H. R. 4365—54
‘‘(A) provide for a broad range of research and edu-
cation activities relating to biomedical, psychosocial, and
rehabilitative issues, including studies of the dispropor-
tionate impact of such diseases on women;
‘‘(B) identify priorities among the programs and activi-
ties of the National Institutes of Health regarding such
diseases; and
‘‘(C) reflect input from a broad range of scientists,
patients, and advocacy groups.
‘‘(2) CERTAIN ELEMENTS OF PLAN.—The plan under para-
graph (1) shall, with respect to autoimmune diseases, provide
for the following as appropriate:
‘‘(A) Research to determine the reasons underlying the
incidence and prevalence of the diseases.
‘‘(B) Basic research concerning the etiology and causes
of the diseases.
‘‘(C) Epidemiological studies to address the frequency
and natural history of the diseases, including any dif-
ferences among the sexes and among racial and ethnic
groups.
‘‘(D) The development of improved screening tech-
niques.
‘‘(E) Clinical research for the development and evalua-
tion of new treatments, including new biological agents.
‘‘(F) Information and education programs for health
care professionals and the public.
‘‘(3) IMPLEMENTATION OF PLAN.—The Director of NIH shall
ensure that programs and activities of the National Institutes
of Health regarding autoimmune diseases are implemented in
accordance with the plan under paragraph (1).
‘‘(d) REPORTS
TO CONGRESS.—The Coordinating Committee
under subsection (b)(1) shall biennially submit to the Committee
on Commerce of the House of Representatives, and the Committee
on Health, Education, Labor and Pensions of the Senate, a report
that describes the research, education, and other activities on auto-
immune diseases being conducted or supported through the national
research institutes, and that in addition includes the following:
‘‘(1) The plan under subsection (c)(1) (or revisions to the
plan, as the case may be).
‘‘(2) Provisions specifying the amounts expended by the
National Institutes of Health with respect to each of the auto-
immune diseases included in the plan.
‘‘(3) Provisions identifying particular projects or types of
projects that should in the future be considered by the national
research institutes or other entities in the field of research
on autoimmune diseases.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005. The authorization of appropriations established in
the preceding sentence is in addition to any other authorization
of appropriations that is available for conducting or supporting
through the National Institutes of Health research and other activi-
ties with respect to autoimmune diseases.’’.
H. R. 4365—55
TITLE XX—GRADUATE MEDICAL EDU-
CATION PROGRAMS IN CHILDREN’S
HOSPITALS
SEC. 2001. PROVISIONS TO REVISE AND EXTEND PROGRAM.
(a) PAYMENTS.—Section 340E(a) of the Public Health Service
Act (42 U.S.C. 256e(a)) is amended—
(1) by striking ‘‘and 2001’’ and inserting ‘‘through 2005’’;
and
(2) by adding at the end the following: ‘‘The Secretary
shall promulgate regulations pursuant to the rulemaking
requirements of title 5, United States Code, which shall govern
payments made under this subpart.’’.
(b) UPDATING
RATES.—Section 340E(c)(2)(F) of the Public
Health Service Act (42 U.S.C. 256e(c)(2)(F)) is amended by striking
‘‘hospital’s cost reporting period that begins during fiscal year 2000’’
and inserting ‘‘Federal fiscal year for which payments are made’’.
(c) 
RESIDENT
COUNT
FOR
INTERIM
PAYMENTS.—Section
340E(e)(1) of the Public Health Service Act (42 U.S.C. 256e(e)(1))
is amended by adding at the end the following: ‘‘Such interim
payments to each individual hospital shall be based on the number
of residents reported in the hospital’s most recently filed Medicare
cost report prior to the application date for the Federal fiscal
year for which the interim payment amounts are established. In
the case of a hospital that does not report residents on a Medicare
cost report, such interim payments shall be based on the number
of residents trained during the hospital’s most recently completed
Medicare cost report filing period.’’.
(d) WITHHOLDING.—Section 340E(e)(2) of the Public Health
Service Act (42 U.S.C. 256e(e)(2)) is amended—
(1) by adding ‘‘and indirect’’ after ‘‘direct’’; and
(2) by adding at the end the following: ‘‘The Secretary
shall withhold up to 25 percent from each interim installment
for direct and indirect graduate medical education paid under
paragraph (1) as necessary to ensure a hospital will not be
overpaid on an interim basis.’’.
(e) RECONCILIATION.—Section 340E(e)(3) of the Public Health
Service Act (42 U.S.C. 256e(e)(3)) is amended to read as follows:
‘‘(3) RECONCILIATION.—Prior to the end of each fiscal year,
the Secretary shall determine any changes to the number of
residents reported by a hospital in the application of the hos-
pital for the current fiscal year to determine the final amount
payable to the hospital for the current fiscal year for both
direct expense and indirect expense amounts. Based on such
determination, the Secretary shall recoup any overpayments
made to pay any balance due to the extent possible. The final
amount so determined shall be considered a final intermediary
determination for the purposes of section 1878 of the Social
Security Act and shall be subject to administrative and judicial
review under that section in the same manner as the amount
of payment under section 1186(d) of such Act is subject to
review under such section.’’.
