Text: S.2961 — 101st Congress (1989-1990)All Information (Except Text)

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S 2961 IS
101st CONGRESS
2d Session
S. 2961
To amend the Public Health Service Act to promote greater equity in the
delivery of health care services to women through expanded research on women's
health issues, improved access to health care services, and the development
of disease prevention activities responsive to the needs of women, and for
other purposes.
IN THE SENATE OF THE UNITED STATES
August 2 (legislative day, JULY 10), 1990
Ms. MIKULSKI (for herself, Mr. KENNEDY, Mr. ADAMS, Mr. SIMON, Mr. HARKIN,
Mr. PELL, Mr. DODD, Mr. REID, Mr. METZENBAUM, Mr. BINGAMAN, Mr. INOUYE, and
Mr. AKAKA) introduced the following bill; which was read twice and referred
to the Committee on Labor and Human Resources
A BILL
To amend the Public Health Service Act to promote greater equity in the
delivery of health care services to women through expanded research on women's
health issues, improved access to health care services, and the development
of disease parevention activities responsive to the needs of women, and for
other purposes.
  Be it enacted by the Senate and House of Representatives 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 `Women's Health Equity Act
  of 1990'.
  (b) TABLE OF CONTENTS- The table of contents is as follows:
Sec. 1. Short title; table of contents.
TITLE I--RESEARCH
Subtitle A--Health Research
Sec. 101. Short title.
Sec. 102. Establishment of offices and programs relating to women's health.
Sec. 103. Effective date.
Subtitle B--Clinical Trials
Sec. 111. Short title.
Sec. 112. Inclusion of women and minorities in clinical research conducted
or supported by National Institutes of Health.
Sec. 113. Inclusion of women and minorities in clinical research conducted
or supported by Alcohol, Drug Abuse, and Mental Health Administration.
Sec. 114. Peer review regarding inclusion of women and minorities as subjects
in clinical research.
Sec. 115. Effective date and applicability of requirements.
Subtitle C--Breast Cancer Research
Sec. 121. Breast cancer research.
Subtitle D--Contraceptive and Infertility Research Centers
Sec. 131. Short title.
Sec. 132. Grants and contracts for research centers with respect to
contraception and research centers with respect to infertility.
Sec. 133. Loan repayment program for research with respect to contraception
and infertility.
Sec. 134. Effective date.
Subtitle E--Contraception and Infertility
Sec. 141. Findings.
Sec. 142. Policy of United States.
Subtitle F--Women and AIDS Research Initiative
Sec. 151. Short title.
Sec. 152. Establishment of general program of research regarding women and
acquired immune deficiency syndrome.
Sec. 153. Amendments to program of community-based evaluations of experimental
therapies.
Sec. 154. Effective date.
Subtitle G--Osteoporosis
Sec. 161. Short title.
Sec. 162. Findings.
Sec. 163. Osteoporosis research.
TITLE II--SERVICES
Subtitle A--Breast Cancer Treatment
Sec. 201. Short title.
Sec. 202. Requiring information on alternative treatments for breast cancer.
Sec. 203. Conforming program requirements.
Subtitle B--Reimbursement for Certain Nurse Practitioners Under Medicare
and Medicaid
Sec. 211. Short title.
Sec. 212. Coverage of OB/GYN and women's health nurse practitioner services.
Subtitle C--Adolescent Pregnancy
Sec. 221. Short title.
Sec. 222. Adolescent pregnancy prevention, care, and research grants.
Subtitle D--COBRA Displaced Family Amendments Act of 1990
Sec. 231. Short title.
Sec. 232. Extension of COBRA continuation benefits for individuals 50
years of age or older and their dependents in the case of death, divorce,
or legal separation.
Sec. 233. Treatment of applications for disability.
Sec. 234. Notice of conversion option.
Sec. 235. Treatment of successor employers.
Sec. 236. Effective date.
Subtitle E--Federal Employee Family-Building
Sec. 241. Short title.
Sec. 242. Family-building benefit.
Sec. 243. Use of sick leave; prohibition of coercion.
TITLE III--PREVENTION
Subtitle A--Medicaid Infant Mortality
Sec. 301. Short title.
Sec. 302. Phased-in coverage of pregnant women and infants up to 185 percent
of poverty level.
Sec. 303. Phased-in mandatory coverage of children up to 100 percent of
poverty level.
Sec. 304. Optional coverage of children up to age 6 with income below 185
percent of the poverty level.
Sec. 305. Optional coverage of children up to age 18 with income below 100
percent of the poverty level.
Sec. 306. Optional coverage of prenatal and postpartum home visitation
services.
Sec. 307. Presumptive eligibility.
Sec. 308. Extension of payment provisions for medically necessary services
in disproportionate share hospitals to children under 18 years of age.
Subtitle B--Breast and Cervical Cancer
Sec. 311. Short title.
Sec. 312. Establishment of program of grants to states for prevention and
control of breast and cervical cancer.
Subtitle C--Medicare Screening Mammography
Sec. 321. Short title.
Sec. 322. Medicare coverage of annual screening mammography.
Subtitle D--Bone Mass Measurement
Sec. 331. Short title.
Sec. 332. Medicare coverage of bone mass measurements.
Subtitle E--Women and AIDS Outreach and Prevention Act
Sec. 341. Short title.
Sec. 342. Establishment of program of grants regarding prevention of acquired
immune deficiency syndrome in women.
Subtitle F--Infertility Prevention Demonstration Projects of 1990
Sec. 351. Short title.
Sec. 352. Findings.
Sec. 353. Establishment of program for prevention and control of chlamydia.
TITLE I--RESEARCH
Subtitle A--Health Research
SEC. 101. SHORT TITLE.
  This subtitle may be cited as the `Women's Health Research Act'.
SEC. 102. ESTABLISHMENT OF OFFICES AND PROGRAMS RELATING TO WOMEN'S HEALTH.
  Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is
  amended--
  (1) by redesignating parts F and G as parts G and H, respectively; and
  (2) by inserting after part E the following new part:
`PART F--WOMEN'S HEALTH
`SEC. 486K. OFFICE OF WOMEN'S HEALTH.
  `(a) ESTABLISHMENT- There is established within the Office of the Assistant
  Secretary for Health an Office of Women's Health (referred to in this
  section as the `Office'). The Office shall be headed by a director, who
  shall be appointed by the Secretary.
  `(b) FUNCTIONS- The Director of the Office shall--
  `(1) coordinate all activities within the Department of Health and Human
  Services concerning women's health conditions that relate to disease
  prevention, health promotion, preventive health services, or health
  information or education regarding the appropriate use of health care; and
  `(2) coordinate all activities within the Department that relate to women's
  health research.
  `(c) BIENNIAL REPORT- The Director of the Office shall prepare a biennial
  report on the status of women's health conditions. The Director shall
  include the report in the biennial report submitted to the President and
  Congress under section 403.
  `(d) DEFINITIONS- As used in this section:
  `(1) WOMEN'S HEALTH CONDITIONS- The term `women's health conditions'
  means diseases, disorders, or other health conditions--
  `(A) that are unique to women, more prevalent in women, or more serious
  for women; or
  `(B) for which the risk factors or interventions are different for women.
  `(2) WOMEN'S HEALTH RESEARCH- The term `women's health research' means
  research on women's health conditions.
`SEC. 486L. OFFICE OF WOMEN'S HEALTH RESEARCH.
  `(a) ESTABLISHMENT- The Secretary, acting through the Director of the
  National Institutes of Health, shall establish an Office of Women's Health
  Research (referred to in this part as the `Office').
  `(b) DIRECTOR- The Office of Women's Health Research shall be headed by a
  Director who shall be appointed by the Director of the National Institutes
  of Health.
  `(c) ADMINISTRATIVE SUPPORT- The Secretary shall provide administrative
  support and support services to the Director of the Office.
  `(d) FUNCTIONS OF OFFICE- The Office shall ensure that research relating to
  women's health is identified and addressed throughout the research activities
  conducted and supported by the National Institutes of Health. The Director
  of the Office of Women's Health Research shall--
  `(1)(A) identify women's health research needs, including prevention
  research;
  `(B) identify needs for coordinated research activities, especially
  multidisciplinary research relating to women's health, to be conducted
  intramurally and extramurally;
  `(C) encourage researchers whose research is funded or supported by the
  National Institutes of Health to pursue research relating to women's
  health; and
  `(D) support the development and expansion of clinical trials of treatments,
  therapies, and modes of prevention that include women of all ages, races,
  and ethnicities;
  `(2) establish a coordinating council that shall be composed of the Directors
  of the Institutes, Centers, Offices, and Divisions of the National Institutes
  of Health and of the Alcohol, Drug Abuse, and Mental Health Administration,
  to assist in the duties described in paragraph (1);
  `(3) establish within the Office a Women's Health Clinical Research Advisory
  Committee (referred to in this section as the `Committee'), as described
  in subsection (e);
  `(4) establish an intramural research program in gynecology at the National
  Institute of Child Health and Human Development;
  `(5) establish a clinical service in gynecology; and
  `(6) develop plans for and establish, not later than January 1, 1993,
  a Center for Women's Health Research to support research relating to
  women's health conditions.
  `(e) ADVISORY COMMITTEE-
  `(1) COMPOSITION- The Committee shall be composed of not less than 12
  members appointed by the Director of the Office, who shall be appropriately
  qualified representatives of the public who are not officers or employees of
  the Federal Government. The members shall include physicians, practitioners,
  scientists, and other women's health professionals whose clinical practice,
  research specialization, and professional expertise includes a significant
  focus on women's health and gender differences that affect women's health.
  `(2) VACANCIES- The Director of the Office shall fill any vacancy in
  the membership of the Committee in the same manner as the original
  appointment. The vacancy shall not affect the power of the remaining
  members to execute the duties of the Committee.
  `(3) COMPENSATION AND REIMBURSEMENT OF EXPENSES-
  `(A) COMPENSATION- Each member of the Committee who is not an employee of
  the Federal Government shall receive compensation at a rate not to exceed
  the daily equivalent of the rate specified for GS-18 of the General Schedule
  under section 5332 of title 5, United States Code, for each day the member
  is engaged in the performance of duties for the Committee.
  `(B) TRAVEL EXPENSES- Each member of the Committee shall receive travel
  expenses, including per diem in lieu of subsistence, as authorized by section
  5703 of title 5, United States Code, for persons employed intermittently in
  the Government service, 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) EXPERTS AND CONSULTANTS-
  `(A) SERVICES AND COMPENSATION- The Secretary may obtain and compensate such
  temporary and intermittent services of experts and consultants in accordance
  with section 3109(b) of title 5, United States Code, as the Committee
  determines to be necessary to carry out the duties of the Committee.
  `(B) LIMITATION- The rate of compensation for each expert or consultant
  shall not exceed the daily equivalent of the rate specified for GS-18 of
  the General Schedule under section 5332 of title 5, United States Code,
  for each day the expert or consultant is engaged in the actual performance
  of duties for the Committee.
  `(5) DETAIL OF FEDERAL EMPLOYEES- On the request of the Committee, the
  Secretary shall detail, without reimbursement, any of the personnel of the
  Department of Health and Human Services to the Committee as the Committee
  determines to be necessary to carry out the duties of the Committee. Any
  detail shall not interrupt or otherwise affect the civil service status
  or privileges of the Federal employee.
  `(6) TECHNICAL ASSISTANCE- On the request of the Committee, the Secretary
  shall provide, without reimbursement, such technical assistance and
  administrative support services to the Committee as the Committee determines
  to be necessary to carry out the duties of the Committee.
  `(7) DUTIES- The Committee shall--
  `(A) advise the Director of the Office concerning--
  `(i) appropriate research activities to be supported by the Center
  concerning--
  `(I) conditions and diseases that are unique to, more prevalent in, or
  neglected in health areas of women in all age, ethnic, and racial groups;
  `(II) gender differences involved in clinical drug trials, with emphasis
  on pharmacological response and side effects resulting from the trials;
  `(III) gender differences with respect to disease etiology, course,
  and treatment;
  `(IV) obstetrical and gynecological health, conditions, diseases, and
  treatment;
  `(V) health conditions relating to women that require a multidisciplinary
  approach; and
  `(VI) the prevention of health conditions that affect women;
  `(B) report to the Director of the Office on research concerning women's
  health that is publicly and privately supported;
  `(C) provide recommendations to the Director of the Office regarding the
  operations of the Center;
  `(D) monitor the compliance of all research projects supported or conducted
  by the National Institutes of Health with laws and regulations relating
  to the inclusion of women in clinical study populations;
  `(E) provide advice to the Director of the National Institutes of Health
  concerning the manner in which to advance and encourage research on
  women's health;
  `(F) provide advice to the Director of the National Institutes of Health
  concerning the merits of establishing the Center for Women's Health as
  an independent Center within the Office of the Director of the National
  Institutes rather than as a Center that is part of an existing Institute;
  `(G) request that a study be conducted by the Institute of Medicine of the
  National Academy of Sciences to determine means of removing obstacles to,
  advancing, and encouraging research concerning women's health; and
  `(H) make recommendations to the appropriate committees of Congress and
  to the Director of the National Institutes of Health concerning further
  legislative and administrative initiatives, as appropriate, to ensure that
  research relating to women's health is identified and addressed throughout
  the research activities conducted and supported by the National Institutes
  of Health.
  `(f) DEFINITION- As used in this section, the term `women's health
  research' includes research concerning etiology, diagnosis, prevention,
  health promotion, treatment, and gender differences relating to conditions
  and diseases unique to, more prevalent in, or neglected in health areas
  of women in all age, ethnic, and racial groups.'.
`SEC. 486M. AUTHORIZATION OF APPROPRIATIONS.
  `(a) OFFICE OF WOMEN'S HEALTH- There are authorized to be appropriated for
  the purpose of carrying out section 486K $300,000 for fiscal year 1991,
  $400,000 for fiscal year 1992, $600,000 for fiscal year 1993, and $600,000
  for fiscal year 1994.
  `(b) OFFICE OF WOMEN'S HEALTH RESEARCH- There are authorized to be
  appropriated for the purpose of carrying out sections 486L such sums as
  may be necessary for each of fiscal years 1991 through 1994.'.
SEC. 103. EFFECTIVE DATE.
  The amendments made by this subtitle shall take effect October 1, 1990,
  or on the date of the enactment of this Act, whichever occurs later.
Subtitle B--Clinical Trials
SEC. 111. SHORT TITLE.
  This subtitle may be cited as the `Clinical Trials Fairness Act'.
SEC. 112. INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH CONDUCTED
OR SUPPORTED BY NATIONAL INSTITUTES OF HEALTH.
  The Public Health Service Act is amended by inserting after section 492
  (42 U.S.C. 289a) the following new section:
`SEC. 492A. INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH.
  `(a) IN GENERAL- Except as provided in subsection (b), the Secretary shall
  ensure that women and members of minority groups are included as subjects
  in each clinical research project conducted or supported under this title.
  `(b) Limitation-
  `(1) INAPPROPRIATE INCLUSION- The requirement established in subsection
  (a) shall not apply to a clinical research project if the inclusion of
  women and members of minority groups, respectively, as subjects in the
  project is inappropriate, as determined by the Secretary in accordance
  with regulations issued under paragraph (2)--
  `(A) with respect to the health of the subjects;
  `(B) with respect to the purpose of the research; or
  `(C) under such other circumstances as the Secretary may designate.
  `(2) CRITERIA- For purposes of paragraph (1), the Secretary shall by
  regulation establish criteria regarding the circumstances under which the
  inclusion of women and minorities in clinical research is inappropriate.
  `(c) EFFECT OF RESEARCH ON WOMEN AND MINORITIES- The Secretary shall ensure
  that any clinical research project in which the Secretary is required to
  include women or members of minority groups as subjects under subsection
  (a) is designed and carried out in a manner sufficient to provide for a
  valid analysis of whether the variables being tested in the research affect
  women or members of minority groups, as the case may be, differently than
  other subjects in the research.
  `(d) SUBCOMMITTEE-
  `(1) ESTABLISHMENT- The Secretary shall establish within the advisory
  council of each of the national research institutes a subcommittee to be
  known as the Clinical Research Equity Subcommittee (individually referred
  to in this subsection as a `Subcommittee').
  `(2) COMPOSITION-
  `(A) ADVISORY COUNCIL MEMBERS- Each Subcommittee shall be composed of not
  less than 6 members of the advisory council in which it is established. The
  Secretary shall designate the membership of each Subcommittee from among
  members of the advisory council who have expertise regarding clinical
  research on diseases, disorders, or other health conditions--
  `(i) that are unique to women, more prevalent in women, or more serious
  for women; or
  `(ii) for which the risk factors or interventions are different for women.
  `(B) OTHER MEMBERS- If the Secretary determines that an advisory council
  for a national research institute does not contain a sufficient number of
  individuals with the expertise required in accordance with subparagraph
  (A), the Secretary shall appoint to the advisory council a sufficient
  number of individuals from among individuals who are not officers or
  employees of the United States.
  `(3) FUNCTIONS- Each Subcommittee shall review all clinical research
  conducted by the national research institute in which the advisory council
  is established, in order to determine the extent to which the institute is
  conducting research in accordance with subsections (a) through (c). The
  Subcommittee shall conduct the review not less often than annually. Not
  later than 60 days after each review, each Subcommittee shall submit to
  the Secretary and the Director of the National Institutes of Health a
  report describing the findings made as a result of the review.
  `(4) NONCOMPLIANCE- If the Secretary determines that any national research
  institute is not conducting a project of clinical research in accordance
  with subsections (a) through (c), the Secretary shall suspend or revoke the
  authority for the project under such conditions as the Secretary determines
  to be appropriate.
  `(e) DEFINITION- For purposes of this section, the term `minority groups'
  means racial and ethnic minority groups.'.
SEC. 113. INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH CONDUCTED
OR SUPPORTED BY ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION.
  The Public Health Service Act is amended by inserting after section 507
  (42 U.S.C. 290aa-5) the following new section:
`SEC. 507A. INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH.
  `(a) IN GENERAL- Except as provided in subsection (b), the Secretary shall
  ensure that women and members of minority groups are included as subjects
  in each clinical research project conducted or supported under this title.
  `(b) Limitation-
  `(1) INAPPROPRIATE INCLUSION- The requirement established in subsection
  (a) shall not apply to a clinical research project if the inclusion of
  women and members of minority groups, respectively, as subjects in the
  project is inappropriate, as determined by the Secretary in accordance
  with regulations issued in accordance with paragraph (2)--
  `(A) with respect to the health of the subjects;
  `(B) with respect to the purpose of the research; or
  `(C) under such other circumstances as the Secretary may designate.
  `(2) CRITERIA- For purposes of paragraph (1), the Secretary shall by
  regulation establish criteria regarding the circumstances under which the
  inclusion of women and minorities in clinical research is inappropriate.
  `(c) EFFECT OF RESEARCH ON WOMEN AND MINORITIES- The Secretary shall ensure
  that any clinical research project in which the Secretary is required to
  include women or members of minority groups as subjects under subsection
  (a) is designed and carried out in a manner sufficient to provide for a
  valid analysis of whether the variables being tested in the research affect
  women or members of minority groups, as the case may be, differently than
  other subjects in the research.
  `(d) SUBCOMMITTEE-
  `(1) ESTABLISHMENT- The Secretary shall establish within the advisory
  council of each of the agencies of the Alcohol, Drug Abuse, and Mental
  Health Administration a subcommittee to be known as the Clinical Research
  Equity Subcommittee (individually referred to in this subsection as a
  `Subcommittee').
