I
106TH CONGRESS
1ST SESSION
H. R. 1085
To improve the health of children.
IN THE HOUSE OF REPRESENTATIVES
MARCH 11, 1999
Mrs. EMERSON introduced the following bill; which was referred to the Com-
mittee on Commerce, and in addition to the Committees on Ways and
Means, and Education and the Workforce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned
A BILL
To improve the health of children.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Healthy Kids 2000 Act’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—HEALTH CARE ACCESSIBILITY AND ACCOUNTABILITY
FOR MOTHERS AND NEWBORNS
Subtitle A—Accessibility of Mothers and Newborns to Health Insurance
Sec. 101. Short title; references.
Sec. 102. Optional coverage of low-income, uninsured pregnant women under a
State child health plan.
Sec. 103. Automatic enrollment for children born to women receiving preg-
nancy-related assistance.
Sec. 104. Expanded availability of funding for administrative costs related to
outreach and eligibility determinations.
Subtitle B—Patient Rights With Respect to Care
Sec. 111. Patient rights with respect to care.
‘‘Subpart C—Patient Rights with Respect to Care
‘‘Sec. 721. Patient access to obstetric and gynecological care.
‘‘Sec. 722. Access to pediatric care.
‘‘Sec. 723. Accountability through distribution of information.
‘‘Sec. 724. Generally applicable provision.
Sec. 112. Grievances and appeals with respect to children.
Sec. 113. Amendments to the Internal Revenue Code of 1986.
Sec. 114. Effective date.
TITLE II—PAYMENTS TO CHILDREN’S HOSPITALS THAT
OPERATE GME PROGRAMS
Sec. 201. Short title.
Sec. 202. Program of payments to children’s hospitals that operate graduate
medical education programs.
TITLE III—PEDIATRIC PUBLIC HEALTH PROMOTION
Subtitle A—National Center for Birth Defects Research and Prevention
Sec. 301. National Center for Birth Defects Research and Prevention.
Subtitle B—Pregnant Mothers and Infants Health Promotion
Sec. 311. Short title.
Sec. 312. Findings.
Sec. 313. Establishment.
Subtitle C—Safe Motherhood Monitoring and Prevention Research
Sec. 321. Short title.
Sec. 322. Amendment to Public Health Service Act.
Subtitle D—Poison Control Center Enhancement
Sec. 331. Short title.
Sec. 332. Findings.
Sec. 333. Definition.
Sec. 334. Establishment of a national toll-free number.
Sec. 335. Establishment of nationwide media campaign.
Sec. 336. Establishment of a grant program.
TITLE IV—PEDIATRIC RESEARCH CENTER
Sec. 401. Establishment of a pediatric research initiative.
Sec. 402. Investment in tomorrow’s pediatric researchers.
TITLE I—HEALTH CARE ACCES-
SIBILITY AND ACCOUNTABIL-
ITY 
FOR 
MOTHERS 
AND
NEWBORNS
Subtitle A—Accessibility of Moth-
ers and Newborns to Health In-
surance
SEC. 101. SHORT TITLE; REFERENCES.
(a) SHORT TITLE.—This subtitle may be cited as the
‘‘Mothers and Newborns Health Insurance Act of 1999’’.
(b) REFERENCES TO SOCIAL SECURITY ACT.—Ex-
cept as otherwise expressly provided, whenever in this sub-
title an amendment or repeal is expressed as an amend-
ment to, or repeal of, a section or other provision, the ref-
erence shall be considered to be made to a section or other
provision of the Social Security Act.
SEC. 102. OPTIONAL COVERAGE OF LOW-INCOME, UNIN-
SURED PREGNANT WOMEN UNDER A STATE
CHILD HEALTH PLAN.
(a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et
seq.) is amended by adding at the end the following new
section:
‘‘SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNIN-
SURED PREGNANT WOMEN.
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any
other provision of this title, a State child health plan may
provide for coverage of pregnancy-related assistance for
targeted low-income pregnant women in accordance with
this section.
‘‘(b) DEFINITIONS.—For purposes of this section:
‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The
term ‘pregnancy-related assistance’ has the meaning
given the term ‘child health assistance’ in section
2110(a) as if any reference to targeted low-income
children were a reference to targeted low-income
pregnant women, except that the assistance shall be
limited to services related to pregnancy (which in-
clude prenatal, delivery, and postpartum services)
and to other conditions that may complicate preg-
nancy and shall not include pre-pregnancy services
and supplies.
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT
WOMAN.—The term ‘targeted low-income pregnant
woman’ has the meaning given the term ‘targeted
low-income child’ in section 2110(b) as if any ref-
erence to a child were deemed a reference to a
woman during pregnancy and through the end of the
month in which the 60-day period (beginning on the
last day of her pregnancy) ends.
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of pregnancy-related assistance to tar-
geted low-income pregnant women under subsection (a),
the following special rules apply:
‘‘(1) Any reference in this title (other than sub-
section (b)) to a targeted low-income child is deemed
to include a reference to a targeted low-income preg-
nant woman.
‘‘(2) Any such reference to child health assist-
ance with respect to such women is deemed a ref-
erence to pregnancy-related assistance.
‘‘(3) Any such reference to a child is deemed a
reference to a woman during pregnancy and the pe-
riod described in subsection (b)(2).
‘‘(4) The medicaid applicable income level is
deemed a reference to the income level established
under section 1902(l)(2)(A).
‘‘(5) Subsection (a) of section 2103 (relating to
required scope of health insurance coverage) shall
not apply insofar as a State limits coverage to serv-
ices described in subsection (b)(1) and the reference
to such section in section 2105(a)(1) is deemed not
to require, in such case, compliance with the require-
ments of section 2103(a).
‘‘(6) There shall be no exclusion of benefits for
services described in subsection (b)(1) based on any
pre-existing condition, and no waiting period (includ-
ing 
a 
waiting 
period 
to 
carry 
out 
section
2102(b)(3)(C)) shall apply.
‘‘(d) NO IMPACT ON ALLOTMENTS.—Nothing in this
section shall be construed as affecting the amount of any
initial allotment provided to a State under section
2104(b).
‘‘(e) APPLICATION OF FUNDING RESTRICTIONS.—
The coverage under this section (and the funding of such
coverage) is subject to the restrictions of section
2105(c).’’.
(b) 
CONFORMING
AMENDMENT.—Section
2102(b)(1)(B) 
(42 
U.S.C. 
1397bb(b)(1)(B)) 
is
amended—
(1) by striking ‘‘and’’ at the end of clause (i);
(2) by striking the period at the end of clause
(ii) and inserting ‘‘, and’’; and
(3) by adding at the end the following new
clause:
‘‘(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income child who is pregnant.’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall take effect on the date of
the enactment of this Act and shall apply to allotments
for all fiscal years.
SEC. 103. AUTOMATIC ENROLLMENT FOR CHILDREN BORN
TO WOMEN RECEIVING PREGNANCY-RELAT-
ED ASSISTANCE.
(a) IN GENERAL.—Section 2111, as added by section
102, is amended by adding at the end the following new
subsection:
‘‘(f) AUTOMATIC
ENROLLMENT
FOR
CHILDREN
BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS-
SISTANCE.—Notwithstanding any other provision of this
title, if a child is born to a targeted low-income pregnant
woman who was receiving pregnancy-related assistance
under this section on the date of the child’s birth, the child
shall be deemed to have applied for child health assistance
under the State child health plan on the date of such birth,
to have been found eligible for such assistance on such
date, and to remain eligible for such assistance until the
child attains 1 year of age.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect on the date of the enact-
ment of this Act and shall apply to allotments for all fiscal
years.
SEC. 104. EXPANDED AVAILABILITY OF FUNDING FOR AD-
MINISTRATIVE 
COSTS 
RELATED 
TO 
OUT-
REACH AND ELIGIBILITY DETERMINATIONS.
Section 
1931(h) 
(42 
U.S.C. 
1396u–1(h)) 
is
amended—
(1) by striking the subsection heading and in-
serting ‘‘INCREASED FEDERAL MATCHING RATE
FOR ADMINISTRATIVE COSTS RELATED
TO OUT-
REACH AND ELIGIBILITY DETERMINATIONS’’;
(2) in paragraph (2), by striking ‘‘eligibility de-
terminations’’ and all that follows and inserting ‘‘de-
terminations of the eligibility of children and preg-
nant women for benefits under the State plan under
this title or title XXI, outreach to children and preg-
nant women likely to be eligible for such benefits,
and such other outreach- and eligibility-related ac-
tivities as the Secretary may approve.’’;
(3) in paragraph (3), by striking ‘‘and ending
with fiscal year 2000’’; and
(4) by striking paragraph (4) and inserting the
following:
‘‘(4) ENCOURAGING USE OF LOCAL AND COM-
MUNITY-BASED ORGANIZATIONS IN OUTREACH AND
ENROLLMENT ACTIVITIES.—The Secretary shall es-
tablish a procedure under which, if a State does not
otherwise obligate the amounts made available under
this subsection, local and community-based public or
nonprofit private organizations (including local and
county governments, public health departments,
community health centers, children’s hospitals, and
disproportionate share hospitals) may seek to have
administrative costs relating to outreach and enroll-
ment of children and pregnant women under this
title and title XXI treated as administrative costs of
a State described in section 1903(a)(7), if such or-
ganizations have the permission of the State in-
volved. A State may require such an organization to
provide payment of such amounts as the State would
otherwise be responsible for in order to obtain pay-
ment under this paragraph.’’.
Subtitle B—Patient Rights With
Respect to Care
SEC. 111. PATIENT RIGHTS WITH RESPECT TO CARE.
(a) IN GENERAL.—Part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974
(29 U.S.C. 1181 et seq.) is amended—
(1) by redesignating subpart C as subpart D;
and
(2) by inserting after subpart B the following:
‘‘Subpart C—Patient Rights With Respect to Care
‘‘SEC. 721. PATIENT ACCESS TO OBSTETRIC AND GYNECO-
LOGICAL CARE.
‘‘(a) IN GENERAL.—In any case in which a group
health plan (other than a fully insured group health
plan)—
‘‘(1) provides coverage for benefits consisting
of—
‘‘(A) gynecological care (such as preventive
women’s health examinations); or
‘‘(B) obstetric care (such as pregnancy-re-
lated services);
provided by a participating physician who specializes
in such care; and
‘‘(2) requires or provides for the designation by
a participant or beneficiary of a participating pri-
mary care provider;
if the primary care provider designated by such partici-
pant or beneficiary is not such a physician as described
in paragraph (1), then the plan shall meet the require-
ments of subsection (b).
‘‘(b) REQUIREMENTS.—A group health plan (other
than a fully insured group health plan) that meets the re-
quirements of this subsection, in connection with the cov-
erage of benefits described in subsection (a) consisting of
care described in subparagraph (A) or (B) of subsection
(a)(1), if the plan—
‘‘(1) does not require authorization or a referral
by the primary care provider in order to obtain cov-
erage for such benefits; and
‘‘(2) treats the ordering of other routine care
related to the care described in subparagraph (A) or
(B) of subsection (a)(1), by the participating physi-
cian providing the care described in either such sub-
paragraph, as the authorization of the primary care
provider with respect to such care.
‘‘(c) RULE
OF CONSTRUCTION.—Nothing in sub-
section (b)(2) shall be construed as waiving any require-
ments of coverage relating to medical necessity or appro-
priateness with respect to the coverage of the gynecological
or obstetric care so ordered. Nothing in subsection (b)
shall be construed to preclude the health plan from requir-
ing that the obstetrician or gynecologist notify the primary
care provider or the plan of treatment decisions.
‘‘SEC. 722. ACCESS TO PEDIATRIC CARE.
‘‘(a) ACCESS TO APPROPRIATE PEDIATRIC PRIMARY
CARE PROVIDERS.—
‘‘(1) IN
GENERAL.—If a group health plan
(other than a fully insured group health plan) re-
quires or provides for a participant to designate a
participating pediatric primary care provider for a
child of such participant—
‘‘(A) the plan or issuer shall permit the
participant to designate a pediatric primary
care provider who specializes in pediatrics as
the child’s primary care provider; and
‘‘(B) if such a participant has not des-
ignated such a provider for the child, the plan
or issuer shall consider appropriate pediatric ex-
pertise in mandatorily assigning such a partici-
pant to a pediatric primary care provider.
‘‘(2) CONSTRUCTION.—Nothing in paragraph
(1) shall be construed to—
‘‘(A) waive any requirements of coverage
relating to medical necessity or appropriateness
with respect to coverage of services; or
‘‘(B) preclude the group health plan in-
volved from requiring that the pediatric pro-
vider notify the primary care provider or the
plan of treatment decisions.
‘‘(b) REFERRAL TO SPECIALITY CARE FOR CHIL-
DREN REQUIRING TREATMENT BY SPECIALISTS.—
‘‘(1) IN GENERAL.—In the case of a child who
is covered under a group health plan (other than a
fully insured group health plan) and who has a men-
tal or physical condition, disability, or disease of suf-
ficient seriousness and complexity to require diag-
nosis, evaluation or treatment by a specialist, the
plan shall make or provide for a referral to a special-
ist who has extensive experience or training, and is
available and accessible to provide the treatment for
such condition or disease, including the choice of a
nonprimary care specialist participating in the plan
or a referral to a nonparticipating provider as pro-
vided for under paragraph (4) if such a provider is
not available within the plan.
‘‘(2) SPECIALIST
DEFINED.—For purposes of
this subsection, the term ‘specialist’ means, with re-
spect to a condition, disability, or disease, a health
care practitioner, facility (such as a children hos-
pital), or center (such as a center of excellence) that
has extensive pediatric expertise through appropriate
training or experience to provide high quality care in
treating the condition, disability, or disease.
‘‘(3) REFERRALS
TO
PARTICIPATING
PROVID-
ERS.—A group health plan (other than a fully in-
sured group health plan) is not required under para-
graph (1) to provide for a referral to a specialist
that is not a participating provider, unless the plan
does not have an appropriate specialist that is avail-
able and accessible to treat the participant’s or bene-
ficiary’s condition and that is a participating pro-
vider with respect to such treatment.
‘‘(4) TREATMENT OF NONPARTICIPATING PRO-
VIDERS.—If a group health plan (other than a fully
insured group health plan) refers a child beneficiary
to a nonparticipating specialist, services provided
pursuant to the referral shall be provided at no addi-
tional cost to the participant beyond what the partic-
ipant would otherwise pay for services received by
such a specialist who is a participating provider.
‘‘(c) DEFINITION.—In this subpart, the term ‘child’
means an individual who is under 19 years of age.
‘‘SEC. 723. ACCOUNTABILITY THROUGH DISTRIBUTION OF
INFORMATION.
‘‘(a) IN GENERAL.—A group health plan (other than
a fully insured group health plan) shall, with respect to
the coverage of children, submit to participants (and pro-
spective participants), and make available to the public,
in writing the health-related information described in sub-
section (b).
‘‘(b) INFORMATION.—The information to be provided
under subsection (a) shall include information on the
structures, processes, and outcomes regarding each health
insurance product offered to participants and beneficiaries
in a manner that is separate for both the adult and child
participants and beneficiaries, using measures that are
specific to each group.
‘‘SEC. 724. GENERALLY APPLICABLE PROVISION.
‘‘In the case of a group health plan that provides ben-
efits under 2 or more coverage options, the requirements
of this subpart shall apply separately with respect to each
coverage option.’’.
(b) DEFINITION.—Section 733(a) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1191b(a)) is amended by adding at the end the following:
‘‘(3) FULLY INSURED GROUP HEALTH PLAN.—
The term ‘fully insured group health plan’ means a
group health plan where benefits are provided pursu-
ant to the terms of an arrangement between a group
health plan and a health insurance issuer and are
guaranteed by the health insurance issuer under a
contract or policy of insurance.’’.
(c) CONFORMING AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement Income Se-
curity Act of 1974 is amended—
(1) in the item relating to subpart C, by strik-
ing ‘‘Subpart C’’ and inserting ‘‘Subpart D’’; and
(2) by adding at the end of the items relating
to subpart B of part 7 of subtitle B of title I of such
Act the following new items:
‘‘SUBPART C—PATIENT RIGHTS WITH RESPECT TO CARE
‘‘Sec. 721. Patient access to obstetric and gynecological care.
‘‘Sec. 722. Access to pediatric care.
‘‘Sec. 723. Accountability through distribution of information.
‘‘Sec. 724. Generally applicable provision.’’.
SEC. 112. GRIEVANCES AND APPEALS WITH RESPECT TO
CHILDREN.
(a) IN GENERAL.—Section 503 of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 1133)
is amended to read as follows:
‘‘SEC. 503. CLAIMS PROCEDURE, AND GRIEVANCES AND AP-
PEALS WITH RESPECT TO CHILDREN.
‘‘(a) CLAIMS PROCEDURE.—In accordance with regu-
lations of the Secretary, every employee benefit plan
shall—
‘‘(1) provide adequate notice in writing to any
participant or beneficiary whose claim for benefits
under the plan has been denied, setting forth the
specific reasons for such denial, written in a manner
calculated to be understood by the participant, and
‘‘(2) afford a reasonable opportunity to any
participant whose claim for benefits has been denied
for a full and fair review by the appropriate named
fiduciary of the decision denying the claim.
