SECTION 1. SHORT TITLE. This Act may be cited as the ``Quality of Life for Women Act''. SEC. 2. FINDINGS. The Congress finds as follows: (1) Women's pelvic floor disorders are a group of common conditions that cause considerable disability and pain. (2) Such disorders include bladder and bowel dysfunction, including incontinence. Another such disorder is pelvic organ prolapse, which involves a downward shift of uterine or vaginal structures from their normal positions. Often these conditions coexist. (3) Women's pelvic floor disorders are extremely common and are barriers to healthy living. (4) Women often suffer from a broad overlap of all pelvic floor disorders, usually experiencing several disorders simultaneously. (5) Thirty percent of American women will suffer from a form of urinary incontinence. (6) Eleven percent of women in the United States have surgery for urinary incontinence or pelvic organ prolapse during their lifetime, and close to one third will have a second surgery. Many more women are treated with nonsurgical techniques or remain untreated. (7) Of the 3 million vaginal deliveries that occur each year in the United States, 900,000 women will develop symptomatic urinary incontinence and a smaller number will develop pelvic organ prolapse and bowel incontinence. (8) An estimated $26.3 billion is spent annually to either treat or compensate for urinary incontinence. (9) Many health care providers are not prepared to evaluate urinary pelvic floor disorders, including incontinence, and are unaware of treatment options. (10) To address the public health threat posed by women's pelvic floor disorders, there is a need for the establishment of awareness and education programs directed at the public and primary-care providers, including the authorization of research focused on urinary incontinence and other pelvic floor disorders. Such programs will greatly help promote better care and treatment to those women afflicted with these disorders. SEC. 3. EDUCATION REGARDING WOMEN'S PELVIC FLOOR DISORDERS. (a) In General.--Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the end the following section: ``SEC. 399O. EDUCATION REGARDING WOMEN'S PELVIC FLOOR DISORDERS. ``(a) In General.--The Secretary, acting through the Administrator of the Health Resources and Services Administration and the Director of the Centers for Disease Control and Prevention, shall carry out a program to provide education regarding bladder and bowel dysfunction (including incontinence), pelvic organ prolapse, and other pelvic floor disorders to health professionals and the general public. Activities under such program shall be carried out directly by the Secretary and through awards of grants or contracts to States, political subdivisions of States, and other public or nonprofit private entities. ``(b) Certain Information.--The Secretary shall ensure that education under subsection (a) includes, at a minimum-- ``(1) information describing the prevalence of pelvic floor disorders in women; and ``(2) information regarding treatment options for such disorders. ``(c) Use of Internet.--The Secretary shall ensure that the means through which education under subsection (a) is provided includes the posting of information on the Internet site of the Centers for Disease Control and Prevention. The Secretary shall ensure that, in the case of health professionals, such means includes means in addition to the posting of information on such site. ``(d) Authorization of Appropriations.--For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2006 through 2010.''. (b) Sense of Congress.--It is the sense of the Congress that the Director of the Centers for Disease Control and Prevention should establish a national registry for surgical treatment of pelvic floor disorders, especially procedures using new technology. SEC. 4. RESEARCH THROUGH NATIONAL INSTITUTES OF HEALTH. (a) In General.--Part B of title IV of the Public Health Service Act (42 U.S.C. 284 et seq.) is amended by adding at the end the following: ``SEC. 409J. WOMEN'S PELVIC FLOOR DISORDERS. ``(a) In General.--The Directors of the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Child Health and Human Development shall expand and intensify the activities of such Institutes with respect to women's pelvic floor disorders, including proposals for research on such disorders that are developed independently of solicitations by the National Institutes of Health for research proposals. ``(b) Networks.-- ``(1) Urinary incontinence treatment network.--The Director of the National Institute of Diabetes and Digestive and Kidney Diseases, in consultation with the Director of the National Institute of Child Health and Human Development, shall provide for the continuing operation of the Urinary Incontinence Treatment Network. The Network was established pursuant to financial awards from such Institutes, and includes multiple continence treatment centers and a single biostatistical coordinating committee. The Director shall ensure that not fewer than eight such treatment centers are in operation and may provide for the establishment of additional treatment centers, subject to appropriations Acts. ``(2) Clinical trials network for female pelvic disorders.--The Director of the National Institute of Child Health and Human Development, in consultation with the Director of the National Institute of Diabetes and Digestive and Kidney Diseases, shall provide for the continuing operation of the Clinical Trials Network for Female Pelvic Disorders. The Network was established pursuant to financial awards from such Institutes, and includes multiple clinical sites and a single data coordinating committee. The Director shall ensure that not fewer than seven such clinical sites are in operation and may provide for the establishment of additional clinical sites, subject to appropriations Acts. ``(c) Peer Review.--With respect to technical and scientific peer review under section 492, the Director of NIH shall ensure that groups that review research proposals under this section include urogynecologists and other pelvic floor specialists.''. (b) Sense of Congress.-- (1) In general.--The Congress commends-- (A) the National Institute of Diabetes and Digestive and Kidney Diseases for its financial support of the Urinary Incontinence Treatment Network; (B) the National Institute of Child Health and Human Development for its financial support of the Clinical Trials Network for Female Pelvic Disorders; (C) the successful collaboration of such Institutes with respect to the Networks; and (D) each of such Networks for the research it is conducting toward improving women's pelvic health. (2) Certain activities.--It is the sense of the Congress that the Directors of the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Child Health and Human Development should-- (A) increase the size, scope, number, and funding for multidisciplinary research through centers and clinical sites of the Networks referred to in paragraph (1); (B) encourage industry relationships in women's pelvic floor health related research; (C) recruit established scientists from other relevant areas (such as cardiac or gastrointestinal physiology, cell signaling, biomechanical engineering, genomics, and proteomics) to apply their work to the urinary tract and incontinence by encouraging collaborative efforts between basic and clinical scientists; (D) increase research funding for studies that use cellular and molecular techniques to examine the basic mechanisms of bladder and urethral interactions that create urinary continence and incontinence; (E) support research to develop appropriate animal models of urinary incontinence; (F) develop novel techniques (both invasive and noninvasive) for measuring neural, muscular (striated and smooth), and vascular function relating to pelvic floor health; (G) identify risk factors for pelvic floor disorders and urinary incontinence related to childbirth and aging so that prevention measures and improved disease-specific treatment can be developed; (H) initiate research to develop preventive and therapeutic approaches to urinary incontinence that are sensitive to gender, race, and culture, and develop the means of measuring outcomes for treatments in these varied settings; (I) develop a national data registry and tissue bank of people suffering from incontinence to meet the needs of researchers for well-characterized tissue samples; and (J) research the relationship between the anatomic changes of pelvic organ prolapse and the functional derangement's commonly seen in association with them, including voiding dysfunction and incontinence. SEC. 5. INCLUSION OF WOMEN'S PELVIC FLOOR HEALTH IN NATIONAL CHILDREN'S STUDY. The Director of the National Institute of Child Health and Human Development shall include women's pelvic floor health as one of the matters studied in the prospective cohort study regarding child health and human development that is being conducted under section 1004(b) of the Children's Health Act of 2000 (Public Law 106-310; 114 Stat. 1130) and is known as the National Children's Study. SEC. 6. CONSULTATION. In carrying out this Act, the Secretary of Health and Human Services shall consult with the American Urogynecologic Society and such other qualified professional and patient organizations as the Secretary determines to be appropriate.

Summary: Quality of Life for Women Act - Amends the Public Health Service Act to require the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration (HRSA) and the Director of the Centers for Disease Control and Prevention (CDC), to educate health professionals and the public on bladder and bowel dysfunction (including incontinence), pelvic organ prolapse, and other pelvic floor disorders. Expresses the sense of Congress that the Director should establish a national registry for surgical treatment of such disorders. Requires the Directors of the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Child Health and Human Development to: (1) expand and intensify the activities of such Institutes with respect to women's pelvic floor disorders, including developing proposals for research on such disorders; and (2) provide for the continuing operation of the Urinary Incontinence Treatment Network and the Clinical Trials Network for Female Pelvic Disorders. Commends such Institutes for their support of such Networks and such Networks for their research toward improving women's pelvic health. Expresses the sense of Congress as to efforts that such Institutes should undertake, including increasing their research, recruiting established scientists, and developing a national data registry and tissue bank of people suffering from incontinence.


