide 
to the issuer necessary medical information related 
to the care provided. 
‘‘(3) The provider agrees otherwise to adhere to 
the issuer’s policies and procedures, including proce-
dures regarding referrals and obtaining prior au-
thorization and providing services pursuant to a 
treatment plan approved by the issuer. 
‘‘SEC. 2772. CONTINUOUS QUALITY IMPROVEMENT. 
‘‘(a) IN GENERAL.—A health insurance issuer that 
offers health insurance coverage for children shall estab-
lish and maintain an ongoing, internal quality assurance 
program that at a minimum meets the requirements of 
subsection (b).
‘‘(b) REQUIREMENTS.—The internal quality assur-
ance program of an issuer under subsection (a) shall— 
‘‘(1) establish and measure a set of health care, 
functional assessments, structure, processes and out-
comes, and quality indicators that are unique to chil-
dren and based on nationally accepted standards or 
guidelines of care; 
‘‘(2) maintain written protocols consistent with 
recognized clinical guidelines or current consensus 
on the pediatric field, to be used for purposes of in-
ternal utilization review, with periodic updating and 
evaluation by pediatric specialists to determine effec-
tiveness in controlling utilization; 
‘‘(3) provide for peer review by health care pro-
fessionals of the structure, processes, and outcomes
related to the provision of health services, including 
pediatric review of pediatric cases; 
‘‘(4) include in member satisfaction surveys, 
questions on child and family satisfaction and expe-
rience of care, including care to children with special 
needs; 
‘‘(5) monitor and evaluate the continuity of 
care with respect to children; 
‘‘(6) include pediatric measures that are di-
rected at meeting the needs of at-risk children and 
children with chronic conditions, disabilities and se-
vere illnesses; 
‘‘(7) maintain written guidelines to ensure the 
availability of medications appropriate to children; 
‘‘(8) use focused studies of care received by 
children with certain types of chronic conditions and 
disabilities and focused studies of specialized services 
used by children with chronic conditions and disabil-
ities; 
‘‘(9) monitor access to pediatric specialty serv-
ices; and 
‘‘(10) monitor child health care professional 
satisfaction. 
‘‘(c) UTILIZATION REVIEW ACTIVITIES.—
‘‘(1) COMPLIANCE WITH REQUIREMENTS.—
‘‘(A) IN
GENERAL.—A health insurance 
issuer that offers health insurance coverage for 
children shall conduct utilization review activi-
ties in connection with the provision of such 
coverage only in accordance with a utilization 
review program that meets at a minimum the 
requirements of this subsection. 
‘‘(B) DEFINITIONS.—In this subsection: 
‘‘(i) CLINICAL
PEERS.—The term 
‘clinical peer’ means, with respect to a re-
view, a physician or other health care pro-
fessional who holds a non-restricted license 
in a State and in the same or similar spe-
cialty as typically manages the pediatric 
medical condition, procedure, or treatment 
under review. 
‘‘(ii) HEALTH CARE PROFESSIONAL.—
The term ‘health care professional’ means 
a physician or other health care practi-
tioner licensed or certified under State law 
to provide health care services and who is 
operating within the scope of such licen-
sure or certification. 
‘‘(iii) 
UTILIZATION
REVIEW.—The 
terms ‘utilization review’ and ‘utilization
review activities’ mean procedures used to 
monitor or evaluate the clinical necessity, 
appropriateness, efficacy, or efficiency of 
health care services, procedures or settings 
for children, and includes prospective re-
view, concurrent review, second opinions, 
case management, discharge planning, or 
retrospective review specific to children. 
‘‘(2) WRITTEN POLICIES AND CRITERIA.—
‘‘(A) WRITTEN
POLICIES.—A utilization 
review program shall be conducted consistent 
with written policies and procedures that govern 
all aspects of the program. 
‘‘(B) USE OF WRITTEN CRITERIA.—A utili-
zation review program shall utilize written clin-
ical review criteria specific to children and de-
veloped pursuant to the program with the input 
of appropriate physicians, including pediatri-
cians, nonprimary care pediatric specialists, and 
other child health professionals. 
‘‘(C) ADMINISTRATION BY HEALTH CARE 
PROFESSIONALS.—A utilization review program 
shall be administered by qualified health care 
professionals, including health care profes-
100
sionals with pediatric expertise who shall over-
see review decisions. 
‘‘(3) USE OF QUALIFIED, INDEPENDENT PER-
SONNEL.—
‘‘(A) IN
GENERAL.—A utilization review 
program shall provide for the conduct of utiliza-
tion review activities only through personnel 
who are qualified and, to the extent required, 
who have received appropriate pediatric or child 
health training in the conduct of such activities 
under the program. 
‘‘(B) PEER REVIEW OF ADVERSE CLINICAL 
DETERMINATIONS.—A utilization review pro-
gram shall provide that clinical peers shall 
evaluate the clinical appropriateness of adverse 
clinical determinations and divergent clinical 
options. 
‘‘SEC. 2773. APPEALS AND GRIEVANCE MECHANISMS FOR 
CHILDREN. 
‘‘(a) INTERNAL APPEALS PROCESS.—A health insur-
ance issuer in connection with the provision of health in-
surance coverage for children shall establish and maintain 
a system to provide for the resolution of complaints and 
appeals regarding all aspects of such coverage. Such a sys-
tem shall include an expedited procedure for appeals on
101
behalf of a child enrollee in situations in which the time 
frame of a standard appeal would jeopardize the life, 
health, or development of the child. 
‘‘(b) EXTERNAL APPEALS PROCESS.—A health in-
surance issuer in connection with the provision of health 
insurance coverage for children shall provide for an inde-
pendent external review process that meets the following 
requirements:
‘‘(1) External appeal activities shall be con-
ducted through clinical peers, a physician or other 
health care professional who is appropriately 
credentialed in pediatrics with the same or similar 
specialty and typically manages the condition, proce-
dure, or treatment under review or appeal. 
‘‘(2) External appeal activities shall be con-
ducted through an entity that has sufficient pedi-
atric expertise, including subspecialty expertise, and 
staffing to conduct external appeal activities on a 
timely basis. 
‘‘(3) Such a review process shall include an ex-
pedited procedure for appeals on behalf of a child 
enrollee in which the time frame of a standard ap-
peal would jeopardize the life, health, or development 
of the child.
102
‘‘SEC. 2774. ACCOUNTABILITY THROUGH DISTRIBUTION OF 
INFORMATION. 
‘‘(a) IN GENERAL.—A health insurance issuer in con-
nection with the provision of health insurance coverage for 
children shall submit to enrollees (and prospective enroll-
ees), and make available to the public, in writing the 
health-related information described in subsection (b). 
‘‘(b) INFORMATION.—The information to be provided 
under subsection (a) shall include a report of measures 
of structures, processes, and outcomes regarding each 
health insurance product offered to participants and de-
pendents in a manner that is separate for both the adult 
and child enrollees, using measures that are specific to 
each group.’’. 
(b) APPLICATION TO GROUP HEALTH INSURANCE 
COVERAGE.—
(1) IN GENERAL.—Subpart 2 of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg–4 et seq.) is amended by adding at the end 
the following new section: 
‘‘SEC. 2707. CHILDREN’S HEALTH ACCOUNTABILITY STAND-
ARDS. 
‘‘(a) IN GENERAL.—Each health insurance issuer 
shall comply with children’s health accountability require-
ment under part C with respect to group health insurance 
coverage it offers.
103
‘‘(b) ASSURING COORDINATION.—The Secretary of 
Health and Human Services and the Secretary of Labor 
shall ensure, through the execution of an interagency 
memorandum of understanding between such Secretaries, 
that—
‘‘(1) regulations, rulings, and interpretations 
issued by such Secretaries relating to the same mat-
ter over which such Secretaries have responsibility 
under part C (and this section) and section 714 of 
the Employee Retirement Income Security Act of 
1974 are administered so as to have the same effect 
at all times; and 
‘‘(2) coordination of policies relating to enforc-
ing the same requirements through such Secretaries 
in order to have a coordinated enforcement strategy 
that avoids duplication of enforcement efforts and 
assigns priorities in enforcement.’’. 
(2) CONFORMING AMENDMENT.—Section 2792 
of the Public Health Service Act (42 U.S.C. 300gg–
92) is amended by inserting ‘‘and section 2707(b)’’ 
after ‘‘of 1996’’. 
(c) APPLICATION TO INDIVIDUAL HEALTH INSUR-
ANCE COVERAGE.—Part B of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-41 et seq.) is amend-
104
ed by inserting after section 2752 the following new sec-
tion: 
‘‘SEC. 2753. CHILDREN’S HEALTH ACCOUNTABILITY STAND-
ARDS. 
‘‘Each health insurance issuer shall comply with chil-
dren’s health accountability requirements under part C 
with respect to individual health insurance coverage it of-
fers.’’. 
(d) MODIFICATION OF PREEMPTION STANDARDS.—
(1) GROUP HEALTH INSURANCE COVERAGE.—
Section 2723 of the Public Health Service Act (42 
U.S.C. 300gg–23) is amended—
(A) in subsection (a)(1), by striking ‘‘sub-
section (b)’’ and inserting ‘‘subsections (b) and 
(c)’’; 
(B) by redesignating subsections (c) and 
(d) as subsections (d) and (e), respectively; and 
(C) by inserting after subsection (b) the 
following new subsection: 
‘‘(c) SPECIAL RULES
IN CASE
OF CHILDREN’S 
HEALTH ACCOUNTABILITY REQUIREMENTS.—Subject to 
subsection (a)(2), the provisions of section 2707 and part 
C, and part D insofar as it applies to section 2707 or part 
C, shall not prevent a State from establishing require-
ments relating to the subject matter of such provisions
105
so long as such requirements are at least as stringent on 
health insurance issuers as the requirements imposed 
under such provisions.’’. 
(2) INDIVIDUAL
HEALTH
INSURANCE
COV-
ERAGE.—Section 2762 of the Public Health Service 
Act (42 U.S.C. 300gg–62), as added by section 
605(b)(3)(B) of Public Law 104–204, is amended—
(A) in subsection (a), by striking ‘‘sub-
section (b), nothing in this part’’ and inserting 
‘‘subsections (b) and (c), nothing in this part’’, 
and 
(B) by adding at the end the following new 
subsection: 
‘‘(c) SPECIAL RULES
IN CASE
OF CHILDREN’S 
HEALTH ACCOUNTABILITY REQUIREMENTS.—Subject to 
subsection (b), the provisions of section 2753 and part C, 
and part D insofar as it applies to section 2753 or part 
C, shall not prevent a State from establishing require-
ments relating to the subject matter of such provisions 
so long as such requirements are at least as stringent on 
health insurance issuers as the requirements imposed 
under such section.’’.
106
SEC. 1214. AMENDMENTS TO THE EMPLOYEE RETIREMENT 
INCOME SECURITY ACT OF 1974. 
(a) IN GENERAL.—Subpart B of part 7 of subtitle 
B of title I of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add-
ing at the end the following: 
‘‘SEC. 714. CHILDREN’S HEALTH ACCOUNTABILITY STAND-
ARDS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), the 
provisions of part C of title XXVII of the Public Health 
Service Act shall apply under this subpart and part to a 
group health plan (and group health insurance coverage 
offered in connection with a group health plan) as if such 
part C were incorporated in this section. 
‘‘(b) APPLICATION.—In applying subsection (a) 
under this subpart and part, any reference in such part 
C—
‘‘(1) to health insurance coverage is deemed to 
be a reference only to group health insurance cov-
erage offered in connection with a group health plan 
and to also be a reference to coverage under a group 
health plan; 
‘‘(2) to a health insurance issuer is deemed to 
be a reference only to such an issuer in relation to 
group health insurance coverage or, with respect to 
a group health plan, to the plan;
107
‘‘(3) to the Secretary is deemed to be a ref-
erence to the Secretary of Labor; 
‘‘(4) to an applicable State authority is deemed 
to be a reference to the Secretary of Labor; and 
‘‘(5) to an enrollee with respect to health insur-
ance coverage is deemed to include a reference to a 
participant or beneficiary with respect to a group 
health plan.’’. 
(b) MODIFICATION OF PREEMPTION STANDARDS.—
Section 731 of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1191) is amended—
(1) in subsection (a)(1), by striking ‘‘subsection 
(b)’’ and inserting ‘‘subsections (b) and (c)’’; 
(2) by redesignating subsections (c) and (d) as 
subsections (d) and (e), respectively; and 
(3) by inserting after subsection (b) the fol-
lowing new subsection: 
‘‘(c) SPECIAL RULES
IN CASE
OF PATIENT AC-
COUNTABILITY REQUIREMENTS.—Subject to subsection 
(a)(2), the provisions of section 714 shall not prevent a 
State from establishing requirements relating to the sub-
ject matter of such provisions so long as such require-
ments are at least as stringent on group health plans and 
health insurance issuers in connection with group health
108
insurance coverage as the requirements imposed under 
such provisions.’’. 
(c) CONFORMING AMENDMENTS.—
(1) Section 732(a) of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1191a(a)) 
is amended by striking ‘‘section 711’’ and inserting 
‘‘sections 711 and 714’’. 
(2) The table of contents in section 1 of the 
Employee Retirement Income Security Act of 1974 
is amended by inserting after the item relating to 
section 713 the following new item:
‘‘Sec. 714. Children’s health accountability standards.’’.
SEC. 1215. STUDIES. 
(a) BY SECRETARY.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall conduct a study, and prepare and 
submit to Congress a report, concerning—
(1) the unique characteristics of patterns of ill-
ness, disability, and injury in children; 
(2) the development of measures of quality of 
care and outcomes related to the health care of chil-
dren; and 
(3) the access of children to primary mental 
health services and the coordination of managed be-
havioral health services. 
(b) BY GAO.—
109
(1) MANAGED CARE.—Not later than 1 year 
after the date of enactment of this Act, the General 
Accounting Office shall conduct a study, and pre-
pare and submit to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House 
of Representatives a report, concerning—
(A) an assessment of the structure and 
performance of non-governmental health plans, 
medicaid managed care organizations, plans 
under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.), and the program under 
title XXI of the Social Security Act (42 U.S.C. 
1397aa et seq.) serving the needs of children 
with special health care needs; 
(B) an assessment of the structure and 
performance of non-governmental plans in serv-
ing the needs of children as compared to med-
icaid managed care organizations under title 
XIX of the Social Security Act (42 U.S.C. 1396 
et seq.); and 
(C) the emphasis that private managed 
care health plans place on primary care and the 
control of services as it relates to care and serv-
110
ices provided to children with special health 
care needs. 
(2) PLAN SURVEY.—Not later than 1 year after 
the date of enactment of this Act, the General Ac-
counting Office shall prepare and submit to the 
Committee on Health, Education, Labor, and Pen-
sions of the Senate and the Committee on Energy 
and Commerce of the House of Representatives a re-
port that contains a survey of health plan activities 
that address the unique health needs of adolescents, 
including quality measures for adolescents and inno-
vative practice arrangement. 
SEC. 1216. EFFECTIVE DATES. 
(a) GROUP HEALTH INSURANCE COVERAGE.—Sub-
ject to subsection (b), the amendments made by this chap-
ter shall apply with respect to group health plans and with 
respect to health insurance coverage offered, sold, issued, 
renewed, in effect, or operated in the individual market 
for plan years beginning on or after January 1, 2004. 
(b) COLLECTIVE BARGAINING EXCEPTION.—In the 
case of a group health plan maintained pursuant to 1 or 
more collective bargaining agreements between employee 
representatives and 1 or more employers ratified before 
the date of enactment of this Act, the amendments made
111
by this chapter shall not apply to plan years beginning 
before the later of—
(1) the earliest date as of which all such collec-
tive bargaining agreements relating to the plan have 
terminated (determined without regard to any exten-
sion thereof agreed to after the date of the enact-
ment of this Act), or 
(2) January 1, 2004. 
For purposes of paragraph (1), any plan amendment made 
pursuant to a collective bargaining agreement relating to 
the plan which amends the plan solely to conform to any 
requirement added by this chapter shall not be treated as 
a termination of such collective bargaining agreement. 
CHAPTER 3—EPSDT 
SEC. 1221. COLLECTION OF DATA REGARDING THE DELIV-
ERY OF EPSDT SERVICES. 
Section 1902(a)(43) of the Social Security Act (42 
U.S.C. 1396a(a)(43)) is amended—
(1) in subparagraph (C), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (D)(iv), by striking the 
semicolon and inserting ‘‘, and’’; and 
(3) by inserting after subparagraph (D)(iv), the 
following new subparagraph:
112
‘‘(E) beginning with fiscal year 2005, re-
porting to the Secretary (in a uniform form and 
manner established by the Secretary that does 
not identify individual patients and that allows 
for the comparison of data within and among 
States) the following information relating to 
early and periodic screening, diagnostic, and 
treatment services provided to each child en-
rolled under the plan during each fiscal year: 
‘‘(i) as of the date of enrollment of 
the child, the child’s—
‘‘(I) age, State of residence, gen-
der, and race/ethnicity, 
‘‘(II) the basis for eligibility for 
medical assistance, 
‘‘(III) immunization history, 
‘‘(IV) blood-lead level, 
‘‘(V) weight and height percentile 
compared to the widely accepted 
standard percentiles for the child’s 
age, 
‘‘(VI) general health and any 
chronic conditions or disabilities, and 
‘‘(VII) the primary service deliv-
ery arrangement (such as fee-for-serv-
113
ice, managed care, preferred provider 
organization, or other provider prac-
tice arrangement); and 
‘‘(ii) throughout the fiscal year (at 
such intervals as the Secretary shall speci-
fy)—
‘‘(I) the number of medical 
screenings the child received and a 
specific description of the services per-
formed as part of such screenings 
(such as the weighing and measuring 
of the child and the administering of 
a blood-lead level test), 
‘‘(II) the number of screenings 
the child received for vision and hear-
ing problems, 
‘‘(III) the number of dental 
screenings the child received, 
‘‘(IV) 
information 
regarding 
whether a condition was discovered 
from any of such screenings, whether 
the child was referred for, and re-
ceived, further treatment, and if so, 
the number of visits, and the treat-
ments received, and
114
‘‘(V) the actual or estimated 
costs of each of such screenings and 
treatments, 
‘‘(VI) 
information 
regarding 
whether such screenings and treat-
ments are more comprehensive than
similar screenings and treatments pro-
vided to adult individuals enrolled in 
the plan, and 
‘‘(VII) the service delivery ar-
rangement for such screening and 
treatment provided;’’. 
Subtitle D—Reducing Public 
Health Risks 
CHAPTER 1—ASTHMA TREATMENTS 
SEC. 1301. FINDINGS. 
Congress finds that—
(1)(A) asthma is 1 of the most common and 
deadly diseases in the United States, affecting an es-
timated 14,000,000 to 15,000,000 individuals in the 
United States, including almost 5,000,000 children; 
(B) asthma is the most common chronic illness 
in children, affecting an estimated 7 percent of chil-
dren in the United States;
115
(C) although asthma can occur at any age, 
about 80 percent of the children who develop asthma 
do so before starting school; 
(D) asthma is the single greatest cause of 
school absenteeism, with 10,100,000 days missed 
from school per year in the United States; and 
(E) according to a 1995 National Institutes of 
Health workshop report, the cost of lost productivity 
from missed school days for parents of children with 
asthma is estimated at $1,000,000,000 per year; 
and 
(2)(A) vision and hearing screening is an essen-
tial part of child health care; 
(B) a vision or hearing deficit may undermine 
a child’s ability to learn; 
(C) the Chicago public school system has deter-
mined through vision screening that a far higher 
number of children identified as failing academically 
suffer from vision impairment; 
(D) students who have failed a grade 1 or more 
times are even more likely to have a vision problem; 
(E) more than 30 percent of students in Chi-
cago public schools who were retained during the 
1998–1999 school year failed their school-based vi-
116
sion screening, a rate that is 50 percent higher than 
children who were not failing; 
(F) schools play a critical role in promoting a 
clear link between visual and hearing acuity and 
academic performance; 
(G) providing vision and hearing screening in 
schools helps children receive those essential health 
care services in a timely fashion; 
(H) many parents find it difficult to take time 
off work in order to ensure that their children re-
ceive preventive or other nonemergency health care 
services; and 
(I) allowing children to receive nonemergency 
health care services at school would ensure that the 
children receive services that promote healthy lives 
and better academic achievement. 
SEC. 1302. ASTHMA, VISION, AND HEARING SCREENING FOR 
EARLY HEAD START AND HEAD START PRO-
GRAMS. 
(a) EARLY HEAD START PROGRAMS.—Section 645A 
of the Head Start Act (42 U.S.C. 9840a) is amended by 
adding at the end the following: 
‘‘(h) ASTHMA, VISION, AND HEARING SCREENING.—
117
‘‘(1) IN GENERAL.—An entity that receives as-
sistance under this section may carry out a program 
under which the entity—
‘‘(A) determines whether a child eligible to 
participate in the program described in sub-
section (a)(1) has received each of an asthma, 
vision, and hearing screening test using a test 
that is appropriate for age and risk factors on 
the enrollment of the child in the program; and 
‘‘(B) in the case of a child who has not re-
ceived each of an asthma, and vision, and hear-
ing screening test, ensures that the enrolled 
child receives such a test either by referral or 
by performing the test (under contract or other-
wise). 
‘‘(2) REIMBURSEMENT.—
‘‘(A) IN GENERAL.—On the request of an 
entity that performs or arranges for the per-
formance of an asthma, vision, or hearing 
screening test under paragraph (1) on a child 
who is eligible for or receiving medical assist-
ance under a State plan under title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.), 
the Secretary of Health and Human Services, 
notwithstanding any other provision of, or limi-
118
tation under, title XIX of the Social Security 
Act, shall reimburse the entity, from funds that 
are made available under that title, for 100 per-
cent of the cost of the test and data reporting. 
‘‘(B) COSTS.—The costs of a test con-
ducted under this subsection—
‘‘(i) shall include reimbursement for 
testing devices and associated supplies ap-
proved for sale by the Food and Drug Ad-
ministration and used in compliance with 
section 353 of the Public Health Service 
Act (42 U.S.C. 263a); and 
‘‘(ii) shall include reimbursement for 
administering the tests and related serv-
ices, as determined appropriate by the 
State agency. 
‘‘(3) HEAD START.—This subsection shall apply 
to Head Start programs that include coverage, di-
rectly or indirectly, for infants and toddlers under 
the age of 3 years.’’. 
(b) HEAD START PROGRAMS.—Section 642(b) of the 
Head Start Act (42 U.S.C. 9837(b)) is amended—
(1) in paragraph (10), by striking ‘‘and’’ at the 
end;
119
(2) in paragraph (11), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(12) with respect to an agency that elects to 
carry out a program under section 645(h), comply 
with the requirements of such section 645A(h) in the
case of each child eligible to participate in the Head 
Start program to be carried out by the agency.’’. 
(c) PAYMENTS FOR SCREENING AND TREATMENT 
PROVIDED TO CHILDREN ELIGIBLE UNDER MEDICAID OR 
SCHIP.—
(1) MEDICAID.—Section 1903(c) of the Social 
Security Act (42 U.S.C. 1396b(c)) is amended—
(A) by inserting ‘‘(1)’’ after ‘‘(c)’’; and 
(B) by adding at the end the following: 
‘‘(2) Nothing in this title or any other provision of 
law, including the payment limitation commonly known as 
the ‘free care rule’, shall be construed as prohibiting or 
restricting, or authorizing the Secretary to prohibit or re-
strict, payment under subsection (a) for medical assist-
ance for covered services furnished to a child who is eligi-
ble for or receiving medical assistance under the State 
plan and who receives an asthma, vision, hearing, or other 
health screening test, or is provided treatment, education 
in disease management, corrective eyewear, or hearing
120
aids, through a public elementary or secondary school, 
whether directly or indirectly, and regardless of whether 
the school participates in a program established under 
subsection (a) or (b) of section 320B of the Public Health 
Service Act.’’. 
(2) SCHIP.—Section 2105 of the Social Secu-
rity Act (42 U.S.C. 1397ee) is amended by adding 
at the end the following: 
‘‘(g) REQUIRED PAYMENT FOR CERTAIN SCHOOL-
BASED SERVICES.—Nothing in this title or any other pro-
vision of law (including the payment limitation under title 
XIX commonly known as the ‘free care rule’ to the extent, 
if any, such limitation applies to the program established 
under this title), shall be construed as prohibiting or re-
stricting, or authorizing the Secretary to prohibit or re-
strict, payment under subsection (a) for child health as-
sistance for covered services furnished to a child who is 
eligible for or receiving such assistance under the State 
plan and who receives an asthma, vision, or hearing 
screening test, or other health screening test that is avail-
able to children receiving assistance under the State plan, 
or is provided treatment, education in disease manage-
ment, corrective eyewear, or hearing aids through a public 
elementary or secondary school, whether directly or indi-
rectly, and regardless of whether the school participates
121
in a program established under subsection (a) or (b) of 
section 320B of the Public Health Service Act.’’. 
SEC. 1303. ASTHMA, VISION, AND HEARING SCREENING AND 
TREATMENT FOR CHILDREN ENROLLED IN 
PUBLIC SCHOOLS. 
Part B of title III of the Public Health Service Act 
(42 U.S.C. 243 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 320B. ASTHMA, VISION, AND HEARING SCREENING 
AND TREATMENT FOR CHILDREN ENROLLED 
IN PUBLIC SCHOOLS. 
‘‘(a) ASTHMA SCREENING AND CASE MANAGEMENT 
PROGRAM.—
‘‘(1) IN GENERAL.—The Secretary, in collabo-
ration with the Secretary of Education, shall carry 
out an asthma screening and case management pro-
gram under which local educational agencies shall be 
reimbursed for the provision of asthma screening 
and case management to children enrolled in public 
elementary schools and secondary schools located in 
areas with respect to which there is a high incidence 
of childhood asthma. 
‘‘(2) PROGRAM
ELEMENTS.—Under the pro-
gram, a local educational agency shall—
122
‘‘(A) determine whether a child enrolled in 
a school described in paragraph (1) has received 
an asthma screening test using a test that is 
appropriate for age and risk factors on the en-
rollment of the child in the school; 
‘‘(B) in the case of a child who has not re-
ceived an asthma screening test, ensure that 
the child receives such a test either by referral 
or by performing the test (under contract or 
otherwise); and 
‘‘(C) in the case of a child determined to 
have asthma, provide treatment or refer the 
child for treatment (including case manage-
ment) and education in the management of 
asthma.
‘‘(3) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to carry out 
this subsection with respect to a child, and any data 
reporting with respect to the child, who is not eligi-
ble for coverage under title XIX or XXI of the So-
cial Security Act, or is not otherwise covered under 
a health insurance plan, $10,000,000 for each fiscal 
year. 
‘‘(b) VISION AND HEARING SCREENING PROGRAM.—
123
‘‘(1) IN GENERAL.—The Secretary shall carry 
out a vision and hearing screening program under 
which local educational agencies shall be reimbursed 
for the provision of vision and hearing screening and 
corrective eyewear and hearing aids to children en-
rolled in public elementary schools and secondary 
schools. 
‘‘(2) PROGRAM
ELEMENTS.—Under the pro-
gram, a local educational agency shall—
‘‘(A) elect to provide vision and hearing 
screening tests—
‘‘(i) to all children enrolled in a school 
who are most likely to suffer from vision or 
hearing loss; or 
‘‘(ii) to all children enrolled in a 
school; 
‘‘(B) ensure that the category of children 
elected under subparagraph (A) receive such 
tests, either by referral or by performing the 
test (under contract or otherwise), that are ap-
propriate for the age and risk factors of the 
children, based on the enrollment of the chil-
dren in the school; and 
‘‘(C) in the case of any child determined to 
have a vision or hearing impairment, provide
124
the child with such eyewear and hearing aids as 
are appropriate to correct the child’s vision or 
hearing, to the extent that such correction is 
feasible. 
‘‘(3) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to carry out 
this subsection with respect to a child, and any data 
reporting with respect to the child, who is not eligi-
ble for coverage under title XIX or XXI of the So-
cial Security Act, or is not otherwise covered under 
a health insurance plan, $10,000,000 for each fiscal 
year. 
‘‘(c) REIMBURSEMENT.—
‘‘(1) CHILDREN
ENROLLED
IN
OR
ELIGIBLE 
FOR MEDICAID.—
‘‘(A) IN
GENERAL.—With respect to a 
child who is eligible for or receiving medical as-
sistance under a State plan under title XIX of 
the Social Security Act (42 U.S.C. 1396 et 
seq.) and who receives, or is provided, a test, 
treatment, education, corrective eyewear, or 
hearing aid under a program established under 
subsection (a) or (b), the Secretary, notwith-
standing any other provision of, or limitation 
under, such title XIX, including the payment
125
limitation commonly known as the ‘free care 
rule’, shall reimburse the local educational 
agency administering such program from funds 
that are made available under such title XIX 
for 100 percent of the cost of the performance, 
arrangement, or provision and data reporting. 
‘‘(B) COSTS.—The costs of a test con-
ducted under this section shall include reim-
bursement for—
‘‘(i) testing devices and associated 
supplies approved for sale by the Food and 
Drug Administration and used in compli-
ance with section 353; and 
‘‘(ii) administering the tests and re-
lated services, as determined appropriate 
by the State agency responsible for the ad-
ministration of title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.). 
‘‘(2) CHILDREN
ENROLLED
IN
OR
ELIGIBLE 
FOR SCHIP.—
‘‘(A) IN
GENERAL.—With respect to a 
child who is eligible for or receiving child health 
assistance under a State plan under title XXI 
of the Social Security Act (42 U.S.C. 1397aa et 
seq.) and who receives, or is provided, a test,
126
treatment, education, corrective eyewear, or 
hearing aid under a program established under 
subsection (a) or (b), the Secretary, notwith-
standing any other provision of, or limitation 
under, such title XXI, or any other provision of 
law (including the payment limitation under 
title XIX commonly known as the ‘free care 
rule’ to the extent, if any, such limitation ap-
plies to the State children’s health insurance 
program established under title XXI of that 
Act), shall reimburse the local educational agen-
cy administering such program from funds that 
are made available under such title XXI for 
100 percent of the cost of the performance, ar-
rangement, or provision and data reporting. 
‘‘(B) COSTS.—The costs shall include the 
costs described in paragraph (1)(B). 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require that a local educational 
agency participate in a program carried out by the Sec-
retary under this section. 
‘‘(e) DEFINITIONS.—In this section, the terms ‘local 
educational agency’, ‘elementary school’, and ‘secondary 
school’ have the meanings given such terms in section
127
9101 of the Elementary and Secondary Education Act of 
1965 (20 U.S.C. 7801).’’. 
SEC. 1304. GENERAL EFFECTIVE DATE. 
(a) IN GENERAL.—Except as provided in subsection 
(b), the amendments made by this chapter take effect on 
the date that is 18 months after the date of enactment 
of this Act. 
(b) HEAD START WAIVERS.—
(1) IN GENERAL.—An entity carrying out ac-
tivities under section 642 or 645A of the Head Start 
Act (42 U.S.C. 9837, 9840a), may be awarded a 
waiver from the amendments made by section 1302 
if the State where the entity is located establishes to 
the satisfaction of the Secretary of Health and 
Human Services, in accordance with requirements 
and procedures recommended in accordance with 
paragraph (2) to the Secretary by the Director of 
the Centers for Disease Control and Prevention a 
plan for increasing the number of asthma, vision, 
and hearing screening tests of children enrolled in 
the Early Head Start and Head Start programs in 
the State. 
(2) DEVELOPMENT
OF
WAIVER
PROCEDURES 
AND REQUIREMENTS.—Not later than 1 year after 
the date of enactment of this Act, the Director of
128
the Centers for Disease Control and Prevention shall 
develop and recommend to the Secretary of Health 
and Human Services criteria and procedures (includ-
ing a timetable for the submission of the State plan 
described in paragraph (1)) for the awarding of 
waivers under that paragraph. 
CHAPTER 2—INCREASE IN FUNDING FOR 
HUD PROGRAMS 
SEC. 1311. LEAD-BASED PAINT HAZARD CONTROL GRANTS. 
Section 1011(p) of the Residential Lead-Based Paint 
Hazard Reduction Act of 1992 (42 U.S.C. 4852) is 
amended by striking ‘‘appropriated’’ and all that follows 
through the period and inserting ‘‘appropriated—
‘‘(1) $125,000,000 for fiscal year 1993 and 
$250,000,000 for fiscal year 1994; 
‘‘(2) $200,000,000 for fiscal year 2004; 
‘‘(3) $250,000,000 for fiscal year 2005; and 
‘‘(4) $300,000,000 beginning with fiscal year 
2006 and fiscal years thereafter.’’. 
SEC. 1312. HEALTHY HOMES INITIATIVE PROGRAM. 
There are authorized to be appropriated for the 
Healthy Homes Initiative program established under sec-
tions 501 and 502 of the Housing and Urban Develop-
ment Act of 1970 (12 U.S.C. 1701z–1; 1701z–2), for 
which funds were provided under title II of the Depart-
129
ments of Veterans Affairs and Housing and Urban Devel-
opment, 
Independent 
Agencies 
Appropriations 
Act, 
2000—
(1) $100,000,000 for fiscal year 2004; and
(2) $150,000,000 beginning with fiscal year 
2005 and fiscal years thereafter. 
CHAPTER 3—YOUTH SMOKING CESSATION 
AND EDUCATION 
SEC. 1321. SHORT TITLE. 
This chapter may be cited as the ‘‘Kids Deserve Free-
dom from Tobacco Act of 2003’’ or the ‘‘KIDS Act’’. 
Subchapter A—Protection of Children from 
Tobacco 
PART I—FOOD AND DRUG ADMINISTRATION 
JURISDICTION AND GENERAL AUTHORITY 
SEC. 1331. REFERENCE. 
Whenever in this subchapter an amendment or repeal 
is expressed in terms of an amendment to, or repeal of, 
a section or other provision, the reference shall be consid-
ered to be made to a section or other provision of the Fed-
eral Food, Drug, and Cosmetic Act (21 U.S.C. 301 et 
seq.). 
SEC. 1332. STATEMENT OF GENERAL AUTHORITY. 
The regulations promulgated by the Secretary in the 
rule dated August 28, 1996 (Vol. 61, No. 168 C.F.R.),
130
adding part 897 to title 21, Code of Federal Regulations, 
shall be deemed to have been lawfully promulgated under 
the Food, Drug, and Cosmetic Act as amended by this 
subchapter. Such regulations shall apply to all tobacco 
products. 
SEC. 1333. NONAPPLICABILITY TO OTHER DRUGS OR DE-
VICES. 
Nothing in this subchapter, or an amendment made 
by this subchapter, shall be construed to affect the regula-
tion of drugs and devices that are not tobacco products 
by the Secretary under the Federal Food, Drug, and Cos-
metic Act. 
SEC. 1334. CONFORMING AMENDMENTS TO CONFIRM JU-
RISDICTION. 
(a) DEFINITIONS.—
(1) DRUG.—Section 201(g)(1) (21 U.S.C. 
321(g)(1)) is amended by striking ‘‘; and (D)’’ and 
inserting ‘‘; (D) nicotine in tobacco products; and 
(E)’’. 
(2) DEVICES.—Section 201(h) (21 U.S.C. 
321(h)) is amended by adding at the end the fol-
lowing: ‘‘Such term includes a tobacco product.’’. 
(3) OTHER
DEFINITIONS.—Section 201 (21 
U.S.C. 321) is amended by adding at the end the 
following:
131
‘‘(nn) The term ‘tobacco product’ means any 
product made or derived from tobacco that is in-
tended for human consumption.’’. 
(b) PROHIBITED ACTS.—Section 301 (21 U.S.C. 
331) is amended by adding at the end the following: 
‘‘(hh) The manufacture, labeling, distribution, adver-
tising and sale of any adulterated or misbranded tobacco 
product in violation of—
‘‘(1) regulations issued under this Act; or 
‘‘(2) the KIDS Act, or regulations issued under 
such Act.’’. 
(c) ADULTERATED DRUGS AND DEVICES.—
(1) IN GENERAL.—Section 501 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 351) is 
amended by adding at the end the following: 
‘‘(j) If it is a tobacco product and it does not comply 
with the provisions of subchapter D of this chapter or the 
KIDS Act.’’. 
(2) MISBRANDING.—Section 502(q) (21 U.S.C. 
352(q)) is amended—
(A) by striking ‘‘or (2)’’ and inserting in 
lieu thereof ‘‘(2)’’; and 
(B) by inserting before the period the fol-
lowing: ‘‘, or (3) in the case of a tobacco prod-
uct, it is sold, distributed, advertised, labeled,
132
or used in violation of this Act or the KIDS 
Act, or regulations prescribed under such 
Acts’’. 
(d) RESTRICTED
DEVICE.—Section 520(e) (21 
U.S.C. 360j(e)) is amended—
(1) in paragraph (1), by striking ‘‘or use—’’ 
and inserting ‘‘or use, including restrictions on the 
access to, and the advertising and promotion of, to-
bacco products—’’; and 
(2) by adding at the end the following: 
‘‘(3) Tobacco products are a restricted device under 
this paragraph.’’.
(e) REGULATORY AUTHORITY.—Section 503(g) (21 
U.S.C. 353(g)) is amended by adding at the end the fol-
lowing: 
‘‘(6) The Secretary may regulate any tobacco product 
as a drug, device, or both, and may designate the office 
of the Administration that shall be responsible for regu-
lating such products.’’. 
SEC. 1335. GENERAL RULE. 
Section 513(a)(1)(B) (21 U.S.C. 360c(a)(1)(B)) is 
amended by adding at the end the following: ‘‘The sale 
of tobacco products to adults that comply with perform-
ance standards established for these products under sec-
tion 514 and other provisions of this Act and any regula-
133
tions prescribed under this Act shall not be prohibited by 
the Secretary, notwithstanding sections 502(j), 516, and 
518.’’. 
SEC. 1336. SAFETY AND EFFICACY STANDARD AND RECALL 
AUTHORITY. 
(a) SAFETY
AND EFFICACY STANDARD.—Section 
513(a) (21 U.S.C. 360c(a)) is amended—
(1) in paragraph (1)(B), by inserting after the 
first sentence the following: ‘‘For a device which is 
a tobacco product, the assurance in the previous sen-
tence need not be found if the Secretary finds that 
special controls achieve the best public health re-
sult.’’; and 
(2) in paragraph (2)—
(A) by redesignating subparagraphs (A), 
(B) and (C) as clauses (i), (ii) and (iii), respec-
tively; 
(B) by striking ‘‘(2) For’’ and inserting 
‘‘(2)(A) For’’; and 
(C) by adding at the end the following: 
‘‘(B) For purposes of paragraph (1)(B), subsections 
(c)(2)(C), 
(d)(2)(B), 
(e)(2)(A), 
(f)(3)(B)(i), 
and 
(f)(3)(C)(i), and sections 514, 519(a), 520(e), and 520(f), 
the safety and effectiveness of a device that is a tobacco 
product need not be found if the Secretary finds that the
134
action to be taken under any such provision would achieve 
the best public health result. The finding as to whether 
the best public health result has been achieved shall be 
determined with respect to the risks and benefits to the
population as a whole, including users and non-users of 
the tobacco product, and taking into account—
‘‘(i) the increased or decreased likelihood that 
existing consumers of tobacco products will stop 
using such products; and 
‘‘(ii) the increased or decreased likelihood that 
those who do not use tobacco products will start 
using such products.’’. 
(b) RECALL AUTHORITY.—Section 518(e)(1) (21 
U.S.C. 360h(e)(1)) is amended by inserting after ‘‘adverse 
health consequences or death,’’ the following: ‘‘and for to-
bacco products that the best public health result would 
be achieved,’’. 
PART II—REGULATION OF TOBACCO PRODUCTS 
SEC. 1341. PERFORMANCE STANDARDS. 
Section 514(a) (21 U.S.C. 60d(a)) is amended—
(1) in paragraph (2), by striking ‘‘device’’ and 
inserting ‘‘nontobacco product device’’; 
(2) by redesignating paragraphs (3) and (4) as 
paragraphs (5) and (6), respectively; and
135
(3) by inserting after paragraph (2) the fol-
lowing: 
‘‘(3) The Secretary may adopt a performance stand-
ard under section 514(a)(2) for a tobacco product regard-
less of whether the product has been classified under sec-
tion 513. Such standard may—
‘‘(A) include provisions to achieve the best pub-
lic health result; 
‘‘(B) where necessary to achieve the best public 
health result, include—
‘‘(i) provisions respecting the construction, 
components, 
constituents, 
ingredients, 
and 
properties of the tobacco product device, includ-
ing the reduction or elimination (or both) of 
nicotine and the other components, ingredients, 
and constituents of the tobacco product, its 
components and its by-products, based upon the 
best available technology; 
‘‘(ii) provisions for the testing (on a sam-
ple basis or, if necessary, on an individual 
basis) of the tobacco product device or, if it is 
determined that no other more practicable 
means are available to the Secretary to assure 
the conformity of the tobacco product device to 
such standard, provisions for the testing (on a
136
sample basis or, if necessary, on an individual 
basis) by the Secretary or by another person at 
the direction of the Secretary; 
‘‘(iii) provisions for the measurement of 
the performance characteristics of the tobacco 
product device; 
‘‘(iv) provisions requiring that the results 
of each test or of certain tests of the tobacco 
product device required to be made under 
clause (ii) demonstrate that the tobacco product 
device is in conformity with the portions of the 
standard for which the test or tests were re-
quired; and 
‘‘(v) a provision that the sale and distribu-
tion of the tobacco product device be restricted 
but only to the extent that the sale and dis-
tribution of a tobacco product device may other-
wise be restricted under this Act; and 
‘‘(C) where appropriate, require the use and 
prescribe the form and content of labeling for the 
use of the tobacco product device. 
‘‘(4) Not later than 1 year after the date of enact-
ment of the KIDS Act, the Secretary (acting through the 
Commissioner of Food and Drugs) shall establish a Sci-
entific Advisory Committee to evaluate whether a level or
137
range of levels exists at which nicotine yields do not 
produce drug-dependence. The Advisory Committee shall 
also review any other safety, dependence or health issue 
assigned to it by the Secretary. The Secretary need not 
promulgate regulations to establish the Committee.’’.
SEC. 1342. APPLICATION OF FEDERAL FOOD, DRUG, AND 
COSMETIC ACT TO TOBACCO PRODUCTS. 
(a) TOBACCO PRODUCTS REGULATION.—Chapter V 
(21 U.S.C. 351 et seq.) is amended by adding at the end 
the following: 
‘‘SUBCHAPTER F—TOBACCO PRODUCT DEVEL-
OPMENT, MANUFACTURING, AND ACCESS 
RESTRICTIONS 
‘‘SEC. 570. PROMULGATION OF REGULATIONS. 
‘‘Any regulations necessary to implement this sub-
chapter shall be promulgated not later than 12 months 
after the date of enactment of this subchapter using notice 
and comment rulemaking (in accordance with chapter 5 
of title 5, United States Code). Such regulations may be 
revised thereafter as determined necessary by the Sec-
retary. 
‘‘SEC. 571. MAIL-ORDER SALES. 
‘‘(a) IN GENERAL.—Not later than 2 years after the 
date of enactment of this subchapter, the Secretary shall 
review and determine whether persons under the age of
138
18 years are obtaining tobacco products by means of the 
mail.
‘‘(b) RESTRICTIONS.—Based solely upon the review 
conducted under subsection (a), the Secretary may take 
regulatory and administrative action to restrict or elimi-
nate mail order sales of tobacco products. 
‘‘SEC. 572. IMPLEMENTATION OF THE PROPOSED RESOLU-
TION. 
‘‘(a) ADDITIONAL RESTRICTIONS
ON MARKETING, 
ADVERTISING, AND ACCESS.—Not later than 18 months 
after the date of the enactment of this subchapter, the 
Secretary shall revise the regulations related to tobacco 
products promulgated by the Secretary on August 28, 
1996 (61 Fed. Reg. 44396) to include the additional re-
strictions on marketing, advertising, and access described 
in Title IA and Title IC of the Proposed Resolution en-
tered into by the tobacco manufacturers and the State at-
torneys general on June 20, 1997, except that the Sec-
retary shall not include an additional restriction on mar-
keting or advertising in such regulations if its inclusion 
would violate the First Amendment to the Constitution. 
‘‘(b) WARNINGS.—Not later than 18 months after the 
date of the enactment of this subchapter, the Secretary 
shall promulgate regulations to require warnings on ciga-
rette and smokeless tobacco labeling and advertisements.
139
The content, format, and rotation of warnings shall con-
form to the specifications described in Title IB of the Pro-
posed Resolution entered into by the tobacco manufactur-
ers and the State attorneys general on June 20, 1997. 
‘‘(c) RULES OF CONSTRUCTION.—
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed to limit the ability of the Sec-
retary to change the text or layout of any of the 
warning statements, or any of the labeling provi-
sions, under the regulations promulgated under sub-
section (b) and other provisions of this Act, if deter-
mined necessary by the Secretary in order to make 
such statements or labels larger, more prominent, 
more conspicuous, or more effective. 
‘‘(2) UNFAIR
ACTS.—Nothing in this section 
(other than the requirements of subsections (a) and 
(b)) shall be construed to limit or restrict the au-
thority of the Federal Trade Commission with re-
spect to unfair or deceptive acts or practices in the 
advertising of tobacco products. 
‘‘(d) LIMITED PREEMPTION.—
‘‘(1) STATE AND LOCAL ACTION.—No warning 
label with respect to tobacco products, or any other 
tobacco product for which warning labels have been 
required under this section, other than the warning
140
labels required under this Act, shall be required by 
any State or local statute or regulation to be in-
cluded on any package of a tobacco product. 
‘‘(2) EFFECT ON LIABILITY LAW.—Nothing in 
this section shall relieve any person from liability at 
common law or under State statutory law to any 
other person. 
‘‘(e) VIOLATION OF SECTION.—Any tobacco product 
that is in violation of this section shall be deemed to be 
misbranded. 
‘‘SEC. 573. GENERAL RESPONSIBILITIES OF MANUFACTUR-
ERS, DISTRIBUTORS AND RETAILERS. 
‘‘Each manufacturer, distributor, and retailer shall 
ensure that the tobacco products it manufactures, labels, 
advertises, packages, distributes, sells, or otherwise holds 
for sale comply with all applicable requirements of this 
Act. 
‘‘SEC. 574. DISCLOSURE AND REPORTING OF TOBACCO AND 
NONTOBACCO INGREDIENTS AND CONSTITU-
ENTS. 
‘‘(a) DISCLOSURE OF ALL INGREDIENTS.—
‘‘(1) IMMEDIATE AND ANNUAL DISCLOSURE.—
Not later than 30 days after the date of enactment 
of this subchapter, and annually thereafter, each 
manufacturer of a tobacco product shall submit to
141
the Secretary an ingredient list for each brand of to-
bacco product it manufactures that contains the in-
formation described in paragraph (2). 
‘‘(2) REQUIREMENTS.—The list described in 
paragraph (1) shall, with respect to each brand or 
variety of tobacco product of a manufacturer, in-
clude—
‘‘(A) a list of all ingredients, constituents, 
substances, and compounds that are found in or 
added to the tobacco or tobacco product (in-
cluding the paper, filter, or packaging of the 
product if applicable) in the manufacture of the 
tobacco product, for each brand or variety of to-
bacco product so manufactured, including, if 
determined necessary by the Secretary, any ma-
terial added to the tobacco used in the product 
prior to harvesting; 
‘‘(B) the quantity of the ingredients, con-
stituents, substances, and compounds that are 
listed under subparagraph (A) in each brand or 
variety of tobacco product; 
‘‘(C) the nicotine content of the product, 
measured in milligrams of nicotine; 
‘‘(D) for each brand or variety of ciga-
rettes—
142
‘‘(i) the filter ventilation percentage 
(the level of air dilution in the cigarette as 
provided by the ventilation holes in the fil-
ter, described as a percentage); 
‘‘(ii) the pH level of the smoke of the 
cigarette; and
‘‘(iii) the tar, unionized (free) nico-
tine, and carbon monoxide delivery level 
and any other smoking conditions estab-
lished by the Secretary, reported in milli-
grams of tar, nicotine, and carbon mon-
oxide per cigarette; 
‘‘(E) for each brand or variety of smoke-
less tobacco products— 
‘‘(i) the pH level of the tobacco; 
‘‘(ii) the moisture content of the to-
bacco expressed as a percentage of the 
weight of the tobacco; and 
‘‘(iii) the nicotine content—
‘‘(I) for each gram of the prod-
uct, measured in milligrams of nico-
tine; 
‘‘(II) expressed as a percentage 
of the dry weight of the tobacco; and
143
‘‘(III) with respect to unionized 
(free) nicotine, expressed as a percent-
age per gram of the tobacco and ex-
pressed in milligrams per gram of the 
tobacco; and 
‘‘(F) any other information determined ap-
propriate by the Secretary. 
‘‘(3) METHODS.—The Secretary shall have the 
authority to promulgate regulations to establish the 
methods to be used by manufacturers in making the 
determinations required under paragraph (2). 
‘‘(4) OTHER
TOBACCO
PRODUCTS.—The Sec-
retary shall prescribe such regulations as may be 
necessary to establish information disclosure proce-
dures for other tobacco products. 
‘‘(b) SAFETY ASSESSMENTS.—
‘‘(1) APPLICATION TO NEW INGREDIENTS.—
‘‘(A) IN GENERAL.—Not later than 1 year 
after the date of enactment of this subchapter, 
and annually thereafter, each manufacturer 
shall submit to the Secretary a safety assess-
ment for each new ingredient, constituent, sub-
stance, or compound that such manufacturer 
desires to make a part of a tobacco product. 
Such new ingredient, constituent, substance, or
144
compound shall not be included in a tobacco 
product prior to approval by the Secretary of 
such a safety assessment. 
‘‘(B) METHOD OF FILING.—A safety as-
sessment submitted under subparagraph (A) 
shall be signed by an officer of the manufac-
turer who is acting on behalf of the manufac-
turer and who has the authority to bind the 
manufacturer, and contain a statement that en-
sures that the information contained in the as-
sessment is true, complete and accurate. 
‘‘(C) DEFINITION OF NEW INGREDIENT.—
For purposes of subparagraph (A), the term 
‘new ingredient, constituent, substance, or com-
pound’ means an ingredient, constituent, sub-
stance, or compound listed under subsection 
(a)(1) that was not used in the brand or variety 
of tobacco product involved prior to January 1, 
1998. 
‘‘(2) APPLICATION TO OTHER INGREDIENTS.—
With respect to the application of this section to in-
gredients, constituents substances, or compounds 
listed under subsection (a) to which paragraph (1) 
does not apply, all such ingredients, constituents, 
substances, or compounds shall be reviewed through
145
the safety assessment process within the 5-year pe-
riod beginning on the date of enactment of this sub-
chapter. The Secretary shall develop a procedure for 
the submission of safety assessments of such ingre-
dients, constituents, substances, or compounds that 
staggers such safety assessments within the 5-year 
period. 
‘‘(3) BASIS OF ASSESSMENT.—The safety as-
sessment of an ingredient, constituent, substance, or 
compound described in paragraphs (1) and (2) 
shall—
‘‘(A) be based on the best scientific evi-
dence available at the time of the submission of 
the assessment; and
‘‘(B) demonstrate that there is a reason-
able certainty among experts qualified by sci-
entific training and experience who are con-
sulted, that the ingredient, constituent, sub-
stance, or compound will not present any risk 
to consumers or the public in the quantities 
used under the intended conditions of use. 
‘‘(c) PROHIBITION.—
‘‘(1) REGULATIONS.—Not later than 12 months 
after the date of enactment of this subchapter, the 
Secretary shall promulgate regulations to prohibit
146
the use of any ingredient, constituent, substance, or 
compound in the tobacco product of a manufac-
turer—
‘‘(A) if no safety assessment has been sub-
mitted by the manufacturer for the ingredient, 
constituent, substance, or compound as other-
wise required under this section; or
‘‘(B) if the Secretary finds that the manu-
facturer has failed to demonstrate the safety of 
the ingredient, constituent, substance, or com-
pound that was the subject of the assessment 
under paragraph (2). 
‘‘(2) REVIEW OF ASSESSMENTS.—
‘‘(A) GENERAL REVIEW.—Not later than 
180 days after the receipt of a safety assess-
ment under subsection (b), the Secretary shall 
review the findings contained in such assess-
ment and approve or disapprove of the safety of 
the ingredient, constituent, substance, or com-
pound that was the subject of the assessment. 
The Secretary may, for good cause, extend the 
period for such review. The Secretary shall pro-
vide notice to the manufacturer of an action 
under this subparagraph.
147
‘‘(B) INACTION
BY
SECRETARY.—If the 
Secretary fails to act with respect to an assess-
ment of an existing ingredient, constituent, sub-
stance, or additive during the period referred to 
in subparagraph (A), the manufacturer of the 
tobacco product involved may continue to use 
the ingredient, constituent, substance, or com-
pound involved until such time as the Secretary 
makes a determination with respect to the as-
sessment. 
‘‘(d) RIGHT TO KNOW; FULL DISCLOSURE OF IN-
GREDIENTS TO THE PUBLIC.—
‘‘(1) IN GENERAL.—Except as provided in para-
graph (3), a package of a tobacco product shall dis-
close all ingredients, constituents, substances, or 
compounds contained in the product in accordance 
with regulations promulgated under section 701(a) 
by the Secretary. 
‘‘(2) DISCLOSURE OF PERCENTAGE OF DOMES-
TIC AND FOREIGN TOBACCO.—The regulations re-
ferred to in paragraph (1) shall require that the 
package of a tobacco product disclose, with respect 
to the tobacco contained in the product—
‘‘(A) the percentage that is domestic to-
bacco; and
148
‘‘(B) the percentage that is foreign to-
bacco. 
‘‘(3) HEALTH
DISCLOSURE.—Notwithstanding 
section 301(j), the Secretary may require the public 
disclosure of any ingredient, constituent, substance, 
or compound contained in a tobacco product that re-
lates to a trade secret or other matter referred to in 
section 1905 of title 18, United States Code, if the 
Secretary determines that such disclosure will pro-
mote the public health. 
‘‘SEC. 575. REDUCED RISK PRODUCTS. 
‘‘(a) PROHIBITION.—
‘‘(1) IN
GENERAL.—No manufacturer, dis-
tributor or retailer of tobacco products may make 
any direct or implied statement in advertising or on 
a product package that could reasonably be inter-
preted to state or imply a reduced health risk associ-
ated with a tobacco product unless the manufacturer 
demonstrates to the Secretary, in such form as the 
Secretary may require, that based on the best avail-
able scientific evidence the product significantly re-
duces the overall health risk to the public when com-
pared to other tobacco products. 
‘‘(2) SUBMISSION
TO
SECRETARY.—Prior to 
making any statement described in paragraph (1), a
149
manufacturer, distributor or retailer shall submit 
such statement to the Secretary, who shall review 
such statement to ensure its accuracy and, in the 
case of advertising, to prevent such statement from 
increasing, or preventing the contraction of, the size 
of the overall market for tobacco products. 
‘‘(b) DETERMINATION BY SECRETARY.—If the Sec-
retary determines that a statement described in subsection 
(a)(2) is permissible because the tobacco product does 
present a significantly reduced overall health risk to the 
public, the Secretary may permit such statement to be 
made. 
‘‘(c) DEVELOPMENT OR ACQUISITION OF REDUCED 
RISK TECHNOLOGY.—
‘‘(1) IN GENERAL.—Any manufacturer that de-
velops or acquires any technology that the manufac-
turer reasonably believes will reduce the risk from 
tobacco products shall notify the Secretary of the de-
velopment or acquisition of the technology. Such no-
tice shall be in such form and within such time as 
the Secretary shall require. 
‘‘(2) CONFIDENTIALITY.—With respect to any 
technology described in paragraph (1) that is in the 
early stages of development (as determined by the 
Secretary), the Secretary shall establish protections
150
to ensure the confidentiality of any proprietary in-
formation submitted to the Secretary under this sub-
section during such development. 
‘‘SEC. 576. ACCESS TO COMPANY INFORMATION. 
‘‘(a) COMPLIANCE PROCEDURES.—Each manufac-
turer of tobacco products shall establish procedures to en-
sure compliance with this Act. 
‘‘(b) REQUIREMENT.—In addition to any other dis-
closure obligations under this Act, the KIDS Act, or any 
other law, each manufacturer of tobacco products shall, 
not later than 90 days after the date of the enactment 
of the KIDS Act and thereafter as required by the Sec-
retary, disclose to the Secretary all nonpublic information 
and research in its possession or control relating to the 
addiction or dependency, or the health or safety of tobacco 
products, including (without limitation) all research relat-
ing to processes to make tobacco products less hazardous 
to consumers and the research and documents described 
in subsection (c). 
‘‘(c) RESEARCH AND DOCUMENTS.—The documents 
described in this section include any documents concerning 
tobacco product research relating to—
‘‘(1) nicotine, including—
‘‘(A) the interaction between nicotine and 
other components in tobacco products including
151
ingredients in the tobacco and smoke compo-
nents; 
‘‘(B) the role of nicotine in product design 
and manufacture, including product charters, 
and parameters in product development, the to-
bacco blend, filter technology, and paper;
‘‘(C) the role of nicotine in tobacco leaf 
purchasing; 
‘‘(D) reverse engineering activities involv-
ing nicotine (such as analyzing the products of 
other companies); 
‘‘(E) an analysis of nicotine delivery; and 
‘‘(F) the biology, psychopharmacology and 
any other health effects of nicotine; 
‘‘(2) other ingredients, including—
‘‘(A) the identification of ingredients in to-
bacco products and constituents in smoke, in-
cluding additives used in product components 
such as paper, filter, and wrapper; 
‘‘(B) any research on the health effects of 
ingredients; and 
‘‘(C) any research or other information ex-
plaining what happens to ingredients when they 
are heated and burned;
152
‘‘(3) less hazardous or safer products, including 
any research or product development information on 
activities involving reduced risk, less hazardous, low-
tar or reduced-tar, low-nicotine or reduced-nicotine 
or nicotine-free products; and 
‘‘(4) tobacco product advertising, marketing 
and promotion, including—
‘‘(A) documents related to the design of 
advertising campaigns, including the desired de-
mographics for individual products on the mar-
ket or being tested; 
‘‘(B) documents concerning the age of ini-
tiation of tobacco use, general tobacco use be-
havior, beginning smokers, pre-smokers, and 
new smokers; 
‘‘(C) documents concerning the effects of 
advertising; and 
‘‘(D) documents concerning future mar-
keting options or plans in light of the require-
ments and regulations to be imposed under this 
subchapter or the KIDS Act. 
‘‘(d) AUTHORITY OF SECRETARY.—With respect to 
tobacco product manufacturers, the Secretary shall have 
the same access to records and information and inspection
153
authority as is available with respect to manufacturers of 
other medical devices. 
‘‘SEC. 577. OVERSIGHT OF TOBACCO PRODUCT MANUFAC-
TURING. 
‘‘The Secretary shall by regulation prescribe good 
manufacturing practice standards for tobacco products. 
Such regulations shall be modeled after good manufac-
turing practice regulations for medical devices, food, and 
other items under section 520(f). Such standards shall be 
directed specifically toward tobacco products, and shall in-
clude—
‘‘(1) a quality control system, to ensure that to-
bacco products comply with such standards; 
‘‘(2) a system for inspecting tobacco product 
materials to ensure their compliance with such 
standards; 
‘‘(3) requirements for the proper handling of 
finished tobacco products; 
‘‘(4) strict tolerances for pesticide chemical resi-
dues in or on tobacco or tobacco product commod-
ities in the possession of the manufacturer, except 
that nothing in this paragraph shall be construed to 
affect any authority of the Environmental Protection 
Agency;
154
‘‘(5) authority for officers or employees of the 
Secretary to inspect any factory, warehouse, or other 
establishment of any tobacco product manufacturer, 
and to have access to records, files, papers, proc-
esses, controls and facilities related to tobacco prod-
uct manufacturing, in accordance with appropriate 
authority and rules promulgated under this Act; and 
‘‘(6) a requirement that the tobacco product 
manufacturer maintain such files and records as the 
Secretary may specify, as well as that the manufac-
turer report to the Secretary such information as 
the Secretary shall require, in accordance with sec-
tion 519. 
‘‘SEC. 578. PRESERVATION OF STATE AND LOCAL AUTHOR-
ITY. 
‘‘Notwithstanding section 521 and except as other-
wise provided for in section 572(e), nothing in this sub-
chapter shall be construed as prohibiting a State or local-
ity from imposing requirements, prohibitions, penalties or 
other measures to further the purposes of this subchapter 
that are in addition to the requirements, prohibitions, or 
penalties required under this subchapter. State and local 
governments may impose additional tobacco product con-
trol measures to further restrict or limit the use of such 
products.’’.
155
SEC. 1343. FUNDING. 
(a) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this part (and the amendments 
made by this part). 
(b) TRIGGER.—No expenditures shall be made under 
this part (or the amendments made by this part) during 
any fiscal year in which the annual amount appropriated 
for the Food and Drug Administration is less than the 
amount so appropriated for the prior fiscal year. 
SEC. 1344. REPEALS. 
The following provisions of law are repealed: 
(1) The Federal Cigarette Labeling and Adver-
tising Act (15 U.S.C. 1331 et seq.), except for sec-
tions 5(d)(1) and (2) and 6. 
(2) The Comprehensive Smokeless Tobacco 
Health Education Act of 1986 (15 U.S.C. 4401 et 
seq.), except for sections 3(f) and 8(a) and (b). 
(3) The Comprehensive Smoking Education Act 
of 1964 (Public Law 98–474). 
Subchapter B—Miscellaneous Provisions 
SEC. 1351. NONAPPLICATION TO TOBACCO PRODUCERS. 
(a) IN GENERAL.—This chapter and the amendments 
made by this chapter shall not apply to the producers of 
tobacco leaf, including tobacco growers, tobacco ware-
houses, and tobacco grower cooperatives.
156
(b) RULE OF CONSTRUCTION.—Nothing in this chap-
ter, or an amendment made by this chapter, shall be con-
strued to provide the Secretary of Health and Human 
Services with the authority to—
(1) enter onto a farm owned by a producer of 
tobacco leaf without the written consent of such pro-
ducer; or 
(2) promulgate regulations on any matter that 
involves the production of tobacco leaf or a producer 
thereof, other than activities by a manufacturer that 
affect production. 
(c) MANUFACTURER ACTING AS PRODUCER.—Not-
withstanding any other provision of this section, if a pro-
ducer of tobacco leaf is also a tobacco product manufac-
turer or is owned or controlled by a tobacco product manu-
facturer, the producer shall be subject to the provisions 
of this chapter, and the amendments made by this chap-
ter, in the producer’s capacity as a manufacturer. 
(d) DEFINITION.—In this section, the term ‘‘con-
trolled by’’ means a producer that is a member of the same 
controlled group of corporations, as that term is used for 
purposes of section 52(a) of the Internal Revenue Code 
of 1986, or under common control within the meaning of 
the regulations promulgated under section 52(b) of such 
Code.
157
SEC. 1352. EQUAL TREATMENT OF RETAIL OUTLETS. 
The Secretary of Health and Human Services shall 
promulgate regulations to require that retail establish-
ments that are accessible to individuals under the age of 
18, for which the predominant business is the sale of to-
bacco products, comply with any advertising restrictions 
applicable to such establishments. 
CHAPTER 4—COVERAGE OF CHILDHOOD 
IMMUNIZATIONS 
SEC. 1361. SHORT TITLE. 
This chapter be cited as the ‘‘Comprehensive Insur-
ance Coverage of Childhood Immunization Act of 2003’’. 
SEC. 1362. AMENDMENTS TO THE EMPLOYEE RETIREMENT 
INCOME SECURITY ACT OF 1974. 
(a) IN GENERAL.—Subpart B of part 7 of subtitle 
B of title I of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1185 et seq.), as amended by sec-
tion 1214, is further amended by adding at the end the 
following: 
‘‘SEC. 715. STANDARD RELATING TO COVERAGE OF CHILD-
HOOD IMMUNIZATION. 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering health insurance coverage 
in connection with a group health plan, shall provide for 
each plan year comprehensive coverage for routine immu-
nizations for each individual who is a dependent of a par-
158
ticipant or beneficiary under the plan and is under 19 
years of age. 
‘‘(b) COMPREHENSIVE COVERAGE.—For purposes of 
this section, comprehensive coverage for routine immuni-
zations for a plan year consists of coverage, without 
deductibles, coinsurance, or other cost-sharing, for immu-
nizations (including the vaccine itself) in accordance with 
the most recent version of the Recommended Childhood 
Immunization Schedule issued prior to such plan year by 
the Advisory Committee on Immunization Practices of the 
Centers for Disease Control and Prevention.’’. 
(b) CONFORMING AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement Income Se-
curity Act of 1974, as amended by section 1214, is further 
amended by inserting after the item relating to section 
714 the following new item:
‘‘Sec. 715. Standard relating to coverage of childhood immunization.’’.
SEC. 1363. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 
ACT. 
(a) GROUP MARKET.—Subpart 2 of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg–4 et seq.), as amended by section 1213(b), is fur-
ther amended by adding at the end the following:
159
‘‘SEC. 2708. STANDARD RELATING TO COVERAGE OF CHILD-
HOOD IMMUNIZATION. 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering health insurance coverage 
in connection with a group health plan, shall provide for 
each plan year comprehensive coverage for routine immu-
nizations for each individual who is a dependent of a par-
ticipant or beneficiary under the plan and is under 19 
years of age. 
‘‘(b) COMPREHENSIVE COVERAGE.—For purposes of 
this section, comprehensive coverage for routine immuni-
zations for a plan year consists of coverage, without 
deductibles, coinsurance, or other cost-sharing, for immu-
nizations (including the vaccine itself) in accordance with 
the most recent version of the Recommended Childhood 
Immunization Schedule issued prior to such plan year by 
the Advisory Committee on Immunization Practices of the 
Centers for Disease Control and Prevention.’’. 
(b) INDIVIDUAL MARKET.—The first subpart 3 of 
part B of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg–51 et seq.) (relating to other require-
ments) (42 U.S.C. 300gg–51 et seq.) is amended—
(1) by redesignating such subpart as subpart 2; 
and 
(2) by inserting after section 2753, as added by 
section 1213(c), the following:
160
‘‘SEC. 2754. STANDARD RELATING TO COVERAGE OF CHILD-
HOOD IMMUNIZATION. 
‘‘The provisions of section 2708 shall apply to health 
insurance coverage offered by a health insurance issuer 
in the individual market in the same manner as they apply 
to health insurance coverage offered by a health insurance 
issuer in connection with a group health plan in the small 
or large group market.’’. 
SEC. 1364. AMENDMENTS TO THE INTERNAL REVENUE 
CODE OF 1986. 
Subchapter B of chapter 100 of the Internal Revenue 
Code of 1986 is amended—
(1) in the table of sections, by inserting after 
the item relating to section 9812 the following new 
item:
‘‘Sec. 9813. Standard relating to coverage of childhood immuni-
zation.’’;
and 
(2) by inserting after section 9812 the fol-
lowing: 
‘‘SEC. 9813. STANDARD RELATING TO COVERAGE OF CHILD-
HOOD IMMUNIZATION. 
‘‘(a) IN GENERAL.—A group health plan shall pro-
vide for each plan year comprehensive coverage for routine 
immunizations for each individual who is a dependent of
161
a participant or beneficiary under the plan and is under 
19 years of age. 
‘‘(b) COMPREHENSIVE COVERAGE.—For purposes of 
this section, comprehensive coverage for routine immuni-
zations for a plan year consists of coverage, without 
deductibles, coinsurance, or other cost-sharing, for immu-
nizations (including the vaccine itself) in accordance with 
the most recent version of the Recommended Childhood 
Immunization Schedule issued prior to such plan year by 
the Advisory Committee on Immunization Practices of the 
Centers for Disease Control and Prevention.’’. 
SEC. 1365. EFFECTIVE DATES. 
(a) GROUP HEALTH INSURANCE COVERAGE.—Sub-
ject to subsection (c), the amendments made by sections 
1362, 1363(a), and 1364 apply with respect to group 
health plans for plan years beginning on or after January 
1, 2004. 
(b) INDIVIDUAL HEALTH INSURANCE COVERAGE.—
The amendment made by section 1363(b) applies with re-
spect to health insurance coverage offered, sold, issued, 
renewed, in effect, or operated in the individual market 
on or after such date. 
(c) COLLECTIVE BARGAINING EXCEPTION.—In the 
case of a group health plan maintained pursuant to 1 or 
more collective bargaining agreements between employee
162
representatives and 1 or more employers ratified before 
the date of enactment of this Act, the amendments made 
sections 1362, 1363(a), and 1364 shall not apply to plan 
years beginning before the later of—
(1) the earliest date as of which all such collec-
tive bargaining agreements relating to the plan have 
terminated (determined without regard to any exten-
sion thereof agreed to after the date of the enact-
ment of this Act), or 
(2) January 1, 2004. 
For purposes of paragraph (1), any plan amendment made 
pursuant to a collective bargaining agreement relating to 
the plan which amends the plan solely to conform to any 
requirement added by sections 1362, 1363(a), and 1364 
shall not be treated as a termination of such collective bar-
gaining agreement. 
Subtitle E—Reducing 
Environmental Health Risks 
CHAPTER 1—ENVIRONMENTAL 
PROTECTION OF CHILDREN 
SEC. 1401. SHORT TITLE. 
This chapter may be cited as the ‘‘Children’s Envi-
ronmental Protection Act’’.
163
SEC. 1402. ENVIRONMENTAL PROTECTION FOR CHILDREN 
AND OTHER VULNERABLE SUBPOPULATIONS. 
The Toxic Substances Control Act (15 U.S.C. 2601 
et seq.) is amended by adding at the end the following: 
‘‘TITLE 
V—ENVIRONMENTAL 
PROTECTION FOR CHILDREN 
AND 
OTHER 
VULNERABLE 
SUBPOPULATIONS 
‘‘SEC. 501. FINDINGS AND POLICY. 
‘‘(a) FINDINGS.—Congress finds that—
‘‘(1) the protection of public health and safety 
depends on individuals and government officials 
being aware of the pollution dangers that exist in 
their homes, schools, and communities, and whether 
those dangers present special threats to the health 
of children and other vulnerable subpopulations; 
‘‘(2) children spend much of their young lives 
in schools and day care centers, and may face sig-
nificant exposure to pesticides and other environ-
mental pollutants in those locations; 
‘‘(3) the metabolism, physiology, and diet of 
children, and exposure patterns of children to envi-
ronmental pollutants, differ from those of adults, 
and those differences and the inherent nature of im-
mature and developing systems of children can make
164
children more susceptible than adults to the harmful 
effects of environmental pollutants; 
‘‘(4) a study conducted by the National Acad-
emy of Sciences that particularly considered the ef-
fects of pesticides on children concluded that current 
approaches to assessing pesticide risks typically do 
not consider risks to children and, as a result, cur-
rent standards and tolerances often fail to ade-
quately protect children; 
‘‘(5) there are often insufficient data to enable 
the Administrator, when establishing an environ-
mental and public health standard for an environ-
mental pollutant, to evaluate the special suscepti-
bility or exposure of children to environmental pol-
lutants; 
‘‘(6) when data are lacking to evaluate the spe-
cial susceptibility or exposure of children to an envi-
ronmental pollutant, the Administrator generally—
‘‘(A) does not presume that the environ-
mental pollutant presents a special risk to chil-
dren; and 
‘‘(B) does not apply a special or additional 
margin of safety to protect the health of chil-
dren in establishing an environmental or public 
health standard for that pollutant; and
165
‘‘(7) safeguarding children from environmental 
pollutants requires the systematic collection of data 
concerning the special susceptibility and exposure of 
children to those pollutants, and the adoption of an 
additional safety factor of at least 10-fold in the es-
tablishment of environmental and public health 
standards where reliable data are not available. 
‘‘(b) POLICY.—It is the policy of the United States 
that—
‘‘(1) the public has the right to be informed 
about the pollution dangers to which children are 
being exposed in their homes, schools and commu-
nities, and how those dangers may present special 
health threats to children and other vulnerable sub-
populations; 
‘‘(2) each environmental and public health 
standard for an environmental pollutant established 
by the Administrator must, with an adequate margin 
of safety, protect children and other vulnerable sub-
populations; 
‘‘(3) where data sufficient to evaluate the spe-
cial susceptibility and exposure of children (including 
exposure in utero) to an environmental pollutant are 
lacking, the Administrator should presume that the 
environmental pollutant poses a special risk to chil-
166
dren and should apply an appropriate additional 
margin of safety of at least 10-fold in establishing 
an environmental or public health standard for that 
environmental pollutant; 
‘‘(4) since it is difficult to identify all conceiv-
able risks and address all uncertainties associated 
with pesticide use, the use of dangerous pesticides in 
schools and day care centers should be eliminated; 
and 
‘‘(5) the Environmental Protection Agency, the 
Department of Health and Human Services (includ-
ing the National Institute of Environmental Health 
Sciences and the Agency for Toxic Substances and 
Disease Registry), the National Institutes of Health, 
and other Federal agencies should support research 
on the short-term and long-term health effects of cu-
mulative and synergistic exposures of children and 
other vulnerable subpopulations to environmental 
pollutants. 
‘‘SEC. 502. DEFINITIONS. 
‘‘In this title: 
‘‘(1) CHILD.—The term ‘child’ means an indi-
vidual 18 years of age or younger. 
‘‘(2) 
COMMITTEE.—The 
term 
‘Committee’ 
means the Children’s Environmental Health Protec-
167
tion Advisory Committee established under section 
506. 
‘‘(3) DAY CARE CENTER.—The term ‘day care 
center’ means a center-based child care provider that 
is licensed, regulated, or registered under applicable 
State or local law. 
‘‘(4) ENVIRONMENTAL POLLUTANT.—The term 
‘environmental pollutant’ includes—
‘‘(A) a hazardous substance (as defined in 
section 101 of the Comprehensive Environ-
mental Response, Compensation, and Liability 
Act of 1980 (42 U.S.C. 9601)); 
‘‘(B) a contaminant (as defined in section 
1401 of the Safe Drinking Water Act (42 
U.S.C. 300f)) 
‘‘(C) an air pollutant subject to regulation 
under the Clean Air Act (42 U.S.C. 7401 et 
seq.); 
‘‘(D) a water pollutant subject to regula-
tion under the Federal Water Pollution Control 
Act (33 U.S.C. 1251 et seq.); and 
‘‘(E) a pesticide subject to regulation 
under the Federal Insecticide, Fungicide, and 
Rodenticide Act (7 U.S.C. 136 et seq.).
168
‘‘(5) PESTICIDE.—The term ‘pesticide’ has the 
meaning given the term in section 2 of the Federal 
Insecticide, Fungicide, and Rodenticide Act (7 
U.S.C. 136). 
‘‘(6) SCHOOL.—The term ‘school’ means an ele-
mentary school (as defined in section 9101 of the 
Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7801)), a secondary school (as defined in 
section 9101 of that Act), a kindergarten, or a nurs-
ery school that is public or receives Federal funding. 
‘‘(7) 
VULNERABLE
SUBPOPULATION.—The 
term ‘vulnerable subpopulation’ means—
‘‘(A) children; 
‘‘(B) pregnant women; 
‘‘(C) the elderly; 
‘‘(D) individuals with a history of serious 
illness; and 
‘‘(E) any other subpopulation identified by 
the Administrator as being likely to experience 
special health risks from environmental pollut-
ants. 
‘‘SEC. 503. SAFEGUARDING CHILDREN AND OTHER VULNER-
ABLE SUBPOPULATIONS. 
‘‘(a) IN GENERAL.—The Administrator shall—
169
‘‘(1) ensure that each environmental and public 
health standard for an environmental pollutant pro-
tects children and other vulnerable subpopulations 
with an adequate margin of safety; 
‘‘(2) explicitly evaluate data concerning the spe-
cial susceptibility and exposure of children to any 
environmental pollutant for which an environmental 
or public health standard is established; and 
‘‘(3) adopt an additional margin of safety of at 
least 10-fold in the establishment of an environ-
mental or public health standard for an environ-
mental pollutant in the absence of reliable data on 
toxicity and exposure of the child to an environ-
mental pollutant or if there is a lack of reliable data 
on the susceptibility of the child to an environmental 
pollutant for which the environmental and public 
health standard is being established. 
‘‘(b) ESTABLISHING, MODIFYING, OR REEVALUATING 
ENVIRONMENTAL AND PUBLIC HEALTH STANDARDS.—
‘‘(1) IN GENERAL.—In establishing, modifying, 
or reevaluating any environmental or public health 
standard for an environmental pollutant under any 
law administered by the Administrator, the Adminis-
trator shall take into consideration available infor-
mation concerning—
170
‘‘(A) all routes of exposure of children to 
that environmental pollutant; and 
‘‘(B) the special susceptibility of children 
to the environmental pollutant, including—
‘‘(i) neurological differences between 
children and adults; 
‘‘(ii) the effect of exposure to that en-
vironmental pollutant in utero; and 
‘‘(iii) the cumulative effect on a child 
of exposure to that environmental pollutant 
and any other substance having a common 
toxicological mechanism. 
‘‘(2) ADDITIONAL SAFETY MARGIN.—If any of 
the data described in paragraph (1) are not avail-
able, the Administrator shall, in completing a risk 
assessment, risk characterization, or other assess-
ment of risk underlying an environmental or public 
health standard, adopt an additional margin of safe-
ty of at least 10-fold to take into account—
‘‘(A) potential pre-natal and post-natal 
toxicity of an environmental pollutant; and 
‘‘(B) the completeness of data concerning 
the exposure and toxicity of the environmental 
pollutant to children.
171
‘‘(c) IDENTIFICATION AND REVISION OF CURRENT 
ENVIRONMENTAL
AND
PUBLIC
HEALTH
STANDARDS 
THAT PRESENT SPECIAL RISKS TO CHILDREN.—
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this title and annually 
thereafter, based on the recommendations of the 
Committee, the Administrator shall—
‘‘(A) repromulgate, in accordance with this 
section, at least 3 of the environmental and 
public health standards identified by the Com-
mittee as posing a special risk to children; or 
‘‘(B) publish a finding in the Federal Reg-
ister that provides the reasons of the Adminis-
trator for declining to repromulgate at least 3 
of the environmental and public health stand-
ards identified by the Committee as posing a 
special risk to children. 
‘‘(2) DETERMINATION BY ADMINISTRATOR.—If 
the Administrator makes the finding described in 
paragraph (1)(B), the Administrator shall repromul-
gate in accordance with this section at least 3 envi-
ronmental and public health standards determined 
to pose a greater risk to children’s health than the 
environmental and public health standards identified
172
by the Children’s Environmental Health Protection 
Advisory Committee. 
‘‘(3) REPORT.—Not later than 1 year after the 
date of enactment of this title and annually there-
after, the Administrator shall submit a report to 
Congress describing the progress made by the Ad-
ministrator in carrying out this subsection. 
‘‘SEC. 504. SAFER ENVIRONMENT FOR CHILDREN. 
‘‘Not later than 1 year after the date of enactment 
of this title, the Administrator shall—
‘‘(1) identify environmental pollutants com-
monly used or found in areas that are reasonably ac-
cessible to children; 
‘‘(2) create a scientifically peer-reviewed list of 
substances identified under paragraph (1) with 
known, likely, or suspected health risks to children; 
‘‘(3) develop a scientifically peer reviewed list of 
safer-for-children substances and products rec-
ommended by the Administrator for use in areas 
that are reasonably accessible to children that, when 
applied as recommended by the manufacturer, will 
minimize potential risks to children from exposure to 
environmental pollutants; 
‘‘(4) establish guidelines to help reduce and 
eliminate exposure of children to environmental pol-
173
lutants in areas reasonably accessible to children, in-
cluding advice on how to establish an integrated pest 
management program; 
‘‘(5) develop a family right-to-know information 
kit that includes a summary of helpful information 
and guidance to families, such as—
‘‘(A) the information developed under 
paragraph (3); 
‘‘(B) the guidelines established under para-
graph (4); 
‘‘(C) information on the potential health 
effects of environmental pollutants; 
‘‘(D) practical suggestions on how parents 
may reduce the exposure of their children to en-
vironmental pollutants; and 
‘‘(E) other information determined to be 
relevant by the Administrator, in cooperation 
with the Director of the Centers for Disease 
Control and Prevention; 
‘‘(6) make all information developed under this 
subsection available to Federal and State agencies, 
to the public, and on the Internet; and 
‘‘(7) review and update the lists developed 
under paragraphs (2) and (3) at least annually.
174
‘‘SEC. 505. RESEARCH TO IMPROVE INFORMATION ON THE 
EFFECTS OF ENVIRONMENTAL POLLUTANTS 
ON CHILDREN. 
‘‘(a) EXPOSURE AND TOXICITY DATA.—The Admin-
istrator, the Secretary of Agriculture, and the Secretary 
of Health and Human Services shall coordinate and sup-
port the development and implementation of basic and ap-
plied research initiatives to examine—
‘‘(1) the health effects and toxicity of pesticides 
(including active and inert ingredients) and other 
environmental pollutants on children and other vul-
nerable subpopulations; and 
‘‘(2) the exposure of children and other vulner-
able subpopulations to environmental pollutants. 
‘‘(b) BIENNIAL REPORTS.—The Administrator, the 
Secretary of Agriculture, and the Secretary of Health and 
Human Services shall submit biennial reports to Congress 
describing actions taken to carry out this section. 
‘‘SEC. 506. CHILDREN’S ENVIRONMENTAL HEALTH PROTEC-
TION ADVISORY COMMITTEE. 
‘‘(a) ESTABLISHMENT.—The Administrator shall es-
tablish a Children’s Environmental Health Protection Ad-
visory Committee to assist the Administrator in carrying 
out this title. 
‘‘(b) COMPOSITION.—The Committee shall be com-
prised of—
175
‘‘(1) medical professionals specializing in pedi-
atric health; 
‘‘(2) educators; 
‘‘(3) representatives of community groups; 
‘‘(4) representatives of environmental and pub-
lic health nonprofit organizations; 
‘‘(5) industry representatives; and 
‘‘(6) representatives of State environmental and 
public health departments. 
‘‘(c) DUTIES.—Not later than 2 years after the date 
of enactment of this title and annually thereafter, the 
Committee shall develop a list of standards that merit re-
evaluation by the Administrator in order to better protect 
the health of children. 
‘‘(d) TERMINATION.—The Committee shall terminate 
not later than 15 years after the date on which the Com-
mittee is established. 
‘‘SEC. 507. AUTHORIZATION OF APPROPRIATIONS. 
There are authorized to be appropriated such sums 
as are necessary to carry out this title.’’. 
SEC. 1403. CONFORMING AMENDMENT. 
The table of contents in section 1 of the Toxic Sub-
stances Control Act (15 U.S.C. prec. 2601) is amended 
by adding at the end the following:
‘‘TITLE V—ENVIRONMENTAL PROTECTION FOR CHILDREN AND 
OTHER VULNERABLE SUBPOPULATIONS
176
‘‘Sec. 501. Findings and policy. 
‘‘Sec. 502. Definitions. 
‘‘Sec. 503. Safeguarding children and other vulnerable subpopulations. 
‘‘Sec. 504. Safer environment for children. 
‘‘Sec. 505. Research to improve information on the effects of environmental pol-
lutants on children. 
‘‘Sec. 506. Children’s environmental health protection advisory committee. 
‘‘Sec. 507. Authorization of appropriations.’’.
CHAPTER 2—SCHOOL ENVIRONMENTAL 
PROTECTION 
SEC. 1411. SHORT TITLE. 
This chapter may be cited as the ‘‘School Environ-
ment Protection Act’’. 
SEC. 1412. INTEGRATED PEST MANAGEMENT SYSTEMS FOR 
SCHOOLS. 
The Federal Insecticide, Fungicide, and Rodenticide 
Act is amended—
(1) by redesignating sections 33 and 34 (7 
U.S.C. 136x, 136y) as sections 34 and 35, respec-
tively; and 
(2) by inserting after section 32 (7 U.S.C. 
136w–7) the following: 
‘‘SEC. 33. INTEGRATED PEST MANAGEMENT SYSTEMS FOR 
SCHOOLS. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) BOARD.—The term ‘Board’ means the Na-
tional School Integrated Pest Management Advisory 
Board established under subsection (c).