‘‘(b) INTERNAL APPEALS PROCESS.—A group health
plan, or health insurance issuer in connection with the
provisions of health insurance coverage, shall, with respect
to the coverage of children, establish and maintain a sys-
tem to provide for the resolution of complaints and appeals
regarding all aspects of such coverage. Such a system shall
include an expedited procedure for appeals where a stand-
ard appeal would jeopardize the life, health, or develop-
ment of the child.
‘‘(c) EXTERNAL APPEALS PROCESS.—A group health
plan, or health insurance issuer in connection with the
provision of health insurance coverage, shall, with respect
to the coverage of children, provide for an independent ex-
ternal review process that meets the following require-
ments:
‘‘(1) External appeal activities shall be con-
ducted through clinical peers, including a physician
or other health care professional who is appro-
priately credentialed in pediatrics who has the same
or similar specialty as the specialty involved in the
appeal and who has experience managing the condi-
tion, procedure, or treatment under review or ap-
peal.
‘‘(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.’’.
(b) CONFORMING AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement Income Se-
curity Act of 1974 is amended by striking the item relat-
ing to section 503 and inserting the following new item:
‘‘Sec. 503. Claims procedures and grievances and appeals with respect to chil-
dren.’’.
SEC. 113. 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 Patients’ bill of rights.’’; and
(2) by inserting after section 9812 the follow-
ing:
‘‘SEC. 9813. STANDARD RELATING TO PATIENTS’ RIGHTS.
‘‘A group health plan shall comply with the require-
ments of subpart C of part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 (as
in effect as of the date of the enactment of the Healthy
Kids 2000 Act), and such requirements shall be deemed
to be incorporated into this section.’’.
SEC. 114. EFFECTIVE DATE.
(a) IN GENERAL.—The amendments made by this
subtitle shall apply with respect to plan years beginning
on or after January 1 of the second calendar year follow-
ing the date of the enactment of this Act. The Secretary
shall issue all regulations necessary to carry out the
amendments made by this section before the effective date
thereof.
(b) LIMITATION ON ENFORCEMENT ACTIONS.—No
enforcement action shall be taken, pursuant to the amend-
ments made by this subtitle, against a group health plan
with respect to a violation of a requirement imposed by
such amendments before the date of issuance of regula-
tions issued in connection with such requirement.
TITLE II—PAYMENTS TO CHIL-
DREN’S HOSPITALS THAT OP-
ERATE GME PROGRAMS
SEC. 201. SHORT TITLE.
This title may be cited as the ‘‘Pediatric Medical
Education, Training, and Research Act of 1999’’.
SEC. 202. PROGRAM OF PAYMENTS TO CHILDREN’S HOS-
PITALS THAT OPERATE GRADUATE MEDICAL
EDUCATION PROGRAMS.
(a) PAYMENTS.—
(1) IN GENERAL.—The Secretary shall make
payment under this section to each children’s hos-
pital for each hospital cost reporting period begin-
ning after fiscal year 1999 and before fiscal year
2004 for the direct and indirect expenses associated
with operating approved medical residency training
programs.
(2) PAYMENT AMOUNT.—Subject to paragraph
(3), the amount payable under this section to a chil-
dren’s hospital for direct and indirect expenses relat-
ing to approved medical residency training programs
for a cost reporting period ending in a fiscal year is
equal to the sum of the amount determined under
subsection (b) and the amount determined under
subsection (c) for such hospital for such fiscal year.
(3) CAPPED AMOUNT.—
(A) IN GENERAL.—The payments to chil-
dren’s hospitals established in this subsection
for cost reporting periods ending in any fiscal
year shall not exceed the funds appropriated
under subsection (e) for that fiscal year.
(B) PRO RATA REDUCTIONS.—If the Sec-
retary determines that the amount of funds ap-
propriated under subsection (e) for cost report-
ing periods ending in any fiscal year is insuffi-
cient to provide the total amount of payments
otherwise due for such periods, the Secretary
shall reduce each of the amounts payable under
this section for such period on a pro rata basis
to reflect such shortfall.
(b) AMOUNT OF PAYMENT FOR DIRECT MEDICAL
EDUCATION.—
(1) IN
GENERAL.—The amount determined
under this subsection for payments to a children’s
hospital for direct expenses relating to approved
medical residency training programs for a cost re-
porting period ending in fiscal years 2000 through
2003 is equal to the product of—
(A) the per resident rate for direct medical
education, as determined under paragraph (2),
for the cost reporting period; and
(B) the weighted average number of full-
time equivalent residents in the hospital’s ap-
proved medical residency training programs (as
determined under section 1886(h)(4) of the So-
cial Security Act (42 U.S.C. 1395ww(h)(4)))
for the cost reporting period.
(2) PER RESIDENT RATE FOR DIRECT MEDICAL
EDUCATION.—
(A) IN GENERAL.—The per resident rate
for direct medical education for a hospital for
a cost reporting period is the updated rate de-
termined under subparagraph (B).
(B) COMPUTATION UPDATED RATE.—The
updated rate determined under this subpara-
graph is equal to the lesser of—
(i) a rate equal to the weighted aver-
age of the per resident rates computed
under section 1886(h)(2) of the Social Se-
curity Act (42 U.S.C. 1395ww(h)(2)) for
cost reporting periods ending during fiscal
year 1999 for all hospitals located in the
Metropolitan Statistical Area in which the
hospital involved is located; or
(ii) the per resident rate for cost re-
porting periods ending during fiscal year
1999 for the hospital involved (as deter-
mined by the Secretary using the meth-
odology 
described 
in 
section
1886(h)(2)(E)) of such Act (42 U.S.C.
1395ww(h)(2)(E)));
each such rate updated by the hospital market
basket increase percentage from fiscal year
1999 through the fiscal year involved.
(c) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL
EDUCATION.—
(1) IN
GENERAL.—The amount determined
under this subsection for payments to a children’s
hospital for indirect expenses relating to approved
medical residency training programs for a cost re-
porting period ending in fiscal years 2000 through
2003 is equal to an amount determined appropriate
by the Secretary.
(2) FACTORS.—In determining the amount
under paragraph (1), the Secretary shall—
(A) take into account variations in case
mix among children’s hospitals and the weight-
ed average number of full-time equivalent resi-
dents in the hospitals’ approved medical resi-
dency training programs (as determined under
section 1886(h)(4) of the Social Security Act
(42 U.S.C. 1395ww(h)(4))) for the cost report-
ing period; and
(B) assure that the aggregate of the pay-
ments for indirect expenses relating to approved
medical residency training programs under this
section in a fiscal year are equal to the amount
appropriated for such expenses in such year
under subsection (e)(2).
(d) MAKING OF PAYMENTS.—
(1) INTERIM PAYMENTS.—The Secretary shall
estimate, before the beginning of each cost reporting
period for a hospital for which a payment may be
made under this section, the amount of the payment
for such period and shall (subject to paragraph (2))
make payment of such amount in 26 equal interim
installments during such period.
(2) WITHHOLDING.—The Secretary shall with-
hold up to 25 percent from each interim installment
paid under paragraph (1).
(3) RECONCILIATION.—At the end of each such
period, the hospital shall submit to the Secretary
such information as the Secretary determines to be
necessary to determine the percent (if any) of the
amount withheld under paragraph (2) that is due
under this section for the hospital for the period.
Based on such determination, the Secretary shall re-
coup any overpayments made, or pay any balance
due. The amount so determined shall be considered
a final intermediary determination for purposes of
applying section 1878 of the Social Security Act (42
U.S.C. 1395oo) and shall be subject to review under
that section in the same manner as the amount of
payment under section 1886(d) of such Act (42
U.S.C. 1395ww(d)) is subject to review under such
section.
(e) LIMITATION ON EXPENDITURES.—
(1) PAYMENT
FOR
DIRECT
MEDICAL
EDU-
CATION
EXPENSES
REPRESENTING
MEDICARE’S
SHARE OF SUCH EXPENSES.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), there are hereby appropriated, out
of any money in the Treasury not otherwise ap-
propriated, for payments under this section for
direct expenses relating to approved medical
residency training programs for a cost reporting
period for cost reporting periods beginning in—
(i) fiscal year 2000, $35,000,000;
(ii) fiscal year 2001, $95,000,000;
(iii) fiscal year 2002, $95,000,000;
and
(iv) fiscal year 2003, $95,000,000.
(B) CARRYOVER
OF
EXCESS.—If the
amount of payments under this section for cost
reporting periods ending in fiscal year 2000,
2001, or 2002 is less than the amount provided
under this paragraph for such payments for
such periods, then the amount available under
this paragraph for cost reporting periods ending
in the following fiscal year shall be increased by
the amount of such difference.
(2) PAYMENT
FOR
INDIRECT
MEDICAL
EDU-
CATION
EXPENSES
REPRESENTING
MEDICARE’S
SHARE OF SUCH EXPENSES.—There are hereby ap-
propriated, out of any money in the Treasury not
otherwise appropriated, for payments under this sec-
tion for indirect expenses relating to approved medi-
cal residency training programs for a cost reporting
period for cost reporting periods beginning in—
(A) fiscal year 2000, $65,000,000;
(B) fiscal year 2001, $190,000,000;
(C) fiscal year 2002, $190,000,000; and
(D) fiscal year 2003, $190,000,000.
(f) RELATION TO MEDICARE AND MEDICAID PAY-
MENTS.—Notwithstanding any other provision of law,
payments under this section to a hospital for a cost report-
ing period—
(1) are in lieu of any amounts otherwise pay-
able to the hospital under section 1886(h) or
1886(d)(5)(B) of the Social Security Act (42 U.S.C.
1395ww(h); 1395ww(d)(5)B)) to the hospital for
such cost reporting period, but
(2) shall not affect the amounts otherwise pay-
able to such hospitals under a State medicaid plan
under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(g) DEFINITIONS.—In this section:
(1) APPROVED MEDICAL RESIDENCY TRAINING
PROGRAM.—The term ‘‘approved medical residency
training program’’ has the meaning given such term
in section 1886(h)(5)(A) of the Social Security Act
(42 U.S.C. 1395ww(h)(5)(A)).
(2) CHILDREN’S
HOSPITAL.—The term ‘‘chil-
dren’s hospital’’ means a hospital described in sec-
tion 1886(d)(1)(B)(iii) of the Social Security Act
(42 U.S.C. 1395ww(d)(1)(B)(iii)).
(3) DIRECT
GRADUATE
MEDICAL
EDUCATION
COSTS.—The term ‘‘direct graduate medical edu-
cation costs’’ has the meaning given such term in
section 1886(h)(5)(C) of the Social Security Act (42
U.S.C. 1395ww(h)(5)(C)).
(4) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
TITLE III—PEDIATRIC PUBLIC
HEALTH PROMOTION
Subtitle A—National Center for
Birth Defects Research and Pre-
vention
SEC. 301. NATIONAL CENTER FOR BIRTH DEFECTS RE-
SEARCH AND PREVENTION.
Title III of the Public Health Service Act (42 U.S.C.
241 et seq.) is amended by adding at the end the follow-
ing:
‘‘PART Q—PEDIATRIC PUBLIC HEALTH
PROMOTION
‘‘SEC. 399L. NATIONAL CENTER FOR BIRTH DEFECTS RE-
SEARCH AND PREVENTION.
‘‘(a) ESTABLISHMENT.—There is established within
the Centers for Disease Control and Prevention a center
to be known as the National Center for Birth Defects Re-
search and Prevention.
‘‘(b) PURPOSE.—The general purpose of the National
Center established under subsection (a) shall be to—
‘‘(1) collect, analyze, and make available data
on birth defects, including data on the causes of
such defects and on the incidence and prevalence of
such defects;
‘‘(2) conduct applied epidemiological research
on the prevention of such defects; and
‘‘(3) provide information and education to the
public on the prevention of such defects.
‘‘(c) DIRECTOR.—The National Center established
under subsection (a) shall be headed by a director to be
appointed by the Secretary.
‘‘(d) TRANSFERS.—There shall be transferred to the
National Center established under subsection (a) all activi-
ties, budgets and personnel of the National Center for En-
vironmental Health that relate to birth defects, folic acid,
cerebral palsy, mental retardation, child development,
newborn screening, autism, fragile X syndrome, fetal alco-
hol syndrome, pediatric genetics, and disability prevention.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated such sums as may be
necessary to carry out this section.’’.
Subtitle B—Pregnant Mothers and
Infants Health Promotion
SEC. 311. SHORT TITLE.
This subtitle may be cited as the ‘‘Pregnant Mothers
and Infants Health Protection Act’’.
SEC. 312. FINDINGS.
Congress makes the following findings:
(1) Alcohol consumption by a woman during
her pregnancy can cause the woman to have a mis-
carriage and otherwise cause serious harm to her
baby, including low birth weight, birth defects, and
behavioral problems.
(2) Illegal drug usage can cause problems such
as miscarriage, early birth, or high or low blood
pressure for the mother.
(3) Exposure to illegal drugs often causes ba-
bies to die before or after they are born. If a baby
is born alive, the newborn might be addicted to
drugs and have painful withdrawal. Drug exposure
may also cause severe damage to the newborn’s or-
gans, such as the brain, eyes, ears, heart, kidneys,
or genitals.
(4) Smoking tobacco products during pregnancy
significantly increases maternal and fetal risk and
accounts for 20 to 30 percent of the low birth weight
rate and 10 percent of the fetal and infant death
rate in the United States.
(5) Infants of mothers who smoke during and
after pregnancy have nearly a 3 fold increase in the
risk of Sudden Infant Death Syndrome (referred to
in this section as ‘‘SIDS’’) as compared to infants
of mothers who do not smoke.
(6) Smoking during pregnancy has been associ-
ated with certain childhood cancers and birth de-
fects, and it increases the risk of spontaneous abor-
tion, premature rupture of membranes, and delivery
of a stillborn infant.
(7) Smoking during pregnancy may impede the
growth of the fetus and increase the likelihood of
mental retardation by 50 percent.
(8) The proportion of women who quit smoking
during pregnancy but relapse within 6 months is
nearly 63 percent, thereby exposing their infants to
passive smoke and increasing their risk of SIDS and
other health related problems.
(9) Effective prenatal smoking, alcohol, and il-
legal drug cessation methods increase the rate of
cessation during pregnancy.
SEC. 313. ESTABLISHMENT.
Part Q of title III of the Public Health Service Act
(as added by section 301) is amended by adding at the
end the following:
‘‘SEC. 399M. PROGRAMS REGARDING PRENATAL AND POST-
NATAL HEALTH.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Director of the Centers for Disease Control and Pre-
vention, shall carry out programs—
‘‘(1) to collect, analyze, and make available data
on prenatal smoking, alcohol and illegal drug usage,
including data on the implications of such activities
and on the incidence and prevalence of such activi-
ties and their implications;
‘‘(2) to conduct applied epidemiological research
on the prevention of prenatal and postnatal smoking,
alcohol and illegal drug usage;
‘‘(3) to support, conduct, and evaluate the ef-
fectiveness of educational and cessation programs;
and
‘‘(4) to provide information and education to
the public on the prevention and implications of pre-
natal and postnatal smoking, alcohol and illegal drug
usage.
‘‘(b) GRANTS.—In carrying out subsection (a), the
Secretary may award grants to and enter into contracts
with States, local governments, scientific and academic in-
stitutions, Federally qualified health centers, and other
public and nonprofit entities, and may provide technical
and consultative assistance to such entities.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$15,000,000 for each of the fiscal years 2000 and 2001,
and such sums as may be necessary for each of the fiscal
years 2002 and 2003.’’.
Subtitle C—Safe Motherhood Mon-
itoring 
and 
Prevention 
Re-
search
SEC. 321. SHORT TITLE.
This Act may be cited as the ‘‘Safe Motherhood Mon-
itoring and Prevention Research Act’’.
SEC. 322. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.
Part Q of title III of the Public Health Service Act
(as added by section 301 and amended by section 311)
is further amended by adding at the end the following:
‘‘SEC. 399N. SAFE MOTHERHOOD MONITORING.
‘‘(a) PURPOSE.—It is the purpose of this section to
develop monitoring systems at the local, State, and na-
tional level to better understand the burden of maternal
complications and mortality and to decrease the disparities
among population at risk of death and complications from
pregnancy.
‘‘(b) ACTIVITIES.—For the purpose described in sub-
section (a), the Secretary may carry out the following ac-
tivities:
‘‘(1) The Secretary, acting through the Centers
for Disease Control and Prevention, may establish
and implement a national monitoring and surveil-
lance program to identify and promote the investiga-
tion of deaths and severe complications that occur
during pregnancy.
‘‘(2) The Secretary, acting through the Centers
for Disease Control and Prevention, may expand the
Pregnancy Risk Assessment Monitoring System to
provide surveillance and collect data in each of the
50 States.
‘‘(3) The Secretary, acting through the Centers
for Disease Control and Prevention, may expand the
Maternal and Child Health Epidemiology Program
to provide technical support, financial assistance, or
the time-limited assignment of senior epidemiologists
to maternal and child health programs in each of the
50 States.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$25,000,000 for each fiscal year.’’.
‘‘SEC. 399O. PREVENTION RESEARCH TO ENSURE SAFE
MOTHERHOOD.
‘‘(a) PURPOSE.—It is the purpose of this section to
provide the Centers for Disease Control and Prevention
with the authority to further expand research concerning
risk factors, prevention strategies, and the roles of the
family, health care providers and the community in safe
motherhood.
‘‘(b) RESEARCH.—The Secretary, acting through the
Centers for Disease Control and Prevention, may carry
out activities to expand research relating to—
‘‘(1) encouraging preconception counseling, es-
pecially for at risk populations such as diabetics;
‘‘(2) the identification of critical components of
prenatal delivery and postpartum care;
‘‘(3) the identification of outreach and support
services, such as folic acid education, that are avail-
able for pregnant women;
‘‘(4) the identification of women who are at
high risk for complications;
‘‘(5) preventing preterm delivery;
‘‘(6) preventing urinary tract infections;
‘‘(7) preventing unnecessary caesarean sections;
‘‘(8) an examination of the higher rates of ma-
ternal mortality among African American women;
‘‘(9) an examination of the relationship between
domestic violence and maternal complications and
mortality;
‘‘(10) preventing smoking, alcohol and illegal
drug usage before, during and after pregnancy;
‘‘(11) preventing infections that cause maternal
and infant complications; and
‘‘(12) other areas determined appropriate by
the Secretary.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$20,000,000 for each fiscal year.
‘‘SEC. 399P. PREVENTION PROGRAMS TO ENSURE SAFE
MOTHERHOOD.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Centers for Disease Control and Prevention may carry
out activities to promote safe motherhood, including—
‘‘(1) public education campaigns on healthy
pregnancies and the building of partnerships with
outside organizations concerned about safe mother-
hood;
‘‘(2) education programs for physicians, nurses
and other health care providers; and
‘‘(3) activities to promote community support
services for pregnant women.
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$20,000,000 for each fiscal year.’’.
Subtitle D—Poison Control Center
Enhancement
SEC. 331. SHORT TITLE.
This subtitle may be cited as the ‘‘Poison Control
Center Enhancement and Awareness Act’’.
SEC. 332. FINDINGS.
Congress makes the following findings:
(1) Each year more than 2,000,000 poisonings
are reported to poison control centers throughout
the United States. More than 90 percent of these
poisonings happen in the home. Fifty-three percent
of poisoning victims are children younger than 6
years of age.
(2) Poison centers are life-saving and cost-effec-
tive public health services. For every dollar spent on
poison control centers, $7 in medical costs are saved.
The average cost of a poisoning exposure call is
$31.28, while the average cost if other parts of the
medical system are involved is $932. Over the last
2 decades, the instability and lack of funding has re-
sulted in a steady decline in the number of poison
control centers in the United States. Currently,
there are 75 such centers.
(3) Stabilizing the funding structure and in-
creasing accessibility to poison control centers will
increase the number of United States residents who
have access to a certified poison control center, and
reduce the inappropriate use of emergency medical
services and other more costly health care services.
SEC. 333. DEFINITION.
In this subtitle, the term ‘‘Secretary’’ means the Sec-
retary of Health and Human Services.
SEC. 334. ESTABLISHMENT OF A NATIONAL TOLL-FREE
NUMBER.
(a) IN GENERAL.—The Secretary shall provide co-
ordination and assistance to regional poison control cen-
ters for the establishment of a nationwide toll-free phone
number to be used to access such centers.
(b) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out this section,
$2,000,000 for each of the fiscal years 2000 through
2004.
SEC. 335. ESTABLISHMENT OF NATIONWIDE MEDIA CAM-
PAIGN.
(a) IN GENERAL.—The Secretary shall establish a
national media campaign to educate the public and health
care providers about poison prevention and the availability
of poison control resources in local communities and to
conduct advertising campaigns concerning the nationwide
toll-free number established under section 334.
(b) CONTRACT WITH ENTITY.—The Secretary may
carry out subsection (a) by entering into contracts with
1 or more nationally recognized media firms for the devel-
opment and distribution of monthly television, radio, and
newspaper public service announcements.
(c) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out this section,
$600,000 for each of the fiscal years 2000 through 2004.
SEC. 336. ESTABLISHMENT OF A GRANT PROGRAM.
(a) REGIONAL POISON CONTROL CENTERS.—The
Secretary shall award grants to certified regional poison
control centers for the purposes of achieving the financial
stability of such centers, and for preventing and providing
treatment recommendations for poisonings.
(b) OTHER IMPROVEMENTS.—The Secretary shall
also use amounts received under this section to—
(1) develop standard education programs;
(2) develop standard patient management pro-
tocols for commonly encountered toxic exposures;
(3) improve and expand the poison control data
collection systems; and
(4) improve national toxic exposure surveillance.
(c) CERTIFICATION.—Except as provided in sub-
section (d), the Secretary may make a grant to a center
under subsection (a) only if the center has been certified
by a professional organization in the field of poison con-
trol, and the Secretary has approved the organization as
having in effect standards for certification that reasonably
provide for the protection of the public health with respect
to poisoning.
(d) WAIVER OF CERTIFICATION REQUIREMENTS.—
(1) IN GENERAL.—The Secretary may grant a
waiver of the certification requirement of subsection
(a) with respect to a noncertified poison control cen-
ter that applies for a grant under this section if such
center can reasonably demonstrate that the center
will obtain such a certification within a reasonable
period of time as determined appropriate by the Sec-
retary.
(2) RENEWAL.—The Secretary may only renew
a waiver under paragraph (1) for a period of 3
years.
(e) SUPPLEMENT NOT SUPPLANT.—Amounts made
available to a poison control center under this section shall
be used to supplement and not supplant other Federal,
State, local or private funds provided for such center.
(f) MAINTENANCE OF EFFORT.—A poison control
center, in utilizing the proceeds of a grant under this sec-
tion, shall maintain the expenditures of the center for ac-
tivities of the center at a level that is equal to not less
than the level of such expenditures maintained by the cen-
ter for the fiscal year preceding the fiscal year for which
the grant is received.
(g) MATCHING REQUIREMENT.—The Secretary may
impose a matching requirement with respect to amounts
provided under a grant under this section if the Secretary
determines appropriate.
(h) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out this section,
$25,000,000 for each of the fiscal years 2000 through
2004.
TITLE IV—PEDIATRIC
RESEARCH CENTER
SEC. 401. ESTABLISHMENT OF A PEDIATRIC RESEARCH INI-
TIATIVE.
Part A of title IV of the Public Health Service Act
(42 U.S.C. 281 et seq.) is amended by adding at the end
the following:
‘‘SEC. 404F. PEDIATRIC RESEARCH INITIATIVE.
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish within the Office of the Director of NIH a Pediatric
Research Initiative (hereafter in this section referred to
as the ‘Initiative’). The Initiative shall be headed by the
Director of NIH.
‘‘(b) PURPOSE.—The purpose of the Initiative is to
provide funds to enable the Director of NIH to
encourage—
‘‘(1) increased support for pediatric biomedical
research within the National Institutes of Health to
ensure that the expanding opportunities for advance-
ment in scientific investigations and care for chil-
dren are realized;
‘‘(2) expanded clinical pharmacology and exper-
imental therapeutics research, to—
‘‘(A) 
better 
understand 
maturational
changes in drug metabolism and drug actions
from birth through puberty;
‘‘(B) apply the insights gained to address
specific therapeutic and drug toxicity problems
relevant to children;
‘‘(C) conduct pediatric clinical trials which
will lead to approval of important therapeutic
drugs for use by children; and
‘‘(D) serve as an educational resource for
patients, practitioners and students;
‘‘(3) enhanced collaborative efforts among the
Institutes to support multidisciplinary research in
the areas that the Director deems most promising;
‘‘(4) increased support for pediatric outcomes
and medical effectiveness research to demonstrate
how to improve the quality of children’s health care
while reducing cost; and
‘‘(5) recognition of the special attention pedi-
atric research deserves.
‘‘(c) DUTIES.—In carrying out subsection (b), the Di-
rector of NIH shall—
‘‘(1) consult with the Institutes and other advi-
sors as the Director determines appropriate in the
allocation of Initiative funds, including the Institute
for Child Health and Human Development;
‘‘(2) have broad discretion in the allocation of
any Initiative assistance among the Institutes,
among types of grants, and between basic and clini-
cal research so long as the—
‘‘(A) assistance is directly related to the ill-
nesses and diseases of children; and
‘‘(B) assistance is extramural in nature;
and
‘‘(3) be responsible for the oversight of any
newly appropriated Initiative funds and be account-
able with respect to such funds to Congress and to
the public.
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$100,000,000 for each of the fiscal years 2000 and 2001,
and such sums as may be necessary for each fiscal year
thereafter.
‘‘(e) TRANSFER OF FUNDS.—The Director of NIH
may transfer amounts appropriated under this section to
any of the Institutes for a fiscal year to carry out the pur-
poses of the Initiative under this section.’’.
SEC. 402. INVESTMENT IN TOMORROW’S PEDIATRIC RE-
SEARCHERS.
(a) IN GENERAL.—The Secretary of Health and
Human Services, acting through the National Institute of
Child Health and Human Development, shall provide en-
hanced support for extramural activities relating to the
training and career development of pediatric researchers.
(b) PURPOSE.—In carrying out subsection (a), the
Secretary of Health and Human Services shall ensure that
enhanced support is designed to ensure the future supply
of researchers who are dedicated to the care and research
needs of children by providing for—
(1) an increase in the number and size of insti-
tutional training grants to medical school pediatric
departments and children’s hospitals; and
(2) an increase in the number of career develop-
ment awards for pediatric providers building careers
in pediatric clinical research.
(c) PEDIATRIC RESEARCH LOAN REPAYMENT PRO-
GRAM.—
(1) IN GENERAL.—The Secretary of Health and
Human Services, in consultation with the Director of
the National Institute of Child Health and Human
Development, may establish a pediatric research
loan repayment program. Through such program—
(A) the Secretary shall enter into contracts
with qualified pediatricians under which such
pediatricians will agree to conduct pediatric re-
search in consideration of the Federal Govern-
ment agreeing to repay, for each year of such
service, not more than $35,000 of the principal
and interest of the educational loans of such pe-
diatricians; and
(B) the Secretary shall, for the purpose of
providing reimbursements for tax liability re-
sulting from payments made under paragraph
(1) on behalf of an individual, make payments,
in addition to payments under such paragraph,
to the individual in an amount equal to 39 per-
cent of the total amount of loan repayments
made for the taxable year involved.
(2) APPLICATION OF OTHER PROVISIONS.—The
provisions of sections 338B, 338C, and 338E of the
Public Health Service Act (42 U.S.C. 254l–1, 254m,
and 254o) shall, except as inconsistent with para-
graph (1), apply to the program established under
such paragraph to the same extent and in the same
manner as such provisions apply to the National
Health Service Corps Loan Repayment Program es-
tablished under subpart III of part D of title III of
such Act (42 U.S.C. 245l et seq.).
(3) AVAILABILITY OF FUNDS.—Amounts made
available to carry out this subsection shall remain
available until the expiration of the second fiscal
year beginning after the fiscal year for which such
amounts were made available.
(d) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out this section,
$20,000,000 for fiscal year 2000, $25,000,000 for fiscal
year 2001, $30,000,000 for fiscal year 2002, and such
sums as may be necessary for each fiscal year thereafter.
Æ