(f ) AUTHORIZATION OF APPROPRIATIONS.—Section 340E(f ) of the
Public Health Service Act (42 U.S.C. 256e(f )) is amended—
(1) in paragraph (1)(A)—
H. R. 4365—56
(A) in clause (i), by striking ‘‘and’’ at the end;
(B) in clause (ii), by striking the period and inserting
‘‘; and’’; and
(C) by adding at the end the following:
‘‘(iii) for each of the fiscal years 2002 through
2005, such sums as may be necessary.’’; and
(2) in paragraph (2)—
(A) in subparagraph (A), by striking ‘‘and’’ at the end;
(B) in subparagraph (B), by striking the period and
inserting ‘‘; and’’; and
(C) by adding at the end the following:
‘‘(C) for each of the fiscal years 2002 through 2005,
such sums as may be necessary.’’.
(g) DEFINITION OF CHILDREN’S HOSPITAL.—Section 340E(g)(2)
of the Public Health Service Act (42 U.S.C. 256e(g)(2)) is amended
by striking ‘‘described in’’ and all that follows and inserting the
following: ‘‘with a Medicare payment agreement and which is
excluded from the Medicare inpatient prospective payment system
pursuant to section 1886(d)(1)(B)(iii) of the Social Security Act
and its accompanying regulations.’’.
TITLE XXI—SPECIAL NEEDS OF CHIL-
DREN 
REGARDING 
ORGAN 
TRANS-
PLANTATION
SEC. 2101. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK;
AMENDMENTS REGARDING NEEDS OF CHILDREN.
(a) IN GENERAL.—Section 372(b)(2) of the Public Health Service
Act (42 U.S.C. 274(b)(2)) is amended—
(1) in subparagraph (J), by striking ‘‘and’’ at the end;
(2) in each of subparagraphs (K) and (L), by striking the
period and inserting a comma; and
(3) by adding at the end the following subparagraphs:
‘‘(M) recognize the differences in health and in organ
transplantation 
issues 
between 
children 
and 
adults
throughout the system and adopt criteria, polices, and
procedures that address the unique health care needs of
children,
‘‘(N) carry out studies and demonstration projects for
the purpose of improving procedures for organ donation
procurement and allocation, including but not limited to
projects to examine and attempt to increase transplantation
among populations with special needs, including children
and individuals who are members of racial or ethnic
minority groups, and among populations with limited
access to transportation, and
‘‘(O) provide that for purposes of this paragraph, the
term ‘children’ refers to individuals who are under the
age of 18.’’.
(b) STUDY REGARDING IMMUNOSUPPRESSIVE DRUGS.—
(1) IN
GENERAL.—The Secretary of Health and Human
Services (referred to in this subsection as the ‘‘Secretary’’) shall
provide for a study to determine the costs of immunosuppressive
drugs that are provided to children pursuant to organ trans-
plants and to determine the extent to which health plans and
H. R. 4365—57
health insurance cover such costs. The Secretary may carry
out the study directly or through a grant to the Institute
of Medicine (or other public or nonprofit private entity).
(2) RECOMMENDATIONS REGARDING CERTAIN ISSUES.—The
Secretary shall ensure that, in addition to making determina-
tions under paragraph (1), the study under such paragraph
makes recommendations regarding the following issues:
(A) The costs of immunosuppressive drugs that are
provided to children pursuant to organ transplants and
to determine the extent to which health plans, health insur-
ance and government programs cover such costs.
(B) The extent of denial of organs to be released for
transplant by coroners and medical examiners.
(C) The special growth and developmental issues that
children have pre- and post-organ transplantation.
(D) Other issues that are particular to the special
health and transplantation needs of children.
(3) REPORT.—The Secretary shall ensure that, not later
than December 31, 2001, the study under paragraph (1) is
completed and a report describing the findings of the study
is submitted to the Congress.
TITLE XXII—MUSCULAR DYSTROPHY
RESEARCH
SEC. 2201. MUSCULAR DYSTROPHY RESEARCH.
Part B of title IV of the Public Health Service Act, as amended
by section 1901 of this Act, is amended by adding at the end
the following:
‘‘MUSCULAR DYSTROPHY RESEARCH
‘‘SEC. 409F. (a) COORDINATION OF ACTIVITIES.—The Director
of NIH shall expand and increase coordination in the activities
of the National Institutes of Health with respect to research on
muscular dystrophies, including Duchenne muscular dystrophy.
‘‘(b) ADMINISTRATION
OF PROGRAM; COLLABORATION AMONG
AGENCIES.—The Director of NIH shall carry out this section through
the appropriate institutes, including the National Institute of
Neurological Disorders and Stroke and in collaboration with any
other agencies that the Director determines appropriate.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated such sums as may be necessary to carry out
this section for each of the fiscal years 2001 through 2005. Amounts
appropriated under this subsection shall be in addition to any
other amounts appropriated for such purpose.’’.
TITLE XXIII—CHILDREN AND
TOURETTE SYNDROME AWARENESS
SEC. 2301. GRANTS REGARDING TOURETTE SYNDROME.
Part A of title XI of the Public Health Service Act is amended
by adding at the end the following section: