169
ment the plan developed under paragraph (1), includ-
ing measures for the full participation of other
Federal agencies currently conducting HIV vaccine
studies.
(4) For the purpose of carrying out this sub-
section, there are authorized to be appropriated such
sums as may be necessary for each of the fiscal years
1994 through 1996.
SEC. 1902. MALNUTRITION IN THE ELDERLY.
(a) STUDY.—
(1) IN GENERAL.—The Secretary of Health and
Human Services (referred to in this section as the
‘‘Secretary’’), acting through the National Institute
on Aging, coordinating with the Agency for Health
Care Policy and Research and, to the degree possible,
in consultation with the head of the National Nutri-
tion Monitoring System established under section
1428 of the Food and Agriculture Act of 1977 (7
U.S.C. 3178), shall conduct a 3-year nutrition screen-
ing and intervention activities study of the elderly.
(2) EFFICACY AND COST-EFFECTIVENESS OF NU-
TRITION
SCREENING
AND
INTERVENTION
ACTIVI-
TIES.—In conducting the study, the Secretary shall
determine the efficacy and cost-effectiveness of nutri-
tion screening and intervention activities conducted
170
in the elderly health and long-term care continuum,
and of a program that would institutionalize nutri-
tion screening and intervention activities. In evaluat-
ing such a program, the Secretary shall determine—
(A) if health or quality of life is measurably
improved for elderly individuals who receive rou-
tine nutritional screening and treatment;
(B) if federally subsidized home or institu-
tional care is reduced because of increased inde-
pendence of elderly individuals resulting from
improved nutritional status;
(C) if a multidisciplinary approach to nu-
tritional care is effective in addressing the nutri-
tional needs of elderly individuals; and
(D) if reimbursement for nutrition screen-
ing and intervention activities is a cost-effective
approach to improving the health status of elder-
ly individuals.
(3) POPULATIONS.—The populations of elderly
individuals in which the study will be conducted shall
include populations of elderly individuals who are—
(A) living independently, including—
(i) individuals who receive home and
community-based services or family sup-
port;
171
(ii) individuals who do not receive ad-
ditional services and support;
(iii) individuals with low incomes; and
(iv) individuals who are minorities;
(B) hospitalized, including individuals ad-
mitted from home and from institutions; and
(C) institutionalized in residential facilities
such as nursing homes and adult homes.
(b) MALNUTRITION STUDY.—The Secretary, acting
through the National Institute on Aging, shall conduct a
3-year study to determine the extent of malnutrition in el-
derly individuals in hospitals and long-term care facilities
and in elderly individuals who are living independently.
(c) REPORT.—The Secretary shall submit a report to
the Committee on Labor and Human Resources of the Sen-
ate and the Committee on Energy and Commerce of the
House of Representatives containing the findings resulting
from the studies described in subsections (a) and (b), in-
cluding a determination regarding whether a program that
would institutionalize nutrition screening and intervention
activities should be adopted, and the rationale for the deter-
mination.
(d) ADVISORY PANEL.—
(1) ESTABLISHMENT.—The Secretary, acting
through the Director of the National Institute on
172
Aging, shall establish an advisory panel that shall
oversee the design, implementation, and evaluation of
the studies described in subsections (a) and (b).
(2) COMPOSITION.—The advisory panel shall in-
clude representatives appointed for the life of the
panel by the Secretary from the Health Care Financ-
ing Administration, the Social Security Administra-
tion, the National Center for Health Statistics, the
Administration on Aging, the National Council on
the Aging, the American Dietetic Association, the
American Academy of Family Physicians, and such
other agencies or organizations as the Secretary deter-
mines to be appropriate.
(3) COMPENSATION AND EXPENSES.—
(A) COMPENSATION.—Each member of the
advisory panel who is not an employee of the
Federal Government shall receive compensation
at the daily equivalent of the rate specified for
level V of the Executive Schedule under section
5316 of title 5, United States Code, for each day
the member is engaged in the performance of du-
ties for the advisory panel, including attendance
at meetings and conferences of the panel, and
travel to conduct the duties of the panel.
173
(B) TRAVEL EXPENSES.—Each member of
the advisory panel shall receive travel expenses,
including per diem in lieu of subsistence, at
rates authorized for employees of agencies under
subchapter I of chapter 57 of title 5, United
States Code, for each day the member is engaged
in the performance of duties away from the home
or regular place of business of the member.
(4) DETAIL OF FEDERAL EMPLOYEES.—On the
request of the advisory panel, the head of any Federal
agency shall detail, without reimbursement, any of
the personnel of the agency to the advisory panel to
assist the advisory panel in carrying out its duties.
Any detail shall not interrupt or otherwise affect the
civil service status or privileges of the Federal em-
ployee.
(5) TECHNICAL ASSISTANCE.—On the request of
the advisory panel, the head of a Federal agency shall
provide such technical assistance to the advisory
panel as the advisory panel determines to be nec-
essary to carry out its duties.
(6) TERMINATION.—Notwithstanding section 15
of the Federal Advisory Committee Act (5 U.S.C.
App.), the advisory panel shall terminate 3 years
after the date of enactment of this Act.
174
SEC. 1903. RESEARCH ACTIVITIES ON CHRONIC FATIGUE
SYNDROME.
The Secretary of Health and Human Services shall,
not later than May 1, 1993, and annually thereafter for
the next 3 years, prepare and submit to the Committee on
Energy and Commerce of the House of Representatives and
the Committee on Labor and Human Resources of the Sen-
ate, a report that summarizes the research activities con-
ducted or supported by the National Institutes of Health
concerning chronic fatigue syndrome. Such report should
include information concerning grants made, cooperative
agreements or contracts entered into, intramural activities,
research priorities and needs, and a plan to address such
priorities and needs.
SEC. 1904. REPORT ON MEDICAL USES OF BIOLOGICAL
AGENTS IN DEVELOPMENT OF DEFENSES
AGAINST BIOLOGICAL WARFARE.
The Secretary of Health and Human Services, in con-
sultation with other appropriate executive agencies, shall
report to the House Energy and Commerce Committee and
the Senate Labor and Human Resources Committee on the
appropriateness and impact of the National Institutes of
Health assuming responsibility for the conduct of all Fed-
eral research, development, testing, and evaluation func-
tions 
relating 
to 
medical 
countermeasures 
against
biowarfare threat agents. In preparing the report, the Sec-
175
retary shall identify the extent to which such activities are
carried out by agencies other than the National Institutes
of Health, and assess the impact (positive and negative) of
the National Institutes of Health assuming responsibility
for such activities, including the impact under the Budget
Enforcement Act and the Omnibus Budget Reconciliation
Act of 1990 on existing National Institutes of Health re-
search programs as well as other programs within the cat-
egory of domestic discretionary spending. The Secretary
shall submit the report not later than 12 months after the
date of the enactment of this Act.
SEC. 1905. PERSONNEL STUDY OF RECRUITMENT, RETEN-
TION AND TURNOVER.
(a) STUDY OF PERSONNEL SYSTEM.—Not later than
1 year after the date of the enactment of this Act, the Sec-
retary of Health and Human Services, acting through the
Director of the National Institutes of Health, shall conduct
a study to review the retention, recruitment, vacancy and
turnover rates of support staff, including firefighters, law
enforcement, procurement officers, technicians, nurses and
clerical employees, to ensure that the National Institutes of
Health is adequately supporting the conduct of efficient, ef-
fective and high quality research for the American public.
The Director of NIH shall work in conjunction with appro-
176
priate employee organizations and representatives in devel-
oping such a study.
(b) SUBMISSION TO CONGRESS.—Not later than 1 year
after the date of the enactment of this Act, the Secretary
of Health and Human Services shall prepare and submit
to the Committee on Energy and Commerce of the House
of Representatives, and to the Committee on Labor and
Human Resources of the Senate, a report containing the
study conducted under subsection (a) together with the rec-
ommendations of the Secretary concerning the enactment
of legislation to implement the results of such study.
SEC. 1906. PROCUREMENT.
(a) IN GENERAL.—The Director of the National Insti-
tutes of Health and the Administrator of the General Serv-
ices Administration shall jointly conduct a study to develop
a streamlined procurement system for the National Insti-
tutes of Health that complies with the requirements of Fed-
eral law.
(b) REPORT.—Not later than March 1, 1994, the offi-
cials specified in subsection (a) shall complete the study re-
quired in such subsection and shall submit to the Committee
on Energy and Commerce of the House of Representatives,
and the Committee on Labor and Human Resources of the
Senate, a report describing the findings made as a result
of the study.
177
SEC. 1907. CHRONIC PAIN CONDITIONS.
(a) IN GENERAL.—The Director of the National Insti-
tutes of Health (in this section referred to as the ‘Director’),
acting through the Director of the National Institute of Den-
tal Research and as appropriate through the heads of other
agenices of such Institutes, shall conduct a study for the
purpose of determining the incidence in the United States
of cases of chronic pain and the effect of such cases on the
costs of health care in the United States.
(b) CERTAIN ELEMENTS
OF STUDY.—The cases of
chronic pain with respect to which the study required in
subsection (a) is conducted shall include reflex sympathetic
dystrophy syndrome, temporomandibular joint disorder,
post-herpetic neuropathy, painful diabetic neuropathy,
phantom pain, and post-stroke pain.
(c) REPORT.—Not later than 2 years after the date of
the enactment of this Act, the Director shall complete the
study required in subsection (a) and submit to the the Com-
mittee on Energy and Commerce of the House of Represent-
atives, and to the Committee on Labor and Human Re-
sources of the Senate, a report describing the findings made
as a result of the study.
178
TITLE XX—MISCELLANEOUS
PROVISIONS
SEC. 2001. DESIGNATION OF SENIOR BIOMEDICAL RE-
SEARCH SERVICE IN HONOR OF SILVIO O.
CONTE; LIMITATION ON NUMBER OF MEM-
BERS.
(a) IN GENERAL.—Section 228(a) of the Public Health
Service Act (42 U.S.C. 237(a)), as added by section 304
of Public Law 101–509, is amended to read as follows:
‘‘(a)(1) There shall be in the Public Health Service a
Silvio O. Conte Senior Biomedical Research Service, not
to exceed 750 members.
‘‘(2) The authority established in paragraph (1) re-
garding the number of members in the Silvio O. Conte Sen-
ior Biomedical Research Service is in addition to any au-
thority established regarding the number of members in the
commissioned Regular Corps, in the Reserve Corps, and in
the Senior Executive Service. Such paragraph may not be
construed to require that the number of members in the com-
missioned Regular Corps, in the Reserve Corps, or in the
Senior Executive Service be reduced to offset the number
of members serving in the Silvio O. Conte Senior Bio-
medical Research Service (hereafter in this section referred
to as the ‘Service’).’’.
179
(b) CONFORMING AMENDMENT.—Section 228 of the
Public Health Service Act (42 U.S.C. 237), as added by
section 304 of Public Law 101–509, is amended in the head-
ing for the section by amending the heading to read as fol-
lows:
‘‘SILVIO O. CONTE SENIOR BIOMEDICAL RESEARCH
SERVICE’’.
SEC. 2002. MASTER PLAN FOR PHYSICAL INFRASTRUCTURE
FOR RESEARCH.
Not later than 18 months after the date of the enact-
ment of this Act, the Secretary of Health and Human Serv-
ices, acting through the Director of the National Institutes
of Health, shall present to the Congress a master plan to
provide for the replacement or refurbishment of less than
adequate buildings, utility equipment and distribution sys-
tems (including the resources that provide electrical and
other utilities, chilled water, air handling, and other serv-
ices that the Secretary, acting through the Director, deems
necessary), roads, walkways, parking areas, and grounds
that underpin the laboratory and clinical facilities of the
National Institutes of Health. Such plan may make rec-
ommendations for the undertaking of new projects that are
consistent with the objectives of this section, such as encir-
cling the National Institutes of Health Federal enclave with
an adequate chilled water conduit.
180
SEC. 2003. CERTAIN AUTHORIZATION OF APPROPRIATIONS.
Section 399L(a) of the Public Health Service Act (42
U.S.C. 280e–4(a)), as added by Public Law 102–515 (106
Stat. 3376), is amended—
(1) in the first sentence, by striking ‘‘the Sec-
retary’’ and all that follows and inserting the follow-
ing: ‘‘there are authorized to be appropriated
$30,000,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995
through 1996.’’; and
(2) in the second sentence, by striking ‘‘Out of
any amounts used’’ and inserting ‘‘Of the amounts
appropriated under the preceding sentence’’.
TITLE XXI—EFFECTIVE DATES
SEC. 2101. EFFECTIVE DATES.
Subject to section 165, this Act and the amendments
made by this Act take effect upon the date of the enactment
of this Act.
HR 4 RH——2
HR 4 RH——3
HR 4 RH——4
HR 4 RH——5
HR 4 RH——6
HR 4 RH——7
HR 4 RH——8
HR 4 RH——9