  `(2) COMPOSITION-
  `(A) ADVISORY COUNCIL MEMBERS- Each Subcommittee shall be composed of not
  less than 6 members of the advisory council in which it is established. The
  Secretary shall designate the membership of each Subcommittee from among
  members of the advisory council who have expertise regarding clinical
  research on diseases, disorders, or other health conditions--
  `(i) that are unique to women, more prevalent in women, or more serious
  for women; or
  `(ii) for which the risk factors or interventions are different for women.
  `(B) OTHER MEMBERS- If the Secretary determines that an advisory council
  for an agency of the Alcohol, Drug Abuse, and Mental Health Administration
  does not contain a sufficient number of individuals with the expertise
  required in accordance with subparagraph (A), the Secretary shall appoint
  to the advisory council a sufficient number of individuals from among
  individuals who are not officers or employees of the United States.
  `(3) FUNCTIONS- Each Subcommittee shall review all clinical research
  conducted by the agency in which the advisory council is established, in
  order to determine the extent to which the agency is conducting research in
  accordance with subsections (a) through (c). The Subcommittee shall conduct
  the review not less often than annually. Not later than 60 days after each
  review, each Subcommittee shall submit to the Secretary and the Administrator
  a report describing the findings made as a result of the review.
  `(4) NONCOMPLIANCE- If the Secretary determines that any agency of the
  Alcohol, Drug Abuse, and Mental Health Administration is not conducting
  a project of clinical research in accordance with subsections (a) through
  (c), the Secretary shall suspend or revoke the authority for the project
  under such conditions as the Secretary determines to be appropriate.
  `(e) DEFINITION- For purposes of this section, the term `minority groups'
  means racial and ethnic minority groups.'.
SEC. 114. PEER REVIEW REGARDING INCLUSION OF WOMEN AND MINORITIES AS SUBJECTS
IN CLINICAL RESEARCH.
  (a) NATIONAL INSTITUTES OF HEALTH- Section 492 of the Public Health Service
  Act (42 U.S.C. 289a) is amended by adding at the end the following new
  subsection:
  `(c)(1) In technical and scientific peer review of proposals for clinical
  research under this section, the consideration of the proposal (including
  the initial consideration) shall, except as provided in paragraph (2),
  include an evaluation of the technical and scientific merit of the proposal
  regarding the inclusion of women and members of minority groups as subjects
  in the research.
  `(2) Paragraph (1) shall not apply to any proposal for clinical research
  that is not subject to the requirement of section 492A(a) regarding the
  inclusion of women and members of minority groups as subjects in clinical
  research, in accordance with section 492A(b).'.
  (b) ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION- Section 507 of
  the Public Health Service Act (42 U.S.C. 290aa-5) is amended by adding at
  the end the following new subsection:
  `(f)(1) In technical and scientific peer review of proposals for clinical
  research under this section, the consideration of the proposal (including
  the initial consideration) shall, except as provided in paragraph (2),
  include an evaluation of the technical and scientific merit of the proposal
  regarding the inclusion of women and members of minority groups as subjects
  in the research.
  `(2) Paragraph (1) shall not apply to any proposal for clinical research
  that is not subject to the requirement of section 507A(a) regarding the
  inclusion of women and members of minority groups as subjects in clinical
  research, in accordance with section 507A(b).'.
SEC. 115. EFFECTIVE DATE AND APPLICABILITY OF REQUIREMENTS.
  (a) EFFECTIVE DATE- The amendments made by this subtitle shall become
  effective October 1, 1990, or on the date of the enactment of this Act,
  whichever occurs later.
  (b) APPLICABILITY- The amendments made by this subtitle shall apply with
  respect to any project of clinical research whose initial approval by the
  Secretary of Health and Human Services occurs after the expiration of the
  90-day period beginning on the effective date of this subtitle.
Subtitle C--Breast Cancer Research
SEC. 121. BREAST CANCER RESEARCH.
  Section 408 of the Public Health Service Act (42 U.S.C. 284c) is amended
  by adding at the end the following new subsection:
  `(6) In addition to the sums authorized to be appropriated for the National
  Cancer Institute under paragraph (1) and section 301 for fiscal year 1990,
  there are authorized to be appropriated to the National Cancer Institute
  $25,000,000 for the fiscal year for breast cancer research other than
  research that involves treatment or clinical trials.'.
Subtitle D--Contraceptive and Infertility Research Centers
SEC. 131. SHORT TITLE.
  This subtitle may be cited as the `Contraceptive and Infertility Research
  Centers Act of 1990'.
SEC. 132. GRANTS AND CONTRACTS FOR RESEARCH CENTERS WITH RESPECT TO
CONTRACEPTION AND RESEARCH CENTERS WITH RESPECT TO INFERTILITY.
  The Public Health Service Act is amended by inserting after section 451
  (42 U.S.C. 285g-3) the following new section:
`SEC. 452. RESEARCH CENTERS WITH RESPECT TO CONTRACEPTION AND INFERTILITY.
  `(a) IN GENERAL- The Director of the Institute, in consultation with the
  advisory council for the Institute, shall make grants to, or enter into
  contracts with, public or nonprofit private entities to develop and operate--
  `(1) centers to conduct activities for the purpose of improving methods of
  contraception (referred to in this section as `centers on contraception');
  and
  `(2) centers to conduct activities for the purpose of diagnosing and treating
  infertility (referred to in this section as `centers on infertility').
  `(b) NUMBER OF CENTERS- The Director of the Institute shall, subject to
  the extent of funds made available in appropriations Acts, provide for
  the establishment of three centers on contraception and two centers on
  infertility.
  `(c) USE OF FUNDS-
  `(1) IN GENERAL- Each center that receives a grant or enters into a contract
  under this section shall--
  `(A) conduct clinical and other applied research, including--
  `(i) for centers on contraception, clinical trials of new or improved drugs
  and devices for use by males and by females (including barrier methods); and
  `(ii) for centers on infertility, clinical trials of new or improved drugs
  and devices for the diagnosis and treatment of infertility in both males
  and females;
  `(B) develop protocols for training physicians, scientists, nurses, and
  other health and allied health professionals;
  `(C) conduct training programs for the professionals described in
  subparagraph (B);
  `(D) develop model continuing education programs for the professionals; and
  `(E) disseminate information to the professionals.
  `(2) STIPENDS AND FEES- A center may use funds provided under subsection
  (a) to provide stipends for health and allied health professionals enrolled
  in programs described in subparagraph (C) of paragraph (1), and to provide
  fees to individuals serving as subjects in clinical trials conducted under
  the paragraph.
  `(d) APPLICATION- To be eligible to receive a grant or enter into a
  contract under subsection (a), an entity shall submit an application to
  the Director of the Institute at such time, in such manner, and containing
  such agreements, assurances, and information, as the Director determines
  to be necessary to carry out this section.
  `(e) ELIGIBILITY- Each center that receives a grant or enters into a contract
  under this section shall use the facilities of a single institution,
  or be formed from a consortium of cooperating institutions, meeting such
  requirements as may be prescribed by the Secretary, after consultation
  with the Director of the Institute.
  `(f) TERM OF SUPPORT AND PEER REVIEW- Grants or contracts awarded to a
  center under subsection (a) may be for a period of not more than 5 years. The
  period may be extended for one or more additional periods of not more than 5
  years if the operations of the center have been reviewed by an appropriate
  technical and scientific peer review group established by the Director and
  the group has recommended to the Director that the period should be extended.
  `(g) COORDINATION OF INFORMATION- The Director of the Institute shall,
  as appropriate, provide for the coordination of information among the
  centers assisted under this section.
  `(h) AUTHORIZATION OF APPROPRIATIONS- To carry out this section, there are
  authorized to be appropriated $20,000,000 for fiscal year 1991, $20,000,000
  for fiscal year 1992, $12,000,000 for fiscal year 1993, $12,250,000 for
  fiscal year 1994, and $13,000,000 for fiscal year 1995.'.
SEC. 133. LOAN REPAYMENT PROGRAM FOR RESEARCH WITH RESPECT TO CONTRACEPTION
AND INFERTILITY.
  The Public Health Service Act is amended by inserting after section 487A
  (42 U.S.C. 288-1) the following new section:
`SEC. 487B. LOAN REPAYMENT PROGRAM FOR RESEARCH WITH RESPECT TO CONTRACEPTION
AND INFERTILITY.
  `(a) ESTABLISHMENT- The Secretary, in consultation with the Director
  of the National Institute of Child Health and Human Development, shall
  establish a loan repayment program for appropriately qualified health
  professionals, including graduate students. In carrying out the program,
  the Secretary shall enter into contracts with the health professionals
  under which the health professionals shall agree to conduct research with
  respect to contraception or infertility, and the Secretary shall agree to
  repay, for each year of service, not more than $20,000 of the principal
  and interest of the educational loans incurred by the health professionals.
  `(b) ADMINISTRATIVE PROVISIONS- The provisions of the National Health Service
  Corps Loan Repayment Program established in subpart III of part D of title
  III shall, except as inconsistent with subsection (a), apply to the program
  established in subsection (a) to the same extent and in the same manner as
  the provisions apply to the National Health Service Loan Repayment Program.
  `(c) AUTHORIZATION OF APPROPRIATIONS-
  `(1) IN GENERAL- There are authorized to be appropriated to carry out this
  section such sums as may be necessary for each of the fiscal years 1991
  through 1993.
  `(2) AVAILABILITY OF FUNDS- Amounts appropriated under paragraph (1) for
  a fiscal year shall remain available until the expiration of the second
  fiscal year beginning after the fiscal year for which the amounts were
  appropriated.'.
SEC. 134. EFFECTIVE DATE.
  The amendments made by this subtitle shall become effective on October 1,
  1990, or on the date of the enactment of this Act, whichever occurs later.
Subtitle E--Contraception and Infertility
SEC. 141. FINDINGS.
  Congress finds that--
  (1) the incidence in the United States of both unintended pregnancy and
  abortion is substantial and unacceptable;
  (2) there is a significant incidence of infertility in the United States;
  (3) studies estimate that 31,800,000 women nationwide are at risk for
  unintended pregnancy, and that, for a variety of reasons, 13 percent of
  these women are not using any form of contraception;
  (4) although there is a substantial need for the development of new
  contraceptive drugs and devices, only one private pharmaceutical company
  based in the United States is conducting research toward development of
  contraceptives;
  (5) significant benefits would accrue to women and the families of the
  women, including a reduction in the number of babies with low birthweight
  and a reduction in the number of premature births, leading to a reduced
  incidence of maternal and infant mortality, if a variety of safe and
  effective contraceptive options were widely available;
  (6) estimates indicate that one out of six couples in the United States is
  infertile or fails to conceive within 1 year of attempting to have a child;
  (7) the Centers for Disease Control estimates that 20 percent of cases of
  infertility in the United States are caused by sexually transmitted diseases;
  (8) cases of infertility resulting from sexually transmitted diseases are
  the most preventable of infertility cases;
  (9) the obstacles to making an effective response to the problems of
  contraception and infertility are many and include a lack of consistent
  funding, the political controversy concerning abortion, the lengthy and
  complex procedures for the approval by the Food and Drug Administration
  of new drugs and devices, the costs of liability insurance for research
  and for the marketing of drugs and devices, and a shortage of scientists
  in the relevant fields; and
  (10) family planning is universally recognized as a human right.
SEC. 142. POLICY OF UNITED STATES.
  It is the policy of the United States to--
  (1) establish a program of research for the development of new and improved
  methods of contraception and new and improved methods of diagnosing and
  treating infertility, including the establishment of research centers;
  (2) provide adequate long-term resources for the program to ensure that
  the program is among the principal Federal research priorities and that the
  United States is a world leader in research with respect to contraception
  and infertility;
  (3) ensure that Federal programs with respect to the prevention, diagnosis,
  and treatment of sexually transmitted diseases adequately respond to the
  role of the diseases in cases of infertility;
  (4) ensure that the public is educated with respect to contraception and
  infertility, including education on new and improved drugs and devices;
  (5) establish as Federal goals the development, by the year 2010, of--
  (A) improved barrier methods to protect against unintended pregnancy and
  sexually transmitted diseases;
  (B) new methods of contraception for use by men;
  (C) a vaccine-like drug for women that prevents unintended pregnancy for
  a significant period of time without disrupting the menstrual cycle or
  causing adverse metabolic or cardiovascular effects; and
  (D) new and improved techniques of diagnosing and treating infertility;
  (6) require the Secretary of Health and Human Services to take prompt
  action to reestablish the Ethical Advisory Board (terminated in 1980)
  in order to facilitate research with respect to infertility;
  (7) review the policies and procedures of the Food and Drug Administration to
  determine the extent to which the process of approving drugs and devices for
  use by the public, especially with respect to contraception and infertility,
  can be expedited with a reasonable degree of safety, including consideration
  of the role of conducting ongoing surveys and studies of the effects on
  the public of drugs and devices that have been so approved; and
  (8) determine to what extent measures can be implemented by public or
  private entities to resolve liability issues regarding persons conducting
  research into, or marketing, drugs and devices with respect to contraception
  and infertility.
Subtitle F--Women and AIDS Research Initiative
SEC. 151. SHORT TITLE.
  This subtitle may be cited as the `Women and AIDS Research Initiative
  Amendments Act of 1990'.
SEC. 152. ESTABLISHMENT OF GENERAL PROGRAM OF RESEARCH REGARDING WOMEN AND
ACQUIRED IMMUNE DEFICIENCY SYNDROME.
  The Public Health Service Act is amended by inserting after section 2320
  (42 U.S.C. 300cc-20) the following new section:
`SEC. 2321. RESEARCH REGARDING WOMEN.
  `(a) IN GENERAL-  The Secretary, acting through the Director of the National
  Institutes of Health or the Administrator of the Alcohol, Drug Abuse, and
  Mental Health Administration, as appropriate, shall establish a program for
  the purpose of conducting biomedical and behavioral research on cases of
  infection with the etiologic agent for acquired immune deficiency syndrome in
  women. The Secretary may conduct such research directly, and may make grants
  to public and nonprofit private entities for the conduct of the research.
  `(b) RESEARCH SUBJECTS- In carrying out subsection (a), the Secretary
  shall provide for research on--
  `(1) the manner in which the etiologic agent for acquired immune deficiency
  syndrome is transmitted to women, and from women to infants, including the
  relationship between cases of infection with the agent and other cases of
  sexually transmitted diseases;
  `(2) measures for the prevention of exposure to and the transmission of
  the agent, including research on--
  `(A) the prevention of any sexually transmitted disease that may facilitate
  the transmission of the agent; and
  `(B) the development of methods of prevention for use by women;
  `(3) the development and progression of symptoms resulting from infection
  with the agent, including research regarding gynecological infections
  whose occurrence becomes probable as a result of the deterioration of the
  immune system;
  `(4) the treatment of cases of the infection, including clinical research;
  and
  `(5) behavioral research on the prevention of the cases and research on
  model educational programs for the prevention.
  `(c) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriate
  for the purpose of carrying out this section $10,000,000 for fiscal year
  1991, and such sums as may be necessary for each of the fiscal years 1992
  through 1994.'.
SEC. 153. AMENDMENTS TO PROGRAM OF COMMUNITY-BASED EVALUATIONS OF EXPERIMENTAL
THERAPIES.
  (a) AUTHORIZATION OF APPROPRIATIONS FOR THERAPIES FOR WOMEN- Section 2313(e)
  of the Public Health Service Act (42 U.S.C. 300cc-13(e)) is amended by
  adding at the end the following new paragraph:
  `(3) For the purpose of conducting clinical trials on experimental treatments
  for women under subsection (a), there are authorized to be appropriated
  $6,000,000 for fiscal year 1991, and such sums as may be necessary for
  each of the fiscal years 1992 through 1994.'.
  (b) AUTHORITY FOR PROVISION OF INCIDENTAL SERVICES FOR ALL SUBJECTS-
  Section 2313 of the Public Health Service Act, as amended by subsection
  (a) of this section, is amended--
  (1) by redesignating subsection (e) as subsection (f); and
  (2) by inserting after subsection (d) the following new subsection:
  `(e) INCIDENTAL SERVICES- The Director of the National Institutes of Health
  may authorize grantees under subsection (a) to expend the grants to provide
  individuals with such transportation, child care, and other incidental
  services as may be necessary to enable the individuals to participate as
  subjects in the clinical trials.'.
SEC. 154. EFFECTIVE DATE.
  The amendments made by this subtitle shall become effective October 1,
  1990, or on the date of the enactment of this Act, whichever occurs later.
Subtitle G--Osteoporosis
SEC. 161. SHORT TITLE.
  This subtitle may be cited as the `Osteoporosis and Related Bone Disorders
  Research, Education, and Health Services Act of 1990'.
SEC. 162. FINDINGS.
  Congress finds that--
  (1) osteoporosis, or porous bone, is a condition characterized by an
  excessive loss of bone tissue and an increased susceptibility to fractures
  of the hip, spine, and wrist;
  (2) an estimated 24 million Americans have osteoporosis, with many cases
  undiagnosed because the condition develops without symptoms until a strain,
  bump, or fall causes a fracture;
  (3) between 3 and 4 million Americans have Paget's disease, Osteogenesis
  Imperfecta, and other related metabolic bone disorders;
  (4) osteoporosis is responsible for 1,300,000 bone fractures annually,
  including more than 250,000 hip fractures, 500,000 vertebral fractures,
  200,000 fractures of the wrist, and 200,000 fractures at other limb sites;
  (5) osteoporosis affects one-third to one-half of all postmenopausal women
  and nearly half of all people over age 75;
  (6) direct medical costs of osteoporosis reached an estimated $10,000,000,000
  in 1988 for the United States, not including the costs of family care and
  lost work for caregivers;
  (7) direct medical costs of osteoporosis are expected to increase
  precipitously because the proportion of the population comprised of older
  persons is expanding and each generation of older persons tends to have
  a higher incidence of osteoporosis than preceding generations;
  (8) technology now exists, and new technology is developing, that will
  permit early diagnosis and prevention of osteoporosis as well as management
  of the condition once it has developed;
  (9) funding for research on osteoporosis and related bone disorders is
  severely constrained at key research institutes, including the National
  Institute of Arthritis and Musculoskeletal and Skin Diseases and the
  National Institute on Aging;
  (10) further research is needed to improve medical knowledge concerning--
  (A) cellular mechanisms related to the processes of bone resorption and
  bone formation, and the effect of different agents on bone remodeling;
  (B) risk factors for osteoporosis, including newly discovered risk factors,
  risk factors related to groups not ordinarily studied, such as men and
  minorities, and the relationship of aging processes to the development
  of osteoporosis;
  (C) bone mass measurement technology, including techniques for making
  faster and more precise measurements and for interpreting measurements;
  (D) calcium, including bioavailability, intake requirements, and the role
  of calcium in building heavier and denser skeletons;
  (E) prevention and treatment, including the efficacy of current therapies,
  alternative drug therapies for prevention and treatment, and the role of
  exercise; and
  (F) rehabilitation; and
  (11) further educational efforts are needed to increase public and
  professional knowledge of the causes of, methods for avoiding, and treatment
  of osteoporosis.
SEC. 163. OSTEOPOROSIS RESEARCH.
  Subpart 4 of part C of Title IV of the Public Health Service Act (42
  U.S.C. 285d et seq.) is amended--
  (1) by inserting after the subpart heading the following new chapter heading:
`CHAPTER 1--ARTHRITIS';
and
  (2) by adding at the end the following new chapter:
`CHAPTER 2--OSTEOPOROSIS
`SEC. 442A. DEFINITIONS.
  `As used in this chapter:
  `(1) ADVISORY PANEL- The term `Advisory Panel' means the Advisory Panel
  on Osteoporosis and Related Disorders, established in section 442D.
  `(2) COUNCIL- The term `Council' means the Interagency Council on
  Osteoporosis and Related Disorders, established in section 442C.
  `(3) DEPARTMENT- The term `Department' means the Department of Health and
  Human Services.
  `(4) RELATED DISORDERS- The term `related bone disorders' includes--
  `(A) Paget's disease, a bone disease characterized by enlargement and loss
  of density with bowing and deformity of the bones;
  `(B) Osteogenesis Imperfecta, a familial disease marked by extreme
  brittleness of the long bones;
  `(C) hyperparathyroidism, a condition characterized by the presence
  of excess parathormone in the body resulting in disturbance of calcium
  metabolism with loss of calcium from bone and renal damage;
  `(D) hypoparathyroidism, a condition characterized by the absence of
  parathormone resulting in disturbances of calcium metabolism;
  `(E) renal bone disease, a disease characterized by metabolic disturbances
  from dialysis, renal transplants, or other renal disturbances;
  `(F) primary or postmenopausal osteoporosis and secondary osteoporosis,
  such as that induced by corticosteroids; and
  `(G) other general disorders of bone and mineral metabolism including
  abnormalities of vitamin D.
  `(5) RESOURCE CENTER- The term `Resource Center' means the Resource Center
  on Osteoporosis and Related Disorders, established in section 442F.
`SEC. 442B. EXPANSION OF RESEARCH ON OSTEOPOROSIS AND RELATED BONE DISORDERS.
  `(a) RESEARCH- The Director of the National Institute of Arthritis and
  Musculoskeletal and Skin Diseases and the Director of the National Institute
  on Aging shall expand and intensify research on osteoporosis and related
  bone disorders. The research shall be in addition to research that is
  authorized under any other provision of law.
  `(b) RESEARCH CENTERS- The Director of the National Institute of Arthritis
  and Musculoskeletal and Skin Diseases shall increase the number of
  Specialized Centers of Research devoted to research on osteoporosis and
  related bone disorders. The Director of the National Institute on Aging
  shall increase the number of program project grants devoted to creating
  centers of excellence in osteoporosis and related bone disorders.
  `(c) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $24,000,000 for the National Institute of
  Arthritis and Musculoskeletal and Skin Diseases and $12,000,000 for the
  National Institute on Aging for each of the fiscal years 1991 through 1993,
  and such sums as may be necessary for subsequent fiscal years. These funds
  are in addition to amounts authorized to be appropriated for biomedical
  research relating to osteoporosis and related bone disorders under any
  other provision of law.
`SEC. 442C. INTERAGENCY COUNCIL ON OSTEOPOROSIS AND RELATED BONE DISORDERS.
  `(a) ESTABLISHMENT- There is established in the Department an Interagency
  Council on Osteoporosis and Related Disorders. The Council shall be
  composed of--
  `(1) the Assistant Secretary for Health;
  `(2) the Surgeon General of the United States;
  `(3) the Assistant Secretary for Planning and Evaluation of the Department;
  `(4) the Director of the National Institute of Arthritis and Musculoskeletal
  and Skin Diseases;
  `(5) the Director of the National Institute of Mental Health;
  `(6) the Director of the National Institute on Aging;
  `(7) the Director of the National Institute of Child Health and Human
  Development;
  `(8) the Administrator of the Health Care Financing Administration;
  `(9) the Director of the Agency for Health Care Policy and Research;
  `(10) the Director of the Bureau of Child and Maternal Health;
  `(11) the Commissioner of the Food and Drug Administration;
  `(12) the Director of the National Institute of Dental Research;
  `(13) the Director of the National Institute of Diabetes, Digestive,
  and Kidney Diseases;
  `(14) the Commissioner on Aging;
  `(15) the Director of the Office of Disease Prevention and Health Promotion;
  and
  `(16) such additional members as the Secretary considers appropriate.
  `(b) FUNCTIONS- The Council shall--
  `(1) coordinate research conducted by or through the Department on
  osteoporosis and related bone disorders;
  `(2) establish a mechanism for sharing information on osteoporosis and
  related bone disorders among all officers and employees of the Department
  involved in carrying out programs serving older persons, midlife women,
  and young persons, in order to provide for full communication and exchange
  of information;
  `(3) review and coordinate the most promising areas of research concerning
  osteoporosis and related bone disorders;
  `(4) assist the National Institute of Arthritis and Musculoskeletal and
  Skin Diseases, the National Institute on Aging, the National Institute of
  Diabetes, Digestive and Kidney Disease, the National Institute on Dental
  Research, and other institutes in developing and coordinating plans for
  research on osteoporosis and related bone disorders;
  `(5) assist the Office of Disease Prevention and Health Promotion and the
  Administration on Aging and other offices in developing and coordinating
  plans for education and health promotion on osteoporosis and related bone
  disorders; and
  `(6) establish mechanisms to use the results of research concerning
  osteoporosis and related bone disorders in the development of policies,
  programs, and other measures to improve the quality of life for older
  Americans.
  `(c) CHAIRPERSON- The Secretary shall select a Chairperson or co-Chairpersons
  for the Council from among its members.
  `(d) QUORUM- A majority of the members of the Council shall constitute a
  quorum, but a lesser number may hold hearings.
  `(e) MEETINGS- The Council shall meet periodically at the call of the
  Chairperson, but not less often than twice each year.
  `(f) EXECUTIVE SECRETARY- The Secretary shall appoint an Executive Secretary
  for the Council.
  `(g) ADMINISTRATIVE STAFF AND SUPPORT- The Secretary shall provide the
  Council with such additional administrative staff and support as may be
  necessary to enable the Council to carry out its functions.
  `(h) REPORTS-
  `(1) INITIAL REPORT-
  `(A) PREPARATION- Not later than 9 months after the date of enactment
  of this chapter, the Executive Secretary of the Council shall prepare a
  report detailing the research plans referred to in paragraphs (4) and (5)
  of subsection (b). The report shall describe the activities to be carried out
  under the research plans during each of the fiscal years 1991 through 1993.
  `(B) OTHER FEDERAL PROGRAMS- To the maximum extent feasible, the report
  shall ensure that activities carried out under the research plans
  are coordinated with, and use the resources of, other Federal programs
  concerning osteoporosis and related bone disorders, including--
  `(i) centers supported by the National Institute of Arthritis and
  Musculoskeletal and Skin Diseases, the National Institute on Aging, and
  the National Institute of Diabetes, Digestive and Kidney Disease;
  `(ii) other centers supported by Federal funds involved in research on
  osteoporosis and related bone disorders; and
  `(iii) other programs concerning osteoporosis and related bone disorders that
  are planned or conducted by Federal agencies such as the Administration on
  Aging and the Office of Disease Prevention and Health Promotion, Federal
  agencies outside the Department, State or local agencies, community
  organizations, or private foundations.
  `(C) DISTRIBUTION- The Executive Secretary of the Council shall--
  `(i) transmit the report to Congress; and
  `(ii) make the report available to the public and to the Advisory Panel.
  `(2) SUBSEQUENT REPORTS- Not later than 12 months after the date on
  which the report required by paragraph (1) is transmitted to Congress,
  and annually thereafter, the Executive Secretary of the Council shall--
  `(A) prepare a report that--
  `(i) describes research and educational initiatives sponsored by the
  Federal Government on osteoporosis and related bone disorders; and
  `(ii) makes recommendations for new research and educational initiatives
  on osteoporosis and related bone disorders; and
  `(B) transmit the report to Congress and make the report available to
  the public.
 `SEC. 442D. ADVISORY PANEL ON OSTEOPOROSIS AND RELATED DISORDERS.
  `(a) ESTABLISHMENT- There is established in the Department an Advisory
  Panel on Osteoporosis and Related Disorders. The Advisory Panel shall
  be composed of the following 15 voting members and additional nonvoting,
  ex officio members:
  `(1) VOTING MEMBERS- The Director of the Office of Technology Assessment
  shall appoint to the Advisory Panel--
  `(A) 5 members who are biomedical research scientists with demonstrated
  achievement in biomedical research on osteoporosis and related bone
  disorders, including at least 1 researcher at a specialized center for
  research in osteoporosis;
  `(B) 2 members with demonstrated achievements in research on community-based
  and family services covering osteoporosis and related bone disorders;
  `(C) 1 member who is knowledgeable in health promotion and disease prevention
  programs concerning osteoporosis and related bone disorders;
  `(D) 2 members who are associated with specialized bone programs affiliated
  with academic health centers;
  `(E) 2 members who are experts in private health care insurance and
  long-term care financing; and
  `(F) 3 members who are representatives of national voluntary organizations
  that are concerned with the problems of individuals with osteoporosis and
  related bone disorders and their families.
  `(2) NONVOTING, EX OFFICIO MEMBERS- The Advisory Panel shall include as
  nonvoting, ex officio members--
  `(A) the Chairperson of the Council;
  `(B) the Director of National Institute of Arthritis and Musculoskeletal
  and Skin Diseases;
  `(C) the Director of the National Institute on Aging; and
  `(D) such other members as the Secretary may appoint.
  `(3) APPOINTMENT- The Director of the Office of Technology Assessment
  and the Secretary shall appoint members to the Advisory Panel within 90
  days after the date of enactment of this chapter. The Director shall not
  appoint to the Advisory Panel individuals who are officers or employees
  of the Federal Government.
  `(b) FUNCTIONS- The Advisory Panel shall advise the Secretary and Council
  with respect to the identification of--
  `(1) research priorities for projects on osteoporosis, related bone
  disorders, and the care of individuals with osteoporosis or related bone
  disorders;
  `(2) emerging issues in and promising areas of biomedical, clinical,
  and behavioral research on osteoporosis and related bone disorders;
  `(3) emerging issues in research on health services for individuals,
  and the families of individuals, with osteoporosis or related bone disorders;
  `(4) emerging issues in home-based and community-based services and
  systems of services for individuals, and the families of individuals,
  with osteoporosis or related bone disorders;
  `(5) emerging issues in financing health care services and social services
  for individuals, and the families of individuals, with osteoporosis and
  related bone disorders;
  `(6) emerging issues in health promotion programs concerning osteoporosis;
  and
  `(7) emerging issues in professional and individual education concerning
  osteoporosis.
  `(c) CHAIRPERSON- The Secretary shall appoint a Chairperson of the Advisory
  Panel from among the members appointed.
  `(d) TERM OF OFFICE- The term of a member of the Advisory Panel shall
  be for the life of the Advisory Panel. A vacancy on the Advisory Panel
  shall be filled in the same manner as the original appointment was made. A
  vacancy on the Advisory Panel shall not affect its powers.
  `(e) QUORUM- A majority of the members of the Advisory Panel appointed
  shall constitute a quorum, but a lesser number may hold hearings. The
  Advisory Panel may establish such subcommittees as the Advisory Panel
  considers appropriate.
  `(f) MEETINGS- The Advisory Panel shall meet at the call of the Chairperson,
  but not less often than twice per year.
  `(g) EXECUTIVE SECRETARY- The Executive Secretary of the Council shall
  serve as Executive Secretary of the Advisory Panel.
  `(h) STAFF AND SUPPORT- The Secretary shall provide the Advisory Panel
  with such additional administrative staff and support as may be necessary
  to enable the Advisory Panel to carry out its functions.
  `(i) COMPENSATION AND TRAVEL EXPENSES-
  `(1) COMPENSATION- Subject to paragraph (2), no member of the Advisory
  Panel shall receive compensation for service on the Advisory Panel.
  `(2) TRAVEL EXPENSES- Each member of the Advisory Panel shall receive
  reimbursement for travel, subsistence, and other necessary expenses incurred
  in the performance of duties of the Advisory Panel.
  `(j) REPORT- The Advisory Panel shall--
  `(1) prepare an annual report, which shall contain recommendations for
  administrative and legislative actions to--
  `(A) improve services, education, and information for individuals, and
  families of individuals, with osteoporosis and related bone disorders;
  `(B) improve professional education; and
  `(C) provide for promising biomedical research related to osteoporosis
  and related bone disorders; and
  `(2) transmit the annual report to the Congress, the Secretary, and the
  Council and make it available to the public.
  `(k) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $200,000 for each of fiscal years 1991 through
  1993.
`SEC. 442E. AWARDS FOR HEALTH PROMOTION AND DISEASE PREVENTION PROGRAMS.
  `(a) ESTABLISHMENT- The Secretary shall make up to three grants to public
  and private nonprofit entities to establish model health promotion projects
  for community-based education on osteoporosis.
  `(b) PROJECTS-
  `(1) TARGET POPULATIONS- Each project funded under this section shall
  target one of the following populations:
  `(A) Young and teenage girls.
  `(B) Midlife women.
  `(C) Older men and women.
  `(2) SUBJECTS- Projects funded under this section shall--
  `(A) develop educational tools based on scientific information about the
  prevention and management of osteoporosis;
  `(B) provide a model for dissemination of information to the target group,
  with an emphasis on currently existing systems of information; and
  `(C) contain a means of evaluating the effectiveness of the model for the
  target group.
  `(c) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $375,000 for each of fiscal years 1991 through
  1993.
`SEC. 442F. RESOURCE CENTER ON OSTEOPOROSIS AND RELATED DISORDERS.
  `(a) ESTABLISHMENT- The Director of the National Institute of Arthritis
  and Musculoskeletal and Skin Diseases shall make grants or enter into
  contracts with eligible organizations to establish a Resource Center on
  Osteoporosis and Related Disorders.
  `(b) PURPOSE- The purpose of the Resource Center shall be to facilitate
  and enhance knowledge and understanding of osteoporosis and related bone
  disorders by disseminating information about research results, services
  and educational materials to health professionals, patients, and the public.
  `(c) FUNCTIONS- An organization receiving a grant or contract under this
  section shall--
  `(1) compile, archive, and disseminate information concerning research,
  demonstration, evaluation, and training programs and projects concerning
  osteoporosis and related bone disorders;
  `(2) annually publish a summary of the information compiled under paragraph
  (1) during the preceding 12-month period, and make the information available
  on request to appropriate individuals and entities, including educational
  institutions, research entities, and Federal and public agencies;
  `(3) provide information and assistance in accessing community services
  to patients and the public;
  `(4) coordinate leadership training for the development of health
  professional resource network on osteoporosis and related bone disorders; and
  `(5) maintain a resource library on osteoporosis and related bone disorders.
  `(d) INFORMATION SYSTEM AND TELEPHONE LINE-
  `(1) INFORMATION SYSTEM- An organization receiving a grant or contract under
  this section shall establish a central computerized information system to--
  `(A) compile and disseminate information concerning initiatives by State
  and local governments and private entities to provide programs and services
  for individuals with osteoporosis; and
  `(B) translate scientific and technical information concerning the
  initiatives into information readily understandable by the general public,
  and make the information available on request.
  `(2) TELEPHONE LINE- An organization receiving a grant or contract under
  this section shall establish a national toll-free telephone line to make
  available the information described in paragraph (1) and information
  concerning Federal programs, services, and benefits for individuals with
  osteoporosis and their families.
  `(e) FEES- In accordance with regulations issued by the Secretary, the
  organization receiving a grant or contract under this section shall charge
  appropriate fees for providing information through the Research Center as
  specified in subsections (c) or (d). The organization may make exceptions
  to the fees for individuals and organizations who are not financially able
  to pay the fees. The organization shall transfer the sums obtained from
  payment of the fees to the Secretary, who shall use the sums to carry out
  this section.
  `(f) APPLICATION OR PROPOSAL- In order to receive a grant or enter into a
  contract under this section, an organization shall submit an application
  or proposal to the Director of the National Institute of Arthritis and
  Musculoskeletal and Skin Diseases. The application or proposal shall
  contain--
  `(1) information demonstrating that the organization has a network
  of contacts that will enable the organization to receive information
  necessary to operate the central computerized information system described
  in subsection (d)(l); and
  `(2) such other information as the Director may prescribe.
  `(g) ELIGIBLE ORGANIZATIONS- Organizations eligible to receive grants
  under this section shall include public and private nonprofit organizations
  that are knowledgeable about osteoporosis and related bone disorders. The
  Secretary shall establish additional eligibility criteria for organizations
  to receive grants or enter into contracts under this section.
  `(h) RESEARCH SUMMARIES- The Director of the National Institute of Arthritis
  and Musculoskeletal and Skin Diseases, the National Institute on Aging,
  the National Institute of Diabetes, Digestive, and Kidney Diseases,
  the National Institute on Dental Research, and other agencies specified
  by the Secretary shall provide to the Resource Center summaries of the
  findings of research conducted on osteoporosis, related bone disorders,
  or relevant treatments for osteoporosis or related bone disorders.
  `(i) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $500,000 for fiscal year 1991, and such sums as
  may be necessary for fiscal years 1992 and 1993.'.
TITLE II--SERVICES
Subtitle A--Breast Cancer Treatment
SEC. 201. SHORT TITLE.
  This subtitle may be cited as the `Breast Cancer Treatment Informed
  Consent Act.'.
SEC. 202. REQUIRING INFORMATION ON ALTERNATIVE TREATMENTS FOR BREAST CANCER.
  (a) IN GENERAL- Any State receiving funds under titles V or XIX of the
  Social Security Act, or title XIX of the Public Health Service Act shall
  require by law that any physician or surgeon licensed to practice medicine
  in such State inform any breast cancer patient of alternative effective
  methods of treatment for breast cancer before such treatment is begun. Such
  patients shall be informed by means of--
  (1) a standardized written summary in layman's language and in a language
  understood by the patient of alternative efficacious methods of treatment
  which may be medically viable, including surgical, radiological, or
  chemotherapeutic treatments, and other effective means of treatment; and
  (2) an explanation of the treatment options described in such written summary
  together with the advantages, disadvantages, and risks associated with
  each procedure relative to such patient's particular medical circumstances.
  (b) EFFECTIVE DATE- (1) Except as provided in paragraph (2), the provisions
  of this subtitle shall become effective on October 1, 1990.
  (2) If a State demonstrates, to the satisfaction of the Secretary of
  Health and Human Services, that it cannot, by reason of State law, comply
  with the requirements of this subtitle by the effective date specified in
  paragraph (1), the Secretary may prescribe that, in the case of such State,
  the subtitle will become effective the first day of the first month after
  the close of the first session of such State's legislature ending on or
  after October 1, 1990. For purposes of the preceding sentence, the term
  `session of a State's legislature' includes any regular, special, budget,
  or other session of a State legislature.
SEC. 203. CONFORMING PROGRAM REQUIREMENTS.
  (a) MATERNAL AND CHILD HEALTH CARE PROGRAM- Title V of the Social Security
  Act is amended by adding at the end thereof the following new section:
`INFORMED CONSENT
  `SEC. 510. To be eligible for a grant under this title, the chief executive
  officer of each State shall certify to the Secretary that such State has
  complied with the requirements of the Breast Cancer Treatment Informed
  Consent Act.'.
  (b) MEDICAID PROGRAM- Section 1903 of the Social Security Act (42
  U.S.C. 1396b) is amended by adding at the end thereof the following new
  subsection:
  `(w) To be eligible for any payment under this section, the chief executive
  officer of each State shall certify to the Secretary that such State has
  complied with the requirements of the Breast Cancer Treatment Informed
  Consent Act.'.
  (c) PUBLIC HEALTH BLOCK GRANTS- Title XIX of the Public Health Service
  Act is amended by adding at the end thereof the following new part:
`PART D--INFORMED CONSENT
`SEC. 1941. ELIGIBILITY FOR PAYMENT.
  `To be eligible for any payment under this title, the chief executive officer
  of each State shall certify to the Secretary that the State has complied
  with the requirements of the Breast Cancer Treatment Informed Consent Act.'.
Subtitle B--Reimbursement for Certain Nurse Practitioners Under Medicare
and Medicaid
SEC. 211. SHORT TITLE.
  This subtitle may be cited as the `Women's Health Care Coverage Expansion
  Act of 1990'.
SEC. 212. COVERAGE OF OB/GYN AND WOMEN'S HEALTH NURSE PRACTITIONER SERVICES.
  (a) COVERAGE UNDER MEDICARE-
  (1) IN GENERAL- Section 1861(s)(2)(K) of the Social Security Act (42
  U.S.C. 1395x(s)(2)(K)) is amended--
  (A) in clause (ii), by striking `and' at the end;
  (B) in clause (iii), by striking `(i) or (ii)' and inserting `(i), (ii),
  or (iii)';
  (C) by redesignating clause (iii) as clause (iv); and
  (D) by inserting after clause (ii) the following new clause:
  `(iii) qualified obstetrical and gynecological services which would be
  physicians' services if furnished by a physician (as defined in subsection
  (r)(1)) and which are furnished by a nurse practitioner which the nurse
  practitioner is authorized to perform by the State in which the services
  are furnished, and'.
  (2) DIRECT PAYMENT FOR SERVICES- (A) Section 1832(a)(2)(B) of the Act
  (42 U.S.C. 1395k(a)(2)(B)) is amended--
  (i) in clause (ii), by striking `and' at the end;
  (ii) in clause (iii), by striking the semicolon and inserting a comma; and
  (iii) by adding at the end the following new clause:
  `(iv) qualified obstetrical and gynecological services of a nurse
  practitioner (as defined in section 1861(s)(2)(K)(iii)); and'.
  (B) Section 1842(b)(6) of the Act (42 U.S.C. 1395u(b)(6)) is amended
  by striking `section 1861(s)(2)(K)' and inserting `clauses (i) and (ii)
  of section 1861(s)(2)(K)'.
  (3) DEFINITION- Section 1861 of the Act (42 U.S.C. 1395x) is amended by
  adding at the end the following new subsection:
`QUALIFIED OBSTETRICAL AND GYNECOLOGICAL SERVICES
  `(oo) The term `qualified obstetrical and gynecological services' means such
  services and such services and supplies furnished as an incident to such
  services furnished by a nurse practitioner which the nurse practitioner
  is legally authorized to perform under State law (or the State regulatory
  mechanism provided by State law) as would otherwise be covered if furnished
  by a physician or as an incident to a physician's service.'.
  (4) EFFECTIVE DATE- The amendments made by paragraphs (1), (2), and (3)
  shall apply with respect to services provided on or after January 1, 1991.
  (b) COVERAGE UNDER MEDICAID-
  (1) IN GENERAL- Section 1905(a)(21) of the Social Security Act (42
  U.S.C. 1396d(a)(21)) is amended by striking `certified pediatric nurse
  practitioner or certified family nurse practitioner' each place it appears
  and inserting `certified pediatric nurse practitioner, certified family
  nurse practitioner, certified OBGYN nurse practitioner, or certified
  women's health nurse practitioner'.
  (2) CONFORMING AMENDMENTS- Title XIX of the Act is amended  by striking
  `(21)' each place it appears in sections 1902(j) and 1925(b)(4)(B) and
  inserting `(22)'.
  (3) EFFECTIVE DATE- The amendments made by paragraphs (1) and (2) shall
  apply with respect to services furnished during quarters beginning on or
  after January 1, 1991.
Subtitle C--Adolescent Pregnancy
SEC. 221. SHORT TITLE.
  This subtitle may be cited as the `Adolescent Pregnancy Prevention, Care,
  and Research Grants Act of 1990'.
SEC. 222. ADOLESCENT PREGNANCY PREVENTION, CARE, AND RESEARCH GRANTS.
  Title XX of the Public Health Service Act (42 U.S.C. 300z et seq.) is
  amended to read as follows:
`TITLE XX--ADOLESCENT PREGNANCY PREVENTION, CARE, AND RESEARCH GRANTS
`SEC. 2001. FINDINGS AND PURPOSES.
  `(a) FINDINGS- Congress finds that--
  `(1) adolescents are at a high risk for unwanted pregnancy;
  `(2) in 1986, more than 1,000,000 teenagers became pregnant, nearly 500,000
  teenagers carried their pregnancies to term, and 6 out of 10 teenagers
  who carried pregnancies to term gave birth out of wedlock;
  `(3) adolescents aged 17 and younger accounted for 46 percent of the births
  out of wedlock  to teenagers;
  `(4) in a high proportion of cases, the pregnant adolescent was born to
  an unmarried pregnant adolescent and is continuing the pattern;
  `(5) pregnancy and childbirth among unmarried adolescents, particularly
  young adolescents, often results in severe adverse health, social, and
  economic consequences, including--
  `(A) a higher percentage of pregnancy and childbirth complications;
  `(B) a higher incidence of babies with low birth weight;
  `(C) higher infant mortality and morbidity;
  `(D) a greater likelihood that adolescent marriages will end in divorce;
  `(E) a decreased likelihood that adolescents will complete schooling; and
  `(F) higher risks of unemployment and welfare dependency;
  `(6) education, training, and job research services are important for
  adolescent parents;
  `(7) an adolescent who becomes pregnant once is likely to experience rapid
  repeat pregnancies and childbearing, with increased risks;
  `(8) research has shown that in cases in which there is family involvement
  in comprehensive values-based projects and services--
  `(A) low birth weight is significantly reduced;
  `(B) teens delay the initiation of sexual activity;
  `(C) significant reductions in repeat pregnancy, welfare costs, and child
  abuse occur; and
  `(D) teens are more likely to return and complete their high school
  education;
  `(9) the family should become a partner in the development of curriculum
  and programs that reflect the values of the community;
  `(10) the problems of adolescent pregnancy and parenthood are multiple
  and complex and are best approached through a variety of integrated and
  essential services, particularly those that allow the pregnant adolescent
  and adolescent parent to stay in school;
  `(11) integrated and essential services, including a wide array of
  educational and supportive services, often are not available to the
  adolescents who need them, or are available but fragmented and of limited
  effectiveness in preventing pregnancies and future welfare dependency; and
  `(12) Federal policy should encourage the development of appropriate health,
  educational, and social services where they are now lacking or inadequate,
  and the better coordination of existing services where they are available
  in order to prevent unwanted early and repeat pregnancies and to help
  adolescents become productive, independent contributors to family and
  community life.
  `(b) PURPOSES- It is the purpose of this title--
  `(1) to establish better coordination, integration, and linkages among
  existing programs in order to expand and improve the availability of,
  and access to, needed comprehensive community services that--
  `(A) assist in preventing unwanted initial and repeat pregnancies among
  adolescents;
  `(B) enable pregnant adolescents to obtain proper care; and
  `(C) assist pregnant adolescents and adolescent parents to become productive
  independent contributors to family and community life, with primary emphasis
  on services to adolescents who are under 18 years of age and are pregnant
  or who are parents;
  `(2) to expand the availability of the services that are essential to the
  objective described in paragraph (1);
  `(3) to promote innovative, comprehensive, and integrated approaches to
  the delivery of the services;
  `(4) to encourage and support research programs concerning the societal
  causes and consequences of pregnancy, childbearing, and child rearing for
  adolescent females and males;
  `(5) to support evaluative research to identify effective services that
  reduce adolescent pregnancy rates and that improve the outcome of adolescent
  childbearing for the parents, the child, and their families; and
  `(6) to encourage and provide for the dissemination of results, findings,
  and information from programs and research projects relating to adolescent
  pregnancy and parenthood.
`SEC. 2002. DEFINITIONS.
  `For the purposes of this title:
  `(1) ADOLESCENT- The term `adolescent' means an individual under the age
  of 21.
  `(2) CARE SERVICES- The term `care services' means all services for the
  provision of care to pregnant adolescents and adolescent parents. The term
  shall include all core services and may include supplemental services,
  in accordance with regulations prescribed by the Secretary.
  `(3) CORE SERVICES- The term `core services' means those services that shall
  be provided by a grantee, as determined by the Secretary by regulation,
  which shall include--
  `(A) pregnancy testing and maternity counseling, or referral for testing
  and counseling;
  `(B) family planning services, except that services for adolescents
  who are not already parents shall be limited to counseling and referral
  unless suitable and appropriate family planning services are not otherwise
  available in the community;
  `(C) primary and preventive health services, including prenatal and
  postnatal care for mother and children and arrangements for delivery;
  `(D) nutrition information and counseling;
  `(E) referral for screening and treatment of sexually transmitted diseases,
  including acquired immunodeficiency syndrome;
  `(F) referral to appropriate pediatric care;
  `(G) educational services relating to sexuality and family life, including--
  `(i) education on responsible decisionmaking regarding sexual activity;
  `(ii) education on the responsibilities of parenting;
  `(iii) education on a full range of means for delaying pregnancy, including
  contraception, natural family planning, and abstinence; and
  `(iv) assistance to parents, schools, youth agencies, and health
  care providers to educate adolescents and pre-adolescents concerning
  self-discipline and responsibility in human sexuality;
  `(H) referral to appropriate educational, employment, and vocational
  services;
  `(I) adoption counseling services, that present adoption as an option
  for pregnant adolescents, or referral to a licensed adoption agency for
  adoption counseling;
  `(J) mental health services and referral to mental health services and to
  other appropriate physical health services; and
  `(K) encouragement of parent and family involvement in each of the core
  services described in subparagraphs (A) through (J).
  `(4) ELIGIBLE GRANT RECIPIENT AND GRANTEE- The terms `eligible grant
  recipient' and `grantee' mean a public or nonprofit private organization
  or agency that demonstrates, to the satisfaction of the Secretary--
  `(A) in the case of an organization that will provide care services,
  the capability of providing all care services in a single setting or the
  capability of creating a network through which all care services would be
  provided; or
  `(B) in the case of an organization that will provide prevention services,
  the capability of providing the services.
  `(5) ELIGIBLE PERSON- The term `eligible person' means--
  `(A) with regard to the provision of care services, a pregnant adolescent
  or an adolescent parent; or
  `(B) with regard to the provision of prevention services, an adolescent
  who is not already a parent.
  `(6) OTHER SERVICES- The term `other services' means medicaid assistance
  provided under a State plan in accordance with section 1902 of the Social
  Security Act (42 U.S.C. 1396a), services provided by licensed adoption
  agencies, maternity home services, public assistance, employment services,
  child care services for adolescent parents, and other city, county, and
  State programs related to adolescent pregnancy.
  `(7) PREVENTION SERVICES- The term `prevention services' means services
  described in subparagraphs (B) and (G) of paragraph (3) and referrals to
  such other services as may be appropriate for adolescents who are not already
  parents, including services to be offered in schools at local discretion.
  `(8) SUPPLEMENTAL SERVICES- The term `supplemental services' means those
  services that may be provided by a grantee, as determined by the Secretary
  by regulation, which may include--
  `(A) child care sufficient to enable the adolescent parent to continue
  education or to enter into employment, including services to be provided
  within secondary schools at local discretion;
  `(B) consumer education and homemaking;
  `(C) counseling for the immediate and extended family members of the
  eligible person;
  `(D) transportation;
  `(E) referral to licensed residential care or maternity home services;
  `(F) referral to licensed adoption agencies for adoption placement services;
  `(G) employability training and counseling; and
  `(H) such other services as are consistent with this title and as the
  Secretary may approve in accordance with regulations promulgated by the
  Secretary.
`SEC. 2003. AUTHORITY TO MAKE GRANTS FOR SERVICES.
  `The Secretary may make grants to eligible grant recipients to provide care
  services to pregnant adolescents and adolescent parents and prevention
  services to nonpregnant adolescents. Grants shall be used to provide,
  supplement, or improve the quality of the services.
`SEC. 2004. USE OF GRANTS FOR SERVICES.
  `(a) USES- A grant made under this title may be used to--
  `(1) provide care and prevention services to eligible persons including
  supplemental services as provided in paragraph (3);
  `(2) coordinate, integrate, and provide linkages among providers of care,
  prevention, and other services for eligible persons to carry out the
  purposes of this title;
  `(3) provide supplemental services that are essential to the care of
  pregnant adolescents and to the prevention of adolescent pregnancy, where
  such services are not adequate or not available to eligible persons in
  the community;
  `(4) plan, for a period of not more than 1 year, for the administration
  and coordination of pregnancy prevention services and programs of care
  services for pregnant adolescents and adolescent parents that will further
  the purposes of this title; and
  `(5) fulfill assurances required for grant approval under section 2006.
  `(b) FEES- Grantees shall charge fees for services only pursuant to a
  fee schedule, approved by the Secretary as a part of the application
  described in section 2006, that bases fees charged by the grantee on
  the income of the eligible person and takes into account the difficulty
  adolescents face in obtaining resources to pay for services. In no case
  may a grantee discriminate with regard to the provision of services to any
  individual because of the inability of that individual to provide payment
  for the services.
`SEC. 2005. AWARD OF GRANTS FOR SERVICES.
  `(a) PRIORITIES- In approving applications for grants for services under
  this title, the Secretary shall give priority to applicants who meet the
  requirements of paragraphs (3) and (4) of section 2007(a) and who--
  `(1) serve an area where there is a high incidence of adolescent pregnancy;
  `(2) serve an area with a high proportion of low-income families and
  where the availability of programs of care for pregnant adolescents and
  adolescent parents is low;
  `(3) show evidence--
  `(A) in the case of an applicant who will provide care services, of the
  ability to bring together a wide range of needed core services and, as
  appropriate, supplemental services in comprehensive single-site programs, or
  to establish a well-integrated network of the services that are appropriate
  for the target population and geographic area to be served including the
  special needs of rural areas; or
  `(B) in the case of an applicant who will provide prevention services, of
  having the ability to provide prevention services for adolescents and the
  families of adolescents that are appropriate for the target population and
  the geographic area to be served, including the special needs of rural areas;
  `(4) will utilize to the maximum extent feasible existing available
  programs and facilities such as community health centers, child welfare
  agencies, children and youth centers, maternal and infant health centers,
  regional rural health facilities, licensed adoption agencies, maternity
  homes, school and other educational programs, family planning clinics,
  mental health programs, nutrition programs, recreation programs, and other
  ongoing pregnancy prevention and pregnancy- related services;
  `(5) make use, to the maximum extent feasible, of other Federal, State, and
  local funds, programs, contributions, and other third-party reimbursements;
  `(6) can demonstrate a community commitment to the program by making
  available to the program non-Federal funds, personnel, and facilities;
  `(7) have involved the community to be served, including public and
  nonprofit private agencies, adolescents, and families, in the planning
  and implementation of the program; and
  `(8) will demonstrate innovative and effective approaches in addressing
  the problems of adolescent pregnancy or parenthood, including approaches
  to provide pregnant adolescents with adequate information about adoption.
  `(b) Amounts-
  `(1) IN GENERAL- The amount of a grant for a program for services under
  this title shall be determined by the Secretary, based on factors such as
  the incidence of adolescent pregnancy in the geographic area to be served,
  and the adequacy of pregnancy prevention services and programs of care
  for pregnant adolescents and adolescent parents in the area.
  `(2) RURAL AREAS- In making grants for services under this title, the
  Secretary shall consider the special needs of rural areas and, to the maximum
  extent practicable, shall distribute funds taking into consideration the
  relative number of adolescents in the areas in need of the services.
  `(c) Federal Share-
  `(1) IN GENERAL- Subject to paragraph (3), a grant for services under this
  title may not exceed 75 percent of the costs of the program for any year.
  `(2) FORM OF NON-FEDERAL CONTRIBUTIONS- Non-Federal contributions required
  by paragraph (1) may be in cash or in kind, fairly evaluated, including
  plants, equipment, or services.
  `(3) WAIVER- The Secretary may waive the limitation specified in paragraph
  (1) for any year in accordance with criteria established by regulation.
`SEC. 2006. APPLICATIONS FOR GRANTS FOR SERVICES.
  `(a) IN GENERAL- An application for a grant for services under this
  title shall be submitted in such form and contain such information as the
  Secretary may require.  At a minimum, the application shall include--
  `(1) an identification of the incidence of adolescent pregnancy and
  related problems;
  `(2) a description of the economic conditions and income levels in the
  geographic area to be served;
  `(3) a description of existing pregnancy prevention services, adoption
  services, and programs of care for pregnant adolescents and adolescent
  parents, including the population groups receiving the services, the persons
  providing the services, the manner in which services are provided, and
  the extent to which they are coordinated in the geographic area to be served;
  `(4) a description of the major unmet needs for services for adolescents
  at risk of initial or recurrent pregnancies and an estimate of the number
  of adolescents not being served in the area;
  `(5)(A) in the case of an applicant who will provide care services, a
  description of the manner in which the applicant will provide all core
  services in the program using funds under this title or funds provided by
  the grantee in the area to be served, the population to which the services
  will be provided, the manner in which the services will be coordinated,
  integrated, and linked with other related programs and services and the
  source or sources of funding of the core services in the public and private
  sectors; or
  `(B) in the case of an applicant who will provide prevention services,
  a description of the necessary services to be provided and the manner in
  which the applicant will provide the services;
  `(6) a description of the manner in which the applicant will identify
  adolescents needing services other than the services provided directly
  by the applicant and provide access and appropriate referral to other
  services, including a description of a plan to coordinate other services
  with the services supported under this title;
  `(7) a description of the results expected from the provision of services,
  and the procedures to be used for evaluating those results;
  `(8) assurances that the applicant will have an ongoing quality assurance
  program;
  `(9) assurances that the applicant shall have a system for maintaining
  the confidentiality of patient records in accordance with regulations
  prescribed by the Secretary;
  `(10) assurances that the applicant will demonstrate the financial
  responsibility of the applicant by the use of such accounting procedures
  and other requirements as may be prescribed by the Secretary;
  `(11) assurances that the applicant will make maximum use of other sources
  of Federal and State funding;
  `(12)(A) a description of--
  `(i) the schedule of fees to be used in the provision of services, which
  shall comply with section 2004(b); and
  `(ii) a corresponding schedule of discounts to be applied to the payment
  of the fees, which shall comply with section 2004(b) and which shall be
  adjusted on the basis of the ability of the eligible person to pay;
  `(B) assurances that the applicant has made and will continue to make
  every reasonable effort--
  `(i) to secure from eligible persons payment for services in accordance
  with the schedules;
  `(ii) to collect reimbursement for health or other services provided
  to persons who are entitled to have payment made on their behalf for the
  services under any Federal or other government program or private insurance
  program; and
  `(iii) to seek the reimbursement on the basis of the full amount of fees
  for services without application of any discount; and
  `(C) assurances that the applicant has submitted or will submit to the
  Secretary such reports as the Secretary may require to determine compliance
  with this paragraph, including reports required under subsection (c);
  `(13) assurances that the applicant will make maximum use of funds available
  under title X;
  `(14) assurances that the acceptance by any individual of family planning
  services or family planning information (including educational materials)
  provided through financial assistance under this title shall be voluntary
  and shall not be a prerequisite to eligibility for or receipt of any other
  service furnished by the applicant;
  `(15) assurances that fees collected by the applicant for services rendered
  in accordance with this title shall be used by the applicant to further
  the purposes of this title;
  `(16) assurances that the applicant, if providing both prevention and
  care services, will not exclude or discriminate against any adolescent
  who receives prevention services and subsequently requires care services
  as a pregnant adolescent;
  `(17) a description of the manner in which the applicant will ascertain that
  adolescents obtained services for which the adolescents have been referred
  and develop a plan to ensure that needed services actually are received;
  `(18) assurances that the applicant will encourage unemancipated minors
  requesting services from the applicant to consult with their parents
  with respect to the services and that services shall not be denied to
  unemancipated minors who decide not to consult parents;
  `(19) assurances that the applicant will inform all pregnant adolescents
  receiving services of the availability of counseling on all options,
  regarding pregnancy, either by the entity providing core services or through
  a referral agreement with another entity that provides the counseling;
  `(20) assurances that the applicant will give primary emphasis for services
  supported under this title to adolescents 17 and under who are not able
  to obtain needed assistance through other means;
  `(21) assurances that funds received under this title shall not supplant
  funds received from any other Federal, State, or local program or any
  private sources of funds;
  `(22) a plan for the conduct of, and assurances that the applicant will
  conduct, evaluations of the effectiveness of the services supported under
  this title in accordance with subsection (b); and
  `(23) assurances that the applicant will comply with the requirements of
  section 2007.
  `(b) EVALUATIONS-
  `(1) IN GENERAL- Each grantee that receives funds for a grant for services
  under this title shall expend at least 3 percent but not in excess of
  10 percent of the amounts received under this title for the conduct of
  evaluations of the services supported under this title. The Secretary may,
  for a particular grantee on good cause shown, waive the preceding sentence
  with respect to the amounts to be expended on evaluations, but may not
  waive the requirement that the evaluations be conducted.
  `(2) INDEPENDENT EVALUATION- Evaluations required by paragraph (1) shall be
  conducted by an organization or entity that is independent of the grantee
  providing services supported under this title.
  `(c) Reports-
  `(1) IN GENERAL- Each grantee that participates in the program established
  by this title shall make such reports concerning its use of Federal funds
  as the Secretary may require, including reports on prevention programs
  and care programs.
  `(2) CONTENTS OF REPORTS ON PREVENTION PROGRAMS- Reports on prevention
  programs shall be in a standard format as prescribed by the Secretary and
  shall include a description of--
  `(A) the characteristics, educational attainments, and economic status
  of clients;
  `(B) the previous exposure of clients in home, school, or other locations
  to educational efforts regarding sexuality and family life;
  `(C) the types of interventions employed in the prevention program;
  `(D) the measurements on variables appropriate to the intervention, taken
  before and after the intervention;
  `(E) to the extent possible and where appropriate to program goals,
  the pregnancy and sexually transmitted disease rates subsequent to
  intervention; and
  `(F) the extent of parent or family involvement in the program.
  `(3) CONTENTS OF REPORTS ON CARE PROGRAMS- Reports on care programs shall
  be in a standard format as prescribed by the Secretary and shall include
  a description of--
  `(A) the characteristics, health history, educational attainments, and
  economic status of clients at the time of entry;
  `(B) the client prenatal care and pregnancy outcome, complications of
  pregnancy and delivery, and infant birth outcomes;
  `(C) the characteristics, educational attainments, and economic status of
  clients at time of follow-up and infant follow-up information;
  `(D) the types of services provided to clients; and
  `(E) the extent of parent or family involvement in the services provided.
  `(4) COMPARISON DATA- Reports on prevention programs and care programs
  shall include control group data or other appropriate comparison data
  to provide comparisons with project data and to indicate program impact
  or effectiveness.
  `(5) FOLLOW-UP DATA- Reports on prevention programs and care programs
  shall include, to the extent possible, follow-up data on a random sample
  of program graduates and dropouts.
  `(d) TIMING OF SERVICES- No application submitted for a grant for a program
  for care services under this title may be approved unless the Secretary
  is satisfied that core services shall be available through the applicant
  within a reasonable time after the grant is received.
`SEC. 2007. COORDINATION OF FEDERAL AND STATE PROGRAMS.
  `(a) FEDERAL PROGRAMS- The Secretary shall coordinate Federal policies
  and programs providing services relating to the prevention of initial and
  recurrent adolescent pregnancies and providing care services for pregnant
  adolescents and adolescent parents. In achieving the coordination, the
  Secretary shall--
  `(1) require grantees to report periodically to the Secretary concerning
  Federal, State, and local policies and programs that interfere with the
  delivery of and coordination of pregnancy prevention services and other
  programs of care for pregnant adolescents and adolescent parents;
  `(2) provide technical assistance to facilitate coordination by State and
  local recipients of Federal assistance;
  `(3) give priority in the provision of funds, where appropriate, to
  applicants using single or coordinated grant applications for multiple
  programs; and
  `(4) give priority, where appropriate, to the provision of funds under
  Federal programs administered by the Secretary (other than the program
  established by this title) to programs providing comprehensive prevention
  services and comprehensive programs of care for pregnant adolescents and
  adolescent parents.
  `(b) OTHER RECIPIENTS- Each grantee shall coordinate the activities of
  the grantee with any other grantee that is located in the same locality.
`SEC. 2008. GRANTS FOR RESEARCH.
  `(a) In General-
  `(1) AUTHORIZATION- The Secretary may make grants to public agencies or
  nonprofit private organizations or institutions of higher education to
  support the research and dissemination activities described in paragraphs
  (4), (5), and (6) of section 2001(b).
  `(2) DURATION- The Secretary may make grants or enter into contracts under
  this section for a period of 1 year. A grant or contract under this section
  for a program may be renewed for 4 additional 1-year periods, which need
  not be consecutive.
  `(3) AMOUNT LIMITATION- A grant or contract for any 1-year period under
  this section may not exceed $100,000 for the direct costs of conducting
  research or dissemination activities under this section and may include such
  additional amounts for the indirect costs of conducting such activities
  as the Secretary determines appropriate. The Secretary may waive the
  preceding sentence with respect to a specific program if the Secretary
  determines that--
  `(A) exceptional circumstances warrant such waiver and that the program
  will have national impact; or
  `(B) additional amounts are necessary for the direct costs of conducting
  limited programs for the provision of necessary services in order to
  provide data for research carried out under this title.
  `(4) CARRYOVER FOR REPORT- The amount of any grant or contract made under
  this section may remain available for obligation or expenditure after the
  close of the 1-year period for which the grant or contract is made in order
  to assist the recipient in preparing the report required by subsection
  (f)(1).
  `(b) Use of Funds-
  `(1) IN GENERAL- Funds provided for research under this section may
  be used for descriptive or explanatory surveys, evaluation studies,
  longitudinal studies, or limited programs for services that are for the
  purpose of increasing knowledge and understanding of the matters described
  in paragraphs (4) and (5) of section 2001(b).
  `(2) LIMITATIONS- Funds provided under this section may not be used for the
  purchase or improvement of land, or the purchase, construction, or permanent
  improvement of any building or facility, other than minor remodeling.
  `(c) AWARD OF GRANTS OF CONTRACTS- The Secretary may not make any grant
  or enter into any contract to support research or dissemination activities
  under this section unless--
  `(1) the Secretary has received an application for the grant or contract
  that is in such form and that contains such information as the Secretary
  may by regulation require;
  `(2) the applicant has demonstrated that the applicant is capable of
  conducting one or more of the types of research or dissemination activities
  described in paragraph (4), (5), or (6) of section 2001(b); and
  `(3) in the case of an application for a research program, the panel
  established by subsection (e)(2) has determined that the program is of
  scientific merit.
  `(d) COORDINATION- The Secretary shall coordinate research and dissemination
  activities carried out under this section with research and dissemination
  activities carried out by the National Institutes of Health.
  `(e) Review of Applications-
  `(1) SYSTEM- The Secretary shall establish a system for the review of
  applications for grants and contracts under this section. The system
  shall be substantially similar to the system for scientific peer review
  of the National Institutes of Health, established in part G of title IV,
  and shall meet the requirements of paragraphs (2) and (3).
  `(2) PANEL-
  `(A) ESTABLISHMENT- In establishing the system required by paragraph (1), the
  Secretary shall establish a panel to review applications under this section.
  `(B) APPOINTMENT- The Secretary shall appoint to the panel members who have
  expertise in research and evaluation and represent disciplines relevant to
  the study of adolescent pregnancy and parenting. Not more than 25 percent
  of the members of the panel shall be physicians.
  `(C) MEETINGS- The panel shall meet as often as may be necessary to
  facilitate the expeditious review of applications under this section,
  but not less often than once each year.
  `(D) REVIEW- The panel shall review each program for which an application
  is made under this section, evaluate the scientific merit of the
  program, determine whether the program is of scientific merit, and make
  recommendations to the Secretary concerning whether the application for
  the program should be approved.
  `(3) GRANT DETERMINATION- The Secretary shall make grants under this
  section from among the programs determined to be of scientific merit
  by the panel established under paragraph (2). The Secretary shall make a
  determination with respect to an application within 1 month after receiving
  the determinations and recommendations of the panel with respect to the
  application.
  `(f) Reports-
  `(1) Research reports-
  `(A) IN GENERAL- The recipient of a grant or contract for a research program
  under this section shall prepare and transmit to the Secretary a report
  describing the results and conclusions of the research. Except as provided in
  subparagraph (B), the report shall be transmitted to the Secretary not later
  than 12 months after the end of the year for which funds are provided under
  this section. The recipient may utilize reprints of articles published or
  accepted for publication in professional journals to supplement or replace
  the report if the research contained in the articles was supported under
  this section during the year for which the report is required.
  `(B) MULTIYEAR PROGRAMS- In the case of any research program for which
  assistance is provided under this section for 2 or more consecutive 1-year
  periods, the recipient of such assistance shall prepare and transmit the
  report required by subparagraph (A) to the Secretary not later than 12
  months after the end of each 1-year period for which the funding is provided.
  `(2) OTHER REPORTS- Recipients of grants and contracts for dissemination
  under this section shall submit to the Secretary such reports as the
  Secretary determines appropriate.
`SEC. 2009. EVALUATION.
  `The Secretary shall conduct an evaluation of activities carried out under
  this title. The Secretary shall submit to the appropriate committees of
  Congress a summary of each evaluation conducted under this section and a
  summary of the data reported by grantees under section 2006(c).
`SEC. 2010. AUTHORIZATION OF APPROPRIATIONS.
  `(a) IN GENERAL- For the purpose of carrying out this title, there are
  authorized to be appropriated $60,000,000 for each of the fiscal years
  1990 through 1992.
  `(b) GRANTS FOR SERVICES- Not less than two-thirds of the amounts
  appropriated to carry out this title shall be used to make grants for
  services.
  `(c) PREVENTION SERVICES- Not more than one-third of the amounts specified
  under subsection (b) for use for grants for services shall be used for
  grants for prevention services.
  `(d) EVALUATION- Not more than 1 percent and not less than 3 percent of
  the amounts appropriated to carry out this title shall be used to conduct
  the evaluation described in section 2009.
`SEC. 2011. FUND RESTRICTION.
  `No funds for grants made under this title may be used for payment for
  the performance of an abortion.'.
Subtitle D--COBRA Displaced Family Amendments Act of 1990
SEC. 231. SHORT TITLE.
  This subtitle may be cited as the `COBRA Displaced Family Amendments
  of 1990'.
SEC. 232. EXTENSION OF COBRA CONTINUATION BENEFITS FOR INDIVIDUALS 50
YEARS OF AGE OR OLDER AND THEIR DEPENDENTS IN THE CASE OF DEATH, DIVORCE,
OR LEGAL SEPARATION.
  (a) INTERNAL REVENUE CODE- Subclause (IV) of section 4980B(f)(2)(B)(i)
  of the Internal Revenue Code of 1986 (relating to maximum required period
  of continuation coverage for other qualifying events) is amended to read
  as follows:
  `(IV) GENERAL RULE FOR OTHER QUALIFYING EVENTS-
  `(a) IN GENERAL- Except as otherwise provided in this subclause, in the
  case of a qualifying event not described in paragraph (3)(B) or (3)(F),
  the date which is 36 months after the date of the qualifying event.
  `(b) INDIVIDUALS OVER 50 YEARS OF AGE AT TIME OF QUALIFYING EVENT-
  Subdivision (a) shall not apply in the case of a qualifying event described
  in subparagraph (A) or (C) of paragraph (3) for a qualified beneficiary
  who is 50 years of age or older as of the date of the qualifying event.
  `(c) CHILDREN- In the case of a qualified beneficiary described in subsection
  (g)(1)(A)(ii) who is under 20 years of age as of the date of a qualifying
  event described in subparagraph (A) or (C) of paragraph (3) and who has
  a parent who is a qualified beneficiary and is 50 years of age or older
  as of the date of the qualifying event, the period of coverage shall not
  terminate before the 23rd birthday of the individual.'.
  (b) EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974- Clause (iv) of section
  602(2)(A) of the Employee Retirement Income Security Act of 1974 (relating
  to maximum required period of continuation coverage for other qualifying
  events) is amended to read as follows:
  `(iv) GENERAL RULE FOR OTHER QUALIFYING EVENTS-
  `(I) IN GENERAL- Except as otherwise provided in this clause, in the case
  of a qualifying event not described in section 603(2), the date which is
  36 months after the date of the qualifying event.
  `(II) INDIVIDUALS OVER 50 YEARS OF AGE AT TIME OF QUALIFYING EVENT- Subclause
  (I) shall not apply in the case of a qualifying event described in paragraph
  (1) or (3) of section 603 for a qualified beneficiary who is 50 years of
  age or older as of the date of the qualifying event.
  `(III) CHILDREN- In the case of a qualified beneficiary described in section
  607(3)(A)(ii) who is under 20 years of age as of the date of a qualifying
  event described in paragraph (1) or (3) of section 603 and who has a parent
  who is a qualified beneficiary and is 50 years of age or older as of the
  date of the qualifying event, the period of coverage shall not terminate
  before the 23rd birthday of the individual.'.
  (c) PUBLIC HEALTH SERVICE ACT- Clause (iii) of section 2202(2)(A) of
  the Public Health Service Act (relating to maximum required period of
  continuation coverage for other qualifying events) is amended to read
  as follows:
  `(iii) GENERAL RULE FOR OTHER QUALIFYING EVENTS-
  `(I) IN GENERAL- Except as otherwise provided in this clause, in the case
  of a qualifying event not described in section 2203(2), the date which is
  36 months after the date of the qualifying event.
  `(II) INDIVIDUALS OVER 50 YEARS OF AGE AT TIME OF QUALIFYING EVENT- Subclause
  (I) shall not apply in the case of a qualifying event described in paragraph
  (1) or (3) of section 2203 for a qualified beneficiary who is 50 years of
  age or older as of the date of the qualifying event.
  `(III) CHILDREN- In the case of a qualified beneficiary described in
  section 2208(3)(A)(ii) who is under 20 years of age as of the date of a
  qualifying event described in paragraph (1) or (3) of section 2203 and
  who has a parent who is a qualified beneficiary and is 50 years of age
  or older as of the date of the qualifying event, the period of coverage
  shall not terminate before the 23rd birthday of the individual.'.
SEC. 233. TREATMENT OF APPLICATIONS FOR DISABILITY.
  (a) INTERNAL REVENUE CODE- The last sentence in section 4980B(f)(2)(B)(i)
  of the Internal Revenue Code of 1986, as added by 6701(a)(1) of the
  Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239) is amended
  by inserting before the period at the end the following: `and in the case
  of a qualified beneficiary who has applied for (but has not had) such a
  determination before the end of such 18 month period, any such reference
  to 18 months after the date of the qualifying event is deemed a reference
  to the date the determination is made (but not later than 29 months after
  the date of the qualifying event)'.
  (b) EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974- The last sentence in
  section 602(2)(A) of the Employee Retirement Income Security Act of 1974,
  as added by 6703(a)(1) of the Omnibus Budget Reconciliation Act of 1989
  (Public Law 101-239), is amended by inserting before the period at the end
  the following: `and in the case of a qualified beneficiary who has applied
  for (but has not had) such a determination before the end of such 18 month
  period, any such reference to 18 months after the date of the qualifying
  event is deemed a reference to the date the determination is made (but
  not later than 29 months after the date of the qualifying event)'.
  (c) PUBLIC HEALTH SERVICE ACT- The last sentence in section 2202(2)(A)
  of the Public Health Service Act, as added by 6702(a)(1) of the Omnibus
  Budget Reconciliation Act of 1989 (Public Law 101-239) is amended by
  inserting before the period at the end the following: `and in the case
  of a qualified beneficiary who has applied for (but has not had) such a
  determination before the end of such 18 month period, any such reference
  to 18 months after the date of the qualifying event is deemed a reference
  to the date the determination is made (but not later than 29 months after
  the date of the qualifying event)'.
SEC. 234. NOTICE OF CONVERSION OPTION.
  (a) INTERNAL REVENUE CODE- Section 4980B(f)(2)(E) of the Internal Revenue
  Code of 1986 (relating to notice of conversion option) is amended by striking
  `during the 180-day period ending on such expiration date' and inserting
  `during the 120-day period ending 60 days before such expiration date'.
  (b) EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974- Section 602(5) of
  the Employee Retirement Income Security Act of 1974 (relating to notice
  of conversion option) is amended by striking `during the 180-day period
  ending on such expiration date' and inserting `during the 120-day period
  ending 60 days before such expiration date'.
  (c) PUBLIC HEALTH SERVICE ACT- Section 2202(5) of the Public Health Service
  Act (relating to notice of conversion option) is amended by striking
  `during the 180-day period ending on such expiration date' and inserting
  `during the 120-day period ending 60 days before such expiration date'.
SEC. 235. TREATMENT OF SUCCESSOR EMPLOYERS.
  (a) INTERNAL REVENUE CODE- Section 4980b(f)(2)(B)(ii) of the Internal
  Revenue Code of 1986 (relating to end of plans) is amended by inserting
  `or successor employer' after `employer'.
  (b) EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974- Section 602(2)(B)
  of the Public Health Service Act (relating to end of plans) is amended by
  inserting `or successor employer' after `employer'.
  (c) PUBLIC HEALTH SERVICE ACT- Section 2202(2)(B) of the Public Health
  Service Act (relating to end of plans) is amended by inserting `or successor
  employer' after `employer'.
SEC. 236. EFFECTIVE DATE.
  The amendments made by this subtitle shall apply to qualifying events
  occurring on or after the date of the enactment of this Act for plan years
  beginning after December 31, 1990.
Subtitle E--Federal Employee Family-Building
SEC. 241. SHORT TITLE.
  This subtitle may be cited as the `Federal Employee Family-Building Act
  of 1990'.
SEC. 242. FAMILY-BUILDING BENEFIT.
  Section 8902 of title 5, United States Code, is amended by adding at the
  end the following:
  `(n)(1) For the purpose of this subsection--
  `(A) the term `family-building procedure' means--
  `(i) a medical procedure to overcome infertility, including procedures to
  achieve pregnancy and procedures to carry pregnancy to term; and
  `(ii) procedures relating to child adoption; and
  `(B) the term `child' means an individual who is under 18 years of age
  and unmarried.
  `(2) Any contract under this chapter that provides obstetrical benefits
  shall also provide benefits for family-building procedures. Any deductible,
  coinsurance provision, and other similar term or condition under any
  contract shall be no more restrictive for family-building benefits than
  for obstetrical benefits.
  `(3) To the extent that a contract under this chapter relates to procedures
  relating child adoption, the contract shall provide that--
  `(A) benefits shall consist of reimbursement for reasonable and necessary--
  `(i) medical expenses directly relating to the adoption of the child,
  such as those relating to obstetrical care for the biological mother,
  medical care for the child, and physical examinations for the pre-adoptive
  or adoptive parent or parents; and
  `(ii) counseling fees directly relating to the adoption of the child; and
  `(B) benefits shall be available in connection with--
  `(i) obstetrical care for the biological mother if, or to the extent that,
  the pre-adoptive or adoptive parent or parents are legally responsible for
  the cost of the care, whether by contract or under applicable provisions
  of law; and
  `(ii) medical care for the child if, or to the extent that, the pre-adoptive
  or adoptive parent or parents are legally responsible for the cost of the
  care, whether by contract or under applicable provisions of law.'.
SEC. 243. USE OF SICK LEAVE; PROHIBITION OF COERCION.
  Section 6307 of title 5, United States Code, is amended by adding at the
  end the following:
  `(d)(1) The Office of Personnel Management shall prescribe regulations under
  which sick leave otherwise available to an employee under this subchapter
  shall also be available for purposes relating to family-building procedures.
  `(2)(A) An employee may not directly or indirectly intimidate, threaten,
  or coerce, or attempt to intimidate, threaten, or coerce, any other employee
  for the purpose of interfering with the rights of the other employee under
  this subsection.
  `(B) For the purposes of this subsection--
  `(i) the term `family-building procedure' has the meaning given the term
  in section 8902(n)(1)(A)(i); and
  `(ii) the term `intimidate, threaten, or coerce' includes promising
  to confer or conferring any benefit (such as appointment, promotion,
  or compensation), or effecting or threatening to effect any reprisal
  (such as deprivation of appointment, promotion, or compensation).'.
TITLE III--PREVENTION
Subtitle A--Medicaid Infant Mortality
SEC. 301. SHORT TITLE.
  This subtitle may be cited as the `Infant Mortality Amendments of 1990'.
SEC. 302. PHASED-IN COVERAGE OF PREGNANT WOMEN AND INFANTS UP TO 185 PERCENT
OF POVERTY LEVEL.
  (a) IN GENERAL- Section 1902(l)(2)(A) of the Social Security Act (42
  U.S.C. 1396a(l)(2)(A)) is amended--
  (1) in clause (ii)--
  (A) in subclause (I), by striking `and' at the end of subclause (I),
  (B) by striking the period at the end of subclause (II) and inserting a
  comma, and
  (C) by adding at the end the following new subclauses:
  `(III) July 1, 1991, 150 percent, or, if greater, the percentage provided
  under clause (v), and
  `(IV) July 1, 1993, 185 percent.'; and
  (2) by adding at the end the following new clause:
  `(v) In the case of a State which, as of the date of the enactment of
  this clause, has established under clause (i), or has enacted legislation
  authorizing, or appropriating funds, to provide for, a percentage (of
  the income official poverty line) that is greater than 150 percent, the
  percentage provided under clause (ii) for medical assistance on or after
  July 1, 1991, shall not be less than--
  `(I) the percentage specified by the State in an amendment to its State plan
  (whether approved or not) as of the date of the enactment of this clause, or
  `(II) if no such percentage is specified as of the date of the enactment
  of this clause, the percentage established under the State's authorizing
  legislation or provided for under the State's appropriations.'.
  (b) FLEXIBILITY IN INCOME METHODOLOGY AND DEDUCTION OF CHILD CARE
  IN COMPUTATION OF INCOME- Section 1902(l)(3)(E) of the Act (42
  U.S.C. 1396a(l)(3)(E)) is amended by striking `(E)' and inserting the
  following:
  `(E)(i) with respect to an individual described in subparagraph (A) or (B)
  of paragraph (1), family income shall be determined in accordance with a
  methodology which is no more restrictive than the methodology employed under
  the State plan under part A or E of title IV (except to the extent such
  methodology is inconsistent with subparagraph (D) of subsection (a)(17)
  and except that there shall be disregarded costs for such child care as
  is necessary for the employment of the pregnant woman or the caretaker of
  the infant), and costs incurred for medical care or for any other type of
  remedial care shall not be taken into account, and
  `(ii) with respect to an individual described in paragraph (1)(C) or
  (1)(D),'.
  (c) PROHIBITING APPLICATION OF RESOURCE TEST- Section 1902(l)(3) of the Act
  (42 U.S.C. 1396a(l)(3)) is amended--
  (1) by striking subparagraph (A) and inserting the following new
  subparagraph:
  `(A)(i) no resource standard or methodology shall be applied to
  individuals who are eligible for medical assistance because of subsection
  (a)(10)(A)(i)(IV), and (ii) application of a resource standard or methodology
  for individuals who are eligible for medical assistance because of subsection
  (a)(10)(A)(i)(VI) or (a)(10)(A)(ii)(IX) shall be at the option of the State,
  but any such resource standard or methodology may not be more restrictive
  than the corresponding standard or methodology that is applied under the
  State plan under part A of title IV;',
  (2) by striking subparagraphs (B) and (C), and
  (3) by redesignating subparagraphs (D) and (E) as subparagraphs (B) and
  (C), respectively.
  (d) REPORT AND TRANSITION ON ERRORS IN ELIGIBILITY DETERMINATIONS-
  (1) REPORT- The Secretary of Health and Human Services shall report to
  Congress, by not later than July 1, 1991, on error rates by States in
  determining eligibility of individuals described in subparagraph (A) or (B)
  of section 1902(l)(1) of the Social Security Act for medical assistance
  under plans approved under title XIX of the Act. Such report may include
  data for medical assistance provided before July 1, 1989.
  (2) ERROR RATE TRANSITION- There shall not be taken into account, for
  purposes of section 1903(u) of the Social Security Act, payments and
  expenditures for medical assistance which--
  (A) are attributable to medical assistance for individuals described in
  subparagraph (A) or (B) of section 1902(l)(1) of the Act, as amended by
  this section, and
  (B) are made on or after July 1, 1989, and before the first calendar
  quarter that begins more than 12 months after the date of submission of
  the report under paragraph (1).
  (e) EFFECTIVE DATES-
  (1) HIGHER INCOME STANDARDS- Except as provided in paragraph (3), the
  amendments made by subsection (a) shall apply to payments under title XIX of
  the Social Security Act for calendar quarters beginning on or after July 1,
  1991, with respect to eligibility for medical assistance on or after such
  date, without regard to whether or not final regulations to carry out such
  amendments have been promulgated by such date.
  (2) INCOME METHODOLOGY AND RESOURCE STANDARD- Except as provided in paragraph
  (3), the amendments made by subsections (b) and (c) shall apply to payments
  under title XIX of the Social Security Act for calendar quarters beginning
  on or after July 1, 1991, with respect to eligibility for medical assistance
  on or after such date, without regard to whether or not final regulations
  to carry out such amendments have been promulgated by such date.
  (3) EXCEPTION FOR CERTAIN STATES- (A) In the case of a State plan for
  medical assistance under title XIX of the Social Security Act which
  the Secretary of Health and Human Services determines requires State
  legislation (other than legislation appropriating funds) in order for the
  plan to meet the additional requirements imposed by the amendments made by
  this section, the State plan shall not be regarded as failing to comply
  with the requirements of such title solely on the basis of its failure
  to meet these additional requirements before the first day of the first
  calendar quarter beginning after the close of the first regular session
  of the State legislature that begins after the date of the 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 such session shall be
  deemed to be a separate regular session of the State legislature.
  (B) In the case of the State of Texas, the State plan shall not be
  regarded as failing to comply with the requirements of title XIX of
  the Social Security Act solely on the basis of its failure to meet the
  additional requirements imposed by the amendments made by this section
  before September 1, 1991.
SEC. 303. PHASED-IN MANDATORY COVERAGE OF CHILDREN UP TO 100 PERCENT OF
POVERTY LEVEL.
  (a) IN GENERAL- Section 1902 of the Social Security Act (42 U.S.C. 1396a),
  as amended by section 302, is further amended--
  (1) in subsection (a)(10)(A)(i)--
  (A) by striking `or' at the end of subclause (V),
  (B) by striking the semicolon at the end of subclause (VI) and inserting
  `, or', and
  (C) by adding at the end the following new subclause:
  `(VII) who are described in subparagraph (D) of subsection (l)(1) and whose
  family income does not exceed the income level the State is required to
  establish under subsection (l)(2)(C) for such a family;';
  (2) in subsection (a)(10)(A)(ii)(IX), by striking `or clause (i)(VI)'
  and inserting `, clause (i)(VI), or clause (i)(VII)';
  (3) in subsection (l)--
  (A) by striking subparagraph (D) of paragraph (1) and inserting the
  following new subparagraph:
  `(D) children born after September 30, 1983, who have attained one year
  of age but have not attained 19 years of age,';
  (B) by striking subparagraph (C) of paragraph (2) and inserting the
  following:
  `(C) For purposes of paragraph (1) with respect to individuals described
  in subparagraph (D) of that paragraph, the State shall establish an income
  level which is equal to 100 percent of the income official poverty line
  described in subparagraph (A) applicable to a family of the size involved.';
  (C) in paragraph (3)--
  (i) by inserting `, (a)(10)(A)(i)(VII),' after `(a)(10)(A)(i)(VI)', and
  (ii) in subparagraph (C), as redesignated by section 302(c), by striking
  `the methodology employed' and inserting `a methodology which is no more
  restrictive than the methodology employed';
  (D) in paragraph (4)(A), by inserting `or subsection (a)(10)(A)(i)(VII)'
  after `(a)(10)(A)(i)(VI)'; and
  (E) in paragraph (4)(B), by striking `or (a)(10)(A)(i)(VI)' and inserting `,
  (a)(10)(A)(i)(VI), or (a)(10)(A)(i)(VII)'; and
  (4) in subsection (r)(2)(A), by inserting `(a)(10)(A)(i)(VII),' after
  `(a)(10)(A)(i)(VI),'.
  (b) APPLICATIONS USING OUTREACH LOCATIONS- Section 1902(a) of the Act
  (42 U.S.C. 1396a(a)) is amended--
  (1) by striking `and' at the end of paragraph (52),
  (2) by striking the period at the end of paragraph (53) and inserting `;
  and', and
  (3) by inserting after paragraph (53) the following new paragraph:
  `(54) provide for receipt and initial processing of applications of
  individuals for medical assistance under subsections (a)(10)(A)(i)(IV),
  (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or (a)(10)(A)(ii)(IX)--
  `(A) at locations which include locations (such as hospitals or clinics
  providing covered services to such individuals, without discrimination
  based on whether the hospital or clinic is public or private) which are
  other than those used for the receipt and processing of applications for
  aid under part A of title IV, and
  `(B) using applications which are other than those used for applications
  for aid under such part.'.
  (c) CONFORMING AMENDMENT TO QUALIFIED CHILDREN- Section 1905(n)(2) of the
  Act (42 U.S.C. 1396d(n)(2)) is amended by striking `age of 7 (or any age
  designated by the State that exceeds 7 but does not exceed 8)' and inserting
  `age of 18'.
  (d) ADDITIONAL CONFORMING AMENDMENTS-
  (1) Section 1903(f)(4) of the Act (42 U.S.C. 1396b(f)(4)) is amended--
  (A) by striking `1902(a)(10)(A)(i)(IV),' and inserting
  `1902(a)(10)(A)(i)(III), 1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(V),', and
  (B) by inserting after `1902(a)(10)(A)(i)(VI),' the following:
  `1902(a)(10)(A)(i)(VII), 1902(a)(1)(A)(ii)(I),'.
  (2) Subsections (a)(3)(C) and (b)(3)(C)(i) of section 1925 of the Act (42
  U.S.C. 1396r-6) are each amended by inserting `(i)(VII),' after `(i)(VI)'.
  (e) EFFECTIVE DATE- (1) The amendments made by this section apply (except
  as otherwise provided in this subsection) to payments under title XIX of
  the Social Security Act for calendar quarters beginning on or after July 1,
  1991, without regard to whether or not final regulations to carry out such
  amendments have been promulgated by such date.
  (2)(A) In the case of a State plan for medical assistance under title XIX
  of the Social Security Act which the Secretary of Health and Human Services
  determines requires State legislation (other than legislation appropriating
  funds) in order for the plan to meet the additional requirements imposed by
  the amendments made by this section, the State plan shall not be regarded
  as failing to comply with the requirements of such title solely on the
  basis of its failure to meet these additional requirements before the first
  day of the first calendar quarter beginning after the close of the first
  regular session of the State legislature that begins after the date of the
  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 such session
  shall be deemed to be a separate regular session of the State legislature.
  (B) In the case of the State of Texas, the State plan shall not be
  regarded as failing to comply with the requirements of title XIX of
  the Social Security Act solely on the basis of its failure to meet the
  additional requirements imposed by the amendments made by this section
  before September 1, 1991.
SEC. 304. OPTIONAL COVERAGE OF CHILDREN UP TO AGE 6 WITH INCOME BELOW 185
PERCENT OF THE POVERTY LEVEL.
  (a) IN GENERAL- Section 1902 of the Social Security Act (42 U.S.C. 1396a),
  as amended by section 303, is further amended--
  (1) in subclauses (VI) and (VII) of subsection (a)(10)(A)(i), by inserting
  `minimum' before `income level', and
  (2) in subsection (l)(2)(B), by striking `133 percent' and inserting `a
  percentage (established by the State, which is not less than 133 percent
  and not more than 185 percent)'.
  (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to
  payments under title XIX of the Social Security Act for calendar quarters
  beginning on or after July 1, 1991, with respect to eligibility for medical
  assistance on or after such date, without regard to whether or not final
  regulations to carry out such amendments have been promulgated by such date.
SEC. 305. OPTIONAL COVERAGE OF CHILDREN UP TO AGE 18 WITH INCOME BELOW 100
PERCENT OF THE POVERTY LEVEL.
  (a) IN GENERAL- Section 1902(l) of the Social Security Act (42
  U.S.C. 1396a(l)), as amended by section 303, is amended--
  (1) in paragraph (1)--
  (A) by striking `and' at the end of subparagraph (C);
  (B) by adding `and' at the end of subparagraph (D); and
  (C) by adding after subparagraph (D) the following new subparagraph:
  `(E) at the option of the State, children who are not described in
  subparagraph (C) or (D), but have not attained 19 years of age,'; and
  (2) in paragraph (2), by adding at the end thereof the following new
  subparagraph:
  `(D) If a State elects, under subsection (a)(10)(A)(ii)(IX), to cover
  individuals not described in subparagraph (A), (B), (C), or (D) of paragraph
  (1), for purposes of that paragraph and with respect to individuals
  not described in such subparagraphs the State shall establish an income
  level with a percentage not more than 100 percent of the income official
  poverty line described in subparagraph (A), applicable to a family of the
  size involved.'.
SEC. 306. OPTIONAL COVERAGE OF PRENATAL AND POSTPARTUM HOME VISITATION
SERVICES.
  (a) IN GENERAL- Section 1905(a) of the Social Security Act (42
  U.S.C. 1396d(a)) is amended--
  (1) by striking `and' at the end of paragraph (21),
  (2) by redesignating paragraph (22) as paragraph (23), and
  (3) by inserting after paragraph (20) the following new paragraph:
  `(22) prenatal home visitation services for high-risk pregnant women,
  postpartum home visitation services with respect to high-risk infants
  under 1 year of age, or both (as specified by the State), as prescribed
  by a physician; and'.
  (b) CONFORMING AMENDMENTS- Section 1902 of the Act (42 U.S.C. 1396a)
  is amended--
  (1) in subsection (a)(10)(C)(iv), by striking `(20)' and inserting
  `(22)', and
  (2) in subsection (j), by striking `(21)' and inserting `(23)'.
  (c) EFFECTIVE DATE- The amendments made by this section shall apply to
  services furnished on or after July 1, 1991, without regard to whether or
  not final regulations to carry out such amendments have been promulgated
  by such date.
SEC. 307. PRESUMPTIVE ELIGIBILITY.
  (a) EXTENSION OF PRESUMPTIVE ELIGIBILITY PERIOD- Section 1920 of the Social
  Security Act (42 U.S.C. 1396r-1) is amended--
  (1) in subsection (b)(1)(B)--
  (A) by adding `or' at the end of clause (i),
  (B) by striking clauses (ii) and (iii), and
  (C) by adding at the end thereof the following new clause:
  `(ii) in the case of a woman who does not file an application by the last
  day of the month following the month during which the provider makes the
  determination referred to in subparagraph (A), such last day; and'; and
  (2) in subsections (c)(2)(B) and (c)(3), by striking `within 14 calendar
  days after the date on which' and inserting `by not later than the last
  day of the month following the month during which'.
  (b) FLEXIBILITY IN APPLICATION- Section 1920(c)(3) of the Act (42
  U.S.C. 1396r-1(c)(3)) is amended by inserting before the period at the
  end the following: `, which application may be the application used for
  the receipt of medical assistance by individuals described in section
  1902(l)(1)(A)'.
  (c) EFFECTIVE DATES-
  (1) The amendments made by subsection (a) apply to payments under title
  XIX of the Social Security Act for calendar quarters beginning on or after
  July 1, 1991, without regard to whether or not final regulations to carry
  out such amendments have been promulgated by such date.
  (2) The amendment made by subsection (b) shall be effective as if included
  in the enactment of section 9407(b) of the Omnibus Budget Reconciliation
  Act of 1986.
SEC. 308. EXTENSION OF PAYMENT PROVISIONS FOR MEDICALLY NECESSARY SERVICES
IN DISPROPORTIONATE SHARE HOSPITALS TO CHILDREN UNDER 18 YEARS OF AGE.
  (a) COVERAGE OF MEDICALLY NECESSARY SERVICES FOR CHILDREN- Section
  1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended,
  in the subdivision (X) following subparagraph (E), by striking `under one
  year of age' and inserting `under 18 years of age'.
  (b) ASSURING ADEQUATE PAYMENT FOR INPATIENT HOSPITAL SERVICES FOR
  CHILDREN IN DISPROPORTIONATE SHARE HOSPITALS- Section 1923(a)(2) of the
  Act (42 U.S.C. 1396r-4) is amended by adding at the end the following
  new subparagraph:
  `(D) If a State plan under this title provides for payments for inpatient
  hospital services on a prospective basis (whether per diem, per case,
  or otherwise), in order for the plan to be considered to have met such
  requirement of section 1902(a)(13)(A) as of July 1, 1991, the State must
  submit to the Secretary by not later than April 1, 1991, a State plan
  amendment that provides, in the case of hospitals defined by the State as
  disproportionate share hospitals under paragraph (1)(A), for an outlier
  adjustment in payment amounts for medically necessary inpatient hospital
  service provided on or after July 1, 1991, involving exceptionally high
  costs or exceptionally long lengths of stay for individuals one year of
  age or older, but under 18 years of age.'.
  (c) EFFECTIVE DATES- (1)(A) The amendment made by subsection (a) applies
  (except as provided under subparagraph (B)) to payments under title XIX of
  the Social Security Act for calendar quarters beginning on or after July 1,
  1991, without regard to whether or not final regulations to carry out such
  amendment have been promulgated by such date.
  (B) In the case of a State plan for medical assistance under title XIX of
  the Social Security Act which the Secretary of Health and Human Services
  determines requires State legislation (other than legislation appropriating
  funds) in order for the plan to meet the additional requirement imposed by
  the amendment made by subsection (a), the State plan shall not be regarded
  as failing to comply with the requirements of such title solely on the
  basis of its failure to meet this additional requirement before the first
  day of the first calendar quarter beginning after the close of the first
  regular session of the State legislature that begins after the date of the
  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 such session
  shall be deemed to be a separate regular session of the State legislature.
  (2) The amendment made by subsection (b) shall take effect on the date of
  the enactment of this Act.
Subtitle B--Breast and Cervical Cancer
SEC. 311. SHORT TITLE.
  This subtitle may be cited as the `Breast and Cervical Cancer Mortality
  Prevention Act of 1990'.
SEC. 312. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES FOR PREVENTION AND
CONTROL OF BREAST AND CERVICAL CANCER.
  The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
  inserting after title XIV the following new title:
`TITLE XV--PREVENTIVE HEALTH MEASURES WITH RESPECT TO BREAST AND CERVICAL
CANCERS
`SEC. 1501. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES.
  `(a) IN GENERAL- The Secretary, acting through the Director of the Centers
  for Disease Control, may make grants to States for the purpose of carrying
  out programs established in accordance with this title--
  `(1) to screen women for breast and cervical cancer as a preventive
  health measure;
  `(2) to provide appropriate referrals for medical treatment of women
  screened under paragraph (1) and to provide appropriate follow-up services
  with respect to the effect of such referrals;
  `(3) to develop and disseminate public information and education programs
  for the prevention and control of breast and cervical cancer;
  `(4) to improve the education, training, and skills of health professionals,
  including allied health professionals, in the prevention and control of
  breast and cervical cancer;
  `(5) to establish mechanisms through which the State can monitor the
  quality of screening procedures for breast and cervical cancer, including
  the interpretation of the procedures; and
  `(6) to evaluate activities conducted under paragraphs (1) through (5)
  through appropriate surveillance or monitoring activities.
  `(b) PREFERENCES IN MAKING GRANTS- In making grants under subsection (a),
  the Secretary shall give preference to any State in which--
  `(1) there is a substantial rate of mortality associated with breast or
  cervical cancer, relative to the national rate of associated mortality; and
  `(2) there is an inadequate availability of services or activities described
  in subsection (a).
  `(c) GEOGRAPHIC DISTRIBUTION OF GRANTS- In making grants under subsection
  (a), the Secretary shall ensure that the grants are equitably distributed
  among the principal geographic regions of the United States.
  `(d) GRANT AND CONTRACT AUTHORITY OF STATES- A State receiving a grant under
  subsection (a) may expend the grant to carry out the purpose described in
  such subsection through grants to, and contracts with, public or nonprofit
  private entities.
`SEC. 1502. REQUIREMENT OF MATCHING FUNDS.
  `(a) IN GENERAL- The Secretary may not make a grant under section 1501
  unless the State involved agrees, with respect to the costs to be incurred
  by the State in carrying out the purpose described in such section, to make
  available non-Federal contributions (in cash or in kind under subsection
  (b)) toward the costs in an amount equal to not less than $1 for each
  $3 of Federal funds provided in the grant. The contributions may be made
  directly or through donations from public or private entities.
  `(b) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION-
  `(1) IN GENERAL- Non-Federal contributions required in subsection (a)
  may be in cash or in kind, fairly evaluated, including equipment or
  services. Amounts provided by the Federal Government, or services assisted
  or subsidized to any significant extent by the Federal Government, may not
  be included in determining the amount of such non-Federal contributions. In
  making a determination of the non-Federal contribution, the Secretary
  shall exclude indirect or overhead costs.
  `(2) MAINTENANCE OF EFFORT- In making a determination of the amount of
  non-Federal contributions for purposes of subsection (a), the Secretary
  may include only non-Federal contributions in excess of the average amount
  of non-Federal contributions made by the State involved toward the purpose
  described in section 1501 during the 2-year period preceding the first fiscal
  year for which the State is applying to receive a grant under the section.
  `(3) INCLUSION OF RELEVANT NON-FEDERAL CONTRIBUTIONS FOR MEDICAID- In making
  a determination of the amount of non-Federal contributions for purposes of
  subsection (a), the Secretary shall, subject to paragraphs (1) and (2) of
  this subsection, include any non-Federal amounts expended under title XIX
  of the Social Security Act (42 U.S.C. 1396 et seq.) by the State involved
  toward the purpose described in paragraphs (1) and (2) of section 1501(a).
`SEC. 1503. REQUIREMENTS WITH RESPECT TO TYPE AND QUALITY OF SERVICES.
  `(a) REQUIREMENT OF PROVISION OF ALL SERVICES BY DATE CERTAIN- The Secretary
  may not make a grant under section 1501 unless the State involved agrees--
  `(1) to ensure that, initially and throughout the period during which
  amounts are received under the grant, the State will expend not less than
  60 percent of the grant to provide each of the services or activities
  described in paragraphs (1) and (2) of section 1501(a), including making
  available screening procedures for both breast and cervical cancers;
  `(2) subject to subsection (b), to ensure that State screening programs
  established under section 1501(a) shall include--
  `(A) in the case of breast cancer, both a physical examination of the
  breasts and the screening procedure known as a mammography; and
  `(B) in the case of cervical cancer, the screening procedure known as a
  pap smear;
  `(3) to ensure that the State will provide each of the services or
  activities described in section 1501(a) by the end of any second fiscal
  year of payments pursuant to the grant; and
  `(4) to ensure that the State will expend not more than 40 percent of the
  grant to provide the services or activities described in paragraphs (3)
  through (6) of section 1501(a).
  `(b) USE OF IMPROVED SCREENING PROCEDURES- The Secretary may not make
  a grant under section 1501 unless the State involved agrees that, if
  any cytological screening procedure superior to a procedure described
  in subsection (a)(2) becomes commonly available, any entity providing
  screening procedures under the grant will utilize the superior procedure
  rather than the procedure described in the subsection.
  `(c) QUALITY ASSURANCE REGARDING SCREENING FOR BREAST CANCER- The Secretary
  may not make a grant under section 1501 unless the State involved agrees
  that the State will assure the quality of any screening procedure for
  breast cancer conducted under the section and, in the case of mammography,
  will provide that--
  `(1) the equipment used to perform the mammography will be specifically
  designed for mammography and will meet appropriate radiologic standards
  for mammography;
  `(2) the mammography will be performed by an individual who--
  `(A) is licensed by a State to perform radiological procedures; or
  `(B) is certified as qualified to perform radiological procedures by an
  appropriate organization;
  `(3) the results of the mammography will be interpreted by a physician who--
  `(A) is certified as qualified to interpret radiological procedures by an
  appropriate board; or
  `(B) is certified as qualified to interpret screening mammography procedures
  by an appropriate program for assuring the qualifications of the individual
  with respect to the interpretations; and
  `(4) there are satisfactory assurances that the results of the first
  screening mammography performed on a woman for which payment is made
  pursuant to section 1501(a) will be placed in permanent medical records
  maintained with respect to the woman.
  `(d) QUALITY ASSURANCE REGARDING SCREENING FOR CERVICAL CANCER- The Secretary
  may not make a grant under section 1501 unless the State involved agrees
  that the State will assure the quality of any screening procedure for
  cervical cancer conducted under the section and, in the case of the pap
  smear or other cytological screening procedure replacing the pap smear
  pursuant to subsection (b), will establish and enforce--
  `(1) requirements governing the maximum number of cytology slides that
  any individual may screen in a 24-hour period;
  `(2) requirements that a clinical laboratory maintain a record of--
  `(A) the number of cytology slides screened during each 24-hour period by
  each individual who examines cytology slides for the laboratory; and
  `(B) the number of hours devoted during each 24-hour period to screening
  cytology slides by the individual;
  `(3) criteria for requiring rescreening of cytological preparations,
  such as--
  `(A) random rescreening of cytology specimens determined to be in the
  benign category;
  `(B) focused rescreening of the preparations in high risk groups; and
  `(C) for each abnormal cytological result, rescreening of all prior
  cytological specimens for the patient, if available;
  `(4) requirements governing periodic confirmation and evaluation of
  the proficiency of individuals involved in screening or interpreting
  cytological preparations, including announced and unannounced onsite
  proficiency testing of the individuals, with the testing to take place,
  to the extent practicable, under normal working conditions;
  `(5) procedures for detecting inadequately prepared slides, for assuring
  that no cytological diagnosis is rendered on the slides, and for notifying
  referring physicians of the slides;
  `(6) requirements that all cytological screening be done on the premises
  of an appropriately qualified laboratory;
  `(7) requirements for the retention of cytology slides by laboratories
  for appropriate periods of time; and
  `(8) requirements of periodic inspection of cytology services by persons
  capable of evaluating the quality of cytology services.
  `(e) ISSUANCE BY SECRETARY OF GUIDELINES WITH RESPECT TO QUALITY OF
  MAMMOGRAPHY AND CYTOLOGICAL SERVICES-
  `(1) IN GENERAL- The Secretary shall establish guidelines for assuring the
  quality of any mammography and cytological screening procedure conducted
  pursuant to section 1501(a). Guidelines with respect to mammography shall
  include the provisions of paragraphs (1) through (4) of subsection (c),
  and guidelines with respect to cytological screening procedures shall
  include the provisions of paragraphs (1) through (8) of subsection (d).
  `(2) APPLICABILITY WITH RESPECT TO GRANTS- The Secretary may not make a
  grant under section 1501 unless the State involved agrees that the State
  will, with respect to any mammography or cytological screening procedure
  conducted pursuant to such section, ensure that the procedure is conducted in
  accordance with the guidelines issued by the Secretary under paragraph (1).
  `(3) RESPONSIBILITY OF STATES IN ABSENCE OF GUIDELINES- With respect to
  circumstances in which a State receives a grant under section 1501 before
  the issuance of guidelines under paragraph (1), this subsection may not be
  construed to affect the obligation of the State under subsection (a)(1)
  to provide for screening procedures and referrals or the obligations of
  the State under subsections (c) and (d).
`SEC. 1504. ADDITIONAL REQUIRED AGREEMENTS.
  `(a) PRIORITY FOR LOW-INCOME WOMEN- The Secretary may not make a grant under
  section 1501 unless the State involved agrees that low-income women will
  be given priority in the provision of services and activities described
  in paragraphs (1) and (2) of section 1501(a).
  `(b) LIMITATION ON IMPOSITION OF FEES FOR SERVICES- The Secretary may not
  make a grant under section 1501 unless the State involved agrees that,
  if a charge is imposed for the provision of services or activities under
  the grant, the charge--
  `(1) will be made according to a schedule of charges that is made available
  to the public;
  `(2) will be adjusted to reflect the income of the woman involved; and
  `(3) will not be imposed on any woman with an income of less than 100 percent
  of the official poverty line, as established by the Director of the Office
  of Management and Budget and revised by the Secretary in accordance with
  section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)).
  `(c) STATEWIDE PROVISION OF SERVICES-
  `(1) IN GENERAL- The Secretary may not make a grant under section 1501 unless
  the State involved agrees that services and activities under the grant will
  be made available throughout the State, including availability to members
  of any Indian tribe or tribal organization (as such terms are defined in
  subsections (e) and (l) of section 4 of the Indian Self-Determination and
  Education Assistance Act (25 U.S.C. 450b).
  `(2) WAIVER- The Secretary may waive the requirement established in paragraph
  (1) for a State if the Secretary determines that compliance by the State
  with the requirement would result in an inefficient allocation of resources
  with respect to carrying out the purpose described in section 1501(a).
  `(d) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PROGRAMS- The Secretary
  may not make a grant under section 1501 unless the State involved agrees
  that the grant will not be used to pay for any item or service to the
  extent that payment has been made, or can reasonably be expected to be made,
  for the item or service--
  `(1) under any State compensation program, under an insurance policy,
  or under any Federal or State health benefits program; or
  `(2) by an entity that provides health services on a prepaid basis.
  `(e) LIMITATION ON ADMINISTRATIVE EXPENSES- The Secretary may not make a
  grant under section 1501 unless the State involved agrees that not more
  than 10 percent of the grant will be expended for administrative expenses
  with respect to the grant.
  `(f) RECORDS AND AUDITS- The Secretary may not make a grant under section
  1501 unless the State involved agrees that--
  `(1) the State will establish such fiscal control and fund accounting
  procedures as may be necessary to ensure the proper disbursal of, and
  accounting for, amounts received by the State under the section; and
  `(2) upon request, the State will provide records maintained pursuant to
  paragraph (1) to the Secretary or the Comptroller of the United States
  for purposes of auditing the expenditures by the State of the grant.
  `(g) REPORTS TO SECRETARY- The Secretary may not make a grant under section
  1501 unless the State involved agrees to submit to the Secretary such
  reports as the Secretary may require with respect to the grant.
`SEC. 1505. DESCRIPTION OF INTENDED USES OF GRANT.
  `The Secretary may not make a grant under section 1501 unless--
  `(1) the State involved submits to the Secretary an application under
  section 1506 that contains a description of the purposes for which the
  State intends to expend the grant;
  `(2) the description identifies the populations, areas, and localities in
  the State with a need for the services or activities described in section
  1501(a); and
  `(3) the description provides information relating to the services and
  activities to be provided, including a description of the manner in which
  the services and activities will be coordinated with any similar services
  or activities of public or nonprivate entities.
`SEC. 1506. REQUIREMENT OF SUBMISSION OF APPLICATION.
  `The Secretary may not make a grant under section 1501 unless an application
  for the grant is submitted to the Secretary and the application is in such
  form, is made in such manner, and contains such agreements, assurances,
  and information as the Secretary determines to be necessary to carry out
  this title.
`SEC. 1507. TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND SERVICES IN
LIEU OF GRANT FUNDS.
  `(a) TECHNICAL ASSISTANCE- The Secretary may provide training and technical
  assistance with respect to the planning, development, and operation of any
  program or service carried out under section 1501. The Secretary may provide
  the technical assistance directly or through grants to, or contracts with,
  public and private entities.
  `(b) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS-
  `(1) IN GENERAL- Upon the request of a State receiving a grant under section
  1501, the Secretary may, subject to paragraph (2), provide supplies,
  equipment, and services for the purpose of aiding the State in carrying
  out the section and may detail to the State any officer or employee of
  the Department of Health and Human Services.
  `(2) CORRESPONDING REDUCTION IN PAYMENTS- If the Secretary details an
  officer or employee in response to a request described in paragraph (1),
  the Secretary shall reduce the amount of payments under the grant under
  section 1501 to the State involved by an amount equal to the costs of
  detailing personnel (including pay, allowances, and travel expenses) and
  the fair market value of any supplies, equipment, or services provided by
  the Secretary. The Secretary shall expend the amounts withheld to pay for
  the expenses incurred in complying with the request.
`SEC. 1508. EVALUATIONS AND REPORTS.
  `(a) EVALUATIONS- The Secretary shall, directly or through contracts with
  public or private entities, provide for annual evaluations of programs
  carried out pursuant to section 1501.
  `(b) REPORT TO CONGRESS- The Secretary shall, not later than 1 year after
  the date on which amounts are first appropriated pursuant to section
  1509(a), and annually thereafter, 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 summarizing evaluations carried
  out under subsection (a) during the preceding fiscal year and making such
  recommendations for administrative and legislative initiatives with respect
  to this title as the Secretary determines to be appropriate.
`SEC. 1509. FUNDING.
  `(a) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  title, there are authorized to be appropriated $50,000,000 for fiscal year
  1991, and such sums as may be necessary for each of the fiscal years 1992
  and 1993.
  `(b) SET-ASIDE FOR TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND
  SERVICES- The Secretary shall expend not less than 20 percent of the
  amounts appropriated under subsection (a) to carry out section 1507.
  `(c) LIMITATION ON NUMBER OF INITIAL GRANTS- For fiscal year 1991, the
  Secretary may not make more than seven grants under section 1501.'.
Subtitle C--Medicare Screening Mammography
SEC. 321. SHORT TITLE.
  This subtitle may be cited as the `Medicare Screening Mammography Amendments
  of 1990'.
SEC. 322. MEDICARE COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY.
  (a) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x)
  is amended--
  (1) in subsection (s)--
  (A) in paragraph (11), by striking `and' at the end thereof,
  (B) in paragraph (12)(C), by striking the period at the end thereof and
  inserting a semicolon, and
  (C) by inserting after paragraph (12) the following new paragraph:
  `(13) screening mammography (as defined in subsection (jj)); and'; and
  (2) by inserting after subsection (ii) the following new subsection:
`Screening Mammography
  `(jj) The term `screening mammography' means a radiologic procedure provided
  to a woman for the purpose of early detection of breast cancer and includes
  a physician's interpretation of the results of the procedure.'.
  (b) PAYMENT AND COVERAGE- Section 1834 of the Act (42 U.S.C. 1395m)
  is amended--
  (1) in subsection (b)(1)(B), by inserting `and subject to subsection
  (c)(1)(A)' after `conversion factors', and
  (2) by inserting after subsection (b) the following new subsection:
  `(c) PAYMENTS AND STANDARDS FOR SCREENING MAMMOGRAPHY-
  `(1) IN GENERAL- Notwithstanding any other provision of this part, with
  respect to expenses incurred for screening mammography (as defined in
  section 1861(jj))--
  `(A) payment may be made only for screening mammography conducted consistent
  with the frequency permitted under paragraph (2);
  `(B) payment may be made only if the screening mammography meets the
  quality standards established under paragraph (3); and
  `(C) the amount of the payment under this part,
shall, subject to the deductible established under section 1833(b), be equal
to 80 percent of the least of--
  `(i) the actual charge for the screening,
  `(ii) the fee schedule established under subsection (b) with respect to
  both the professional and technical components of the screening mammography,
  in the case of screening mammography subject to such schedule but for this
  paragraph, or
  `(iii) the limit established under paragraph (4) for the screening
  mammography.
  `(2) FREQUENCY COVERED-
  `(A) IN GENERAL- Subject to revision by the Secretary under subparagraph
  (B)--
  `(i) no payment may be made under this part for screening mammography
  performed on a woman under 35 years of age;
  `(ii) payment may be made under this part for only 1 screening mammography
  performed on a woman over 34 years of age, but under 40 years of age;
  `(iii) in the case of a woman over 39 years of age, but under 50 years of
  age, who--
  `(I) is at a high risk of developing breast cancer (as determined pursuant
  to factors identified by the Secretary), payment may not be made under
  this part for a screening mammography performed within the 11 months of
  a previous screening mammography, or
  `(II) is not at a high risk of developing breast cancer, payment may not
  be made under this part for a screening mammography performed within the
  23 months after a previous screening mammography; and
  `(iv) in the case of a woman over 49 years of age, payment may not be made
  under this part for screening mammography performed within 11 months after
  a previous screening mammography.
  `(B) REVISION OF FREQUENCY-
  `(i) REVIEW- The Secretary, in consultation with the Director of the National
  Cancer Institute, shall review periodically the appropriate frequency for
  performing screening mammography, based on age and such other factors as
  the Secretary believes to be pertinent.
  `(ii) REVISION OF FREQUENCY- The Secretary, taking into consideration the
  review made under clause (i), may revise from time to time the frequency
  with which screening mammography may be paid for under this subsection,
  but no such revision shall apply to screening mammography performed before
  January 1, 1993.
  `(3) QUALITY STANDARDS- The Secretary shall establish standards to assure
  the safety and accuracy of screening mammography performed under this
  part. Such standards shall include the requirements that--
  `(A) the equipment used to perform the mammography must be specifically
  designed for mammography and must meet radiologic standards established
  by the Secretary for mammography;
  `(B) the mammography must be performed by an individual who--
  `(i) is licensed by a State to perform radiological procedures, or
  `(ii) is certified as qualified to perform radiological procedures by such
  an appropriate organization as the Secretary specifies in regulations;
  `(C) the results of the mammography must be interpreted by a physician--
  `(i) who is certified as qualified to interpret radiological procedures
  by such an appropriate board as the Secretary specifies in regulations, or
  `(ii) who is certified as qualified to interpret screening mammography
  procedures by such a program as the Secretary recognizes in regulation
  as assuring the qualifications of the individual with respect to such
  interpretation; and
  `(D) with respect to the first screening mammography performed on a woman
  for which payment is made under this part, there are satisfactory assurances
  that the results of the mammography will be placed in permanent medical
  records maintained with respect to the woman.
  `(4) LIMIT-
  `(A) $60, INDEXED- Except as provided by the Secretary under subparagraph
  (B), the limit established under this paragraph--
  `(i) for screening mammography performed in 1991, is $60, and
  `(ii) for screening mammography performed in a subsequent year is the
  limit established under this paragraph for the preceding year increased
  by the percentage increase in the MEI for that subsequent year.
  `(B) REDUCTION OF LIMIT- The Secretary shall review from time to
  time the appropriateness of the amount of the limit established under
  this paragraph. The Secretary may, with respect to screening mammography
  performed in a year after 1992, reduce the amount of such limit as it applies
  nationally or in any area to the amount that the Secretary estimates is
  required to assure that screening mammography of an appropriate quality
  is readily and conveniently available during the year.
  `(C) APPLICATION OF LIMIT IN HOSPITAL OUTPATIENT SETTING- The Secretary
  shall provide for an appropriate allocation of the limit established under
  this paragraph between professional and technical components in the case
  of hospital outpatient screening mammography (and comparable situations)
  where there is a claim for professional services separate from the claim
  for the radiologic procedure.
  `(5) LIMITING CHARGES OF NONPARTICIPATING PHYSICIANS-
  `(A) IN GENERAL- In the case of mammography screening performed on or
  after January 1, 1991, for which payment is made under this subsection,
  if a nonparticipating physician or supplier provides the screening to an
  individual entitled to benefits under this part, the physician or supplier
  may not charge the individual more than the limiting charge (as defined in
  subparagraph (B), or, if applicable and if less, as defined in subsection
  (b)(5)(B) or as established under section 1848(g)(2)).
  `(B) LIMITING CHARGE DEFINED- In subparagraph (A), the term `limiting
  charge' means, with respect to screening mammography performed--
  `(i) in 1991, 125 percent of the limit established under paragraph (4),
  `(ii) in 1992, 120 percent of the limit established under paragraph (4), and
  `(iii) in 1993, 115 percent of the limit established under paragraph (4).
  `(C) ENFORCEMENT- If a physician or supplier knowing and willfully imposes
  a charge in violation of subparagraph (A), the Secretary may apply sanctions
  against such physician or supplier in accordance with section 1842(j)(2).'.
  (c) CERTIFICATION OF SCREENING MAMMOGRAPHY QUALITY STANDARDS-
  (1) Section 1863 of the Act (42 U.S.C. 1395z) is amended by inserting
  `or whether screening mammography meets the standards established under
  section 1834(c)(3),' after `1832(a)(2)(F)(i),'.
  (2) The first sentence of section 1864(a) of the Act (42 U.S.C. 1395aa(a)) is
  amended by inserting before the period the following: `, or whether screening
  mammography meets the standards established under section 1834(c)(3)'.
  (3) Section 1865(a) of the Act (42 U.S.C. 1395bb(a)) is amended by inserting
  `1834(c)(3),' after `1832(a)(2)(F)(i),'.
  (d) CONFORMING AMENDMENTS-
  (1) Section 1833(a)(2)(E) of the Act (42 U.S.C. 1395l(a)(2)(E)) is amended by
  inserting `, but excluding screening mammography' after `imaging services'.
  (2) Section 1862(a) of the Act (42 U.S.C. 1395y(a)) is amended--
  (A) in paragraph (1)--
  (i) in subparagraph (A), by striking `subparagraph (B), (C), (D), or (E)'
  and inserting `a succeeding subparagraph',
  (ii) in subparagraph (D), by striking `and' at the end,
  (iii) in subparagraph (E), by striking the semicolon at the end and inserting
  `, and', and
  (iv) by adding at the end the following new subparagraph:
  `(F) in the case of screening mammography, which is performed more
  frequently than is covered under section 1834(c)(2) or which does not meet
  the standards established under section 1834(c)(3);'; and
  (B) in paragraph (7), by inserting `or under paragraph (1)(F)' after
  `(1)(B)'.
  (e) EFFECTIVE DATE- The amendments made by this section shall apply to
  screening mammography performed on or after January 1, 1991.
Subtitle D--Bone Mass Measurement
SEC. 331. SHORT TITLE.
  This subtitle may be cited as the `Medicare Bone Mass Measurement Coverage
  Act of 1990'.
SEC. 332. MEDICARE COVERAGE OF BONE MASS MEASUREMENTS.
  (a) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x),
  as amended by section 322, is further amended--
  (1) in subsection (s)--
  (A) in paragraph (13), by striking `and' at the end thereof,
  (B) in paragraph (14), by striking the period at the end thereof and
  inserting `; and',
  (C) by inserting after paragraph (14) the following new paragraph:
  `(15) bone mass measurement (as defined in subsection (kk));', and
  (D) by redesignating paragraphs (15) and (16) as paragraphs (16) and (17),
  respectively; and
  (2) by inserting after subsection (jj) the following new subsection:
`Bone Mass Measurement
  `(kk)(1) The term `bone mass measurement' means a radiologic or radioisotopic
  procedure performed on a qualified individual (as defined in paragraph
  (2) for the purpose of detecting bone loss through the use of single and
  dual photon absorptiometry, dual energy x ray absorptiometry or similar
  dual energy techniques, or quantitative computed tomography, and includes
  a physician's interpretation of the results of the procedure.
  `(2) For purposes of paragraph (1), the term `qualified individual' means
  (in accordance with regulations prescribed by the Secretary)--
  `(A) an estrogen-deficient woman at clinical risk for osteoporosis;
  `(B) an individual with vertebral abnormalities;
  `(C) an individual receiving long-term glucocorticoid steroid therapy; or
  `(D) an individual with primary hyperparathyroidism.'.
  (b) EFFECTIVE DATE- The amendments made by this section shall apply to
  bone mass measurements performed on or after January 1, 1991.
Subtitle E--Women and AIDS Outreach and Prevention Act
SEC. 341. SHORT TITLE.
  This subtitle may be cited as the `Women and AIDS Outreach and Prevention
  Act'.
SEC. 342. ESTABLISHMENT OF PROGRAM OF GRANTS REGARDING PREVENTION OF ACQUIRED
IMMUNE DEFICIENCY SYNDROME IN WOMEN.
  Title XXV of the Public Health Service Act (42 U.S.C. 300ee et seq.) is
  amended by adding at the end the following new part:
`PART C--MISCELLANEOUS PROGRAMS
`SEC. 2531. PREVENTION ACTIVITIES FOR WOMEN.
  `(a) ESTABLISHMENT OF PROGRAM- The Secretary may make grants to eligible
  entities for the purpose of--
  `(1) providing preventive health services to women, including the provision
  of counseling regarding the etiologic agent for acquired immune deficiency
  syndrome, the provision of counseling regarding other sexually transmitted
  diseases, and the provision of voluntary family planning services;
  `(2) screening women for infection with the agent and for other sexually
  transmitted diseases;
  `(3) providing treatment for sexually transmitted diseases other than
  acquired immune deficiency syndrome;
  `(4) providing appropriate referrals for other services to women who
  are receiving services under paragraph (1), (2), or (3), including,
  as appropriate, referrals for treatment for infection with the agent,
  referrals for treatment for substance abuse, referrals regarding pregnancy,
  childbirth, and pediatric care, and referrals for housing services;
  `(5) providing follow-up services regarding the referrals, to the extent
  practicable;
  `(6) improving referral arrangements for purposes of paragraph (4);
  `(7) providing the services described in any of paragraphs (1) through (6)
  to the partner of any woman receiving services pursuant to any of paragraphs
  (1) through (6), as appropriate;
  `(8) providing outreach services to inform women of the availability of
  the services specified in paragraphs (1) through (7); and
  `(9) providing training regarding the effective provision of services to
  individuals receiving services under the grant.
  `(b) ELIGIBLE ENTITIES- The Secretary may not make a grant under subsection
  (a) unless the applicant for the grant--
  `(1) is a recipient of a grant under section 329, 330, or 1001, or is another
  public or nonprofit private entity that provides health or voluntary family
  planning services to a significant number of low-income women; and
  `(2) provides the health or voluntary family planning services in a
  geographic area for which a significant number of cases of acquired immune
  deficiency syndrome in women, and in newborn infants, has been reported
  to and confirmed by the Director of the Centers for Disease Control.
  `(c) CONFIDENTIALITY- The Secretary may not make a grant under subsection (a)
  unless the applicant for the grant agrees to maintain the confidentiality
  of information on individuals regarding screenings of the individuals for
  sexually transmitted diseases, subject to complying with applicable law.
  `(d) REQUIREMENT OF APPLICATION- The Secretary may not make a grant under
  subsection (a) unless an application for the grant is submitted to the
  Secretary and the application is in such form, is made in such manner,
  and contains such agreements, assurances, and information as the Secretary
  determines to be necessary to carry out the subsection.
  `(e) EVALUATIONS AND REPORTS-
  `(1) EVALUATIONS- The Secretary shall, directly or through contracts with
  public or private entities, provide for evaluations of projects carried
  out pursuant to subsection (a).
  `(2) REPORTS- Not later than 1 year after the date on which amounts are
  first appropriated under subsection (f), and annually thereafter, the
  Secretary shall submit to the Congress a report summarizing evaluations
  carried out under paragraph (1) during the preceding fiscal year.
  `(f) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there are authorized to be appropriated $10,000,000 for fiscal
  year 1991, $15,000,000 for fiscal year 1992, and $20,000,000 for fiscal
  year 1993.'.
Subtitle F--Infertility Prevention Demonstration Projects of 1990
SEC. 351. SHORT TITLE.
  This subtitle may be cited as the `Infertility Prevention Demonstration
  Projects Act of 1990'.
SEC. 352. FINDINGS.
  Congress finds that--
  (1) as of July 1990, the most common sexually transmitted disease in the
  United States is chlamydia, with an estimated 4,000,000 new cases of the
  disease occurring each year;
  (2) women and sexually active teenagers are at particular risk for
  contracting chlamydia;
  (3) if left untreated, chlamydia can have serious consequences for women,
  including infertility and life-threatening complications in pregnancy;
  (4) an estimated 125,000 women become infertile each year as a result
  of complications resulting from chlamydia and other sexually transmitted
  diseases, and the infertility often occurs before the women have made the
  decision to begin or complete families;
  (5) women with chlamydia are twice as likely to experience an ectopic
  pregnancy, and the occurrence of the disease during pregnancy is associated
  with premature births, with stillbirths, and with low birthweight;
  (6) although chlamydia is easily detected and treated, few women with the
  disease experience any symptoms and therefore women rarely seek routine
  screening and treatment for the disease;
  (7) the single most effective means of preventing infertility and serious
  complications in pregnancy is through routine annual screening for, and
  prompt treatment of, chlamydia in women and partners of the women;
  (8) providers of gynecological services are particularly appropriate
  entities to provide routine annual screenings and treatment, as appropriate;
  (9) as a result of insufficient funding, health clinics that provide
  gynecological care to low-income women are currently unable to provide
  screening for chlamydia as part of routine gynecological care; and
  (10) in 1987, chlamydia resulted in $1,400,000,000 of direct and indirect
  costs to the taxpayers of the United States, and 75 percent of the
  costs were due to cases of the disease that could have been easily and
  successfully treated.
SEC. 353. ESTABLISHMENT OF PROGRAM FOR PREVENTION AND CONTROL OF CHLAMYDIA.
  Part B of title III of the Public Health Service Act (42 U.S.C. 243 et
  seq.) is amended by inserting after section 318 the following new section:
`SEC. 318A. PREVENTION AND CONTROL OF CHLAMYDIA.
  `(a) IN GENERAL- The Secretary may make grants for the purpose of carrying
  out demonstration projects--
  `(1) to provide counseling to women on the prevention and control of the
  sexually transmitted disease known as chlamydia;
  `(2) to screen women for the disease and for secondary conditions resulting
  from the disease, and as appropriate, to provide pregnancy testing;
  `(3) to provide treatment to women for the disease;
  `(4) to provide appropriate referrals for other medical services to women
  screened under paragraph (2), including, as appropriate, referrals for
  evaluation and treatment regarding acquired immune deficiency syndrome
  and other sexually transmitted diseases and referrals regarding pregnancy,
  childbirth, and pediatric care;
  `(5) to provide follow-up services regarding the referrals, to the extent
  practicable;
  `(6) to provide the services described in paragraphs (1) through (5) to
  the partner of any woman receiving services under any of the paragraphs,
  as appropriate;
  `(7) to provide outreach services to inform women, as appropriate, of the
  availability of the services described in paragraphs (1) through (6);
  `(8) to develop and disseminate public information and education programs
  for the prevention and control of chlamydia; and
  `(9) to collect data on the incidence of chlamydia in accordance with
  subsection (h) in order to assist in determining the extent of the need for
  carrying out activities for the prevention and control of such disease,
  including the need for activities to educate the public regarding the
  disease.
  `(b) ELIGIBLE ENTITIES- The Secretary may not make a grant under subsection
  (a) unless the applicant for the grant is a recipient of a grant under
  section 329, 330, or 1001 that provides preventive gynecological health care.
  `(c) GEOGRAPHIC DISTRIBUTION OF GRANTS- In making grants under subsection
  (a), the Secretary shall ensure that the grants are equitably distributed
  among the principal geographic regions of the United States.
  `(d) DIRECT PROVISION OF SERVICES-
  `(1) IN GENERAL- The Secretary may not make a grant under subsection (a)
  unless the applicant for the grant agrees to provide directly each of the
  services described in paragraphs (1) through (7) of the subsection.
  `(2) EXCEPTION REGARDING PUBLIC INFORMATION AND DATA COLLECTION- A grantee
  may carry out activities described in paragraph (8) or (9) of subsection
  (a) directly, and may enter into agreements with other public or nonprofit
  entities under which the entities carry out the activities.
  `(e) OFFERING OF SERVICES-
  `(1) IN GENERAL- The Secretary may not make a grant under subsection (a)
  unless the applicant for the grant agrees to offer appropriate services under
  the subsection to women as a regular practice in providing gynecological
  services and, with the consent of the women, to provide the services as
  a regular practice.
  `(2) SUFFICIENCY OF AMOUNT OF GRANT- With respect to compliance with the
  agreement made under paragraph (1), the Secretary may require a grantee
  under subsection (a) to offer and provide services under the subsection
  only to the extent that the amount of the grant is sufficient to pay the
  costs of offering and providing the services.
  `(f) CONFIDENTIALITY- The Secretary may not make a grant under subsection (a)
  unless the applicant for the grant agrees to maintain the confidentiality
  of information on individuals regarding screenings of the individuals for
  sexually transmitted diseases, subject to complying with applicable law.
  `(g) PROHIBITION AGAINST IMPOSITION OF FEES- The Secretary may not make a
  grant under subsection (a) unless the applicant for the grant agrees that
  the applicant will not impose a charge on any individual for providing
  services or information to the individual under the subsection.
  `(h) REPORTS TO SECRETARY- The Secretary may not make a grant under
  subsection (a) unless the applicant for the grant agrees to submit to the
  Secretary, for each fiscal year for which the applicant receives such a
  grant, a report containing--
  `(1) information on the incidence of chlamydia among the population of
  individuals served by the applicant;
  `(2) information on the number and demographic characteristics of the
  population;
  `(3) information on the types of interventions and treatments provided by
  the applicant, and the health conditions with respect to which referrals
  have been made pursuant to paragraph (4) of subsection (a);
  `(4) an estimate by the applicant of the effect of the services relating to
  chlamydia provided under the grant on the community in which the services
  have been provided; and
  `(5) such other information as is available to the applicant and determined
  by the Secretary to be relevant regarding the prevention and control
  of chlamydia.
  `(i) LIMITATIONS ON CERTAIN EXPENDITURES- The Secretary may not make a
  grant under subsection (a) unless the applicant for the grant agrees that--
  `(1) not more than 10 percent of the grant will be expended to carry out
  subsection (a)(8); and
  `(2) not more than 2 percent of the grant will be expended in making
  the reports required under subsection (h), including collecting the data
  required to be contained in the report.
  `(j) REQUIREMENT OF APPLICATION- The Secretary may not make a grant under
  subsection (a) unless an application for the grant is submitted to the
  Secretary and the application is in such form, is made in such manner,
  and contains such agreements, assurances, and information as the Secretary
  determines to be necessary to carry out this section.
  `(k) EVALUATIONS AND REPORTS BY SECRETARY-
  `(1) EVALUATIONS- The Secretary shall, directly or through contracts with
  public or private entities, provide for annual evaluations of programs
  carried out pursuant to subsection (a).
  `(2) REPORT TO CONGRESS- Not later than 1 year after the date on which
  amounts are first appropriated pursuant to subsection (m), and annually
  thereafter, the Secretary shall 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--
  `(A) summarizing the information provided to the Secretary in reports
  made under subsection (h), including information on the incidence of
  chlamydia; and
  `(B) summarizing evaluations carried out under paragraph (1) during the
  preceding fiscal year.
  `(l) COORDINATION OF FEDERAL PROGRAMS- The Secretary shall coordinate
  the activities carried out under the program established in this section
  with any similar activities regarding chlamydia that are carried out under
  other programs administered by the Secretary, including the coordination
  of the activities of the Director of the Centers for Disease Control with
  the activities of the Director of the National Institutes of Health.
  `(m) FUNDING-
  `(1) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
  section, there is authorized to be appropriated $10,000,000 for each of
  the fiscal years 1991 through 1994.
  `(2) ALLOCATIONS FOR EVALUATIONS- Of the amounts apropriated under paragraph
  (1) for a fiscal year, the Secretary may expend not more than 3 percent
  to carry out evaluations under subsection (k).
  `(3) LIMITATION ON INITIAL NUMBER OF GRANTS- For fiscal year 1991, the
  Secretary may not make more than 10 grants under subsection (a).'.