SECTION 1. SHORT TITLE. This Act may be cited as the ``Fluke Fairness Act of 2013''. SEC. 2. FINDINGS. Congress finds the following: (1) Summer flounder is an important economic fish stock for commercial and recreational fishermen across the Northeast and Mid-Atlantic United States. (2) The Magnuson-Stevens Fishery Conservation and Management Act (16 U.S.C. 1801 et seq.) was reauthorized in 2006 and instituted annual catch limits and accountability measures for important fish stocks. (3) That reauthorization prompted fishery managers to look at alternate management schemes to rebuild depleted stocks like summer flounder. (4) Summer flounder occur in both State and Federal waters and are managed through a joint fishery management plan between the Council and the Commission. (5) The Council and the Commission decided that each State's recreational and commercial harvest limits for summer flounder would be based upon landings in previous years. (6) These historical landings were based on flawed data sets that no longer provide fairness or flexibility for fisheries managers to allocate resources based on the best science. (7) This allocation mechanism resulted in an uneven split among the States along the East Coast which is problematic. (8) The Fishery Management Plan for summer flounder does not account for regional changes in the location of the fluke stock even though the stock has moved further to the north and changes in effort by anglers along the East Coast. (9) The States have been locked in a management system based on data that occurred over a decade ago and the summer flounder stock is not being managed using the best available science and modern fishery management techniques. (10) It is in the interest of the Federal Government to establish a new fishery management plan for summer flounder that is based on current geographic, scientific, and economic realities. SEC. 3. DEFINITIONS. In this Act: (1) Commission.--The term ``Commission'' means the Atlantic States Marine Fisheries Commission. (2) Council.--The term ``Council'' means the Mid-Atlantic Fishery Management Council established under section 302(a) of the Magnuson-Stevens Fishery Conservation and Management Act (16 U.S.C. 1852(a)). (3) National standards.--The term ``National Standards'' means the national standards for fishery conservation and management set out in section 301(a) of the Magnuson-Stevens Fishery Conservation and Management Act (16 U.S.C. 1851(a)). (4) Secretary.--The term ``Secretary'' means the Secretary of Commerce. (5) Summer flounder.--The term ``summer flounder'' means the species Paralichthys dentatus. SEC. 4. SUMMER FLOUNDER MANAGEMENT REFORM. (a) Fishery Management Plan Modification.--Not later than 1 year after the date of the enactment of this Act, the Council shall submit to the Secretary, and the Secretary may approve, a modified fishery management plan for the commercial and recreational management of summer flounder under title III of the Magnuson-Stevens Fishery Conservation and Management Act (16 U.S.C. 1851 et seq.) or an amendment to such plan that-- (1) shall be based on the best scientific information available; (2) reflects changes in the distribution, abundance, and location of summer flounder in establishing distribution of the commercial and recreational catch quotas; (3) considers regional, coastwide, or other management measures for summer flounder that comply with the National Standards; and (4) prohibits the allocation of commercial or recreational catch quotas for summer flounder on a State-by-State basis using historical landings data that does not reflect the status of the summer flounder stock, based on the most recent scientific information. (b) Consultation With the Commission.--In preparing the modified fishery management plan or an amendment to such a plan as described in subsection (a), the Council shall consult with the Commission to ensure consistent management throughout the range of the summer flounder. (c) Failure To Submit Plan.--If the Council fails to submit a modified fishery management plan or an amendment to such a plan as described in subsection (a) that may be approved by the Secretary, the Secretary shall prepare and approve such a modified plan or amendment. SEC. 5. REPORT. Not later than 1 year after the date of the approval under section 4 of a modified fishery management plan for the commercial and recreational management of summer flounder or an amendment to such plan, the Comptroller General of the United States shall submit to Congress a report on the implementation of such modified plan or amendment that includes an assessment of whether such implementation complies with the National Standards.

Summary: Fluke Fairness Act of 2013 - Directs the Mid-Atlantic Fishery Management Council to submit for approval by the Secretary of Commerce a modified fishery management plan for the commercial and recreational management of summer flounder, or an amendment to such plan, that: (1) is based on the best scientific information available; (2) reflects changes in the distribution, abundance, and location of summer flounder in establishing distribution of the commercial and recreational catch quotas; (3) considers regional, coastwide, or other management measures that comply with national standards under the Magnuson-Stevens Fishery Conservation and Management Act; and (4) prohibits the allocation of catch quotas on a state-by-state basis using historical landings data that does not reflect the status of the summer flounder stock, based on the most recent scientific information. Requires the Council, in preparing such modifications or amendments, to consult with the Atlantic States Marine Fisheries Commission. Directs the Secretary to prepare and approve a plan if the Council fails to submit such modifications or amendments. Requires a Comptroller General (GAO) report that assesses whether the subsequent implementation of the approved plan complies with national standards.


SECTION 1. SHORT TITLE. This Act may be cited as the ``Employee Benefit Plan Security and Protection Act of 1994''. SEC. 2. CLARIFICATION OF SCOPE OF FIDUCIARY DUTIES UNDER ERISA. (a) In General.--Section 404(a) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1104(a)) is amended by adding at the end the following new paragraphs: ``(3)(A) In any case in which a fiduciary, in the course of managing a plan or exercising authority or control respecting management or disposition of its assets, has an occasion to choose between any two alternative investments of plan assets, if the fiduciary in making such choice takes into account other factors in addition to the rate of return, the riskiness of the investment, and other direct economic factors, the fiduciary shall not be considered to be discharging the fiduciary's duties with respect to the plan in accordance with paragraph (1) and section 403(c)(1) unless-- ``(i) the fiduciary has determined in advance that both alternatives are economically equally advantageous to the participants and beneficiaries under the plan, and ``(ii) such other factors are taken into account solely to the extent that they would be in the economic interest of participants and beneficiaries of the plan. ``(B)(i) A fiduciary with respect to a plan shall not be considered to be discharging the fiduciary's duties with respect to the plan in accordance with paragraph (1) and section 403(c)(1) if the fiduciary, in making investment decisions with respect to plan assets, takes into account external benefits. ``(ii) A fiduciary shall not be treated as failing to discharge the fiduciary's duties with respect to the plan in accordance with paragraph (1) or section 403(c)(1) solely because such investment yields external benefits. ``(iii) For purposes of this subparagraph, the term `external benefit' means, in connection with any investment of plan assets, a benefit to individuals other than participants or beneficiaries under the plan. ``(4)(A) Neither the Secretary nor any other agency or instrumentality of the Government of the United States may-- ``(i) establish or maintain, or cause to be established or maintained, by means of subsidy or otherwise, any list of investments or classes of investments purporting to satisfy the requirements of paragraph (1) or section 403(c)(1), or ``(ii) in any manner pledge, guarantee, ensure, or otherwise represent that any particular investment or class of investments will yield a sufficiently high rate of return at a sufficiently low level of risk to satisfy the requirements of paragraph (1) or section 403(c)(1). ``(B) None of the funds authorized or appropriated to carry out this Act or any other provision of law may be used-- ``(i) by the Secretary or any other agency or instrumentality of the United States, or ``(ii) by any other institution or entity established, chartered, or subsidized by the United States, to subsidize, or to otherwise increase the rate of return on, any particular investment or class of investments for the purpose of causing the requirements of paragraph (1) or section 403(c)(1) to be met with respect to such investment or class of investments. ``(5) Nothing in this title shall be construed to permit any matter unrelated to the economic interests of participants and beneficiaries under employee benefit plans to be taken into account in determining whether a fiduciary has discharged such fiduciary's duties with respect to a plan in accordance with paragraph (1) and section 403(c)(1).''. SEC. 3. CLARIFICATION OF SCOPE OF EXCLUSIVE BENEFIT RULE UNDER THE INTERNAL REVENUE CODE. (a) In General.--Section 401(a) of the Internal Revenue Code of 1986 (requirements for qualification of pension, profit-sharing, and stock bonus plans) is amended by inserting after paragraph (31) the following new paragraph: ``(32) Additional rules relating to exclusive benefit rule.-- ``(A) In general.--The requirements of paragraph (2) shall not be treated as satisfied with respect to a plan, in any case in which a fiduciary, in the course of managing a plan or exercising authority or control respecting management or disposition of its assets, has an occasion to choose between any two alternative investments of plan assets, if the fiduciary in making such choice takes into account other factors in addition to the rate of return, the riskiness of the investment, and other direct economic factors, unless-- ``(i) the fiduciary has determined in advance that both alternatives are economically equally advantageous to the employees and their beneficiaries under the plan, and ``(ii) such other factors are taken into account solely to the extent that they would be in the economic interest of the employees and their beneficiaries of the plan. ``(B) Disregard of external benefits.-- ``(i) In general.--The requirements of paragraph (2) shall not be treated as satisfied with respect to a plan in any case in which a fiduciary with respect to the plan, in making investment decisions with respect to plan assets, takes into account external benefits. ``(ii) External benefits permissible.--The requirements of paragraph (2) shall not be treated as not satisfied solely because such investment yields external benefits. ``(iii) External benefit.--For purposes of this subparagraph, the term `external benefit' means, in connection with any investment of plan assets, a benefit to individuals other than the employees or their beneficiaries under the plan. ``(C) Noninterference with fiduciary responsibilities.-- ``(i) Prohibition against lists and other referrals.--Neither the Secretary nor any other agency or instrumentality of the Government of the United States may-- ``(I) establish or maintain, or cause to be established or maintained, by means of subsidy or otherwise, any list of investments or classes of investments purporting to satisfy the requirements of subparagraph (A), or ``(II) in any manner pledge, guarantee, ensure, or otherwise represent that any particular investment or class of investments will yield a sufficiently high rate of return at a sufficiently low level of risk to satisfy the requirements of subparagraph (A). ``(ii) Prohibition against subsidies.--None of the funds authorized or appropriated to carry out this title or any other provision of law may be used-- ``(I) by the Secretary or any other agency or instrumentality of the United States, or ``(II) by any other institution or entity established, chartered, or subsidized by the United States, to subsidize, or to otherwise increase the rate of return on, any particular investment or class of investments for the purpose of causing the requirements of subparagraph (A) to be met with respect to such investment or class of investments. ``(D) Irrelevance of matters other than economic interests of employees and their beneficiaries.-- Nothing in this paragraph or paragraph (2) shall be construed to permit any matter unrelated to the economic interests of the employees and their beneficiaries to be taken into account in determining whether the requirements of paragraph (2) have been satisfied.''. SEC. 4. EFFECTIVE DATE. The amendments made by this Act shall apply with respect to acts or failures to act occurring on or after the date of the enactment of this Act.

Summary: Employee Benefit Plan Security and Protection Act of 1994 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue Code to revise provisions regarding employee benefit plan fiduciary duties in relation to external benefits, social investing, and economically targeted investments.


SECTION 1. CHILD OPPORTUNITY ZONE FAMILY CENTERS. Title X of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 8001 et seq.) is amended by adding at the end the following: ``Part L--Child Opportunity Zone Family Centers ``SEC. 10995A. SHORT TITLE. ``This part may be cited as the `Child Opportunity Zone Family Center Act of 2001'. ``SEC. 10995B. PURPOSE. ``The purpose of this part is to encourage eligible partnerships to establish or expand child opportunity zone family centers in public elementary schools and secondary schools in order to provide comprehensive support services for children and their families, and to improve the children's educational, health, mental health, and social outcomes. ``SEC. 10995C. DEFINITIONS. ``In this part: ``(1) Child opportunity zone family center.--The term `child opportunity zone family center' means a school-based or school-linked community service center that provides and links children and their families with comprehensive information, support, services, and activities to improve the education, health, mental health, safety, and economic well-being of the children and their families. ``(2) Eligible partnership.--The term `eligible partnership' means a partnership-- ``(A) that contains-- ``(i) at least 1 public elementary school or secondary school that-- ``(I) receives assistance under title I and for which a measure of poverty determination is made under section 1113(a)(5) with respect to a minimum of 40 percent of the children in the school; and ``(II) demonstrates parent involvement and parent support for the partnership's activities; ``(ii) a local educational agency; ``(iii) a public agency, other than a local educational agency, such as a local or State department of health, mental health, or social services; and ``(iv) a nonprofit community-based organization, providing health, mental health, or social services; ``(v) a local child care resource and referral agency; and ``(vi) a local organization representing parents; and ``(B) that may contain-- ``(i) an institution of higher education; and ``(ii) other public or private nonprofit entities with experience in providing services to disadvantaged families. ``SEC. 10995D. GRANTS AUTHORIZED. ``(a) In General.--The Secretary may award, on a competitive basis, grants to eligible partnerships to pay for the Federal share of the cost of establishing and expanding child opportunity zone family centers. ``(b) Duration.--The Secretary shall award grants under this section for periods of 5 years. ``SEC. 10995E. REQUIRED ACTIVITIES. ``Each eligible partnership receiving a grant under this part shall use the grant funds-- ``(1) in accordance with the needs assessment described in section 10995F(b)(1), to provide or link children and their families with information, support, activities, or services in core areas such as education, child care, before- and after- school care and enrichment programs, health services, mental health services, family support, nutrition, literacy services, parenting skills, and drop-out prevention; ``(2) to provide intensive, high-quality, research-based programs that-- ``(A) provide violence prevention education for families and developmentally appropriate instructional services to children (including children below the age of compulsory school attendance); and ``(B) provide effective strategies for nurturing and supporting the emotional, social, and cognitive growth of children; and ``(3) to provide training, information, and support to families to enable the families to participate effectively in their children's education, and to help their children meet challenging standards, including assisting families to-- ``(A) understand the applicable accountability systems, including State and local content standards, performance standards, and assessments, their children's educational performance in comparison to the standards, and the steps the school is taking to address the children's needs and to help the children meet the standards; and ``(B) communicate effectively with personnel responsible for providing educational services to the families' children, and to participate in the development and implementation of school-parent compacts, parent involvement policies, and school plans. ``SEC. 10995F. APPLICATIONS. ``(a) In General.--Each eligible partnership desiring a grant under this part shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require. ``(b) Contents.--Each application submitted pursuant to subsection (a) shall-- ``(1) include a needs assessment, including a description of how the partnership will ensure that the activities to be assisted under this part will be tailored to meet the specific needs of the children and families to be served; ``(2) describe arrangements that have been formalized between the participating public elementary school or secondary school, and other partnership members; ``(3) describe how the partnership will effectively coordinate with the centers under section 1118 and utilize Federal, State, and local sources of funding that provide assistance to families and their children; ``(4) describe the partnership's plan to-- ``(A) develop and carry out the activities assisted under this part with extensive participation of parents, administrators, teachers, pupil services personnel, social and human service agencies, and community organizations and leaders; and ``(B) coordinate the activities assisted under this part with the education reform efforts of the participating public elementary school or secondary school, and the participating local educational agency; ``(5) describe how the partnership will ensure that underserved populations such as families of students with limited English proficiency, or families of students with disabilities, are effectively involved, informed, and assisted; ``(6) describe how the partnership will collect and analyze data, and will utilize specific performance measures and indicators to-- ``(A) determine the impact of activities assisted under this part as described in section 10995I(a); and ``(B) improve the activities assisted under this part; and ``(7) describe how the partnership will protect the privacy of families and their children participating in the activities assisted under this part. ``SEC. 10995G. FEDERAL SHARE. ``The Federal share of the cost of establishing and expanding child opportunity zone family centers-- ``(1) for the first year for which an eligible partnership receives assistance under this part shall not exceed 90 percent; ``(2) for the second such year, shall not exceed 80 percent; ``(3) for the third such year, shall not exceed 70 percent; ``(4) for the fourth such year, shall not exceed 60 percent; and ``(5) for the fifth such year, shall not exceed 50 percent. ``SEC. 10995H. FUNDING. ``(a) Continuation of Funding.--Each eligible partnership that receives a grant under this part shall, after the third year for which the partnership receives funds through the grant, be eligible to continue to receive the funds if the Secretary determines that the partnership has made significant progress in meeting the performance measures used for the partnership's local evaluation under section 10995I(a). ``(b) Limitation on Use of Funds To Offset Other Programs.-- Notwithstanding any other provision of law, none of the funds received under a grant under this part may be used to pay for expenses related to any other Federal program, including treating such funds as an offset against such a Federal program. ``SEC. 10995I. EVALUATIONS AND REPORTS. ``(a) Local Evaluations.--Each partnership receiving funds under this part shall conduct annual evaluations and submit to the Secretary reports containing the results of the evaluations. The reports shall include the results of the partnership's performance assessment effectiveness in reaching and meeting the needs of families and children served under this part, including performance measures demonstrating-- ``(1) improvements in areas such as student achievement, family participation in schools, and access to health care, mental health care, child care, and family support services, resulting from activities assisted under this part; and ``(2) reductions in such areas as violence among youth, truancy, suspension, and dropout rates, resulting from activities assisted under this part. ``(b) National Evaluations.--The Secretary shall reserve not more than 3 percent of the amount appropriated under this part to carry out a national evaluation of the effectiveness of the activities assisted under this part. Such evaluation shall be completed not later than 3 years after the date of enactment of the Child Opportunity Zone Family Center Act of 2001, and every year thereafter and shall be submitted to Congress. ``(c) Exemplary Activities.--The Secretary shall broadly disseminate information on exemplary activities developed under this part. ``SEC. 10995J. AUTHORIZATION OF APPROPRIATIONS. ``There are authorized to be appropriated to carry out this part $100,000,000 for fiscal year 2002, and such sums as may be necessary for each of the fiscal years 2003 through 2005.''.

Summary: Child Opportunity Zone Family Center Act of 2001 - Amends the Elementary and Secondary Education Act of 1965 to provide for Child Opportunity Zone Family Centers (school-based or school-linked community service centers that provide and link children and their families with comprehensive information, support, services, and activities to improve the children's and families' education, health, mental health, safety, and economic well-being).Authorizes the Secretary of Education to award competitive grants to eligible partnerships for the Federal share of costs of establishing and expanding such centers.


SECTION 1. SHORT TITLE, REFERENCE. (a) Short Title.--This Act may be cited as the ``Public Health Pesticides Protection Act of 1993''. (b) Reference.--Whenever in this Act an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of the Federal Insecticide, Fungicide, and Rodenticide Act. SEC. 2. DEFINITIONS. (a) Adverse Effects.--Section 2(bb) (7 U.S.C. 136(bb)) is amended by adding at the end the following: ``The Administrator shall consider the risks and benefits of public health pesticides separate from the risks and benefits of other pesticides. In weighing any regulatory action concerning a public health pesticide under this Act, the Administrator shall weigh any risks of the pesticide against the health risks such as the diseases transmitted by the vector to be controlled by the pesticide.''. (b) New Definitions.--Section 2 (7 U.S.C. 136) is amended by adding at the end the following: ``(hh) Minor Use.--The term `minor use' means the total anticipated small volume use of any pesticide product against a particular pest or group of pests which, by itself, would not economically justify a full, separate pesticide registration. Wherever a minor use is designated in this Act for agricultural crop production or agricultural uses, such term includes any use intended to protect the public from insects or other pests or the diseases which such pests may transmit to man or domestic animals. ``(ii) Public Health Pesticide.--The term `public health pesticide' means any minor use pesticide product registered for use and used predominantly in public health programs for vector control or for other recognized health protection uses, including the prevention or mitigation of viruses, bacteria, or other microorganisms (other than viruses, bacteria, or other microorganisms on or in living man or other living animal) that pose a threat to public health. ``(jj) Vector.--The term `vector' means any animal capable of transmitting the causative agent of human disease or capable of producing human discomfort or injury, including mosquitoes, flies, fleas, cockroaches, or other insects and ticks, mites, or rats.''. SEC. 3. REGISTRATION. Section 3(c)(2)(A) (7 U.S.C 136a(c)(2)(A)) is amended-- (1) by inserting after ``pattern of use,'' the following: ``the public health and agricultural need for such minor use,'', and (2) by striking out ``potential exposure of man and the environment to the pesticide'' and inserting in lieu thereof ``potential beneficial or adverse effects on man and the environment''. SEC. 4. REREGISTRATION. Section 4 (7 U.S.C. 136a-1) is amended-- (1) in subsection (i)(4), by redesignating subparagraphs (B) and (C) as subparagraphs (C) and (D), respectively and by adding after subparagraph (A) the following: ``(B) Any pesticide defined as a public health pesticide of which more than 50 percent of its usage is devoted to the promotion of public health shall be exempt from fees prescribed by paragraph (3).''. (2) in subsection (i)(5), by redesignating subparagraphs (F) and (G) as subparagraphs (G) and (H), respectively, and by adding after subparagraph (E) the following: ``(F) An end use product that is registered for a public health pesticide of which at least 50 percent of its usage is devoted to the promotion of public health shall be exempt from the fees prescribed by this paragraph.''. (3) in subsection (i)(7)(B), by striking out ``or to determine'' and inserting in lieu thereof ``, to determine'' and by inserting before the period the following: ``, or to determine the volume usage for public health pesticides''. (4) in subsection (k)(3)(A), by striking out ``or'' at the end of clause (i), by striking the period at the end of clause (ii) and inserting in lieu thereof ``; or'', and by inserting after clause (ii) the following: ``(iii) proposes the initial or amended registration of an end use pesticide that, if registered as proposed, would be used for a public health pesticide.''. SEC. 5. CANCELLATION. Section 6(b) is amended by striking out ``or'' at the end of paragraph (1), by striking out the period at the end of paragraph (2) and inserting in lieu thereof ``; or'', and by adding after paragraph (2) the following: ``(3) if a pesticide is registered or proposed for registration for public health uses, to send the notice specified in this subsection to the Secretary of Health and Human Services for review. The Secretary of Health and Human Services shall comment under paragraph (3) in accordance with the procedures followed and subject to the same conditions as comments by the Secretary of Agriculture in the case of agricultural pesticides.''. SEC. 6. VIEWS. Section 21 (7 U.S.C. 136s) is amended by redesignating subsections (b) and (c) as subsections (c) and (d), respectively, and by adding after subsection (a) the following: ``(b) Secretary of Health and Human Services.--The Administrator, before publishing regulations under this Act for any public health pesticide, shall solicit the views of the Secretary of Health and Human Services in the same manner as the views of the Secretary of Agriculture are solicited under section 25(a).''. SEC. 7. AUTHORITY OF ADMINISTRATOR. Section 25(a)(1) (7 U.S.C 136w(a)(1)) is amended-- (1) by inserting after ``various classes of pesticides'' the following: ``, including public health pesticides,'', and (2) by striking out ``and nonagricultural pesticides'' and inserting in lieu thereof ``, nonagricultural, and public health pesticides''. SEC. 8. IDENTIFICATION OF PESTS. Section 28 (7 U.S.C. 136w-3) is amended by adding at the end the following: ``(d) Public Health Pests.--The Administrator, in coordination with the Secretary of Health and Human Services, shall identify pests of significant public health importance and, in coordination with the Public Health Service, develop and implement programs to improve and facilitate the safe and necessary use of chemical, biological, and other methods to combat and control such pests of public health importance.''. SEC. 9. PUBLIC HEALTH PESTICIDES. The Federal Insecticide, Fungicide, and Rodenticide Act is amended by adding at the end the following: ``SEC. 32. PUBLIC HEALTH PESTICIDES. ``The Administrator, in conjunction with the Secretary of Health and Human Services, shall submit an annual report to the Congress by March 1 of each year describing the uses of public health pesticides to promote human health protection in the United States. The report shall include ``(1) an analysis of vector control practices, ``(2) an analysis of the approximately 50 diseases which are associated with arthropods or other vectors, including a consideration of the impact of vector control on the incidence of such diseases, ``(3) an analysis of the role of IPM in vector control and how agricultural IPM practices impact public health vector control, and ``(4) an analysis of public health pesticides, including the benefits of vectored disease prevention and a comparison of such benefits to the relative risks of the use of public health pesticides and the risks of vectored diseases.''.

Summary: Public Health Pesticides Protection Act of 1993 - Amends the Federal Insecticide, Fungicide, and Rodenticide Act to direct the Administrator of the Environmental Protection Agency to consider the risks and benefits of public health pesticides separately from the risks and benefits of other pesticides. Requires the Administrator, in weighing any regulatory action concerning a public health pesticide, to weigh any risks of the pesticide against the health risks to be controlled by the pesticide. Defines: (1) a "public health pesticide" as a minor use pesticide registered for use and used predominantly in public health programs for vector control or other health protection uses; and (2) "vector" as any animal capable of transmitting the causative agent of human disease or of producing human discomfort or injury. Exempts from reregistration fees public health pesticides of which more than 50 percent of usage (or at least 50 percent in the case of certain end use products) is devoted to the promotion of public health. Provides for expedited processing and review of pesticide applications that propose the initial or amended registration of an end use pesticide that, if registered as proposed, would be used as a public health pesticide. Provides for review by the Secretary of Health and Human Services of registrations of public health pesticides proposed for cancellation. Directs the Administrator to identify pests of significant public health importance and to implement programs to improve and facilitate the safe use of methods to combat such pests.


SECTION 1. SHORT TITLE. This Act may be cited as the ``Border Crossing Deterrence Act of 2008''. SEC. 2. EXPANSION OF OPERATION STREAMLINE. (a) In General.--Not later than December 31, 2009, the Secretary of Homeland Security, in Cooperation with the Attorney General, shall expand Operation Streamline (the zero-tolerance prosecution policy for illegal entry and reentry) to all 20 border sectors. (b) Authorization of Appropriations.--There are authorized to be appropriated $500,000,000 for each of the fiscal years 2009 through 2018 to carry out this section. SEC. 3. MANDATORY MINIMUM SENTENCES FOR ILLEGAL ENTRY. Section 275 of the Immigration and Nationality Act (8 U.S.C. 1325) is amended-- (1) by redesignating subsections (c) and (d) as subsections (d) and (e), respectively; and (2) by inserting after subsection (b) the following: ``(c) Improper Time or Place; Criminal Penalties.--Any alien who is apprehended while entering, or attempting to enter, the United States at a time and place other than as designated by immigration offices-- ``(1) in the case of a first violation of subsection (a), shall be sentenced to a term of imprisonment of not less than 10 days and not more than 364 days; ``(2) in the case of a second violation of subsection (a), shall be sentenced to a term of imprisonment of not less than 60 days and not more than 2 years; and ``(3) in the case of a third or subsequent violation of subsection (a), shall be sentenced to a term of imprisonment of not less than 90 days and not more than 3 years.''. SEC. 4. MANDATORY MINIMUM SENTENCES FOR ILLEGAL REENTRY. Section 276 (8 U.S.C. 1326) is amended to read as follows: ``SEC. 276. REENTRY OF REMOVED ALIEN. ``(a) Reentry After Removal.--Any alien who has been denied admission, excluded, deported, or removed, or who has departed the United States while an order of exclusion, deportation, or removal is outstanding, and subsequently enters, attempts to enter, crosses the border to, attempts to cross the border to, or is at any time found in the United States, shall be fined under title 18, United States Code, and imprisoned not less than 90 days and not more than 2 years. ``(b) Reentry of Criminal Offenders.--Notwithstanding the penalty prescribed under subsection (a), an alien described in that subsection who was-- ``(1) convicted for 3 or more misdemeanors or a felony before such removal or departure, shall be fined under title 18, United States Code, and imprisoned for not less than 1 year and not more than 10 years; ``(2) convicted for a felony before such removal or departure for which the alien was sentenced to a term of imprisonment of not less than 30 months, shall be fined under such title, and imprisoned for not less than 2 years and not more than 15 years; ``(3) convicted for a felony before such removal or departure for which the alien was sentenced to a term of imprisonment of not less than 60 months, shall be fined under such title and imprisoned for not less than 4 years and not more than 20 years; ``(4) convicted for 2 or more felonies before such removal or departure, shall be fined under such title and imprisoned for not less than 4 years and for not more than 20 years; or ``(5) convicted, before such removal or departure, for murder, rape, kidnapping, for a felony offense described in chapter 77 (relating to peonage and slavery) or 113B (relating to terrorism) of such title, shall be fined under such title and imprisoned for not less than 5 years and not more than 20 years. ``(c) Reentry After Repeated Removal.--Any alien who, after having been denied admission, excluded, deported, or removed 2 or more times, enters, attempts to enter, crosses the border to, attempts to cross the border to, or is at any time found in the United States, shall be fined under title 18, United States Code, and imprisoned for not less than 2 years and not more than 10 years. ``(d) Proof of Prior Convictions.--The prior convictions described in subsection (b) are elements of the crimes described in that subsection, and the penalties in that subsection shall apply only in cases in which the conviction or convictions that form the basis for the additional penalty are-- ``(1) alleged in the indictment or information; and ``(2) proven beyond a reasonable doubt at trial or admitted by the defendant. ``(e) Affirmative Defenses.--It shall be an affirmative defense to a violation of this section that-- ``(1) the alien had sought and received, before the alleged violation, the express consent of the Secretary of Homeland Security to reapply for admission into the United States; ``(2) with respect to an alien previously denied admission and removed, the alien-- ``(A) was not required to obtain such advance consent under the Immigration and Nationality Act or under any prior Act; and ``(B) had complied with all other laws and regulations governing the alien's admission into the United States; or ``(3) at the time of the prior exclusion, deportation, removal, or denial of admission alleged in the violation, the alien-- ``(A) was younger than 18 years of age; and ``(B) had not been convicted of a crime or adjudicated a delinquent minor by a court of the United States, or a court of a State or territory, for conduct that would constitute a felony if committed by an adult. ``(f) Limitation on Collateral Attack on Underlying Removal Order.--In a criminal proceeding under this section, an alien may not challenge the validity of any prior removal order concerning the alien unless the alien demonstrates by clear and convincing evidence that-- ``(1) the alien exhausted all administrative remedies that may have been available to seek relief against the order; ``(2) the removal proceedings at which the order was issued improperly deprived the alien of the opportunity for judicial review; and ``(3) the entry of the order was fundamentally unfair. ``(g) Reentry of Alien Removed Before Completing Term of Imprisonment.--Any alien removed pursuant to section 241(a)(4) who enters, attempts to enter, crosses the border to, attempts to cross the border to, or is at any time found in, the United States shall be-- ``(1) incarcerated for the remainder of the term of imprisonment, which was pending at the time of deportation without any reduction for parole or supervised release unless the alien affirmatively demonstrates that the Secretary of Homeland Security has expressly consented to the alien's reentry; and ``(2) subject to such other penalties relating to the reentry of removed aliens as may be available under this section or any other provision of law. ``(h) Limitation.--An individual who provides an alien with emergency humanitarian assistance, including emergency medical care and food, or transports the alien to a location where such assistance can be rendered without compensation or the expectation of compensation may not be prosecuted for aiding and abetting a violation of this section based on the provision of such humanitarian services . ``(i) Definitions.--In this section: ``(1) Felony.--The term `felony' means any criminal offense punishable by a term of imprisonment of more than 1 year under the laws of the United States, of any State, or of a foreign government. ``(2) Misdemeanor.--The term `misdemeanor' means any criminal offense punishable by a maximum term of imprisonment of not more than 1 year under the applicable laws of the United States, of any State, or of a foreign government. ``(3) Removal.--The term `removal' includes any denial of admission, exclusion, deportation, or removal, or any agreement by which an alien stipulates or agrees to exclusion, deportation, or removal. ``(4) State.--The term `State' means any of the several States of the United States, the District of Columbia, and any commonwealth, territory, or possession of the United States.''. SEC. 5. MANDATORY MINIMUM SENTENCES FOR DESTROYING BORDER BARRIERS OR INFRASTRUCTURE. Section 1361 of title 18, United States Code, is amended-- (1) by striking ``Whoever'' and inserting the following: ``(a) In General.--Whoever''; and (2) by adding at the end the following: ``(b) Destruction of Border Barriers or Infrastructure.--Any alien who damages or destroys fencing or infrastructure, such as cameras, sensors, and vehicle barriers, that has been installed along the international border of the United States by the United States Government shall be fined under this title and imprisoned for not less than 5 years.''.

Summary: Border Crossing Deterrence Act of 2008 - Directs the Secretary of Homeland Security to expand Operation Streamline (the zero-tolerance prosecution policy for illegal entry and reentry) to all 20 border sectors. Authorizes appropriations. Amends the Immigration and Nationality Act to: (1) revise and increase criminal penalties, including establishing mandatory minimum penalties, for an alien's entry into the United States at an improper time or place; and (2) revise criminal penalty and related provisions, and establish mandatory minimum sentences, respecting the reentry of an alien who has been removed from the United States. Amends the federal criminal code to establish a mandatory minimum criminal penalty of five years for an alien's destruction of U.S. government-installed border barriers or infrastructure.


SECTION 1. SHORT TITLE. This Act may be cited as the ``Medicare Patient Safeguards Act of 2009''. SEC. 2. FINDINGS. The Congress finds the following: (1) The 2009 Medicare Trustees Report estimates that Medicare spending could grow from 3.2 percent of the U.S. economy to 11.4 percent during the next 75 years and warns of the significant cost burden growth of this magnitude would place on workers, Medicare beneficiaries, and the Federal budget. (2) In 2009, Congress provided $1,150,000,000 for comparative effectiveness research, including cost- effectiveness analysis. (3) The Medicare Payment and Advisory Commission suggested that the Centers for Medicare & Medicaid Services use cost effectiveness analysis to look at groups of services used to treat specific illnesses that have small differences in quality but large differences in cost. (4) MedPAC has reported concerns that the rigid use of cost effectiveness analysis might limit Medicare beneficiaries' access to certain services, ration rather than promote appropriate care, slow innovation, and interfere with the practice of medicine. (5) MedPAC has listed methodological and reporting shortcomings of cost effectiveness analysis, including not using all available clinical evidence, not sufficiently reporting on the extent to which the results are applicable to the general population, selectively reporting results, and placing undue emphasis on certain results of such analysis. (6) While serving as the head of Congressional Budget Office, White House Budget director Peter Orszag said determining which treatment was most cost effective for a given population would involve placing a dollar value on an additional year of life. (7) While serving as the head of Congressional Budget Office, White House Budget director Peter Orszag suggested the possibility of limiting Medicare coverage for more effective but more expensive services. (8) CMS recently described cost effectiveness analysis expertise as one of its most critical needs to Medicare Evidence Development & Coverage Advisory Committee, which advises CMS on national coverage determinations (NCDs). (9) CMS, through proposed rule making, has twice failed in attempts to formally incorporate cost effectiveness analysis into NCDs. (10) CMS officials report that the agency considers potential cost savings before deciding to make changes to a NCD that narrows coverage under the Medicare program. (11) AARP has stated that comparative effectiveness research is intended to help consumers and providers determine the best treatment, not just the least costly treatment. AARP warned that this information from comparative effectiveness research should not be used as a means to deny individuals access to appropriate therapeutic options. (12) The Congressional Black Caucus, focusing in particular on the exacerbating of health inequities across subpopulation groups, expressed concerns that comparative effectiveness research should not be used as rationale for limiting care to the care that works best for the average patient, rather than providing coverage for the care that works best for each individual patient. (13) Congressional New Democrats-- (A) argued that any application of comparative effectiveness research must protect against the use of this research to deny access to care solely based on cost; and (B) urged Congress to ensure that clinical effectiveness and medical outcomes are the focus of comparative effectiveness research funding. (14) The American Heart Association-- (A) urges Congress to include patient safeguards in legislation to prevent the misuse of cost effectiveness analysis; and (B) argues that the primary focus of comparative effectiveness research should be optimizing clinical outcomes and value for patients and society and not for the purpose of minimizing costs. SEC. 3. SENSE OF CONGRESS. It is the sense of the Congress that-- (1) efforts to make the Medicare program financially sustainable, including the application of comparative effectiveness research, should not-- (A) deprive patients of medically necessary care solely due to the cost of such care; or (B) limit access to needed health care services due to a patient's age, gender, ethnicity, or disability status; and (2) Congress should protect patients' access to needed care by ensuring that the Administrator of CMS relies on adequate clinical expertise when the Administrator proposes to narrow coverage for a product or service under the Medicare program under title XVIII of the Social Security Act. SEC. 4. PROCESS FOR CERTAIN NATIONAL COVERAGE DETERMINATIONS. (a) Requirements for the Issuance of Certain Medicare National Coverage Determinations.--Unless all of the conditions under subsection (b) are met, the Administrator may not issue a final national coverage determination (referred to in this Act as a NCD)-- (1) if the NCD restricts local or national coverage for an item or service that, before the date of the issuance of such NCD, was routinely covered under the Medicare program under title XVIII of the Social Security Act; (2) if the NCD would result in significant cost savings for the Medicare program; (3) if there is controversy in the available peer-reviewed medical and scientific literature about the evidence supporting the NCD; (4) if the NCD restricts local or national coverage for an item or service that-- (A) is supported by current clinical practice guidelines-- (i) included in the National Guideline Clearinghouse maintained by the Agency for Healthcare Research and Quality; or (ii) maintained by a State medical society; or (B) is endorsed by the National Quality Forum or by another national organization that evaluates voluntary consensus-based provides quality measures and is designated by the Secretary for purposes of making an endorsement under this subparagraph; or (5) if the Administrator determines that-- (A) significant differences in opinion exist among experts concerning-- (i) what evidence should be reviewed in developing the NCD; or (ii) how data should be interpreted for purposes of developing the NCD; and (B) an independent analysis of the evidence and data analysis would be valuable in developing the final NCD. (b) Required Conditions.--The conditions under this subsection are as follows: (1) Request for review.--Before the start of the public comment period for a proposed NCD that contains all the restrictions on the coverage of products and services included in the final NCD, the Administrator makes a formal request to MEDCAC for a review of the scientific and clinical evidence supporting and opposing the NCD. (2) MEDCAC review subcommittee.-- (A) In general.--MEDCAC convenes a subcommittee to-- (i) review the evidence supporting the proposed NCD (including clinical practice guidelines published by medical specialty societies), taking into account-- (I) the evidence related to subpopulations of beneficiaries (including men, women, racial and ethnic minorities, the elderly, individuals with disabilities, and individuals with genetic variations); and (II) the extent to which patient preference is a factor in the use of the item or service that is the subject of the NCD; (ii) conduct an evaluation of the clinical and scientific evidence relating to the clinical benefits and risks of a technology affected by such NCD; and (iii) determine if the NCD will limit the access of Medicare beneficiaries to medically necessary care. (B) Membership.--The subcommittee under subparagraph (A) shall have 15 members, each of whom-- (i) shall be a clinical expert in the medical specialty or specialties that are most relevant to the topic of the NCD; and (ii) to the extent feasible, shall have expertise in the development of clinical practice guidelines. (C) Outside experts allowed.--MEDCAC may include individuals who are not members of MEDCAC in the membership of the subcommittee convened under subparagraph (A). (3) Subcommittee comment.-- (A) In general.--Not later than the last day of the period under paragraph (1), the subcommittee convened under paragraph (3)(A) shall submit to the Administrator a public comment on the NCD that contains an evaluation of whether-- (i) the NCD is appropriate based on the subcommittee's activities under paragraph (2)(A); (ii) the NCD is consistent with clinical guidelines; (iii) the NCD would adversely impact the access of subpopulations to items or services which may benefit such subpopulations; or (iv) the NCD would adversely impact access to treatment options that are primarily selected by patients, with their physicians, based on patient preference and quality of life criteria. (B) Ncds that prevent access to care.--If MEDCAC determines that the proposed NCD could prevent Medicare patients from receiving medically necessary care, the MEDCAC panel shall include in such public comment a recommendation that the proposed NCD not be issued as a final NCD. (c) Restriction on Additional Limitation on Coverage.--The Administrator may not issue a final NCD that contains any restrictions on the coverage of products and services that were not included in the proposed NCD reviewed under subsection (b). (d) Construction.--Nothing in this Act shall be construed as preventing a Medicare beneficiary from using private funds to purchase supplemental health insurance coverage or to directly purchase medically necessary care. SEC. 5. DEFINITIONS. For purposes of this Act: (1) Administrator.--The term ``Administrator'' means the Administrator of CMS. (2) CMS.--The term ``CMS'' means the Centers for Medicare & Medicaid Services. (3) MEDCAC.--The term ``MEDCAC'' means the Medicare Evidence Development & Coverage Advisory Committee established by the Secretary of Health and Human Services pursuant to section 222 of the Public Health Service Act. (4) Medically necessary services.--The term ``medically necessary care'' means health care services or products that a prudent physician would provide to a patient for the purpose of preventing, diagnosing, treating or rehabilitating an illness, injury, disease or its associated symptoms, impairments or functional limitations in a manner that is-- (A) in accordance with generally accepted standards of medical practice; (B) clinically appropriate in terms of type, frequency, extent, site and duration; and (C) not primarily for the convenience of the patient, physician, or other health care provider. (5) MedPAC.--The term ``MedPAC'' means the Medicare Payment Advisory Commission established under Section 1805 of the Social Security Act. (6) National coverage determination.--The term ``national coverage determination'' has the meaning given such term in section 1869(f)(1)(B) of the Social Security Act.

Summary: Medicare Patient Safeguards Act of 2009 - Expresses the sense of Congress that: (1) efforts to make the Medicare program financially sustainable, including application of comparative effectiveness research, should not deprive patients of medically necessary care solely due to its cost or limit access to needed health care services due to a patient's age, gender, ethnicity, or disability status; and (2) Congress should protect patients' access to needed care by ensuring that the Administrator of Centers for Medicare and Medicaid Services (CMS) relies on adequate clinical expertise when the Administrator proposes to narrow coverage for a product or service under title XVIII (Medicare) of the Social Security Act. Establishes a process for the issuing of Medicare national coverage determinations by the Administrator. Enumerates prohibitions and conditions.


SECTION 1. SHORT TITLE. This Act may be cited as the ``Ending Maternal Mortality Act of 2018''. SEC. 2. FINDINGS. The Congress finds as follows: (1) Four million American women give birth each year, and an estimated 700 will die annually during pregnancy, childbirth, or the postpartum period. (2) The United States ranks 47th for maternal mortality rate globally, and is one of only eight countries in which the maternal mortality rate is rising. It is estimated that, between 2000 and 2014, the United States maternal mortality rate grew by 26.6 percent. (3) Common causes of maternal mortality include obstetric hemorrhage, hypertension and preeclampsia, sepsis, and substance use disorder and overdose. (4) More than half of maternal deaths are likely preventable. (5) Additionally, 65,000 American women experience severe maternal morbidity (SMM) annually, meaning the physical and psychological conditions that result from, or are aggravated by, pregnancy have an adverse effect on the health of a woman. (6) Racial and ethnic disparities persist across the Nation, and Black women are three to four times more likely to die from complications of pregnancy or childbirth than White women. SEC. 3. PLAN FOR REDUCING MATERNAL MORTALITY. The Public Health Service Act is amended by inserting after section 229 of such Act (42 U.S.C. 237a) the following new section: ``SEC. 229A. PLAN FOR REDUCING MATERNAL MORTALITY. ``(a) In General.--Not later than 1 year after the date of enactment of the Ending Maternal Mortality Act of 2018, and biennially thereafter, the Secretary shall develop and submit to the Congress a national plan to reduce the rate of preventable maternal mortality, with the goals of-- ``(1) cutting the rate in half over the 10 years following such date of enactment; and ``(2) eliminating preventable maternal deaths by the date that is 20 years after such date of enactment. ``(b) Objectives; Strategy.--In each biennial plan under subsection (a), the Secretary shall include-- ``(1) a list of objectives for meeting the goals described in subsection (a); and ``(2) a strategy for implementing the plan across the agencies and offices of the Department of Health and Human Services. ``(c) Specific Issues.--In each biennial plan under subsection (a), the Secretary shall address the following: ``(1) Increasing public understanding of maternal mortality and severe maternal morbidity, including risk factors, warning signs, and prevention of common causes like hemorrhage, preeclampsia, and substance use disorders and other mental health conditions. ``(2) Improving understanding of the root causes of maternal mortality and severe maternal morbidity, including both medical and socioeconomic factors. ``(3) Improving data collection, including State-level reporting. ``(4) Identifying at-risk populations and eliminating disparities that persist based on a mother's race, ethnicity, socioeconomic status, and geographic location. ``(5) Supporting and expanding maternal mortality review committees that bring together public and private relevant stakeholders to review cases of pregnancy-related and pregnancy-associated complications and deaths to make recommendations to improve the quality of care and outcomes. ``(6) Assessing hospital culture of safety in maternity care and how best to provide resources to improve outcomes. ``(7) Improving health and treatment services for expectant mothers struggling with substance use and mental health disorders. ``(8) Studying and supporting local and targeted responses to maternal death. ``(9) Identifying Federal programs and activities to reduce maternal mortality and making recommendations for improving the effectiveness and coordination of such programs and activities. ``(d) Public Posting.--The Secretary shall make each plan submitted to the Congress under this section publicly accessible on the website of the Department of Health and Human Services. ``(e) Consultation.--In developing each biennial plan under this section, the Secretary shall solicit input from organizations representing patients, health care providers, hospitals, other treatment facilities, public health departments and practitioners, and other entities, as appropriate. ``(f) Definitions.--In this section: ``(1) The term `maternal mortality' refers to maternal deaths that occur during, or within the 12 months following, pregnancy. ``(2) The term `maternal morbidity' refers to pregnancy- related and pregnancy-associated complications that do not result in maternal death. ``(3) The term `severe maternal morbidity' includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health.''.

Summary: Ending Maternal Mortality Act of 2018 This bill amends the Public Health Service Act to require the Department of Health and Human Services to publish every two years a national plan to reduce the rate of preventable maternal mortality (maternal deaths that occur during or within 12 months of pregnancy). Each plan must address specific issues relating to maternal mortality and severe maternal morbidity (unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health), such as issues surrounding public awareness, at-risk populations and disparities, and quality of care.


SECTION 1. SHORT TITLE. This Act may be cited as the ``Backcountry Landing Strip Access Act''. SEC. 2. FINDINGS. Congress finds that aircraft landing strips-- (1) serve an essential safety function as emergency landing areas; (2) serve as trailhead access points for-- (A) outdoor enthusiasts and their activities, including hiking, fishing, and hunting; (B) land management activities, including forest management and firefighting; and (C) inholdings, including mining, ranching, scientific research, and tourism; (3) provide access to national parks, national forests, wilderness areas, and other Federal land for people who would otherwise be physically unable to enjoy such places; (4) support the economies of the surrounding communities by providing efficient access for visitors seeking recreational activities; and (5) serve an essential role in search and rescue, forest and ecological management, research, wildlife management, aerial mapping, firefighting, and disaster relief. SEC. 3. DEFINITIONS. In this Act: (1) Administrator.--The term ``Administrator'' means the Administrator of the Federal Aviation Administration. (2) Aircraft landing strip.--The term ``aircraft landing strip'' means an established aircraft landing strip located on Federal land under the administrative jurisdiction of the Secretary that is for aircraft landing and departure activities. (3) Permanently close.--The term ``permanently close'' means any closure lasting more than 30 consecutive days in any calendar year. (4) Secretary.--The term ``Secretary'' means-- (A) with respect to land under the jurisdiction of the Department of the Interior, the Secretary of the Interior; and (B) with respect to land under the jurisdiction of the Department of Agriculture, the Secretary of Agriculture. SEC. 4. PROCEDURE FOR CONSIDERATION OF ACTIONS AFFECTING CERTAIN AIRCRAFT LANDING STRIPS. (a) In General.--The Secretary shall not take any action that would permanently close, restrict, or render or declare as unserviceable any aircraft landing strip unless-- (1) the action has been approved by the head of the aviation department of the State in which the aircraft landing strip is located; (2) the Secretary publishes notice of the proposed action in the Federal Register, including notice that the action would permanently close, restrict, or render or declare as unserviceable the aircraft landing strip; (3) the Secretary provides for a 90-day public comment period beginning on the date on which the notice under paragraph (2) is published; and (4) the Secretary and the head of the aviation department of the State in which the affected aircraft landing strip is located have taken into consideration any comments received during the comment period described in paragraph (3). (b) Policies.-- (1) Backcountry aviation policies.--Not later than 2 years after the date of the enactment of this Act, the Secretary of the Interior and the Secretary of Agriculture shall jointly-- (A) establish a national policy for governing backcountry aviation issues relating to the management of Federal land under the jurisdiction of the Department of the Interior and the Department of Agriculture; and (B) require officials with jurisdiction over the land described in subparagraph (A) to adhere to the policy established pursuant to such subparagraph. (2) Requirements.--Any policy affecting air access to an aircraft landing strip, including the policy established under paragraph (1), shall not take effect unless the policy-- (A) acknowledges that the Administrator has the sole authority to control aviation and airspace over the United States; and (B) was developed after seeking and considering comments from State governments and the public. (c) Maintenance of Airstrips.-- (1) In general.--To ensure that aircraft landing strips are maintained in a manner that is consistent with the resource values of any adjacent area, the Secretary shall consult with-- (A) the head of the aviation department of each State in which an aircraft landing strip is located; and (B) any other interested parties. (2) Cooperative agreements.--The Secretary may enter into cooperative agreements with interested parties for the maintenance of aircraft landing strips. (3) Maintenance standards.--State aircraft landing strip maintenance standards shall be used as the minimum standard when such standards are available. (d) Exchanges or Acquisitions.-- (1) Conditions.--If the Federal Government acquires private or public property on which an aircraft landing strip is located, the acquisition may not require-- (A) the closure or purposeful neglect of the aircraft landing strip; or (B) any other action that would restrict the use of any aircraft landing strip. (2) Availability.--Each private or publicly owned aircraft landing strip acquired by the Federal Government shall be made available to the general public for unrestricted use. (e) Effect on Federal Aviation Administration Authority.--Nothing in this Act may be construed to affect the authority of the Administrator over aviation or airspace.

Summary: Backcountry Landing Strip Access Act - Prohibits the Secretaries of the Interior or Agriculture from taking any action that would permanently close, restrict, or render or declare unserviceable any aircraft landing strip located on land under their jurisdiction unless: (1) the action has been approved by the head of the aviation department of the state in which the landing strip is located; (2) the Secretary publishes notice of the proposed action and provides for a 90-day public comment thereafter; and (3) the Secretary and appropriate state aviation department head have taken into consideration any comments received. Requires the Secretaries to: (1) establish a nationwide policy for governing backcountry aviation issues relating to the management of federal land under the jurisdiction of the Departments of the Interior and Agriculture; and (2) require officials with jurisdiction over such land to adhere to such policy. Requires private and publicly-owned aircraft landing strips acquired by the government to be made available to the public for unrestricted use.


SECTION 1. ENERGY INNOVATION HUBS. (a) Authorization of Program.-- (1) In general.--The Secretary of Energy shall carry out a program to enhance the Nation's economic, environmental, and energy security by making awards to consortia for establishing and operating Energy Innovation Hubs to conduct and support, whenever practicable at one centralized location, multidisciplinary, collaborative research, development, demonstration, and commercial application of advanced energy technologies. (2) Technology development focus.--The Secretary shall designate for each Hub a unique advanced energy technology focus. (3) Coordination.--The Secretary shall ensure the coordination of, and avoid unnecessary duplication of, the activities of Hubs with those of other Department of Energy research entities, including the National Laboratories, the Advanced Research Projects Agency--Energy, Energy Frontier Research Centers, and within industry. (b) Consortia.-- (1) Eligibility.--To be eligible to receive an award under this section for the establishment and operation of a Hub, a consortium shall-- (A) be composed of no fewer than 2 qualifying entities; and (B) operate subject to an agreement entered into by its members that documents-- (i) the proposed partnership agreement, including the governance and management structure of the Hub; (ii) measures to enable cost-effective implementation of the program under this section; (iii) a proposed budget, including financial contributions from non-Federal sources; (iv) a plan for managing intellectual property rights; and (v) an accounting structure that enables the Secretary to ensure that the consortium has complied with the requirements of this section. (2) Application.--A consortium seeking to establish and operate a Hub under this section, acting through a prime applicant, shall transmit to the Secretary an application at such time, in such form, and accompanied by such information as the Secretary shall require, including a detailed description of the elements of the consortium agreement required under paragraph (1)(B). If the consortium members will not be located at one centralized location, such application shall include a communications plan that ensures close coordination and integration of the Hub's activities. (c) Selection and Schedule.--The Secretary shall select consortia for awards for the establishment and operation of Hubs through competitive selection processes. In selecting consortia, the Secretary shall consider the information a consortium must disclose according to subsection (b), as well as any existing facilities a consortium will provide for Hub activities. Awards made to a Hub shall be for a period not to exceed 5 years, after which the award may be renewed, subject to a rigorous merit review. A Hub already in existence on the date of enactment of this Act may continue to receive support for a period of 5 years beginning on the date of establishment of that Hub. (d) Hub Operations.-- (1) In general.--Each Hub shall conduct or provide for multidisciplinary, collaborative research, development, demonstration, and, where appropriate, commercial application of advanced energy technologies within the technology development focus designated under subsection (a)(2). Each Hub shall-- (A) encourage collaboration and communication among the member qualifying entities of the consortium and awardees by conducting activities whenever practicable at one centralized location; (B) develop and publish on the Department of Energy's website proposed plans and programs; (C) submit an annual report to the Secretary summarizing the Hub's activities, including detailing organizational expenditures, and describing each project undertaken by the Hub; and (D) monitor project implementation and coordination. (2) Conflicts of interest.-- (A) Procedures.--Hubs shall maintain conflict of interest procedures, consistent with those of the Department of Energy, to ensure that employees and consortia designees for Hub activities who are in decisionmaking capacities disclose all material conflicts of interest and avoid such conflicts. (B) Disqualification and revocation.--The Secretary may disqualify an application or revoke funds distributed to a Hub if the Secretary discovers a failure to comply with conflict of interest procedures established under subparagraph (A). (3) Prohibition on construction.-- (A) In general.--No funds provided pursuant to this section may be used for construction of new buildings or facilities for Hubs. Construction of new buildings or facilities shall not be considered as part of the non-Federal share of a Hub cost-sharing agreement. (B) Test bed and renovation exception.--Nothing in this subsection shall prohibit the use of funds provided pursuant to this section, or non-Federal cost share funds, for research or for the construction of a test bed or renovations to existing buildings or facilities for the purposes of research if the Secretary determines that the test bed or renovations are limited to a scope and scale necessary for the research to be conducted. (e) Termination.--Consistent with the existing authorities of the Department, the Secretary may terminate an underperforming Hub for cause during the performance period. (f) Definitions.--For purposes of this section: (1) Advanced energy technology.--The term ``advanced energy technology'' means-- (A) an innovative technology-- (i) that produces energy from solar, wind, geothermal, biomass, tidal, wave, ocean, or other renewable energy resources; (ii) that produces nuclear energy; (iii) for carbon capture and sequestration; (iv) that enables advanced vehicles, vehicle components, and related technologies that result in significant energy savings; (v) that generates, transmits, distributes, utilizes, or stores energy more efficiently than conventional technologies, including through Smart Grid technologies; or (vi) that enhances the energy independence and security of the United States by enabling improved or expanded supply and production of domestic energy resources, including coal, oil, and natural gas; (B) research, development, demonstration, and commercial application activities necessary to ensure the long-term, secure, and sustainable supply of energy critical elements; or (C) another innovative energy technology area identified by the Secretary. (2) Energy critical element.--The term ``energy critical element'' means any of a class of chemical elements that have a high risk of a supply disruption and are critical to one or more new, energy-related technologies such that a shortage of such element would significantly inhibit large-scale deployment of technologies that produce, transmit, store, or conserve energy. (3) Hub.--The term ``Hub'' means an Energy Innovation Hub established or operating in accordance with this section, including any Energy Innovation Hub existing as of the date of enactment of this Act. (4) Qualifying entity.--The term ``qualifying entity'' means-- (A) an institution of higher education; (B) an appropriate State or Federal entity, including the Department of Energy Federally Funded Research and Development Centers; (C) a nongovernmental organization with expertise in advanced energy technology research, development, demonstration, or commercial application; or (D) any other relevant entity the Secretary considers appropriate.

Summary: This bill requires the Department of Energy (DOE) to carry out a grant program to enhance the nation's economic, environmental, and energy security by making awards to consortia for establishing and operating Energy Innovation Hubs to conduct and support multidisciplinary, collaborative research, development, demonstration, and commercial application of advanced energy technologies. Advanced energy technologies are innovative technologies or research, development, demonstration, and commercial application activities necessary to ensure the long-term, secure, and sustainable supply of energy critical elements. These elements have a high risk of a supply disruption and are critical to new, energy-related technologies in that a shortage of the element would significantly inhibit large-scale deployment of technologies that produce, transmit, store, or conserve energy. Examples of advanced energy technology include an innovative technology that: produces energy from renewable energy resources; produces nuclear energy; includes carbon capture and sequestration; enables advanced vehicles, vehicle components, and related technologies that result in significant energy savings; generates, transmits, distributes, utilizes, or stores energy more efficiently than conventional technologies; and enhances the energy independence and security of the United States by enabling improved or expanded supply and production of domestic energy resources. DOE must designate a unique advanced energy technology focus for each hub. Grants may not be used for constructing new buildings or facilities for hubs. Further, construction of new buildings or facilities may not be considered as part of the non-federal share of a hub cost-sharing agreement. Grants and non-federal cost share funds may be used for research or for the construction of a test bed or renovations to existing buildings or facilities for the purposes of research.


SECTION 1. SHORT TITLE. This Act may be cited as the ``National Center for Pain Research Act of 1996''. SEC. 2. NATIONAL CENTER FOR PAIN RESEARCH. (a) Establishment.--Section 401(b)(2) of the Public Health Service Act (42 U.S.C. 281(b)(2)) is amended by adding at the end thereof the following new subparagraph: ``(F) The National Center for Pain Research.''. (b) Operation.--Part E of title IV (42 U.S.C. 287 et seq.) is amended by adding at the end thereof the following new subpart: ``Subpart 5--National Center for Pain Research ``SEC. 485E. ESTABLISHMENT AND PURPOSE OF THE CENTER. ``(a) Establishment.--The Secretary shall establish within the National Institutes of Health, a center to be known as the National Center for Pain Research (hereafter referred to in this subpart as the `Center'). The Center shall be headed by a Director (hereafter referred to in this subpart as the `Director') who shall be appointed by the Director of NIH, after consultation with experts in the fields of pain research and treatment representing the disciplines designated in subsection (b)(3), and have the powers described in section 405. ``(b) General Purpose.--The general purpose of the National Center for Pain Research is-- ``(1) to improve the quality of life of individuals suffering from pain by fostering of clinical and basic science research into the causes of and effective treatments for pain; ``(2) to establish a national agenda for conducting and supporting pain research in the specific categories described in subparagraphs (A), (B), (C), and (D) of paragraph (3); ``(3) to identify, coordinate and support research, training, health information dissemination and related activities with respect to-- ``(A) acute pain; ``(B) cancer and HIV-related pain; ``(C) back pain, headache pain, and facial pain; and ``(D) other painful conditions; including the biology of pain, the development of new and the refinement of existing pain treatments, the delivery of pain treatment through the health care system and the coordination of interdisciplinary pain management, that should be conducted or supported by the National Institutes of Health; ``(4) to conduct and support pain research, training, education and related activities that have been identified as requiring additional, special priority as determined appropriate by the Director of the Center and the advisory council established under subsection (c); ``(5) to coordinate all pain research, training, and related activities being carried out among and within the National Institutes of Health; ``(6) to initiate a comprehensive program of collaborative interdisciplinary research among schools, colleges and universities, including colleges of medicine and osteopathy, colleges of nursing, colleges of chiropractic who are members of the Association of Chiropractic Colleges, schools of dentistry, schools of physical therapy, schools of occupational therapy, and schools of clinical psychology, comprehensive health care centers, and specialized centers of pain research and treatment; and ``(7) to promote the sufficient allocation of the resources of the National Institutes of Health for conducting and supporting pain research in the specific categories described in subparagraphs (A), (B), (C), and (D) of paragraph (3). ``(c) Advisory Council.-- ``(1) In general.--The National Pain Research Center Advisory Board shall be the advisory council for the Center. Section 406 applies to the advisory council established under this paragraph, except that-- ``(A) the members of the advisory council shall include representatives of the broad range of health and scientific disciplines involved in research and treatment related to those categories of pain described in subsection (b)(2), and shall include an equal number of representatives of physicians who practice pain management, clinical psychologists, individuals who provide physical medicine and rehabilitative services (including physical therapy and occupational therapy), nurses, dentists, and chiropractic health care professionals; ``(B) the nonvoting ex officio members shall include-- ``(i) the Director of the National Cancer Institute; ``(ii) the Director of the National Institute of Dental Research; ``(iii) the Director of the National Institute of Child Health and Human Development; ``(iv) the Director of the National Institute of Nursing Research; ``(v) the Director of the National Institute of Allergy and Infectious Diseases; ``(vi) the Director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases; ``(vii) the Director of the National Institute of Neurological Disorders and Stroke; ``(viii) the Director of the National Institute on Drug Abuse; and ``(ix) the Director of the National Institute on Disability and Rehabilitation Research of the Department of Education; and ``(3) the council shall meet at least two times each fiscal year. ``(2) Duties.--The advisory council shall advise, assist, consult with and make recommendations to the Director of the Center concerning matters relating to the coordination, research, training, education, and related general purposes set forth in sub section (b), including policy recommendations with regard to grants, contracts, and the operations of the Center. ``(d) Establishment of Regional Pain Research Centers.-- ``(1) Establishment.--To facilitate and enhance the research, training, education, and related activities to be carried out by the Center, the Director of the Center, in consultation with the advisory council established under subsection (c), shall establish not less than six regional pain research centers. ``(2) Focus and distribution.-- ``(A) Focus.--The regional centers established under paragraph (1) shall have as their primary focus one of the categories of pain described in subparagraphs (A), (B), (C), and (D) of subsection (b)(3). ``(B) Distribution.--One regional pain research center shall be established in each of the following six regions of the United States as defined by the Secretary: ``(A) The northeast region. ``(B) The southeast region. ``(C) The midwest region. ``(D) The southwest region. ``(E) The west region, including Hawaii. ``(F) The Pacific Northwest region, including Alaska. ``(2) Use of technology.--The regional centers established under paragraph (1) shall be a part of the Center and shall be interconnected to the Center headquarters through the utilization of distance learning technologies, satellites, fiber optic links, or other telecommunications and computer systems, to allow for the interactive exchange of information, research data, findings, training programs, educational programs, and other Center research and related initiatives. ``(3) Initial regional centers.--The initial regional centers shall be selected through a competitive process from among institutions and centers of the type described in subsection (b)(6). ``(e) Authorization of Appropriations.-- ``(1) In general.--For the purposes of carrying out this section, there are authorized to be appropriated $20,000,000 for each of fiscal years 1997, 1998, and 1999, and such sums as may be necessary for fiscal year 2000. ``(2) Regional centers.--Of the amount appropriated under paragraph (1) for fiscal year 1998 and each subsequent fiscal year, not less than $1,000,000 shall be made available to each of the regional centers established under subsection (d). ``(3) Report to congress.--Not later than January 1, 1998, and each January 1, thereafter, the Director of the Center shall prepare and submit to the committees of Congress a report concerning the total amount of funds expended to support for pain-related research in for the year for which the report was prepared.''.

Summary: National Center for Pain Research Act of 1996 - Amends the Public Health Service Act to establish, in the National Institutes of Health, the National Center for Pain Research. Makes the National Pain Research Center Advisory Board the advisory council for the Center. Mandates establishment of not less than six regional pain research centers. Authorizes appropriations.