[Pages S1553-S1573]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

By Mr. McCONNELL (for himself, Mr. Biden, and Mr.
Leahy):
S. 348. A bill to amend title I of the Omnibus Crime Control and Safe
Streets Act of 1968 to encourage States to enact a Law Enforcement
Officers' Bill of Rights, to provide standards and protection for the
conduct of internal police investigations, and for other purposes; to
the Committee on the Judiciary.

THE LAW ENFORCEMENT OFFICERS' BILL OF RIGHTS ACT OF 1997

<bullet> Mr. McCONNELL. Mr. President, American families turn on the
news every night and get bombarded by the reality that the war against
crime and drugs is escalating. No one understands the dangers of this
domestic war better than the men and women who serve on the front
lines. I'm talking about our Nation's police officers.
These dedicated individuals offer up their lives as an act of service
every day. They know the stress and the strain of walking the daily
beat, of being caught in the crossfire in a world of gangs and drugs.
These officers experience first-hand the casualties of our national
epidemic.
As the Washington Post reported this Sunday, seven law enforcement
officers right here in the Nation's Capital have been killed--in little
more than 2 years. Moreover, the ambush of these ``men and women
wearing badges [occurred]--even though the officers posed no immediate
threat to their attackers.''
Our Nation's police officers endure unfathomable pressure every day
as they fight to take back our streets. In the words of one officer,
``the ultimate sacrifice could occur at any time. * * * [The gangs and
criminals] have rewritten the rule book.''
To make matters worse, the pressure of crime and drugs--of gangs and
thugs--is multiplied by the fear of unjust disciplinary actions. Our
law enforcement officers face intrusive investigations into their
professional and personal lives--oftentimes at the behest of some
recently arrested criminal looking for a payback.
Our officers live in the fear of: being investigated without notice;
being interrogated without an attorney; and being dismissed without a
hearing.
We must act now to address this situation by guaranteeing our police
officers their basic and fundamental rights. So, today, along with Mr.
Biden and Mr. Leahy, I proudly introduce the Law Enforcement Officers'
Bill of Rights.
This bill protects rights that most of us take for granted. For
example, it allows police officers to be involved in, or refrain from,
political activity.
The bill also gives significant due process rights to every police
officer subject to investigation for noncriminal disciplinary action.
Some of these rights include:
The right to be informed of the administrative charges prior to being
questioned; the right to be advised of the results of an investigation;
the right to a hearing and an opportunity to respond; and the right to
be represented by counsel or other representative.
We owe our law enforcement officers a national debt of gratitude for
their valiant fight in a battle that must be won. I ask my colleagues
to show their appreciation and understanding of the plight of our
police force. We must act boldly to equip every officer with basic and
fundamental rights.
Finally, I must conclude by explaining that this bill is a product of
years of input from the men and women who have experienced these daily
pressures, and continue to endure them. This legislation has benefited
from the thoughtful ideas and past support of many law enforcement
groups, including the Fraternal Order of Police, the National
Association of Police Organizations, and the International Brotherhood
of Police Officers.

[[Page S1554]]

In particular, I am grateful to the contribution made by the
Fraternal Order of Police. Over the past 6 years, I have worked closely
with the Kentucky FOP to develop and promote this legislation. Seasoned
and well-informed officers like Ray Franklin and Mike Hettich, both of
whom are National FOP officers from my home State, have worked with me
in refining the language of this bill and developing grassroots
momentum. I would also like to say a personal word of thanks to Verlin
Flaherty, Rick McCubbin, and Martin Scott.
The time has come to protect those who protect us. We must give our
law enforcement officers the basic and fundamental rights that they
desperately need and deserve.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 348

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Law Enforcement Officers'
Bill of Rights Act of 1997''.

SEC. 2. RIGHTS OF LAW ENFORCEMENT OFFICERS.

(a) In General.--Part H of title I of the Omnibus Crime
Control and Safe Streets Act of 1968 (42 U.S.C. 3781 et seq.)
is amended by adding at the end the following:

``SEC. 820. RIGHTS OF LAW ENFORCEMENT OFFICERS.

``(a) Definitions.--In this section:
``(1) Disciplinary action.--The term `disciplinary action'
means the suspension, demotion, reduction in pay or other
employment benefit, dismissal, transfer, or similar action
taken against a law enforcement officer as punishment for
misconduct.
``(2) Disciplinary hearing.--The term `disciplinary
hearing' means an administrative hearing initiated by a law
enforcement agency against a law enforcement officer, based
on probable cause to believe that the officer has violated or
is violating a rule, regulation, or procedure related to
service as an officer and is subject to disciplinary action.
``(3) Emergency suspension.--The term `emergency
suspension' means temporary action imposed by the head of the
law enforcement agency if that official determines that there
is probable cause to believe that a law enforcement officer--
``(A) has committed a felony; or
``(B) poses an immediate threat to the safety of the
officer or others or the property of others.
``(4) Investigation.--The term `investigation'--
``(A) means the action of a law enforcement agency, acting
alone or in cooperation with another agency, or a division or
unit within an agency, or the action of an individual law
enforcement officer, taken with respect to another
enforcement officer, if such action is based on reasonable
suspicion that the law enforcement officer has violated, is
violating, or will in the future violate a statute or
ordinance, or administrative rule, regulation, or procedure
relating to service as a law enforcement officer; and
``(B) includes--
``(i) asking questions of other law enforcement officers or
nonlaw enforcement officers;
``(ii) conducting observations;
``(iii) evaluating reports, records, or other documents;
and
``(iv) examining physical evidence.
``(5) Law enforcement agency.--The term `law enforcement
agency' means a State or local public agency charged by law
with the duty to prevent or investigate crimes or apprehend
or hold in custody persons charged with or convicted of
criminal offenses.
``(6) Law enforcement officer.--The terms `law enforcement
officer' and `officer'--
``(A) mean a member of a law enforcement agency serving in
a law enforcement position, which is usually indicated by
formal training (regardless of whether the officer has
completed or been assigned to such training) and is usually
accompanied by the power to make arrests; and
``(B) include--
``(i) a member who serves full-time, whether probationary
or nonprobationary, commissioned or noncommissioned, career
or noncareer, tenured or nontenured, and merit or nonmerit;
and
``(ii) the chief law enforcement officer of a law
enforcement agency.
``(7) Summary punishment.--The term `summary punishment'
means punishment imposed for a minor violation of a rule,
regulation, or procedure of a law enforcement agency that
does not result in suspension, demotion, reduction in pay or
other employment benefit, dismissal, or transfer.
``(b) Application of Section.--
``(1) In general.--This section sets forth rights that
shall be afforded any law enforcement officer who is the
subject of an investigation.
``(2) Nonapplicability.--This section does not apply in the
case of--
``(A) a criminal investigation of the conduct of a law
enforcement officer; or
``(B) a nondisciplinary action taken in good faith on the
basis of the employment related performance of a law
enforcement officer.
``(c) Political Activity.--Except if on duty or acting in
an official capacity, no law enforcement officer shall be
prohibited from engaging in political activity or be denied
the right to refrain from engaging in such activity.
``(d) Rights of Law Enforcement Officers Under
Investigation.--If a law enforcement officer is under
investigation that could lead to disciplinary action, each of
the following minimum standards shall apply:
``(1) Notice of investigation.--A law enforcement officer
shall be notified of the investigation within a reasonable
time after the commencement of the investigation. Notice
shall include the general nature and scope of the
investigation and all departmental violations for which
reasonable suspicion exists. No investigation based on a
complaint from outside the law enforcement agency may
commence unless the complainant provides a signed detailed
statement. An investigation based on a complaint from outside
the agency shall commence not later than 15 days after
receipt of the complaint by the agency.
``(2) Notice of investigative findings and recommendation
for disciplinary action.--At the conclusion of the
investigation, the person in charge of the investigation
shall inform the law enforcement officer under investigation,
in writing, of the investigative findings and any
recommendation for disciplinary action that the person
intends to make.
``(e) Rights of Law Enforcement Officers Before and During
Questioning.--If a law enforcement officer is subjected to
questioning that could lead to disciplinary action, each of
the following minimum standards shall apply:
``(1) Reasonable hours.--Questioning of a law enforcement
officer shall be conducted at a reasonable hour, preferably
during the time that the law enforcement officer is on duty,
unless exigent circumstances otherwise require.
``(2) Place of questioning.--Questioning of the law
enforcement officer shall take place at the offices of the
persons who are conducting the investigation or the place
where the law enforcement officer reports for duty, unless
the officer consents in writing to being questioned
elsewhere.
``(3) Identification of questioner.--The law enforcement
officer under investigation shall be informed, at the
commencement of any questioning, of the name, rank, and
command of the officer conducting the questioning.
``(4) Single questioner.--During any single period of
questioning of the law enforcement officer, all questions
shall be asked by or through a single investigator.
``(5) Notice of nature of investigation.--The law
enforcement officer under investigation shall be informed in
writing of the nature of the investigation not less than 72
hours before any questioning.
``(6) Reasonable time period.--Any questioning of a law
enforcement officer in connection with an investigation shall
be for a reasonable period of time and shall allow for
reasonable periods for the rest and personal necessities of
the law enforcement officer.
``(7) No threats or promises.--Threats against, harassment
of, or promise of reward shall not be made in connection with
an investigation to induce the answering of any question. No
statement given by the officer may be used in a subsequent
criminal proceeding unless the officer has received a written
grant of use and derivative use immunity or transactional
immunity.
``(8) Recordation.--All questioning of any law enforcement
officer in connection with the investigation shall be
recorded in full, in writing or by electronic device, and a
copy of the transcript shall be made available to the officer
under investigation.
``(9) Counsel.--The law enforcement officer under
investigation shall be entitled to counsel (or any other one
person of the officer's choice) during any questioning of the
officer, unless the officer consents in writing to being
questioned outside the presence of counsel.
``(f) Disciplinary Hearing.--
``(1) Notice of opportunity for hearing.--Except in a case
of summary punishment or emergency suspension described in
subsection (h), if an investigation of a law enforcement
officer results in a recommendation of disciplinary action,
the law enforcement agency shall notify the law enforcement
officer that the law enforcement officer is entitled to a
hearing on the issue by a hearing officer or board before the
imposition of any disciplinary action.
``(2) Requirement of determination of violation.--No
disciplinary action may be taken unless a hearing officer or
board determines, pursuant to a fairly conducted disciplinary
hearing, that the law enforcement officer violated a statute,
ordinance, or published administrative rule, regulation, or
procedure.
``(3) Time limit.--No disciplinary charges may be brought
against a law enforcement officer unless filed not later than
90 days after the commencement of an investigation, except
for good cause shown.
``(4) Notice of filing of charges.--The law enforcement
agency shall provide written, actual notification to the law
enforcement officer, not later than 30 days after the

[[Page S1555]]

filing of disciplinary charges, of the following:
``(A) Date, time, and location of hearing.--The date, time,
and location of the disciplinary hearing, which shall take
place not sooner than 30 days and not later than 60 days
after notification to the law enforcement officer under
investigation unless waived in writing by the officer.
``(B) Information relating to hearing officer.--The full
name and mailing address of the hearing officer.
``(C) Information relating to prosecutor.--The name, rank,
and command of the prosecutor, if a law enforcement officer,
or the name, position, and mailing address of the prosecutor,
if not a law enforcement officer.
``(5) Representation.--During a disciplinary hearing, an
officer shall be entitled to be represented by counsel or
other representative.
``(6) Hearing board and procedure.--
``(A) In general.--Subject to subparagraph (B), a State
shall determine the composition of a disciplinary hearing
board and the procedures for a disciplinary hearing.
``(B) Membership.--A disciplinary hearing board that
includes employees of the law enforcement agency of which the
officer who is the subject of the hearing is a member shall
include not less than 1 law enforcement officer of equal or
lesser rank to the officer who is the subject of the hearing.
``(7) Access to evidence.--A law enforcement officer who is
brought before a disciplinary hearing board shall be provided
access to all transcripts, records, written statements,
written reports, analyses, and electronically recorded
information pertinent to the case that--
``(A) contain exculpatory information;
``(B) are intended to support any disciplinary action; or
``(C) are to be introduced in the disciplinary hearing.
``(8) Identification of witnesses.--The disciplinary
advocate for the law enforcement agency of which the officer
who is the subject of the hearing is a member shall notify
the law enforcement officer, or his attorney if he is
represented by counsel, not later than 15 days before the
hearing, of the name and addresses of all witnesses for the
law enforcement agency.
``(9) Copy of investigative file.--The disciplinary
advocate for the law enforcement agency of which the officer
who is the subject of the hearing is a member shall provide
to the law enforcement officer, upon the request of the law
enforcement officer, not later than 15 days before the
hearing, a copy of the investigative file, including all
exculpatory and inculpatory information, except that the law
enforcement agency may exclude confidential sources, unless
the law enforcement officer is entitled to such sources under
subparagraph (A), (B), or (C) of paragraph (7).
``(10) Examination of physical evidence.--The disciplinary
advocate for the law enforcement agency of which the officer
who is the subject of the hearing is a member shall notify
the law enforcement officer, at the request of the officer,
not later than 15 days before the hearing, of all physical,
nondocumentary evidence, and provide reasonable date, time,
place, and manner for the officer to examine such evidence
not less than 10 days before the hearing.
``(11) Summonses.--The hearing board shall have the power
to issue summonses to compel testimony of witnesses and
production of documentary evidence. If confronted with a
failure to comply with a summons, the hearing officer or
board may petition a court to issue an order, with failure to
comply being subject to contempt of court.
``(12) Closed hearing.--A disciplinary hearing shall be
closed to the public unless the law enforcement officer who
is the subject of the hearing requests, in writing, that the
hearing be open to specified individuals or the general
public.
``(13) Recordation.--All aspects of a disciplinary hearing,
including prehearing motions, shall be recorded by audio
tape, video tape, or transcription.
``(14) Sequestration of witnesses.--Either side in a
disciplinary hearing may move for and be entitled to
sequestration of witnesses.
``(15) Testimony under oath.--The hearing officer or board
shall administer an oath or affirmation to each witness, who
shall testify subject to the applicable laws of perjury.
``(16) Verdict on each charge.--At the conclusion of all
the evidence, and after oral argument from both sides, the
hearing officer or board shall deliberate and render a
verdict on each charge.
``(17) Burden of persuasion.--The burden of persuasion of
the prosecutor shall be by clear and convincing evidence as
to each charge involving false representation, fraud,
dishonesty, deceit, or criminal behavior and by a
preponderance of the evidence as to all other charges.
``(18) Finding of not guilty.--If the law enforcement
officer is found not guilty of the disciplinary violations,
the matter is concluded and no disciplinary action may be
taken.
``(19) Finding of guilty.--If the law enforcement officer
is found guilty, the hearing officer or board shall make a
written recommendation of a penalty. The sentencing authority
may not impose greater than the penalty recommended by the
hearing officer or board.
``(20) Appeal.--A law enforcement officer may appeal from a
final decision of a law enforcement agency to a court to the
extent available in any other administrative proceeding, in
accordance with the applicable State law.
``(g) Waiver of Rights.--A law enforcement officer may
waive any of the rights guaranteed by this section subsequent
to the time that the officer has been notified that the
officer is under investigation. Such a waiver shall be in
writing and signed by the officer.
``(h) Summary Punishment and Emergency Suspension.--
``(1) In general.--This section does not preclude a State
from providing for summary punishment or emergency
suspension.
``(2) Health benefits.--An emergency suspension shall not
affect or infringe on the health benefits of a law
enforcement officer or any dependent of the officer.
``(i) Retaliation for Exercising Rights.--There shall be no
penalty or threat of penalty against a law enforcement
officer for the exercise of the rights of the officer under
this section.
``(j) Other Remedies Not Impaired.--Nothing in this section
shall be construed to impair any other legal right or remedy
that a law enforcement officer may have as a result of a
constitution, statute, ordinance, regulation, collective
bargaining agreement or other sources of rights.
``(k) Declaratory or Injunctive Relief.--A law enforcement
officer who is being denied any right afforded by this
section may petition a State court for declaratory or
injunctive relief to prohibit the law enforcement agency from
violating such right.
``(l) Prohibition of Adverse Material in Officer's File.--A
law enforcement agency shall not insert any adverse material
into the file of any law enforcement officer, or possess or
maintain control over any adverse material in any form within
the law enforcement agency, unless the officer has had an
opportunity to review and comment in writing on the adverse
material.
``(m) Disclosure of Personal Assets.--A law enforcement
officer shall not be required or requested to disclose any
item of the officer's personal property, income, assets,
sources of income, debts, or personal or domestic
expenditures (including those of any member of the officer's
household), unless--
``(1) the information is necessary to the investigation of
a violation of any Federal, State or local law, rule, or
regulation with respect to the performance of official
duties; and
``(2) such disclosure is required by Federal, State, or
local law.
``(n) States' Rights.--This section does not preempt State
laws in existence on the effective date of this section that
confer rights that equal or exceed the rights and coverage
afforded by this section. This section shall not be a bar to
the enactment of a police officer's bill of rights, or
similar legislation, by any State. A State law that confers
fewer rights or provides less protection to law enforcement
officers than this section shall be preempted by this
section.
``(o) Mutually Agreed Upon Collective Bargaining
Agreements.--This section does not preempt any mutually
agreed upon collective bargaining agreement in existence on
the effective date of this section that is substantially
similar to the rights and coverage afforded under this
section.
``(p) Effective Date.--This section shall take effect with
respect to each State on the earlier of--
``(1) 2 years after the date of enactment of the Law
Enforcement Officers' Bill of Rights Act of 1997; or
``(2) upon the conclusion of the second legislative session
of the State that begins on or after the date of enactment of
the Law Enforcement Officers' Bill of Rights Act of 1997.''.
(b) Technical Amendment.--The table of contents of title I
of the Omnibus Crime Control and Safe Streets Act of 1968 (42
U.S.C. preceding 3701) is amended by inserting after the item
relating to section 819 the following:

``Sec. 820. Rights of law enforcement officers.''.<bullet>

<bullet> Mr. BIDEN. Mr. President, today, we renew our call for the
congress to pass the ``law enforcement officers' bill of rights act.''
For 6 years, I have been working with Senator McConnell, other
Senators, and the Nation's police officers to pass into law a bill
protecting the rights of law enforcement officers on the front line of
this Nation's fight against violent crime and drug trafficking.
Before addressing the specifics of this legislation, I want to
discuss the reality of law enforcement today. The simple fact is that
as Federal, State, and local officials push to expand ``community'' or
``problem-solving'' policing we are necessarily requiring police
officers to move away from standard procedures and towards more
creative approaches.
Of course, as we encourage creativity, there is always the need to
guarantee the highest standards of police conduct.
Unfortunately, because police department's internal disciplinary
procedures vary so widely across the Nation, we are literally moving at
cross-purposes. On the one hand, we are calling on police officers to
take more creative approaches--which naturally raises the

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chances of technical violations of department procedures.
While, on the other hand, we subject police officers to varying,
often ad hoc, disciplinary procedures which do make clear what specific
conduct is appropriate, nor what will happen should the conduct turn
out to be a mistake.
In fact, the practices that many departments use to guide internal
investigations frequently allow police executives to take arbitrary and
unfair actions against innocent police officers, while allowing
culpable officers to avoid any punishment at all.
The law enforcement officers' bill of rights is designed to replace
the ad hoc nature of many internal police investigations by encouraging
States to provide minimum procedural standards to guide such
investigations. The standards and protections offered by this bill are
modeled on the standards for law enforcement agencies developed by the
National Commission on Accreditation for Law Enforcement.
As the preface to the commission's standards on internal affairs
notes:

``The internal affairs function is important for the
maintenance of professional conduct in a law enforcement
agency. The integrity of the agency depends on the personal
integrity and discipline of each employee. To a large degree,
the pubic image of the agency is determined by the quality of
the internal affairs function in responding to allegations of
misconduct by the agency or its employees.''

The specific standards and rights guaranteed by the law enforcement
officers bill of rights are designed to improve and enhance the quality
of the internal affairs function, including: The right to be informed
by a written statement of the charges brought against an officer; The
right to be free from undue coercion or harassment during an
investigation; and The right to counsel during an investigation.
The provisions of this bill will take effect at the end of the second
full legislative term of each State. After such time, a law enforcement
officer whose rights have been abridged may sue in state court for
pecuniary and other damages, including full reinstatement.
Although the bill provides certain procedural rights, it gives States
considerable discretion in implementing these safeguards, including the
flexibility to provide for summary punishment and emergency suspensions
of law enforcement officers.
It is also important to note what the bill does not do. The bill
explicitly provides that the standards and protections governing
internal investigations shall not apply to investigations of criminal
misconduct by law enforcement officers. As a result, criminal
investigations of law enforcement officers would not be affected by
this bill.
Moreover, the protections in this bill do not apply to minor
violations of departmental rules or regulations, nor to actions taken
on the basis of an officers' employment-related performance.
I would also like to acknowledge the hard work of several of the
Nation's leading law enforcement organizations on this important bill.
The real leaders behind this effort--and they have been the leaders
since the police officers' bill of rights won passage in the Senate in
1991--are the Fraternal Order of Police, the National Association of
Police Organizations, the International Brotherhood of Police Officers,
and the National Troopers Coalition. No one should be confused about
where the force behind the law enforcement officers bill of rights
lies--it lies with these organizations.<bullet>
<bullet> Mr. LEAHY. Mr. President, I join as an original sponsor of the
Law Enforcement Officers' Bill of Rights Act of 1997.
Our State and local law enforcement officers are the backbone of our
nation's anticrime, antigang and anti-drug efforts. Together with local
prosecutors and an energized public, our local law enforcement officers
are responsible for much of the good news we have had over the last few
years, as crime rates across the county have declined. The President's
community policing program, which is assisting local law enforcement to
add 100,000 additional cops on the beat, is paying off. More police
officers are patrolling our neighborhoods, towns, cities, and rural
areas, and it is helping communities across America.
On the first day of this Congress, I joined in sponsoring S. 15 with
the minority leader and other Democrats. With that bill, we hope to
take the next step against crime by redoubling our efforts against
youth gangs and drugs. State and local officers are essential
participants in these initiatives.
When I was privileged to serve as state's attorney for Chittenden
County, I had the good fortune to work alongside a number of dedicated
State and local officers. These public servants literally put their
lives on the line each day to protect all of us. Since coming to the
Senate, I have tried to do my best to support local law enforcement.
Their responsibilities require split-second judgment, dedication,
timing, and guts. We hold the men and women who serve in law
enforcement to the highest standards because public respect for the law
is so critical.
This legislation is an effort to spell out what the Constitution's
guarantee of due process means to law enforcement officers subjected to
administrative disciplinary proceedings. It is our hope that these
standards will serve the public by helping specify fair, prompt
procedures for determining whether a rule relating to an officer's
service has been violated. This measure should make unnecessary
prolonged litigation challenging whether disciplinary procedures were
sufficient to satisfy officers' constitutional rights to due process.
These kinds of fair processes should provide the public and law
enforcement officers with confidence in both the outcome of such
administrative proceedings as well as the fairness of the procedures
used to determine questions of possible misconduct.
When a law enforcement officer engages in wrongdoing, it reflects
badly on all law enforcement. No one is harder on those few officers
who go bad than fellow law enforcement officers. This bill will do
nothing to protect those wrongdoers. Officers under criminal
investigation or those subject to immediate suspension because there is
probable cause to believe they committed a felony or pose a threat to
public safety will find no comfort here. This bill should not affect
criminal investigations, nor for that matter, civil lawsuits against
officers.
The procedural protections provided by this bill attach in
administrative proceedings. They provide officers with a minimum
threshold of due process protection by requiring that the officers be
informed of charges against them, have a right to a fair hearing, be
allowed representation, be advised of the results of internal
investigations and be afforded an opportunity to review and comment on
adverse actions.
I hope that we can make progress on this bill and look forward to
working with representatives of State and local government, police
chiefs, sheriffs, troopers, and other interested parties as we proceed.
As a cosponsor, I will work to improve this bill. For example, I would
like to be able to provide greater privacy protection for officers'
medical records as well as for the financial information already
included in the bill. At the same time, I remain concerned that
disciplinary actions be open to the public. When a hearing is
justifiably closed, its results should nonetheless be made public. I am
confident that we can work out such details in a consensus, bipartisan
effort.
I am convinced that it is worth the effort to reassure those who
serve us that we respect their rights and reputations. While no one is
above the law, everyone is entitled to be treated fairly.<bullet>
______

By Mrs. BOXER (for herself, Mr. Kennedy and Mr. Hollings):
S. 349. A bill to amend the Public Health Service Act to provide for
expanding, intensifying, and coordinating activities of the National
Heart, Lung, and Blood Institute with respect to heart attack, stroke,
and other cardiovascular diseases in women; to the Committee on Labor
and Human Resources.

THE WOMEN'S CARDIOVASCULAR DISEASES RESEARCH AND PREVENTION ACT

<bullet> Mrs. BOXER. Mr. President, today I am introducing the Women's
Cardiovascular Diseases Research and Prevention Act, a bill to expand
and intensify research and educational outreach programs regarding
cardiovascular diseases in women. This bill will aid our Nation's
doctors and scientists in developing a coordinated and comprehensive
strategy for fighting this terrible disease.

[[Page S1557]]

Cardiovascular disease is the No. 1 killer of women in the United
States. Over 479,000 women die from cardiovascular disease each year
and 1 in 5 women has some form of the disease. Research is our best
hope for averting this national tragedy which strikes so many of our
grandmothers, mothers, aunts, and daughters.
The Women's Cardiovascular Diseases Research and Prevention Act
authorizes $140 million to the National Heart, Lung and Blood Institute
to expand and intensify research, prevention, and educational outreach
programs for heart attack, stroke, and other cardiovascular diseases in
women.
This bill will educate women and doctors about the dire threat heart
disease poses to women's health. It will help train doctors to better
recognize symptoms of cardiovascular disease which are unique to women.
It would also teach women about risk factors, such as smoking, obesity,
and physical inactivity, which greatly increase their chances of
developing coronary heart disease.
For years, women have been under-represented in studies conducted on
heart disease and stroke. Models and tests for detection have been
conducted largely on men. This legislation will help ensure that women
are well represented in future heart and stroke research studies.
The Women's Cardiovascular Diseases Research and Prevention Act is
being introduced in the House today by Representative Maxine Waters.
I urge my colleagues to commit to combating cardiovascular disease by
supporting this bill.
I ask unanimous consent that the full text of the bill be printed in
the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 349

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Women's Cardiovascular
Diseases Research and Prevention Act''.

SEC. 2. FINDINGS.

The Congress finds as follows with respect to women in the
United States:
(1) Heart attack, stroke, and other cardiovascular diseases
are the leading causes of death in women.
(2) Heart attacks and strokes are leading causes of
disability in women.
(3) Cardiovascular diseases claim the lives of more women
each year than does cancer. Each year more than 479,000
females die of cardiovascular diseases, while approximately
246,000 females die of cancer. Heart attack kills more than 5
times as many females as breast cancer. Stroke kills twice as
many females as breast cancer.
(4) One in 5 females has some form of cardiovascular
disease. Of females under age 65, each year more than 20,000
die of heart attacks. In the case of African-American women,
from ages 35 to 74 the death rate from heart attacks is
approximately twice that of white women and 3 times that of
women of other races.
(5) Each year since 1984, cardiovascular diseases have
claimed the lives of more females than males. In 1992, of the
number of individuals who died of such diseases, 52 percent
were females and 48 percent were males.
(6) The clinical course of cardiovascular diseases is
different in women than in men, and current diagnostic
capabilities are less accurate in women than in men. Once a
woman develops a cardiovascular disease, she is more likely
than a man to have continuing health problems, and she is
more likely to die.
(7) Of women who have had a heart attack, approximately 44
percent die within 1 year of the attack. Of men who have had
such an attack, 27 percent die within 1 year. At older ages,
women who have had a heart attack are twice as likely as men
to die from the attack within a few weeks. Women are more
likely than men to have a stroke during the first 6 years
following a heart attack. More than 60 percent of women who
suffer a stroke die within 8 years. Long-term survivorship of
stroke is better in women than in men. Of individuals who die
from a stroke, each year approximately 61 percent are
females. In 1992, 87,124 females died from strokes. Women
have unrecognized heart attacks more frequently than men. Of
women who died suddenly from heart attack, 63 percent had no
previous evidence of disease.
(8) More than half of the annual health care costs that are
related to cardiovascular diseases are attributable to the
occurrence of the diseases in women, each year costing this
Nation hundreds of billions of dollars in health care costs
and lost productivity.

SEC. 3. EXPANSION AND INTENSIFICATION OF ACTIVITIES REGARDING
HEART ATTACK, STROKE, AND OTHER CARDIOVASCULAR
DISEASES IN WOMEN.

Subpart 2 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285b et seq.) is amended by inserting
after section 424 the following:

``heart attack, stroke, and other cardiovascular diseases in women

``Sec. 424A. (a) In General.--The Director of the Institute
shall expand, intensify, and coordinate research and related
activities of the Institute with respect to heart attack,
stroke, and other cardiovascular diseases in women.
``(b) Coordination With Other Institutes.--The Director of
the Institute shall coordinate activities under subsection
(a) with similar activities conducted by the other national
research institutes and agencies of the National Institutes
of Health to the extent that such Institutes and agencies
have responsibilities that are related to heart attack,
stroke, and other cardiovascular diseases in women.
``(c) Certain Programs.--In carrying out subsection (a),
the Director of the Institute shall conduct or support
research to expand the understanding of the causes of, and to
develop methods for preventing, cardiovascular diseases in
women. Activities under such subsection shall include
conducting and supporting the following:
``(1) Research to determine the reasons underlying the
prevalence of heart attack, stroke, and other cardiovascular
diseases in women, including African-American women and other
women who are members of racial or ethnic minority groups.
``(2) Basic research concerning the etiology and causes of
cardiovascular diseases in women.
``(3) Epidemiological studies to address the frequency and
natural history of such diseases and the differences among
men and women, and among racial and ethnic groups, with
respect to such diseases.
``(4) The development of safe, efficient, and cost-
effective diagnostic approaches to evaluating women with
suspected ischemic heart disease.
``(5) Clinical research for the development and evaluation
of new treatments for women, including rehabilitation.
``(6) Studies to gain a better understanding of methods of
preventing cardiovascular diseases in women, including
applications of effective methods for the control of blood
pressure, lipids, and obesity.
``(7) Information and education programs for patients and
health care providers on risk factors associated with heart
attack, stroke, and other cardiovascular diseases in women,
and on the importance of the prevention or control of such
risk factors and timely referral with appropriate diagnosis
and treatment. Such programs shall include information and
education on health-related behaviors that can improve such
important risk factors as smoking, obesity, high blood
cholesterol, and lack of exercise.
``(d) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated $140,000,000 for fiscal year 1998, and such sums
as may be necessary for each of the fiscal years 1999 to
2000. The authorization of appropriations established in the
preceding sentence is in addition to any other authorization
of appropriations that is available for such
purpose.''.<bullet>
______

By Mr. THURMOND:
S. 350. A bill to authorize payment of special annuities to surviving
spouses of deceased members of the uniformed services who are
ineligible for a survivor annuity under transition laws relating to the
establishment of the Survivor Benefit Plan under chapter 73 of title
10, United States Code; to the Committee on Armed Services.

annuity legislation

Mr. THURMOND. Mr. President, I rise today to introduce a bill that
would authorize a modest annuity of $165 a month for a group of
surviving spouses of former service members who died before March 21,
1974, and were retired from active duty. The bill would also apply to
surviving spouses of service members retired from the Reserves between
September 21, 1972 and October 1, 1978.
At the time these service members retired from the military, there
was no plan to take care of these widows as we have today. The same
concerns that moved the Congress to authorize the current survivor
benefit plan are true for this group of forgotten widows. The
beneficiaries of this plan are all seniors now. For some, this small
annuity will make the difference between a life of dependency and a
life of dignity and independence. Let us correct this situation and
take care of the service members spouses who had the courage to serve
their Nation in the troubling time periods of the Korean and Vietnam
wars.
I have tried to get this legislation passed in previous Congresses
only to be frustrated by budget rules and CBO scoring.
Mr. President, we must not allow bureaucratic rules to stand in our
way because, one fact remains true. The

[[Page S1558]]

longer we delay, the fewer of these widows there are to benefit from
the legislation. I do not want to be remembered as one who forgot this
group who have become known as the Forgotten Widows. I urge my
colleagues to join me and support this important legislation.
______

By Mrs. MURRAY:

S. 351. A bill to provide for teacher technology training; to the
Committee on Labor and Human Resources.

THE TEACHER TECHNOLOGY TRAINING ACT OF 1997

Mrs. MURRAY. Mr. President, technology is changing our world. It
affects the way we communicate, the way we conduct commerce, and the
way our children learn in school. Young people today are in the midst
of a technology explosion that has really opened up limitless
possibilities in the classroom. In order for our students to tap into
this potential and be prepared for the 21st century, they have to learn
how to use technology. But all too often today, teachers are expected
to incorporate technology into their instruction without being given
the training to do so.
A recent study by the Office of Technology Assessment shows that a
majority of teachers feel they need additional training in order to
adequately use a personal computer. In fact, school districts across
the country spend less than 15 percent of their technology budgets on
teacher training. Hardware, software, access to the Internet are only
helpful to the educational process if teachers are equipped with the
knowledge to use that technology.
That is why I am introducing today the Teacher Technology Training
Act of 1997, which will add technology to the areas of professional
development and teacher training on the Elementary and Secondary
Schools Act of 1994. My legislation will require States to incorporate
technology requirements in teacher training content and performance
standards. School districts and local educational agencies that receive
Federal funding for professional development have to include technology
classes in their programs. In addition, institutions of higher
education will be strongly encouraged to include technology in their
education programs.
There are two parts to providing students access to technology:
putting computers into the schools, and training teachers in how to use
them. Last year, I authored and we passed two amendments that would
allow surplus computers from Government agencies to be made available
to educational institutions across this country. In addition, Congress
provided the E-rate in the telecommunications legislation we passed
last year that will provide Internet connections to schools at
discounted rates. I also fought for a fivefold increase in
appropriations for new technology and classrooms.
These are steps toward ensuring that all schools have computer
technology. Now I want work to make sure that teachers are properly
trained to use these computers.
Recently, the Department of Education reported that only one in five
of our Nation's teachers currently use computers in our classrooms--one
out of five. Since technology training today focuses primarily on the
mechanics of operating equipment, not on integrating technology into
the curriculum, this is not surprising.
Washington State, my home State, has become a State synonymous with
Microsoft, Boeing, and thousands of other leading high-technology
companies. The Information Technology Association of America reports
that these information technology companies are short 190,000 employees
today. These are employees dependent upon a technology curriculum and
trained teachers in our schools.
When I toured my State of Washington last week, I was astounded by
the advances made within our classrooms. At Seattle's Nathan Hale High
School, I saw a science class that utilized computers to track weather
patterns and charts the effects on their region. They have created
their own web pages and are able to hourly tap into the National
Weather Service. Their final grade was then based on their ability to
produce an accurate 5-day weather forecast.
I also saw physically challenged students openly communicate with
their teacher through enhanced computer technology. In the city of
Bellingham, I spoke with a student-teacher who was concerned that when
she and others went out into the field, there would be teachers who did
not know how to use the technology. She felt that many of the students
are far ahead of the teachers in their ability to use technology. In
Grays Harbor County, I toured a facility supported by a public-private
partnership. This lifelong learning center takes surplus computers and
teaches student how to repair them and maintain their technology. The
possibilities for learning are limitless.
Having technology available for instructors does not directly change
teaching or learning. What matters is how successfully teachers can
incorporate technology into their classrooms.
We know that technology is only one tool the teachers need to be
effective in their jobs. My bill seeks to promote technology training.
I have received support for this legislation from the National
Education Association, the Washington Software and Digital Alliance,
University Presidents and Deans, Washington School Principals, and many
corporate and educational institutions.
Mr. President, as a former preschool teacher, a parent education
instructor, a former school board member, and as a parent, I know the
needs of students and teachers have changed dramatically in recent
years. My own children have benefit from the use of technology in their
classrooms. But a school full of computers is useless if teachers don't
have the necessary training to show students how to use them.
As a member of the Labor and Human Resources Committee, I intend to
fight for this legislation in Congress. I urge my colleagues' support
for this bill so that we can provide teachers with the tools necessary
to teach in today's changing classrooms and tomorrow's work force.
______

By Mr. BIDEN:
S. 352. A bill to require the United States Sentencing Commission to
amend the Federal sentencing guidelines to provide an enhanced penalty
for follow-on bombings; to the Committee on the Judiciary.

The Police and rescue squad protection act

<bullet> Mr. BIDEN. Mr. President, the bombings in Atlanta over the
past 2 months--the second of which occurred last weekend--have marked
the opening of yet another unfortunate new chapter in the escalation of
domestic terrorism.
While the magnitude of these attacks were far less than the World
Trade Center and Oklahoma City bombings, they were noteworthy for the
pernicious technique this criminal--or criminal organization--used:
First, the terrorists attracted police, firefighters, and rescue
workers to the scene by detonating one bomb,
And then, with the unmistakable intent to injure the public safety
officers responding to the first explosion, detonated a second
explosive device in the parking lot outside the location of the first
bombing.
According to the experts, this tactic is one imported from the hotbed
of terrorist activity--the Middle East.
On two occasions last year, follow-on bombs were detonated in
Southern Lebanon. One almost killed Israel's northern commander--Maj.
Gen. Amiram Levine.
Then this January, only 6 days before the Atlanta abortion clinic
bombing, two bombs were detonated only 10 minutes apart near a bus
station in Tel Aviv. Thirteen people were injured, including one police
officer who came to the scene in response to the first bomb and was
wounded by the second.
Last month in Atlanta, the first bomb injured no one, but the
``follow-on'' bomb wounded seven people, including two FBI agents, one
ATF agent, and two local firefighters. Experts have stated that many
more rescue workers would have been injured had the force of the second
blast not been deflected by a car, which just happened to be parked in
the right spot.
Five people were injured by the bomb that exploded in an Atlanta
restaurant last Friday, but fortunately, the police found the second
bomb and detonated it with a remote-controlled robot.
Of course, all terrorist acts are horrific. But this follow-on
bombing tactic

[[Page S1559]]

is especially henious because the technique is designed to do one
thing-- kill the police, firefighters, paramedics, and all the other
professionals who unhesitatingly rush to the scene of a bombing to
provide aid to the wounded.

Mark my words: now that this tactic has been employed in Atlanta,
covered by the national media, and probably communicated across the
country through the Internet, some other devious, sick, individual,
somewhere in the United States, will do it again. Mark my words.
I believe that those who employ tactics aimed exclusively at injuring
the police, firefighters, and other public safety officers should be
punished above and beyond whatever punishment they would receive for
destroying property or causing injury.
That is why today I am introducing the Police and Rescue Squad
Protection Act.
The bill will increase the punishment for anyone who plants a follow-
on bomb with the intent to injure public safety officers. And it
clearly states that anyone who detonates, or attempts to detonate one
bomb right after another bomb in the same location is acting with the
criminal intent to injure law enforcement and emergency medical
officials.
In my view, this legislation will send a strong message that we will
not tolerate the grotesque tactics that we've seen in the streets of
Tel Aviv, and now, in Atlanta.
More importantly, this legislation honors those who, without fear or
hesitation, put themselves in jeopardy at a time of crisis.
If this bill deters one terrorist from planting a follow-on bomb and
saves the life of one police officer, firefighter, ambulance driver, or
paramedic that rushes to the scene of a crime, then it will have been
well worth the energy expended to enact it.
I hope my colleagues will join me in this effort.
F_____

By Mr. KENNEDY:
S. 353. A bill to amend title XXVII of the Public Health Service Act
and part 7 of subtitle B of title I of the Employee Retirement Income
Security Act of 1974 to establish standards for protection of consumers
in managed care plans and other health plans; to the Committee on Labor
and Human Resources.

THE HEALTH INSURANCE BILL OF RIGHTS OF 1997

Mr. KENNEDY. Mr. President, I am introducing today the Health
Insurance Bill of Rights Act to provide quality assurance and patient
protection. Companion legislation is being introduced in the House of
Representatives by Congressman Dingell, Congressman Waxman, Congressman
Cardin, and others.
This legislation is a needed response to the surging growth of
managed care and the rapid changes taking place in the health insurance
market--changes that too often put insurance industry profits ahead of
patients' health needs.
Managed care has mushroomed over the past decade. In 1987, only 13
percent of privately insured Americans were enrolled in HMOs. Today,
that figure is 75 percent. At its best, managed care offers the
opportunity to achieve both greater efficiency and higher quality in
health care. In too many cases, however, the pressure for profits leads
to lesser care--not better care. Too many managed care firms and other
insurance companies have decided that the shortest route to higher
profits and a competitive edge is by denying patients the care they
need and deserve.
Some of the most flagrant abuses by insurance plans have been
documented in recent months:
Just last year Congress enacted legislation to block drive-by
deliveries and prevent new mothers and their babies from being evicted
from hospitals in less than 48 hours.
Breast cancer patients are being forced to undergo mastectomies on an
outpatient basis, when sound medical advice requires a reasonable
hospital stay.
Children are being permanently injured or even losing their lives
because their parents are forced to drive past the nearest emergency
room to a more distant hospital because it has the contract with their
health plan.
Doctors are being subjected to gag rules that keep them from giving
their patients their best medical advice.
People with rare and dangerous diseases are being denied access to
specialists to treat their conditions.
Patients can't get needed pharmaceutical drugs, because the
particular drug they need is not on the list of drugs approved for
coverage by their insurance plan; sometimes such lists are developed
and administered by pharmaceutical companies bent on selling their own
drugs and blocking competition.

Patients are being misdiagnosed, sometimes with fatal results,
because insurance plans cut corners on diagnostic tests.
Victims of cancer and other serious diseases are being denied
participation in quality clinical trials offering the only hope of cure
for otherwise incurable conditions.
Children afflicted with serious, chronic conditions are being denied
access to the medical centers with the only available expertise to
treat their conditions effectively.
These abuses are not typical of most insurance companies. But they
are common enough that an overwhelming 80 percent of Americans now
believe that their quality of care is often compromised by their
insurance plan to save money. It is time to deal with these festering
problems. Good business practices can improve health care, but health
care must be more than just another business.
The legislation we are introducing today establishes basic standards
for insurance plans in six specific areas:
First, access to care, including specialty care, emergency care, and
clinical trials.
Second, standards for quality of care.
Third, information that must be available to patients.
Fourth, expeditious and fair appeal procedures when physicians or
patients disagree with plan decisions.
Fifth, protection of the doctor-patient relationship, by banning gag
rules and objectionable compensation arrangements.
Sixth, a requirement that plan guidelines may not override good
medical practice.
These steps will not eliminate every abuse that occurs in the
insurance industry, but they will go a long way to addressing the major
problems patients confront.
At the most basic level, the legislation establishes a right to
needed care. A patient facing a health emergency should not be required
to go to a distant emergency room, or to obtain prior authorization for
care. Someone suffering from a serious condition requiring specialty
care should not be denied that care because an insurance company thinks
it is too expensive. Someone with a condition that cannot be addressed
by conventional therapies should have a reasonable opportunity to
participate in a quality clinical trial that offers the hope of
effective treatment. Plans should set up clear, fair, and timely appeal
procedures for cases in which the plan fails to fulfill its
obligations.

Historically, patients have relied on their personal physician to be
the best source of impartial advice on needed care. This legislation
maintains that critical role by prohibiting plans from restricting
doctor-patient communications or from establishing compensation plans
that bribe or penalize doctors into representing the plan's interest at
the expense of their patients' health.
To maintain and improve quality of care, all managed care plans will
be required to set up a separate unit dedicated to quality, and to
collect data to verify that the plan, in fact, is providing care that
meets objective quality standards.
Patients will be guaranteed full information about plan coverage,
appeal rights, access to primary care doctors and other specialists,
and other needed information. Plans will be required to collect and
make available standardized data for consumers to compare plans.
These provisions add up to a health insurance bill of rights that
will protect millions of Americans.
I look forward to working with a broad range of physician, patient,
and industry groups as Congress considers this legislation. Action is
essential and overdue to provide these needed protections. The bottom
line in health care must be patient needs, not industry profits.
Concerned citizens in all parts of the country are demanding action,
and Congress owes them a response.
Mr. President, I ask unanimous consent that additional material be
printed in the Record.

[[Page S1560]]

There being no objection, the material was ordered to be printed in
the Record, as follows:

S. 353

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Health
Insurance Bill of Rights Act of 1997''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Amendments to the Public Health Service Act.

``Part C--Patient Protection Standards

``Sec. 2770. Notice; additional definitions.

``Subpart 1--Access to Care

``Sec. 2771. Access to emergency care.
``Sec. 2772. Access to specialty care.
``Sec. 2773. Continuity of care.
``Sec. 2774. Choice of provider.
``Sec. 2775. Coverage for individuals participating in approved
clinical trials.
``Sec. 2776. Access to needed prescription drugs.

``Subpart 2--Quality Assurance

``Sec. 2777. Internal quality assurance program.
``Sec. 2778. Collection of standardized data.
``Sec. 2779. Process for selection of providers.
``Sec. 2780. Drug utilization program.
``Sec. 2781. Standards for utilization review activities.

``Subpart 3--Patient Information

``Sec. 2782. Patient information.
``Sec. 2783. Protection of patient confidentiality.

``Subpart 4--Grievance Procedures

``Sec. 2784. Establishment of complaint and appeals process.
``Sec. 2785. Provisions relating to appeals of utilization review
determinations and similar determinations.
``Sec. 2786. State health insurance ombudsmen.

``Subpart 5--Protection of Providers Against Interference with Medical
Communications and Improper Incentive Arrangements

``Sec. 2787. Prohibition of interference with certain medical
communications.
``Sec. 2788. Prohibition against transfer of indemnification or
improper incentive arrangements.

``Subpart 6--Promoting Good Medical Practice and Protecting the Doctor-
Patient Relationship

``Sec. 2789. Promoting good medical practice.
Sec. 3. Amendments to the Employee Retirement Income Security Act of
1974.
``Sec. 713. Patient protection standards.

SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

(a) Patient Protection Standards.--Title XXVII of the
Public Health Service Act is amended--
(1) by redesignating part C as part D, and
(2) by inserting after part B the following new part:

``Part C--Patient Protection Standards

``SEC. 2770. NOTICE; ADDITIONAL DEFINITIONS.

``(a) Notice.--A health insurance issuer under this part
shall comply with the notice requirement under section 711(d)
of the Employee Retirement Income Security Act of 1974 with
respect to the requirements of this part as if such section
applied to such issuer and such issuer were a group health
plan.
``(b) Additional Definitions.--For purposes of this part:
``(1) Nonparticipating physician or provider.--The term
`nonparticipating physician or provider' means, with respect
to health care items and services furnished to an enrollee
under health insurance coverage, a physician or provider that
is not a participating physician or provider for such
services.
``(2) Participating physician or provider.--The term
`participating physician or provider' means, with respect to
health care items and services furnished to an enrollee under
health insurance coverage, a physician or provider that
furnishes such items and services under a contract or other
arrangement with the health insurance issuer offering such
coverage.

``Subpart 1--Access to Care

``SEC. 2771. ACCESS TO EMERGENCY CARE.

``(a) Prohibition of Certain Restrictions on Coverage of
Emergency Services.
``(1) In general.--If health insurance coverage provides
any benefits with respect to emergency services (as defined
in paragraph (2)(B)), the health insurance issuer offering
such coverage shall cover emergency services furnished to an
enrollee--
``(A) without the need for any prior authorization
determination,
``(B) subject to paragraph (3), whether or not the
physician or provider furnishing such services is a
participating physician or provider with respect to such
services, and
``(C) subject to paragraph (3), without regard to any other
term or condition of such coverage (other than an exclusion
of benefits, or an affiliation or waiting period, permitted
under section 2701).
``(2) Emergency services; emergency medical condition.--For
purposes of this section--
``(A) Emergency medical condition based on prudent
layperson.--The term `emergency medical condition' means a
medical condition manifesting itself by acute symptoms of
sufficient severity (including severe pain) such that a
prudent layperson, who possesses an average knowledge of
health and medicine, could reasonably expect the absence of
immediate medical attention to result in--
``(i) placing the health of the individual (or, with
respect to a pregnant woman, the health of the woman or her
unborn child) in serious jeopardy,
``(ii) serious impairment to bodily functions, or
``(iii) serious dysfunction of any bodily organ or part.
``(B) Emergency services.--The term `emergency services'
means--
``(i) a medical screening examination (as required under
section 1867 of the Social Security Act) that is within the
capability of the emergency department of a hospital,
including ancillary services routinely available to the
emergency department, to evaluate an emergency medical
condition (as defined in subparagraph (A)), and
``(ii) within the capabilities of the staff and facilities
available at the hospital, such further medical examination
and treatment as are required under section 1867 of the
Social Security Act to stabilize the patient.
``(C) Trauma and burn centers.--The provisions of clause
(ii) of subparagraph (B) apply to a trauma or burn center, in
a hospital, that--
``(i) is designated by the State, a regional authority of
the State, or by the designee of the State, or
``(ii) is in a State that has not made such designations
and meets medically recognized national standards.
``(3) Application of network restriction permitted in
certain cases.--
``(A) In general.--Except as provided in subparagraph (B),
if a health insurance issuer in relation to health insurance
coverage denies, limits, or otherwise differentiates in
coverage or payment for benefits other than emergency
services on the basis that the physician or provider of such
services is a nonparticipating physician or provider, the
issuer may deny, limit, or differentiate in coverage or
payment for emergency services on such basis.
``(B) Network restrictions not permitted in certain
exceptional cases.--The denial or limitation of, or
differentiation in, coverage or payment of benefits for
emergency services under subparagraph (A) shall not apply in
the following cases:
``(i) Circumstances beyond control of enrollee.--The
enrollee is unable to go to a participating hospital for such
services due to circumstances beyond the control of the
enrollee (as determined consistent with guidelines and
subparagraph (C)).
``(ii) Likelihood of an adverse health consequence based on
layperson's judgment.--A prudent layperson possessing an
average knowledge of health and medicine could reasonably
believe that, under the circumstances and consistent with
guidelines, the time required to go to a participating
hospital for such services could result in any of the adverse
health consequences described in a clause of subsection
(a)(2)(A).
``(iii) Physician referral.--A participating physician or
other person authorized by the plan refers the enrollee to an
emergency department of a hospital and does not specify an
emergency department of a hospital that is a participating
hospital with respect to such services.
``(C) Application of `beyond control' standards.--For
purposes of applying subparagraph (B)(i), receipt of
emergency services from a nonparticipating hospital shall be
treated under the guidelines as being `due to circumstances
beyond the control of the enrollee' if any of the following
conditions are met:
``(i) Unconscious.--The enrollee was unconscious or in an
otherwise altered mental state at the time of initiation of
the services.
``(ii) Ambulance delivery.--The enrollee was transported by
an ambulance or other emergency vehicle directed by a person
other than the enrollee to the nonparticipating hospital in
which the services were provided.
``(iii) Natural disaster.--A natural disaster or civil
disturbance prevented the enrollee from presenting to a
participating hospital for the provision of such services.
``(iv) No good faith effort to inform of change in
participation during a contract year.--The status of the
hospital changed from a participating hospital to a
nonparticipating hospital with respect to emergency services
during a contract year and the plan or issuer failed to make
a good faith effort to notify the enrollee involved of such
change.
``(v) Other conditions.--There were other factors (such as
those identified in guidelines) that prevented the enrollee
from controlling selection of the hospital in which the
services were provided.
``(b) Assuring Coordinated Coverage of Maintenance Care and
Post-Stabilization Care.--
``(1) In general.--In the case of an enrollee who is
covered under health insurance coverage issued by a health
insurance issuer and who has received emergency services
pursuant to a screening evaluation conducted (or

[[Page S1561]]

supervised) by a treating physician at a hospital that is a
nonparticipating provider with respect to emergency services,
if--
``(A) pursuant to such evaluation, the physician identifies
post-stabilization care (as defined in paragraph (3)(B)) that
is required by the enrollee,
``(B) the coverage provides benefits with respect to the
care so identified and the coverage requires (but for this
subsection) an affirmative prior authorization determination
as a condition of coverage of such care, and
``(C) the treating physician (or another individual acting
on behalf of such physician) initiates, not later than 30
minutes after the time the treating physician determines that
the condition of the enrollee is stabilized, a good faith
effort to contact a physician or other person authorized by
the issuer (by telephone or other means) to obtain an
affirmative prior authorization determination with respect to
the care,

then, without regard to terms and conditions specified in
paragraph (2) the issuer shall cover maintenance care (as
defined in paragraph (3)(A)) furnished to the enrollee during
the period specified in paragraph (4) and shall cover post-
stabilization care furnished to the enrollee during the
period beginning under paragraph (5) and ending under
paragraph (6).
``(2) Terms and conditions waived.--The terms and
conditions (of coverage) described in this paragraph that are
waived under paragraph (1) are as follows:
``(A) The need for any prior authorization determination.
``(B) Any limitation on coverage based on whether or not
the physician or provider furnishing the care is a
participating physician or provider with respect to such
care.
``(C) Any other term or condition of the coverage (other
than an exclusion of benefits, or an affiliation or waiting
period, permitted under section 2701 and other than a
requirement relating to medical necessity for coverage of
benefits).
``(3) Maintenance care and post-stabilization care
defined.--In this subsection:
``(A) Maintenance care.--The term `maintenance care' means,
with respect to an individual who is stabilized after
provision of emergency services, medically necessary items
and services (other than emergency services) that are
required by the individual to ensure that the individual
remains stabilized during the period described in paragraph
(4).
``(B) Post-stabilization care.--The term `post-
stabilization care' means, with respect to an individual who
is determined to be stable pursuant to a medical screening
examination or who is stabilized after provision of emergency
services, medically necessary items and services (other than
emergency services and other than maintenance care) that are
required by the individual.
``(4) Period of required coverage of maintenance care.--The
period of required coverage of maintenance care of an
individual under this subsection begins at the time of the
request (or the initiation of the good faith effort to make
the request) under paragraph (1)(C) and ends when--
``(A) the individual is discharged from the hospital;
``(B) a physician (designated by the issuer involved) and
with privileges at the hospital involved arrives at the
emergency department of the hospital and assumes
responsibility with respect to the treatment of the
individual; or
``(C) the treating physician and the issuer agree to
another arrangement with respect to the care of the
individual.
``(5) When post-stabilization care required to be
covered.--
``(A) When treating physician unable to communicate
request.--If the treating physician or other individual makes
the good faith effort to request authorization under
paragraph (1)(C) but is unable to communicate the request
directly with an authorized person referred to in such
paragraph within 30 minutes after the time of initiating such
effort, then post-stabilization care is required to be
covered under this subsection beginning at the end of such
30-minute period.
``(B) When able to communicate request, and no timely
response.--
``(i) In general.--If the treating physician or other
individual under paragraph (1)(C) is able to communicate the
request within the 30-minute period described in subparagraph
(A), the post-stabilization care requested is required to be
covered under this subsection beginning 30 minutes after the
time when the issuer receives the request unless a person
authorized by the plan or issuer involved communicates (or
makes a good faith effort to communicate) a denial of the
request for the prior authorization determination within 30
minutes of the time when the issuer receives the request and
the treating physician does not request under clause (ii) to
communicate directly with an authorized physician concerning
the denial.
``(ii) Request for direct physician-to-physician
communication concerning denial.--If a denial of a request is
communicated under clause (i), the treating physician may
request to communicate respecting the denial directly with a
physician who is authorized by the issuer to deny or affirm
such a denial.
``(C) When no timely response to request for physician-to-
physician communication.--If a request for physician-to-
physician communication is made under subparagraph (B)(ii),
the post-stabilization care requested is required to be
covered under this subsection beginning 30 minutes after the
time when the issuer receives the request from a treating
physician unless a physician, who is authorized by the issuer
to reverse or affirm the initial denial of the care,
communicates (or makes a good faith effort to communicate)
directly with the treating physician within such 30-minute
period.
``(D) Disagreements over post-stabilization care.--If,
after a direct physician-to-physician communication under
subparagraph (C), the denial of the request for the post-
stabilization care is not reversed and the treating physician
communicates to the issuer involved a disagreement with such
decision, the post-stabilization care requested is required
to be covered under this subsection beginning as follows:
``(i) Delay to allow for prompt arrival of physician
assuming responsibility.--If the issuer communicates that a
physician (designated by the plan or issuer) with privileges
at the hospital involved will arrive promptly (as determined
under guidelines) at the emergency department of the hospital
in order to assume responsibility with respect to the
treatment of the enrollee involved, the required coverage of
the post-stabilization care begins after the passage of such
time period as would allow the prompt arrival of such a
physician.
``(ii) Other cases.--If the issuer does not so communicate,
the required coverage of the post-stabilization care begins
immediately.
``(6) No requirement of coverage of post-stabilization care
if alternate plan of treatment.--
``(A) In general.--Coverage of post-stabilization care is
not required under this subsection with respect to an
individual when--
``(i) subject to subparagraph (B), a physician (designated
by the plan or issuer involved) and with privileges at the
hospital involved arrives at the emergency department of the
hospital and assumes responsibility with respect to the
treatment of the individual; or
``(ii) the treating physician and the issuer agree to
another arrangement with respect to the post-stabilization
care (such as an appropriate transfer of the individual
involved to another facility or an appointment for timely
followup treatment for the individual).
``(B) Special rule where once care initiated.--Required
coverage of requested post-stabilization care shall not end
by reason of subparagraph (A)(i) during an episode of care
(as determined by guidelines) if the treating physician
initiated such care (consistent with a previous paragraph)
before the arrival of a physician described in such
subparagraph.
``(7) Construction.--Nothing in this subsection shall be
construed as--
``(A) preventing an issuer from authorizing coverage of
maintenance care or post-stabilization care in advance or at
any time; or
``(B) preventing a treating physician or other individual
described in paragraph (1)(C) and an issuer from agreeing to
modify any of the time periods specified in paragraphs (5) as
it relates to cases involving such persons.
``(c) Limits on Cost-Sharing for Services Furnished in
Emergency Departments.--If health insurance coverage provides
any benefits with respect to emergency services, the health
insurance issuer offering such coverage may impose cost
sharing with respect to such services only if the following
conditions are met:
``(1) Limitations on cost-sharing differential for
nonparticipating providers.--
``(A) No differential for certain services.--In the case of
services furnished under the circumstances described in
clause (i), (ii), or (iii) of subsection (a)(3)(B) (relating
to circumstances beyond the control of the enrollee, the
likelihood of an adverse health consequence based on
layperson's judgment, and physician referral), the cost-
sharing for such services provided by a nonparticipating
provider or physician does not exceed the cost-sharing for
such services provided by a participating provider or
physician.
``(B) Only reasonable differential for other services.--In
the case of other emergency services, any differential by
which the cost-sharing for such services provided by a
nonparticipating provider or physician exceeds the cost-
sharing for such services provided by a participating
provider or physician is reasonable (as determined under
guidelines).
``(2) Only reasonable differential between emergency
services and other services.--Any differential by which the
cost-sharing for services furnished in an emergency
department exceeds the cost-sharing for such services
furnished in another setting is reasonable (as determined
under guidelines).
``(3) Construction.--Nothing in paragraph (1)(B) or (2)
shall be construed as authorizing guidelines other than
guidelines that establish maximum cost-sharing differentials.
``(d) Information on Access to Emergency Services.--A
health insurance issuer, to the extent a health insurance
issuer offers health insurance coverage, shall provide
education to enrollees on--
``(1) coverage of emergency services (as defined in
subsection (a)(2)(B)) by the issuer in accordance with the
provisions of this section,
``(2) the appropriate use of emergency services, including
use of the 911 telephone system or its local equivalent,

[[Page S1562]]

``(3) any cost sharing applicable to emergency services,
``(4) the process and procedures of the plan for obtaining
emergency services, and
``(5) the locations of--
``(A) emergency departments, and
``(B) other settings,

in which participating physicians and hospitals provide
emergency services and post-stabilization care.
``(e) General Definitions.--For purposes of this section:
``(1) Cost sharing.--The term `cost sharing' means any
deductible, coinsurance amount, copayment or other out-of-
pocket payment (other than premiums or enrollment fees) that
a health insurance issuer offering health insurance issuer
imposes on enrollees with respect to the coverage of
benefits.
``(2) Good faith effort.--The term `good faith effort' has
the meaning given such term in guidelines and requires such
appropriate documentation as is specified under such
guidelines.
``(3) Guidelines.--The term `guidelines' means guidelines
established by the Secretary after consultation with an
advisory panel that includes individuals representing
emergency physicians, health insurance issuers, including at
least one health maintenance organization, hospitals,
employers, the States, and consumers.
``(4) Prior authorization determination.--The term `prior
authorization determination' means, with respect to items and
services for which coverage may be provided under health
insurance coverage, a determination (before the provision of
the items and services and as a condition of coverage of the
items and services under the coverage) of whether or not such
items and services will be covered under the coverage.
``(5) Stabilize.--The term `to stabilize' means, with
respect to an emergency medical condition, to provide (in
complying with section 1867 of the Social Security Act) such
medical treatment of the condition as may be necessary to
assure, within reasonable medical probability, that no
material deterioration of the condition is likely to result
from or occur during the transfer of the individual from the
facility.
``(6) Stabilized.--The term `stabilized' means, with
respect to an emergency medical condition, that no material
deterioration of the condition is likely, within reasonable
medical probability, to result from or occur before an
individual can be transferred from the facility, in
compliance with the requirements of section 1867 of the
Social Security Act.
``(7) Treating physician.--The term `treating physician'
includes a treating health care professional who is licensed
under State law to provide emergency services other than
under the supervision of a physician.

``SEC. 2772. ACCESS TO SPECIALTY CARE.

``(a) Obstetrical and Gynecological Care.--
``(1) In general.--If a health insurance issuer, in
connection with the provision of health insurance coverage,
requires or provides for an enrollee to designate a
participating primary care provider--
``(A) the issuer shall permit a female enrollee to
designate a physician who specializes in obstetrics and
gynecology as the enrollee's primary care provider; and
``(B) if such an enrollee has not designated such a
provider as a primary care provider, the issuer--
``(i) may not require prior authorization by the enrollee's
primary care provider or otherwise for coverage of routine
gynecological care (such as preventive women's health
examinations) and pregnancy-related services provided by a
participating physician who specializes in obstetrics and
gynecology to the extent such care is otherwise covered, and
``(ii) may treat the ordering of other gynecological care
by such a participating physician as the prior authorization
of the primary care provider with respect to such care under
the coverage.
``(2) Construction.--Nothing in paragraph (1)(B)(ii) shall
waive any requirements of coverage relating to medical
necessity or appropriateness with respect to coverage of
gynecological care so ordered.
``(b) Specialty Care.--
``(1) Referral to specialty care for enrollees requiring
treatment by specialists.--
``(A) In general.--In the case of an enrollee who is
covered under health insurance coverage offered by a health
insurance issuer and who has a condition or disease of
sufficient seriousness and complexity to require treatment by
a specialist, the issuer shall make or provide for a referral
to a specialist who is available and accessible to provide
the treatment for such condition or disease.
``(B) Specialist defined.--For purposes of this subsection,
the term `specialist' means, with respect to a condition, a
health care practitioner, facility, or center (such as a
center of excellence) that has adequate expertise through
appropriate training and experience (including, in the case
of a child, appropriate pediatric expertise) to provide high
quality care in treating the condition.
``(C) Care under referral.--Care provided pursuant to such
referral under subparagraph (A) shall be--
``(i) pursuant to a treatment plan (if any) developed by
the specialist and approved by the issuer, in consultation
with the designated primary care provider or specialist and
the enrollee (or the enrollee's designee), and
``(ii) in accordance with applicable quality assurance and
utilization review standards of the issuer.

Nothing in this subsection shall be construed as preventing
such a treatment plan for an enrollee from requiring a
specialist to provide the primary care provider with regular
updates on the specialty care provided, as well as all
necessary medical information.
``(D) Referrals to participating providers.--An issuer is
not required under subparagraph (A) to provide for a referral
to a specialist that is not a participating provider, unless
the issuer does not have an appropriate specialist that is
available and accessible to treat the enrollee's condition
and that is a participating provider with respect to such
treatment.
``(E) Treatment of nonparticipating providers.--If an
issuer refers an enrollee to a nonparticipating specialist,
services provided pursuant to the approved treatment plan
shall be provided at no additional cost to the enrollee
beyond what the enrollee would otherwise pay for services
received by such a specialist that is a participating
provider.
``(2) Specialists as primary care providers.--
``(A) In general.--A health insurance issuer, in connection
with the provision of health insurance coverage, shall have a
procedure by which a new enrollee upon enrollment, or an
enrollee upon diagnosis, with an ongoing special condition
(as defined in subparagraph (C)) may receive a referral to a
specialist for such condition who shall be responsible for
and capable of providing and coordinating the enrollee's
primary and specialty care. If such an enrollee's care would
most appropriately be coordinated by such a specialist, the
issuer shall refer the enrollee to such specialist.
``(B) Treatment as primary care provider.--Such specialist
shall be permitted to treat the enrollee without a referral
from the enrollee's primary care provider and may authorize
such referrals, procedures, tests, and other medical services
as the enrollee's primary care provider would otherwise be
permitted to provide or authorize, subject to the terms of
the treatment plan (referred to in paragraph (1)(C)(i)).
``(C) Ongoing special condition defined.--In this
paragraph, the term `special condition' means a condition or
disease that--
``(i) is life-threatening, degenerative, or disabling, and
``(ii) requires specialized medical care over a prolonged
period of time.
``(D) Terms of referral.--The provisions of subparagraphs
(C) through (E) of paragraph (1) shall apply with respect to
referrals under subparagraph (A) of this paragraph in the
same manner as they apply to referrals under paragraph
(1)(A).
``(3) Standing referrals.--
``(A) In general.--A health insurance issuer, in connection
with the provision of health insurance coverage, shall have a
procedure by which an enrollee who has a condition that
requires ongoing care from a specialist may receive a
standing referral to such specialist for treatment of such
condition. If the issuer, or the primary care provider in
consultation with the medical director of the issuer and the
specialist (if any), determines that such a standing referral
is appropriate, the issuer shall make such a referral to such
a specialist.
``(C) Terms of referral.--The provisions of subparagraphs
(C) through (E) of paragraph (1) shall apply with respect to
referrals under subparagraph (A) of this paragraph in the
same manner as they apply to referrals under paragraph
(1)(A).

``SEC. 2773. CONTINUITY OF CARE.

``(a) In General.--If a contract between a health insurance
issuer, in connection with the provision of health insurance
coverage, and a health care provider is terminated (other
than by the issuer for failure to meet applicable quality
standards or for fraud) and an enrollee is undergoing a
course of treatment from the provider at the time of such
termination, the issuer shall--
``(1) notify the enrollee of such termination, and
``(2) subject to subsection (c), permit the enrollee to
continue the course of treatment with the provider during a
transitional period (provided under subsection (b)).
``(b) Transitional Period.--
``(1) In general.--Except as provided in paragraphs (2)
through (4), the transitional period under this subsection
shall extend for at least--
``(A) 60 days from the date of the notice to the enrollee
of the provider's termination in the case of a primary care
provider, or
``(B) 120 days from such date in the case of another
provider.
``(2) Institutional care.--The transitional period under
this subsection for institutional or inpatient care from a
provider shall extend until the discharge or termination of
the period of institutionalization and shall include
reasonable follow-up care related to the institutionalization
and shall also include institutional care scheduled prior to
the date of termination of the provider status.
``(3) Pregnancy.--If--
``(A) an enrollee has entered the second trimester of
pregnancy at the time of a provider's termination of
participation, and
``(B) the provider was treating the pregnancy before date
of the termination,

the transitional period under this subsection with respect to
provider's treatment of the

[[Page S1563]]

pregnancy shall extend through the provision of post-partum
care directly related to the delivery.
``(4) Terminal illness.--
``(A) In general.--If--
``(i) an enrollee was determined to be terminally ill (as
defined in subparagraph (B)) at the time of a provider's
termination of participation, and
``(ii) the provider was treating the terminal illness
before the date of termination,

the transitional period under this subsection shall extend
for the remainder of the enrollee's life for care directly
related to the treatment of the terminal illness.
``(B) Definition.--In subparagraph (A), an enrollee is
considered to be `terminally ill' if the enrollee has a
medical prognosis that the enrollee's life expectancy is 6
months or less.
``(c) Permissible Terms and Conditions.--An issuer may
condition coverage of continued treatment by a provider under
subsection (a)(2) upon the provider agreeing to the following
terms and conditions:
``(1) The provider agrees to continue to accept
reimbursement from the issuer at the rates applicable prior
to the start of the transitional period as payment in full.
``(2) The provider agrees to adhere to the issuer's quality
assurance standards and to provide to the issuer necessary
medical information related to the care provided.
``(3) The provider agrees otherwise to adhere to the
issuer's policies and procedures, including procedures
regarding referrals and obtaining prior authorization and
providing services pursuant to a treatment plan approved by
the issuer.

``SEC. 2774. CHOICE OF PROVIDER.

``(a) Primary Care.--A health insurance issuer that offers
health insurance coverage shall permit each enrollee to
receive primary care from any participating primary care
provider who is available to accept such enrollee.
``(b) Specialists.--
``(1) In general.--Subject to paragraph (2), a health
insurance issuer that offers health insurance coverage shall
permit each enrollee to receive medically necessary specialty
care, pursuant to appropriate referral procedures, from any
qualified participating health care provider who is available
to accept such enrollee for such care.
``(2) Limitation.--Paragraph (1) shall not apply to
speciality care if the issuer clearly informs enrollees of
the limitations on choice of participating providers with
respect to such care.
``(c) List of Participating Providers.--For disclosure of
information about participating primary care and specialty
care providers, see section 2782(b)(3).

``SEC. 2775. COVERAGE FOR INDIVIDUALS PARTICIPATING IN
APPROVED CLINICAL TRIALS.

``(a) In General.--If a health insurance issuer offers
health insurance coverage to a qualified enrollee (as defined
in subsection (b)), the issuer--
``(1) may not deny the enrollee participation in the
clinical trial referred to in subsection (b)(2);
``(2) subject to subsection (c), may not deny (or limit or
impose additional conditions on) the coverage of routine
patient costs for items and services furnished in connection
with participation in the trial; and
``(3) may not discriminate against the enrollee on the
basis of the enrollee's participation in such trial.
``(b) Qualified Enrollee Defined.--For purposes of
subsection (a), the term `qualified enrollee' means an
enrollee under health insurance coverage who meets the
following conditions:
``(1) The enrollee has a life-threatening or serious
illness for which no standard treatment is effective.
``(2) The enrollee is eligible to participate in an
approved clinical trial with respect to treatment of such
illness.
``(3) The enrollee and the referring physician conclude
that the enrollee's participation in such trial would be
appropriate.
``(4) The enrollee's participation in the trial offers
potential for significant clinical benefit for the enrollee.
``(c) Payment.--
``(1) In general.--Under this section an issuer shall
provide for payment for routine patient costs described in
subsection (a)(2) but is not required to pay for costs of
items and services that are reasonably expected (as
determined by the Secretary) to be paid for by the sponsors
of an approved clinical trial.
``(2) Payment rate.--In the case of covered items and
services provided by--
``(A) a participating provider, the payment rate shall be
at the agreed upon rate, or
``(B) a nonparticipating provider, the payment rate shall
be at the rate the issuer would normally pay for comparable
services under subparagraph (A).
``(d) Approved Clinical Trial Defined.--In this section,
the term `approved clinical trial' means a clinical research
study or clinical investigation approved and funded by one or
more of the following:
``(1) The National Institutes of Health.
``(2) A cooperative group or center of the National
Institutes of Health.
``(3) The Department of Veterans Affairs.
``(4) The Department of Defense.

``SEC. 2776. ACCESS TO NEEDED PRESCRIPTION DRUGS.

``If a health insurance issuer offers health insurance
coverage that provides benefits with respect to prescription
drugs but the coverage limits such benefits to drugs included
in a formulary, the issuer shall--
``(1) ensure participation of participating physicians in
the development of the formulary;
``(2) disclose the nature of the formulary restrictions;
and
``(3) provide for exceptions from the formulary limitation
when medical necessity, as determined by the enrollee's
physician subject to reasonable review by the issuer,
dictates that a non-formulary alternative is indicated.

``Subpart 2--Quality Assurance

``SEC. 2777. INTERNAL QUALITY ASSURANCE PROGRAM.

``(a) Requirement.--A health insurance issuer that offers
health insurance coverage shall establish and maintain an
ongoing, internal quality assurance and continuous quality
improvement program that meets the requirements of subsection
(b).
``(b) Program Requirements.--The requirements of this
subsection for a quality improvement program of an issuer are
as follows:
``(1) Administration.--The issuer has a separate
identifiable unit with responsibility for administration of
the program.
``(2) Written plan.--The issuer has a written plan for the
program that is updated annually and that specifies at least
the following:
``(A) The activities to be conducted.
``(B) The organizational structure.
``(C) The duties of the medical director.
``(D) Criteria and procedures for the assessment of
quality.
``(E) Systems for ongoing and focussed evaluation
activities.
``(3) Systematic review.--The program provides for
systematic review of the type of health services provided,
consistency of services provided with good medical practice,
and patient outcomes.
``(4) Quality criteria.--The program--
``(A) uses criteria that are based on performance and
clinical outcomes where feasible and appropriate, and
``(B) includes criteria that are directed specifically at
meeting the needs of at-risk populations and enrollees with
chronic or severe illnesses.
``(5) System for reporting.--The program has procedures for
reporting of possible quality concerns by providers and
enrollees and for remedial actions to correct quality
problems, including written procedures for responding to
concerns and taking appropriate corrective action.
``(6) Data collection.--The program provides for the
collection of systematic, scientifically based data to be
used in the measure of quality.
``(c) Deeming.--For purposes of subsection (a), the
requirements of subsection (b) are deemed to be met with
respect to a health insurance issuer if the issuer--
``(1) is a qualified health maintenance organization (as
defined in section 1310(d)), or
``(2) is accredited by a national accreditation
organization that is certified by the Secretary.

``SEC. 2778. COLLECTION OF STANDARDIZED DATA.

``(a) In General.--A health insurance issuer that offers
health insurance coverage shall collect uniform quality data
that include--
``(1) a minimum uniform data set described in subsection
(b), and
``(2) additional data that are consistent with the
requirements of a nationally recognized body identified by
the Secretary.
``(b) Minimum Uniform Data Set.--The Secretary shall
specify the data required to be included in the minimum
uniform data set under subsection (a)(1) and the standard
format for such data. Such data shall include at least--
``(1) aggregate utilization data;
``(2) data on the demographic characteristics of enrollees;
``(3) data on disease-specific and age-specific mortality
rates of enrollees;
``(4) data on enrollee satisfaction, including data on
enrollee disenrollment and grievances; and
``(5) data on quality indicators.
``(c) Availability.--A summary of the data collected under
subsection (a) shall be disclosed under section 2782(b)(4).

``SEC. 2779. PROCESS FOR SELECTION OF PROVIDERS.

``(a) In General.--A health insurance issuer that offers
health insurance coverage shall have a written process for
the selection of participating health care professionals,
including minimum professional requirements.
``(b) Verification of Background.--Such process shall
include verification of a health care provider's license, a
history of suspension or revocation, and liability claim
history.
``(c) Restriction.--Such process shall not use a high-risk
patient base or location of a provider in an area with
residents with poorer health status as a basis for excluding
providers from participation.

``SEC. 2780. DRUG UTILIZATION PROGRAM.

``A health insurance issuer that provides health insurance
coverage that includes benefits for prescription drugs shall
establish and maintain a drug utilization program which--
``(1) encourages appropriate use of prescription drugs by
enrollees and providers,
``(2) monitors illnesses arising from improper drug use or
from adverse drug reactions or interactions, and
``(3) takes appropriate action to reduce the incidence of
improper drug use and adverse drug reactions and
interactions.

[[Page S1564]]

``SEC. 2781. STANDARDS FOR UTILIZATION REVIEW ACTIVITIES.

``(a) Compliance with Requirements.--
``(1) In general.--A health insurance issuer shall conduct
utilization review activities in connection with the
provision of health insurance coverage only in accordance
with a utilization review program that meets the requirements
of this section.
``(2) Use of outside agents.--Nothing in this section shall
be construed as preventing a health insurance issuer from
arranging through a contract or otherwise for persons or
entities to conduct utilization review activities on behalf
of the issuer, so long as such activities are conducted in
accordance with a utilization review program that meets the
requirements of this section.
``(3) Utilization review defined.--For purposes of this
section, the terms `utilization review' and `utilization
review activities' mean procedures used to monitor or
evaluate the clinical necessity, appropriateness, efficacy,
or efficiency of health care services, procedures or
settings, and includes ambulatory review, prospective review,
concurrent review, second opinions, case management,
discharge planning, or retrospective review.
``(b) Written Policies and Criteria.--
``(1) Written policies.--A utilization review program shall
be conducted consistent with written policies and procedures
that govern all aspects of the program.
``(2) Use of written criteria.--
``(A) In general.--Such a program shall utilize written
clinical review criteria developed pursuant to the program
with the input of appropriate physicians.
``(B) Continuing use of standards in retrospective
review.--If a health care service has been specifically pre-
authorized or approved for an enrollee under such a program,
the program shall not, pursuant to retrospective review,
revise or modify the specific standards, criteria, or
procedures used for the utilization review for procedures,
treatment, and services delivered to the enrollee during the
same course of treatment.
``(C) No adverse determination based on refusal to observe
service.--Such a program shall not base an adverse
determination on--
``(i) a refusal to consent to observing any health care
service, or
``(ii) lack of reasonable access to a health care
provider's medical or treatment records, unless the program
has provided reasonable notice to the enrollee.
``(c) Conduct of Program Activities.--
``(1) Administration by health care professionals.--A
utilization review program shall be administered by qualified
health care professionals who shall oversee review decisions.
In this subsection, the term `health care professional' means
a physician or other health care practitioner licensed,
accredited, or certified to perform specified health services
consistent with State law.
``(2) Use of qualified, independent personnel.--
``(A) In general.--A utilization review program shall
provide for the conduct of utilization review activities only
through personnel who are qualified and, to the extent
required, who have received appropriate training in the
conduct of such activities under the program.
``(B) Peer review of adverse clinical determinations.--Such
a program shall provide that clinical peers shall evaluate
the clinical appropriateness of adverse clinical
determinations. In this subsection, the term `clinical peer'
means, with respect to a review, a physician or other health
care professional who holds a non-restricted license in a
State and in the same or similar specialty as typically
manages the medical condition, procedure, or treatment under
review.
``(C) Prohibition of contingent compensation
arrangements.--Such a program shall not, with respect to
utilization review activities, permit or provide compensation
or anything of value to its employees, agents, or contractors
in a manner that--
``(i) provides incentives, direct or indirect, for such
persons to make inappropriate review decisions, or
``(ii) is based, directly or indirectly, on the quantity or
type of adverse determinations rendered.
``(D) Prohibition of conflicts.--Such a program shall not
permit a health care professional who provides health care
services to an enrollee to perform utilization review
activities in connection with the health care services being
provided to the enrollee.
``(3) Toll-free telephone number.--Such a program shall
provide that--
``(A) appropriate personnel performing utilization review
activities under the program are reasonably accessible by
toll-free telephone not less than 40 hours per week during
normal business hours to discuss patient care and allow
response to telephone requests, and
``(B) the program has a telephone system capable of
accepting, recording, or providing instruction to incoming
telephone calls during other than normal business hours and
to ensure response to accepted or recorded messages not less
than one business day after the date on which the call was
received.
``(4) Limits on frequency.--Such a program shall not
provide for the performance of utilization review activities
with respect to a class of services furnished to an enrollee
more frequently than is reasonably required to assess whether
the services under review are medically necessary.
``(5) Limitation on information requests.--Under such a
program, information shall be required to be provided by
health care providers only to the extent it is necessary to
perform the utilization review activity involved.
``(d) Deadline for Determinations.--
``(1) Prior authorization services.--Except as provided in
paragraph (2), in the case of a utilization review activity
involving the prior authorization of health care items and
services, the utilization review program shall make a
determination concerning such authorization, and provide
notice of the determination to the enrollee or the enrollee's
designee and the enrollee's health care provider by telephone
and in writing, as soon as possible in accordance with the
medical exigencies of the cases, and in no event later than 3
business days after the date of receipt of the necessary
information respecting such determination.
``(2) Continued care.--In the case of a utilization review
activity involving authorization for continued or extended
health care services, or additional services for an enrollee
undergoing a course of continued treatment prescribed by a
health care provider, the utilization review program shall
make a determination concerning such authorization, and
provide notice of the determination to the enrollee or the
enrollee's designee and the enrollee's health care provider
by telephone and in writing, within 1 business day of the
date of receipt of the necessary information respecting such
determination. Such notice shall include, with respect to
continued or extended health care services, the number of
extended services approved, the new total of approved
services, the date of onset of services, and the next review
date.
``(3) Previously provided services.--In the case of a
utilization review activity involving retrospective review of
health care services previously provided, the utilization
review program shall make a the determination concerning such
services, and provide notice of the determination to the
enrollee or the enrollee's designee and the enrollee's health
care provider by telephone and in writing, within 30 days of
the date of receipt of the necessary information respecting
such determination.
``(4) Reference to special rules for emergency services,
maintenance care, and post-stabilization care.--For waiver of
prior authorization requirements in certain cases involving
emergency services and maintenance care and post-
stabilization care, see sections 2771(a)(1)(A) and
2771(a)(2)(A), respectively.
``(e) Notice of Adverse Determinations.--
``(1) In general.--Notice of an adverse determination under
a utilization review program (including as a result of a
reconsideration under subsection (f)) shall be in writing and
shall include--
``(A) the reasons for the determination (including the
clinical rationale);
``(B) instructions on how to initiate an appeal under
section 2785; and
``(C) notice of the availability, upon request of the
enrollee (or the enrollee's designee) of the clinical review
criteria relied upon to make such determination.
``(2) Specification of any additional information.--Such a
notice shall also specify what (if any) additional necessary
information must be provided to, or obtained by, person
making the determination in order to make a decision on such
an appeal.
``(f) Reconsideration.--
``(1) At request of provider.--In the event that a
utilization review program provides for an adverse
determination without attempting to discuss such matter with
the enrollee's health care provider who specifically
recommended the health care service, procedure, or treatment
under review, such health care provider shall have the
opportunity to request a reconsideration of the adverse
determination under this subsection.
``(2) Timing and conduct.--Except in cases of retrospective
reviews, such reconsideration shall occur as soon as possible
in accordance with the medical exigencies of the cases, and
in no event later than 1 business day after the date of
receipt of the request and shall be conducted by the
enrollee's health care provider and the health care
professional making the initial determination or a designated
qualified health care professional if the original
professional cannot be available.
``(3) Notice.--In the event that the adverse determination
is upheld after reconsideration, the utilization review
program shall provide notice as required under subsection
(e).
``(4) Construction.--Nothing in this subsection shall
preclude the enrollee from initiating an appeal from an
adverse determination under section 2785.

``Subpart 3--Patient Information

``SEC. 2782. PATIENT INFORMATION.

``(a) Disclosure Requirement.--A health insurance issuer in
connection with the provision of health insurance coverage
shall submit to the applicable State authority, provide to
enrollees (and prospective enrollees), and make available to
the public, in writing the information described in
subsection (b).
``(b) Information.--The information described in this
subsection includes the following:
``(1) Description of coverage.--A description of coverage
provisions, including health care benefits, benefit limits,
coverage exclusions, coverage of emergency care, and the
definition of medical necessity used in determining whether
benefits will be covered.

[[Page S1565]]

``(2) Enrollee financial responsibility.-- An explanation
of an enrollee's financial responsibility for payment of
premiums, coinsurance, copayments, deductibles, and any other
charges, including limits on such responsibility and
responsibility for health care services that are provided by
nonparticipating providers or are furnished without meeting
applicable utilization review requirements.
``(3) Information on providers.--A description--
``(A) of procedures for enrollees to select, access, and
change participating primary and specialty providers,
``(B) of the rights and procedures for obtaining referrals
(including standing referrals) to participating and
nonparticipating providers, and
``(C) in the case of each participating provider, of the
name, address, and telephone number of the provider, the
credentials of the provider, and the provider's availability
to accept new patients.
``(4) Utilization review activities.--A description of
procedures used and requirements (including circumstances,
time frames, and rights to reconsideration and appeal) under
any utilization review program under section 2781 or any drug
utilization program under section 2780, as well as a summary
of the minimum uniform data collected under section
2778(a)(1).
``(5) Grievance procedures.--Information on the grievance
procedures under sections 2784 and 2785, including
information describing--
``(A) the grievance procedures used by the issuer to
process and resolve disputes between the issuer and an
enrollee (including method for filing grievances and the time
frames and circumstances for acting on grievances);
``(B) written complaints and appeals, by type of complaint
or appeal, received by the issuer relating to its coverage;
and
``(C) the disposition of such complaints and appeals.
``(6) Payment methodology.--A description of the types of
methodologies the issuer uses to reimburse different classes
of providers and, as specified by the Secretary, the
financial arrangements or contractual provisions with
providers.
``(7) Information on issuer.--Notice of appropriate mailing
addresses and telephone numbers to be used by enrollees in
seeking information or authorization for treatment.
``(8) Assuring communications with enrollees.--A
description of how the issuer addresses the needs of non-
English-speaking enrollees and others with special
communications needs, including the provision of information
described in this subsection to such enrollees.
``(c) Form of Disclosure.--
``(1) Uniformity.--Information required to be disclosed
under this section shall be provided in accordance with
uniform, national reporting standards specified by the
Secretary, after consultation with applicable State
authorities, so that prospective enrollees may compare the
attributes of different issuers and coverage offered within
an area.
``(2) Information into handbook.--Nothing in this section
shall be construed as preventing an issuer from making the
information under subsection (b) available to enrollees
through an enrollee handbook or similar publication.
``(3) Updating.--The information on participating providers
described in subsection (a)(3)(C) shall be updated not less
frequently than monthly. Nothing in this section shall
prevent an issuer from changing or updating other information
made available under this section.
``(4) Construction.--Nothing in subsection (a)(6) shall be
construed as requiring disclosure of individual contracts or
financial arrangements between an issuer and any provider.
Nothing in this subsection shall be construed as preventing
the information described in subsection (a)(3)(C) from being
provided in a separate document.

``SEC. 2783. PROTECTION OF PATIENT CONFIDENTIALITY.

``A health insurance issuer that offers health insurance
coverage shall establish appropriate policies and procedures
to ensure that all applicable State and Federal laws to
protect the confidentiality of individually identifiable
medical information are followed.

``Subpart 4--Grievance Procedures

``SEC. 2784. ESTABLISHMENT OF COMPLAINT AND APPEALS PROCESS.

``(a) Establishment of System.--A health insurance issuer
in connection with the provision of health insurance coverage
shall establish and maintain a system to provide for the
presentation and resolution of complaints and appeals brought
by enrollees, designees of enrollees, or by health care
providers acting on behalf of an enrollee and with the
enrollee's consent, regarding any aspect of the issuer's
health care services, including complaints regarding quality
of care, choice and accessibility of providers, network
adequacy, and compliance with the requirements of this part.
``(b) Components of System.--Such system shall include the
following components (which shall be consistent with
applicable requirements of section 2785):
``(1) Written notification to all enrollees and providers
of the telephone numbers and business addresses of the issuer
employees responsible for resolution of complaints and
appeals.
``(2) A system to record and document, over a period of at
least 3 years, all complaints and appeals made and their
status.
``(3) The availability of an enrollee services
representative to assist enrollees, as requested, with
complaint and appeal procedures.
``(4) Establishment of a specified deadline (not to exceed
30 days after the date of receipt of a complaint or appeal)
for the issuer to respond to complaints or appeals.
``(5) A process describing how complaints and appeals are
processed and resolved.
``(6) Procedures for follow-up action, including the
methods to inform the complainant or appellant of the
resolution of a complaint or appeal.
``(7) Notification to the continuous quality improvement
program under section 2777(a) of all complaints and appeals
relating to quality of care.
``(c) No Reprisal for Exercise of Rights.--A health
insurance issuer shall not take any action with respect to an
enrollee or a health care provider that is intended to
penalize the enrollee, a designee of the enrollee, or the
health care provider for discussing or exercising any rights
provided under this part (including the filing of a complaint
or appeal pursuant to this section).

``SEC. 2785. PROVISIONS RELATING TO APPEALS OF UTILIZATION
REVIEW DETERMINATIONS AND SIMILAR
DETERMINATIONS.

``(a) Right of Appeal.--
``(1) In general.--An enrollee in health insurance coverage
offered by a health insurance issuer, and any provider acting
on behalf of the enrollee with the enrollee's consent, may
appeal any appealable decision (as defined in paragraph (2))
under the procedures described in this section and (to the
extent applicable) section 2784. Such enrollees and providers
shall be provided with a written explanation of the appeal
process upon the conclusion of each stage in the appeal
process and as provided in section 2782(a)(5)
``(2) Appealable decision defined.--In this section, the
term `appealable decision' means any of the following:
``(A) An adverse determination under a utilization review
program under section 2781.
``(B) Denial of access to specialty and other care under
section 2772.
``(C) Denial of continuation of care under section 2773.
``(D) Denial of a choice of provider under section 2774.
``(E) Denial of coverage of routine patient costs in
connection with an approval clinical trial under section
2775.
``(F) Denial of access to needed drugs under section
2776(3).
``(G) The imposition of a limitation that is prohibited
under section 2789.
``(H) Denial of payment for a benefit,
``(b) Informal Internal Appeal Process (Stage 1).--
``(1) In general.--Each issuer shall establish and maintain
an informal internal appeal process (an appeal under such
process in this section referred to as a `stage 1 appeal')
under which any enrollee or any provider acting on behalf of
an enrollee with the enrollee's consent, who is dissatisfied
with any appealable decision has the opportunity to discuss
and appeal that decision with the medical director of the
issuer or the health care professional who made the decision.
``(2) Timing.--All appeals under this paragraph shall be
concluded as soon as possible in accordance with the medical
exigencies of the cases, and in no event later than 72 hours
in the case of appeals from decisions regarding urgent care
and 5 days in the case of all other appeals.
``(3) Further review.--If the appeal is not resolved to the
satisfaction of the enrollee at this level by the deadline
under paragraph (2), the issuer shall provide the enrollee
and provider (if any) with a written explanation of the
decision and the right to proceed to a stage 2 appeal under
subsection (c).
``(c) Formal Internal Appeal Process (Stage 2).--
``(1) In general.--Each issuer shall establish and maintain
a formal internal appeal process (an appeal under such
process in this section referred to as a `stage 2 appeal')
under which any enrollee or provider acting on behalf of an
enrollee with the enrollee's consent, who is dissatisfied
with the results of a stage 1 appeal has the opportunity to
appeal the results before a panel that includes a physician
or other health care professional (or professionals) selected
by the issuer who have not been involved in the appealable
decision at issue in the appeal.
``(2) Availability of clinical peers.--The panel under
subparagraph (A) shall have available either clinical peers
(as defined in section 2781(c)(2)(B)) who have not been
involved in the appealable decision at issue in the appeal or
others who are mutually agreed upon by the parties. If
requested by the enrollee or enrollee's provider with the
enrollee's consent, such a peer shall participate in the
panel's review of the case.
``(3) Timely acknowledgment.--The issuer shall acknowledge
the enrollee or provider involved of the receipt of a stage 2
appeals upon receipt of the appeal.
``(4) Deadline.--
``(A) In general.--The issuer shall conclude each stage 2
appeal as soon as possible after the date of the receipt of
the appeal in accordance with medical exigencies of the case
involved, but in no event later than 72 hours in the case of
appeals from decisions

[[Page S1566]]

regarding urgent care and (except as provided in subparagraph
(B)) 20 business days in the case of all other appeals.
``(B) Extension.--An issuer may extend the deadline for an
appeal that does not relate to a decision regarding urgent or
emergency care up to an additional 20 business days where it
can demonstrate to the applicable State authority reasonable
cause for the delay beyond its control and where it provides,
within the original deadline under subparagraph (A), a
written progress report and explanation for the delay to such
authority and to the enrollee and provider involved.
``(5) Notice.--If an issuer denies a stage 2 appeal, the
issuer shall provide the enrollee and provider involved with
written notification of the denial and the reasons therefore,
together with a written notification of rights to any further
appeal
``(d) Direct Use of Further Appeals.--In the event that the
issuer fails to comply with any of the deadlines for
completion of appeals under this section or in the event that
the issuer for any reason expressly waives its rights to an
internal review of an appeal under subsection (b) or (c), the
enrollee and provider involved shall be relieved of any
obligation to complete the appeal stage involved and may, at
the enrollee's or provider's option, proceed directly to seek
further appeal through any applicable external appeals
process.
``(e) External Appeal Process in Case of Use of
Experimental Treatment to Save Life of Patient.--
``(1) In general.--In the case of an enrollee described in
paragraph (2), the health insurance issuer shall provide for
an external independent review process respecting the
issuer's decision not to cover the experimental therapy
(described in paragraph (2)(B)(ii)).
``(2) Enrollee described.--An enrollee described in this
paragraph is an enrollee who meets the following
requirements:
``(A) The enrollee has a terminal condition that is highly
likely to cause death within 2 years.
``(B) The enrollee's physician certifies that--
``(i) there is no standard, medically appropriate therapy
for successfully treating such terminal condition, but
``(ii) based on medical and scientific evidence, there is a
drug, device, procedure, or therapy (in this section referred
to as the `experimental therapy') that is more beneficial
than any available standard therapy.
``(C) The issuer has denied coverage of the experimental
therapy on the basis that it is experimental or
investigational.
``(3) Description of process and decision.--The process
under this subsection shall provide for a determination on a
timely basis, by a panel of independent, impartial physicians
appointed by a State authority or by an independent review
organization certified by the State, of the medical
appropriateness of the experimental therapy. The decision of
the panel shall be in writing and shall be accompanied by an
explanation of the basis for the decision. A decision of the
panel that is favorable to the enrollee may not be appealed
by the issuer except in the case of misrepresentation of a
material fact by the enrollee or a provider. A decision of
the panel that is not favorable to the enrollee may be
appealed by the enrollee.
``(4) Issuer covering process costs.--Direct costs of the
process under this subsection shall be borne by the issuer,
and not by the enrollee.
``(f) Other Independent or External Review.--
``(1) In general.--In the case of appealable decision
described in paragraph (2), the health insurance issuer shall
provide for--
``(A) an external review process for such decisions
consistent with the requirements of paragraph (3), or
``(B) an internal independent review process for such
decisions consistent with the requirements of paragraph (4).
``(2) Appealable decision described.--An appealable
decision described in this paragraph is decision that does
not involve a decision described in subsection (e)(1) but
involves--
``(A) a claim for benefits involving costs over a
significant threshold, or
``(B) assuring access to care for a serious condition.
``(3) External review process.--The requirements of this
subsection for an external review process are as follows:
``(A) The process is established under State law and
provides for review of decisions on stage 2 appeals by an
independent review organization certified by the State.
``(B) If the process provides that decisions in such
process are not binding on issuers, the process must provide
for public methods of disclosing frequency of noncompliance
with such decisions and for sanctioning issuers that
consistently refuse to take appropriate actions in response
to such decisions.
``(C) Results of all such reviews under the process are
disclosed to the public, along with at least annual
disclosure of information on issuer compliance.
``(D) All decisions under the process shall be in writing
and shall be accompanied by an explanation of the basis for
the decision.
``(E) Direct costs of the process shall be borne by the
issuer, and not by the enrollee.
``(F) The issuer shall provide for publication at least
annually of information on the numbers of appeals and
decisions considered under the process.
``(4) Internal, independent review process.--The
requirements of this subsection for an internal, independent
review process are as follows:
``(A)(i) The process must provide for the participation of
persons who are independent of the issuer in conducting
reviews and (ii) the Secretary must have found (through
reviews conducted no less often than biannually) the process
to be fair and impartial.
``(B) If the process provides that decisions in such
process are not binding on issuers, the process must provide
for public methods of disclosing frequency of noncompliance
with such decisions and for sanctioning issuers that
consistently refuse to take appropriate actions in response
to such decisions.
``(C) Results of all such reviews under the process are
disclosed to the public, along with at least annual
disclosure of information on issuer compliance.
``(D) All decisions under the process shall be in writing
and shall be accompanied by an explanation of the basis for
the decision.
``(E) Direct costs of the process shall be borne by the
issuer, and not by the enrollee.
``(F) The issuer shall provide for publication at least
annually of information on the numbers of appeals and
decisions considered under the process.

The Secretary may delegate the authority under subparagraph
(A)(ii) to applicable State authorities.
``(5) Oversight.--The Secretary (and applicable State
authorities in the case of delegation of Secretarial
authority under paragraph (4)) shall conduct reviews not less
often than biannually of the fairness and impartiality
issuers who desired to use an internal, independent review
process described in paragraph (4) to satisfy the requirement
of paragraph (1).
``(6) Report.--The Secretary shall provide for periodic
reports on the effectiveness of this subsection in assuring
fair and impartial reviews of stage 2 appeals. Such reports
shall include information on the number of stage 2 appeals
(and decisions), for each of the types of review processes
described in paragraph (2), by health insurance coverage.
``(g) Construction.--Nothing in this part shall be
construed as removing any legal rights of enrollees under
State or Federal law, including the right to file judicial
actions to enforce rights.

``SEC. 2786. STATE HEALTH INSURANCE OMBUDSMEN.

``(a) In General.--Each State that obtains a grant under
subsection (c) shall establish and maintain a Health
Insurance Ombudsman. Such Ombudsman may be part of a
independent, nonprofit entity, and shall be responsible for
at least the following:
``(1) To assist consumers in the State in choosing among
health insurance coverage.
``(2) To provide counseling and assistance to enrollees
dissatisfied with their treatment by health insurance issuers
in regard to such coverage and in the filing of complaints
and appeals regarding determinations under such coverage.
``(3) To investigate instances of poor quality or improper
treatment of enrollees by health insurance issuers in regard
to such coverage and to bring such instances to the attention
of the applicable State authority.
``(b) Federal Role.--In the case of any State that does not
establish and maintain such an Ombudsman under subsection
(a), the Secretary shall provide for the establishment and
maintenance of such an official as will carry out with
respect to that State the functions otherwise provided under
subsection (a) by a Health Insurance Ombudsman.
``(c) Authorization of Appropriations.--There are
authorized to be appropriated to the Secretary such amounts
as may be necessary to provide for grants to States to
establish and operate Health Insurance Ombudsmen under
subsection (a) or for the operation of Ombudsmen under
subsection (b).

``Subpart 5--Protection of Providers Against Interference with Medical
Communications and Improper Incentive Arrangements

``SEC. 2787. PROHIBITION OF INTERFERENCE WITH CERTAIN MEDICAL
COMMUNICATIONS.

``(a) Prohibition.--
``(1) General rule.--The provisions of any contract or
agreement, or the operation of any contract or agreement,
between a health insurance issuer in relation to health
insurance coverage (including any partnership, association,
or other organization that enters into or administers such a
contract or agreement) and a health care provider (or group
of health care providers) shall not prohibit or restrict the
provider from engaging in medical communications with the
provider's patient.
``(2) Nullification.--Any contract provision or agreement
described in paragraph (1) shall be null and void.
``(3) Prohibition on provisions.--A contract or agreement
described in paragraph (1) shall not include a provision that
violates paragraph (1).
``(b) Rules of Construction.--Nothing in this section shall
be construed--
``(1) to prohibit the enforcement, as part of a contract or
agreement to which a health care provider is a party, of any
mutually agreed upon terms and conditions, including terms
and conditions requiring a health care provider to
participate in, and cooperate with, all programs, policies,
and procedures developed or operated by a health insurance
issuer to assure, review, or improve the quality and
effective utilization of health care services (if such
utilization is according to

[[Page S1567]]

guidelines or protocols that are based on clinical or
scientific evidence and the professional judgment of the
provider) but only if the guidelines or protocols under such
utilization do not prohibit or restrict medical
communications between providers and their patients; or
``(2) to permit a health care provider to misrepresent the
scope of benefits covered under health insurance coverage or
to otherwise require a health insurance issuer to reimburse
providers for benefits not covered under the coverage.
``(c) Protection of Religious or Moral Expression.--
``(1) In general.--An health insurance issuer may fully
advise--
``(A) licensed or certified health care providers at the
time of their employment with the issuer or at any time
during such employment, or
``(B) enrollees at the time of their enrollment for health
insurance coverage with the issuer or at any time during
which such enrollees have such coverage,

of the coverage's limitations on providing particular medical
services (including limitations on referrals for care
provided outside of the coverage) based on the religious or
moral convictions of the issuer.
``(2) Health care providers.--Nothing in this section shall
be construed to alter the rights and duties of a health care
provider to determine what medical communications are
appropriate with respect to each patient, except as provided
for in subsection (a).
``(d) Medical Communication Defined.--
``(1) In general.--In this section, the term `medical
communication' means any communication made by a health care
provider with a patient of the health care provider (or the
guardian or legal representative of such patient) with
respect to--
``(A) the patient's health status, medical care, or
treatment options;
``(B) any utilization review requirements that may affect
treatment options for the patient; or
``(C) any financial incentives that may affect the
treatment of the patient.
``(2) Misrepresentation.--The term `medical communication'
does not include a communication by a health care provider
with a patient of the health care provider (or the guardian
or legal representative of such patient) if the communication
involves a knowing or willful misrepresentation by such
provider.

``SEC. 2788. PROHIBITION AGAINST TRANSFER OF INDEMNIFICATION
OR IMPROPER INCENTIVE ARRANGEMENTS.

``(a) Prohibition of Transfer of Indemnification.--No
contract or agreement between a health insurance issuer (or
any agent acting on behalf of such an issuer) and a health
care provider shall contain any clause purporting to transfer
to the health care provider by indemnification or otherwise
any liability relating to activities, actions, or omissions
of the issuer or agent (as opposed to the provider).
``(b) Prohibition of Improper Physician Incentive Plans.--
``(1) In general.--A health insurance issuer offering
health insurance coverage may not operate any physician
incentive plan unless the following requirements are met:
``(A) No specific payment is made directly or indirectly by
the issuer to a physician or physician group as an inducement
to reduce or limit medically necessary services provided with
respect to a specific individual enrolled with the issuer.
``(B) If the plan places a physician or physician group at
substantial financial risk (as determined by the Secretary)
for services not provided by the physician or physician
group, the issuer--
``(i) provides stop-loss protection for the physician or
group that is adequate and appropriate, based on standards
developed by the Secretary that take into account the number
of physicians placed at such substantial financial risk in
the group or under the plan and the number of individuals
enrolled with the issuer who receive services from the
physician or the physician group, and
``(ii) conducts periodic surveys of both individuals
enrolled and individuals previously enrolled with the issuer
to determine the degree of access of such individuals to
services provided by the issuer and satisfaction with the
quality of such services.
``(C) The issuer provides the applicable State authority
(or the Secretary if such authority is implementing this
section) with descriptive information regarding the plan,
sufficient to permit the authority (or the Secretary in such
case) to determine whether the plan is in compliance with the
requirements of this paragraph.
``(2) Physician incentive plan defined.--In this section,
the term `physician incentive plan' means any compensation
arrangement between a health insurance issuer and a physician
or physician group that may directly or indirectly have the
effect of reducing or limiting services provided with respect
to individuals enrolled with the issuer.
``(3) Application of medicare rules.--The Secretary shall
provide for the application of rules under this subsection
that are substantially the same as the rules established to
carry out section 1876(i)(8) of the Social Security Act.

``Subpart 6--Promoting Good Medical Practice and Protecting the Doctor-
Patient Relationship

``SEC. 2789. PROMOTING GOOD MEDICAL PRACTICE.

``(a) Prohibiting Arbitrary Limitations or Conditions for
the Provision of Services.--A health insurance issuer, in
connection with the provision of health insurance coverage,
may not impose limits on the manner in which particular
services are delivered if the services are medically
necessary and appropriate for the treatment or diagnosis of
an illness or injury to the extent that such treatment or
diagnosis is otherwise a covered benefit.
``(b) Medical Necessity and Appropriateness Defined.--In
subsection (a), the term `medically necessary and
appropriate' means, with respect to a service or benefit, a
service or benefit determined by the treating physician
participating in the health insurance coverage after
consultation with the enrollee, to be required, accordingly
to generally accepted principles of good medical practice,
for the diagnosis or direct care and treatment of an illness
or injury of the enrollee.
``(c) Construction.--Subsection (a) shall not be construed
as requiring coverage of particular services the coverage of
which is otherwise not covered under the terms of the
coverage.''.
(b) Application to Group Health Insurance Coverage.--
(1) Subpart 2 of part A of title XXVII of the Public Health
Service Act is amended by adding at the end the following new
section:

``SEC. 2706. PATIENT PROTECTION STANDARDS.

``(a) In General.--Each health insurance issuer shall
comply with patient protection requirements under part C with
respect to group health insurance coverage it offers.
``(b) Assuring Coordination.--The Secretary of Health and
Human Services and the Secretary of Labor shall ensure,
through the execution of an interagency memorandum of
understanding between such Secretaries, that--
``(1) regulations, rulings, and interpretations issued by
such Secretaries relating to the same matter over which such
Secretaries have responsibility under part C (and this
section) and section 713 of the Employee Retirement Income
Security Act of 1974 are administered so as to have the same
effect at all times; and
``(2) coordination of policies relating to enforcing the
same requirements through such Secretaries in order to have a
coordinated enforcement strategy that avoids duplication of
enforcement efforts and assigns priorities in
enforcement.''.''.
(2) Section 2792 of such Act (42 U.S.C. 300gg-92) is
amended by inserting ``and section 2706(b)'' after ``of
1996''.
(c) Application to Individual Health Insurance Coverage.--
Part B of title XXVII of the Public Health Service Act is
amended by inserting after section 2751 the following new
section:

``SEC. 2752. PATIENT PROTECTION STANDARDS.

``Each health insurance issuer shall comply with patient
protection requirements under part C with respect to
individual health insurance coverage it offers.''.
(d) Modification of Preemption Standards.--
(1) Group health insurance coverage.--Section 2723 of such
Act (42 U.S.C. 300gg-23) is amended--
(A) in subsection (a)(1), by striking ``subsection (b)''
and inserting ``subsections (b) and (c)'';
(B) by redesignating subsections (c) and (d) as subsections
(d) and (e), respectively; and
(C) by inserting after subsection (b) the following new
subsection:
``(c) Special Rules in Case of Patient Protection
Requirements.--Subject to subsection (a)(2), the provisions
of section 2706 and part C (other than section 2771), and
part D insofar as it applies to section 2706 or part C, shall
not prevent a State from establishing requirements relating
to the subject matter of such provisions (other than section
2771) so long as such requirements are at least as stringent
on health insurance issuers as the requirements imposed under
such provisions. Subsection (a) shall apply to the provisions
of section 2771 (and section 2706 insofar as it relates to
such section).''.
(2) Individual health insurance coverage.--Section 2762 of
such Act (42 U.S.C. 300gg-62), as added by section
605(b)(3)(B) of Public Law 104-204, is amended--
(A) in subsection (a), by striking ``subsection (b),
nothing in this part'' and inserting ``subsections (b) and
(c)'', and
(B) by adding at the end the following new subsection:
``(c) Special Rules in Case of Managed Care Requirements.--
Subject to subsection (b), the provisions of section 2752 and
part C (other than section 2771), and part D insofar as it
applies to section 2752 or part C, shall not prevent a State
from establishing requirements relating to the subject matter
of such provisions so long as such requirements are at least
as stringent on health insurance issuers as the requirements
imposed under such section. Subsection (a) shall apply to the
provisions of section 2771 (and section 2752 insofar as it
relates to such section).''.
(e) Additional Conforming Amendments.--
(1) Section 2723(a)(1) of such Act (42 U.S.C. 300gg-
23(a)(1)) is amended by striking ``part C'' and inserting
``parts C and D''.
(2) Section 2762(b)(1) of such Act (42 U.S.C. 300gg-
62(b)(1)) is amended by striking ``part C'' and inserting
``part D''.
(f) Effective Dates.--(1)(A) Subject to subparagraph (B),
the amendments made by subsections (a), (b), (d)(1), and (e)
shall apply with respect to group health insurance coverage
for group health plan years beginning on or after July 1,
1998 (in this subsection referred to as the ``general
effective date'') and

[[Page S1568]]

also shall apply to portions of plan years occurring on and
after January 1, 1999.
(B) In the case of group health insurance coverage provided
pursuant to a group health plan maintained pursuant to 1 or
more collective bargaining agreements between employee
representatives and 1 or more employers ratified before the
date of enactment of this Act, the amendments made by
subsections (a), (b), (d)(1), and (e) shall not apply to plan
years beginning before the later of--
(i) the date on which the last collective bargaining
agreements relating to the plan terminates (determined
without regard to any extension thereof agreed to after the
date of enactment of this Act), or
(ii) the general effective date.

For purposes of clause (i), any plan amendment made pursuant
to a collective bargaining agreement relating to the plan
which amends the plan solely to conform to any requirement
added by subsection (a) or (b) shall not be treated as a
termination of such collective bargaining agreement.
(2) The amendments made by subsections (a), (c), (d)(2),
and (e) shall apply with respect to individual health
insurance coverage offered, sold, issued, renewed, in effect,
or operated in the individual market on or after the general
effective date.

SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY
ACT OF 1974.

(a) In General.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 is
amended by adding at the end the following new section:

``SEC. 713. PATIENT PROTECTION STANDARDS.

``(a) In General.--Subject to subsection (b), a group
health plan (and a health insurance issuer offering group
health insurance coverage in connection with such a plan)
shall comply with the requirements of part C (other than
section 2786) of title XXVII of the Public Health Service
Act.
``(b) Application.--In applying subsection (a) under this
part, any reference in such subpart C--
``(1) to a health insurance issuer and health insurance
coverage offered by such an issuer is deemed to include a
reference to a group health plan and coverage under such
plan, respectively;
``(2) to the Secretary is deemed a reference to the
Secretary of Labor;
``(3) to an applicable State authority is deemed a
reference to the Secretary of Labor; and
``(4) to an enrollee with respect to health insurance
coverage is deemed to include a reference to a participant or
beneficiary with respect to a group health plan.
``(c) Group Health Plan Ombudsman.--With respect to group
health plans that provide benefits other than through health
insurance coverage, the Secretary shall provide for the
establishment and maintenance of such a Federal Group Health
Plan Ombudsman that will carry out with respect to such plans
the functions described in section 2786(a) of the Public
Health Service Act with respect to health insurance issuers
that offer group health insurance coverage.
``(d) Assuring Coordination.--The Secretary of Health and
Human Services and the Secretary of Labor shall ensure,
through the execution of an interagency memorandum of
understanding between such Secretaries, that--
``(1) regulations, rulings, and interpretations issued by
such Secretaries relating to the same matter over which such
Secretaries have responsibility under such part C (and
section 2706 of the Public Health Service Act) and this
section are administered so as to have the same effect at all
times; and
``(2) coordination of policies relating to enforcing the
same requirements through such Secretaries in order to have a
coordinated enforcement strategy that avoids duplication of
enforcement efforts and assigns priorities in enforcement.''.
(b) Modification of Preemption Standards.--Section 731 of
such Act (42 U.S.C. 1191) is amended--
(1) in subsection (a)(1), by striking ``subsection (b)''
and inserting ``subsections (b) and (c)'';
(2) by redesignating subsections (c) and (d) as subsections
(d) and (e), respectively; and
(3) by inserting after subsection (b) the following new
subsection:
``(c) Special Rules in Case of Patient Protection
Requirements.--Subject to subsection (a)(2), the provisions
of section 713 and part C of title XXVII of the Public Health
Service Act (other than section 2771 of such Act), and
subpart C insofar as it applies to section 713 or such part,
shall not prevent a State from establishing requirements
relating to the subject matter of such provisions (other than
section 2771 of such Act) so long as such requirements are at
least as stringent on health insurance issuers as the
requirements imposed under such provisions. Subsection (a)
shall apply to the provisions of section 2771 of such Act
(and section 713 of this Act insofar as it relates to such
section).''.
(c) Conforming Amendments.-- (1) Section 732(a) of such Act
(29 U.S.C. 1185(a)) is amended by striking ``section 711''
and inserting ``sections 711 and 713''.
(2) The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 712
the following new item:

``Sec. 713. Patient protection standards.''.

(3) Section 734 of such Act (29 U.S.C. 1187) is amended by
inserting ``and section 713(d)'' after ``of 1996''.
(d) Effective Date.--(1) Subject to paragraph (2), the
amendments made by this section shall apply with respect to
group health plans for plan years beginning on or after July
1, 1998 (in this subsection referred to as the ``general
effective date'') and also shall apply to portions of plan
years occurring on and after January 1, 1999.
(2) In the case of a group health plan maintained pursuant
to 1 or more collective bargaining agreements between
employee representatives and 1 or more employers ratified
before the date of enactment of this Act, the amendments made
by this section shall not apply to plan years beginning
before the later of--
(A) the date on which the last collective bargaining
agreements relating to the plan terminates (determined
without regard to any extension thereof agreed to after the
date of enactment of this Act), or
(B) the general effective date.

For purposes of subparagraph (A), any plan amendment made
pursuant to a collective bargaining agreement relating to the
plan which amends the plan solely to conform to any
requirement added by subsection (a) shall not be treated as a
termination of such collective bargaining agreement.
____

Summary of the Quality Assurance and Patient Protection Act

Subpart 1: Access to care.
Subpart 2: Quality Assurance.
Subpart 3. Patient Information.
Subpart 4: Grievance Procedures.
Subpart 5: Protection of providers against interference
with medical communications and improper incentive
arrangements.
Subpart 6: Promoting good medical practice and protecting
the doctor-patient relationship.

Subpart 1: Access to Care

Emergency care.--A plan may not deny coverage for emergency
care assessment and stabilization if a prudent layperson
would seek such care given the symptoms experienced. Prior
authorization for such care is not required. After assessment
and stabilization, further needed care is covered if
medically necessary.
Access to specialty care.--Obstetrician/gynecologist
care.--If a plan requires patients to designate a primary
care physician, women have the right to choose an
obstetrician/gynecologist as their primary care provider. In
any case, they have the right to direct access to an
obstetrician/gynecologist for routine gynecological care and
pregnancy services without prior authorization from their
primary care provider.
Other specialty care.--Enrollees with life-threatening,
chronic, degenerative or other serious conditions which
require specialty care must be provided access to the
appropriate specialists or centers of excellence capable of
providing quality care for the condition. If a plan does not
have a participating specialist for a condition covered under
the plan, the plan must refer the patient to a non-
participating specialist at no additional cost.
A plan must have a procedure to allow individuals with a
serious illness and ongoing need for specialty care to
receive care from a specialist who will coordinate all care
for that individual.
A plan must have a procedure for standing referrals for
individuals requiring on-going specialty care if a primary
care provider, in consultation with the patient, the medical
director of the plan and specialist (if any) determine that a
standing referral is needed.
Continuity of Care.--If a plan or provider terminates a
contract for reasons other than failure to meet quality
requirements, the plan must allow an enrollee continued
treatment with the provider for a transitional period. Time
frames vary depending upon type of care being provided (e.g.
primary, institutional, pregnancy, terminal, etc.)
Participation in clinical trials.--If an enrollee has a
serious condition for which there is no effective standard
treatment and is eligible for an approved clinical trial that
offers the potential for substantial clinical benefit, the
plan must pay for the routine patient costs of participation
in the trial.
Choice of Provider.--A plan must provide an updated list of
all participating providers and their ability to accept
additional patients. Enrollees must be permitted to obtain
services from any provider within the plan identified in the
plan documents as available to the enrollee.
Prescription Drugs.--If a plan provides benefits for
prescription drugs within a formulary, the plan must allow
physicians to participate in the development of the plan
formulary, disclose the nature of formulary restrictions, and
provide for exceptions when medically necessary.

Subpart 2: Quality Assurance

Internal quality assurance program.--Every plan is required
to establish and maintain a quality assurance and improvement
program that uses data based on both performance and patient
outcomes.
Collection of standardized data.--Plans must report certain
standard information to state agencies and the public. The
information must be reported in accordance with uniform
national standards to be specified by the Secretary. This
information will include at least utilization data,
demographic data, mortality rates, disenrollment statistics
and satisfaction surveys, and quality indicators.
Selection of providers.--The plan must have a written
process for selection of providers including a listing of the
professional

[[Page S1569]]

requirements. The process must include verification of the
provider's credentials. Plans may not use a high risk patient
base or a provider's location in an area serving residents
with poor health status as a basis for exclusion.
Drug utilization program.--If the plan covers prescription
medications, it must have a plan to encourage appropriate
drug use and monitor and reduce illness arising from improper
use.
Standards for utilization review activities.--Utilization
review refers to the plan's review of requests for care. It
is defined as evaluation of clinical necessity and efficacy.
Written clinical review criteria are required. Utilization
review must be supervised by a licensed physician. Its
activities must be executed by appropriately qualified staff.
There can be no incentives to render adverse determinations.
Deadlines for response to requests for authorization of care
are established. Adverse determinations must be in writing
and include the reasons for the determination. Such notices
must also include instructions for making an appeal.

Subpart 3: Patient Information

Patient Information.--Plans must describe and make
available to current and prospective enrollees procedures for
providing emergency care and care outside normal business
hours, for selecting and changing physicians, and for
obtaining consultations. They must also list participating
providers by category and make clear which members of that
list are available to a prospective or current enrollee. The
plan must provide information which describes coverage,
financial responsibilities of enrollees, methods of obtaining
referrals, utilization review processes, and grievance
procedures and must include a description of how the plan
addresses the needs of non-English speaking enrollees and
others with special communication needs. It must describe how
providers are paid.
Protection of patient confidentiality.--A program to assure
compliance with state and federal confidentiality
requirements must be in place.

Subpart 4: Grievance Procedures

Provisions relating to appeals of utilization review
determination and similar determinations.--A plan must
establish and maintain a system to handle and resolve
complaints brought against the plan by enrollees and
providers. The system should address all aspects of the
plan's services, including complaints regarding quality of
care, choice and accessibility of providers, and network
adequacy. The legislation specifies several components of
such a system, including provisions for staffing and staff
accessibility, information about appeal procedures, and the
time frame within which the plan must respond to complaints.
The bill provides for a two stage appeal process, with
requirements for a review panel of non-involved providers and
consultants employed by the plan in the second phase. Written
explanation of each stage of an appeal must be provided.
Timely decisions are required. Examples of adverse
determinations include denial for emergency care, access to
specialists, choice of provider, continuity of care, or
payment for routine costs in connection with an approved
clinical trial. In the case of experimental therapy to save
the life of a patient, an external independent review process
with mandatory decision powers is available if the plan
chooses not to provide coverage for the treatment. For
appeals of other important issues, the plan must either (1)
participate in an independent review process established by
the state (or the Secretary of Labor for self-insured plans)
to make advisory determinations; or (2) establish a third
stage of appeal within the plan certified by the Secretary as
fair, impartial, and involving independent reviewers to make
advisory decisions.
Health Insurance Ombudsman.--A Health Insurance Ombudsman
will be established in each state to assist consumers in
choosing health insurance, and to provide assistance to
patients dissatisfied with their treatment. Assistance
includes aiding enrollees in filing complaints and appeals,
investigating poor quality or improper treatment, and
bringing such instances to the attention of the applicable
state authority or, in the case of self-insured insurance
plans, to the attention of the Secretary of Labor. The
legislation authorizes funds to be appropriated to the
Secretary to provide grants to state authorities to establish
the program.

Subpart 5: Protection of Providers against Interference with Medical
Communications and Improper Incentives

Prohibition of interference with certain medical
communications.--The plan may not prohibit or restrict the
provider from engaging in medical communications with the
enrollee. Such communications may include discussion of the
enrollee's health status, medical care, or treatment options;
provisions of the plan's utilization review requirements; or
any financial incentives that may affect the treatment of the
enrollee.
Ban on improper incentive arrangements.--There may be no
incentives to limit medically necessary services. Provider
risk is limited. The Secretary shall apply the same rules
which apply to the Medicare program. The plan may not have a
contract which requires transfer of liability for malpractice
caused by the plan from the plan to the provider.

Subpart 6: Promoting Good Medical Practice and Protecting the Doctor-
Patient Relationship

Plans are prohibited from denying coverage for medically
necessary and appropriate care otherwise covered by the plan,
as determined by the treating physician and consistent with
generally accepted principles of good medical practice. This
provision would prohibit plans from arbitrarily limiting care
provided, for example, by requiring that mastectomies be
provided on an outpatient basis.
______

By Mr. KENNEDY (for himself and Mr. Kerry):
S. 354. A bill to amend the Federal Property and Administrative
Services Act of 1949 to prohibit executive agencies from awarding
contracts that contain a provision allowing for the acquisition by the
contractor, at Government expense, of certain equipment or facilities
to carry out the contract if the principal purpose of such provision is
to increase competition by establishing an alternative source of supply
for property or services; to the Committee on Governmental Affairs.

the fair competition in federal procurement act of 1997

Mr. KENNEDY. Mr. President, Senator Kerry and I are offering
legislation today to present a serious injustice in Federal
procurement. Congressman John Olver is introducing identical
legislation in the House of Representatives. This issue has come to our
attention in the context of the Bureau of Engraving and Printing's
contract for U.S. currency paper production, but it could arise in
other contexts that would pose similar inequities.
A respected, long-standing family-owned business in Dalton, MA, Crane
and Company, has supplied currency paper for the Treasury for the past
117 years. Crane has been a trusted supplier to the Federal Government,
providing high quality products on a timely basis. It has negotiated
reasonable terms with the Government, keeping its price increases below
the rate of inflation. And it has made substantial investments over the
years to ensure that it has the sophisticated equipment needed to
produce the currency, including the special security features now built
into the paper itself.
This year, however, the Bureau of Engraving and Printing has proposed
to go to extraordinary lengths to create alternate sources for currency
paper production. The Bureau has proposed subsidies to other companies
to help them become competitive and buy the state-of-the-art equipment
that Crane bought on its own. This is not fair competition. It's a
misguided policy that will give other companies an unfair advantage and
create an unlevel playing field.
Our legislation is straightforward. It amends section 303 of the
Federal Property and Administrative Services Act of 1949 to prohibit
nondefense agencies in the executive branch from financing equipment or
facilities to help a contractor compete against an existing contractor
in Federal procurement. With all the pressures of the deficit, we
should not be spending taxpayer money on this sort of sham competition.
It's unfair to leading-edge firms like Crane that have invested their
own resources to obtain Government contracts, and it's hard to see how
any taxpayers will benefit. Crane is in a class by itself. There is no
suggestion of antitrust problems. Crane wins these contracts fair and
square against potential competitors, and it should not have to compete
with Uncle Sam.
I urge the Congress to enact this legislation and prevent an
extremely unfair and unwise policy from moving forward at the Treasury
Department or other Federal agencies.
______

By Mr. GRAMM (for himself, and Mrs. Hutchison):
S. 355. A bill to amend the Internal Revenue Code of 1986 to make the
research credit permanent; to the Committee on Finance.

research credit legislation

<bullet> Mr. GRAMM. Mr. President, today Senator Hutchison and I are
introducing a bill to permanently extend the research and development
tax credit. The R&D tax credit was originally enacted as a part of
President Reagan's Economic Recovery and Tax Act of 1981 in order to
encourage greater private sector investment in research and
development. Since its creation, the credit has been extended seven
times, and it is currently set to expire on May 31, 1997.
Since its enactment in 1981, the benefits of the R&D credit have been
enormous. Studies show that in the short

[[Page S1570]]

run, every dollar of the R&D credit stimulates a dollar of additional
private R&D spending, and in the long run, each dollar of the credit
yields up to $2 in additional private R&D spending. Furthermore, the
rate of return from R&D spending to society as a whole is estimated to
be as high as 60 percent.
Given these facts, we can easily expect that the benefits of the
credit will only be enhanced if it is extended permanently. A permanent
extension of the R&D credit would encourage companies to take on
additional research and development projects by allowing them to be
certain that the credit will be in effect during these long-run
initiatives. In fact, the ratio of R&D spending to output rose over 40
percent in the 1980's when the R&D credit was in effect for the longest
period of time.
The R&D credit is an effective and proven incentive for companies to
increase investment in U.S.-based research and development. The
continued existence of the R&D credit is particularly important given
the substantial tax incentives provided by many of our international
competitors to their domestic R&D industries. The jobs created by R&D
expenditures are exactly the kind of jobs we all claim to vote. In my
home State of Texas alone, the average high-technology job pays $47,019
a year--almost $20,000 more per year than the average private sector
salary of $27,147.
The need to make the credit permanent is only further highlighted by
the fact that in 1996, for the first time in its history, the R&D
credit was allowed to lapse--there was a gap in the law between July 1,
1995, through July 1, 1996. Haphazard and unpredictable temporary
extensions of the credit, combined with this recent lapse, have set a
negative precedent for the research community.
Businesses cannot and do not ignore the possibility of future gaps in
the R&D credit, and will be understandably driven to scale back new
long-term projects if they cannot be certain that the credit will
continue. We should permanently extend the R&D tax credit to finally
remove this unnecessary barrier to long-term research and development
which has been created by the stop-and-go extension process.
Finally, Mr. President, I want to point out that the R&D credit has a
long history of bipartisan support. The President has signaled his
support for the credit, not only by signing last year's extension as a
part of the Small Business Job Protection Act, but also by proposing a
further extension as a part of his fiscal year 1998 budget.
Unfortunately, his proposal follows the ill-advised precedent of merely
temporarily extending the credit.
I believe that this credit must be made permanent, and I am proud to
have joined 17 members of the Texas delegation in a letter to Chairman
Archer and Chairman Roth calling for a permanent extension of the R&D
tax credit. I ask unanimous consent that the text of this letter and
the text of the bill be printed in the Record at the conclusion of my
remarks. The time has come for us to demonstrate our long-term
commitment to research and development, and I urge my colleagues to
join me and Senator Hutchison in sponsoring this bill.
Mr. President, I ask unanimous consent that additional material be
printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

S. 355

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. EXTENSION OF RESEARCH CREDIT.

(a) Credit Made Permanent.--
(1) In general.--Section 41 of the Internal Revenue Code of
1986 is amended by striking subsection (h).
(2) Conforming amendment.--Section 45C(b)(1) of such Code
is amended by striking subparagraph (D).
(3) Effective date.--The amendments made by this subsection
shall apply to amounts paid or incurred after May 31, 1997,
in taxable years ending after such date.
____

Congress of the United States,

Washington, DC, February 13, 1997.
Hon William Roth,
U.S. Senate, Washington, DC.

Hon. Bill Archer,
Washington, DC.
Dear Gentlemen: We want to thank you for your leadership
last year in extending the Research and Development (R&D) tax
credit, and to solicit your further support. As you know, the
R&D credit will expire on May 31, 1997. We would like to
express out strong support for a prompt, permanent extension
of the credit.
There are a number of excellent reasons why Congress should
permanently extend the credit. According to a recent study,
each dollar of tax benefits generates as much as two dollars
of long-term investment spending by the private sector. Also,
the ``spillover effects'' of R&D are outstanding; the rate of
return derived by society generally from R&D spending is
estimated to be as much as sixty percent.
The R&D credit enjoys broad, bipartisan support and
provides a critical, effective and proven incentive for
companies to increase their investment in U.S.-based research
and development. The continued encouragement of private
sector led R&D is particularly important in light of the
substantial tax and other financial incentives offered by
many of our major foreign trade competitors. Moreover,
targeted almost exclusively at wages and salaries paid to
employees engaged in direct U.S.-based research and
development, the credit promotes the creation of new, high-
skilled jobs.
Texas companies lead the nation in many areas of research
and development and the growth of high wage jobs. Continued
growth of our economy is closely tied to the ability of our
companies to make a sustained commitment to long-term high
cost research. Again, thank you for your outstanding effort
on Texas' behalf in the past, and we look forward to working
with you to continue our shared commitment in research and
development.
Sincerely,
Phil Gramm
(and 17 other Members).<bullet>
______

By Mr. GRAHAM (for himself, Mr. Hutchinson, Ms. Mikulski, and Mr.
Chafee):
S. 356. A bill to amend the Internal Revenue Code of 1986, the Public
Health Service Act, the Employee Retirement Income Security Act of
1974, the title XVIII and XIX of the Social Security Act to assure
access to emergency medical services under group health plans, health
insurance coverage, and the Medicare and Medicaid Programs; to the
Committee on Finance.

THE ACCESS TO EMERGENCY MEDICAL SERVICES ACT

Ms. MIKULSKI. Mr. President, I am proud to join Senator Graham in
introducing the Access to Emergency Medical Services Act of 1997. This
bill prohibits health plans from denying coverage and payment for
emergency room visits. I support this bill for three reasons. It
protects patients and patients' pocketbooks. It respects medical
decisions made by doctors and nurses. It gives HMO's the opportunity to
do the right thing.
Personal health is not something to take chances with. That's why
many people seek emergency assistance when they think something may be
seriously wrong with their health. They go to the emergency room
thinking their insurance company covers emergency room treatment. But
when the problem turns out to be a nonemergency, the insurance company
denies payment. This is called retrospective denial. I want to end
retrospective denials. No family should have to second guess getting
the care they need because they are worried about being stuck with an
enormous bill.
Last week my office received a phone call from a woman in Frederick,
MD. She was distraught. She had begged her husband not to take her to
the emergency room when she complained of serious chest pains. She knew
their insurance company wouldn't pay. It had happened before. But her
husband insisted she go. He was worried about her and wanted her to see
a doctor. She cried all the way to the hospital. A few weeks later she
got the notice--her claim was denied. She was stuck with the bill.
She was right to go to the emergency room. There are approximately
200 medical problems that could cause the type of chest pain she
experienced ranging from a heart attack to pulmonary emboli to simple
indigestion. The point is, no one knows for sure what problem they are
having until they get treatment from an emergency room physician.
Maryland already has laws in place to guarantee that HMO's will cover
to emergency services. But we can't practice good emergency medicine
one patient, one ER room, or one State at a time. That's why we need a
national law that ensures that medical decisions are made in the ER
room, not the corporate boardbroom.

[[Page S1571]]

This bill will set a new national definition for the term
``emergency'' without preempting stronger State laws. The ``Prudent
Layperson Standard'' means that a person with average knowledge of
health and medicine can seek emergency treatment when they think they
have a serious medical condition. Quite often, patients do not know
when they go to an emergency room whether their illness is life-
threatening or not. With this standard, they are not required to know--
they can use their own best judgment. After all, we can't expect the
average person to be able to diagnose like a doctor.
I am proud that the State of Maryland was the first State to enact
legislation to counter these unfair practices. They passed their first
law in 1993. But it took two follow-up laws to clarify the intent of
the first one. Work still needs to be done to make sure the law is
enforced. I salute the Maryland emergency physicians who took this
issue on, and continue to fight for fair play on behalf of their
patients.
I want to see managed care, but I don't want to see doctors managed.
There is a fundamental distinction. We have to start getting our
priorities straight and decide where we are going to be making our
decisions. And in the case of emergencies--I believe the decisions need
to be made in the emergency room and not the boardroom.
______

By Mr. BENNETT (for himself, Mr. Hatch, Mr. Murkowski, Mr. Craig,
Mr. Burns, and Mr. Thomas):
S. 357. A bill to authorize the Bureau of Land Management to manage
the Grand Staircase-Escalante National Monument, and for other
purposes; to the Committee on Energy and Natural Resources.

THE GRAND STAIRCASE-ESCALANTE RESOURCE PROTECTION ACT

Mr. BENNETT. Mr. President, in the last Congress, by coincidence, on
my birthday, President Clinton announced the creation of the Grand
Staircase-Escalante National Monument, taking 1.7 million acres in the
State of Utah and creating a national monument under the authority of
the Antiquities Act of 1906. This, frankly, caught a number of us by
complete surprise --well, maybe not complete surprise, because we had
seen reports in the newspaper that this might be coming. But whenever
we spoke to anybody in the administration about it, we were constantly
told that no decision has been made.
Congressman Orton, the Democratic Congressman in the district in
which this land was located, was told ``nothing is imminent.'' Even 24
hours before the announcement was made, people in the White House were
insisting that nothing was coming down on this particular subject. And
then, as I say, on the morning of my birthday, I received a phone call
from Leon Panetta, not to wish me happy birthday, but to inform me that
the President would indeed be creating a new national monument in Utah
under his authority as outlined in the Antiquities Act.
The process by which the monument was put together was entirely
closed to any elected official. No one from the State of Utah who holds
elected office--not the Governor, neither of the Members of this body,
not the Members of the other body, no one--was allowed to make comments
or be involved in the process of creating the monument. We now know,
however, from press reports that members of what is called the
environmental community were involved in writing this proclamation.
They had access to the White House, to the Department of Interior, and
to administration officials that the rest of us were denied.
Out of this closed process came the national monument and, with it,
frankly, Mr. President, considerable antagonism and disappointment on
the part of many people in Utah--if polls can be believed, a large
majority of the people of Utah--at the way they were treated in this
matter. ``Not to worry,'' we were assured by the President at the Grand
Canyon. And I was assured personally on the phone by Leon Panetta that
there would be protections of the rights of ordinary citizens written
into the pattern of the way this monument would be managed.
Mr. Panetta outlined those to me, and I wrote them down. Then, when
the President appeared on national television, I followed my list and
saw that the President was going down the same list. That is, he made
exactly the same promises that Mr. Panetta had made as to the way
things would be handled in the monument.
Mr. President, today I am introducing a bill. It will be known as the
Grand Staircase-Escalante Resource Protection Act. Its sole purpose is
to codify the promises the President made when he created the monument.
I said to my staff, ``Do not put everything in this bill you think we
must have. Just make sure the act is entirely just what the President
promised he would do.''
Let me give you some examples of what I mean. On this chart we have
the President's statement made on September 18 when he said: ``Families
will be able to use this canyon as they always have. The land will
remain open for multiple uses, including hunting, fishing, hiking,
camping, and grazing.''
Many of the people who have reacted to the creation of the monument
have made it clear that there should never be multiple uses on this
land. They say that this would be incompatible with its designation as
``wilderness.'' But the President did not designate the land as
wilderness. He designated it as a national monument, and he
specifically promised--these are his words--that ``The land will remain
open for multiple use . . .'' This was taken off the transcript that
was available to us the day the President made his statement.
Another promise the President made is on this chart. It is a little
bit longer, but to the people in Utah it may be even more important. He
said, ``Mining revenues from Federal and State land help to support
your schools.''
He was speaking to the people of Utah.

I know the children of Utah have a big stake in school
lands located within the boundaries of the monument that I am
designating today . . . creating this national monument
should not and will not come at the expense of Utah's
children.

That is a very important commitment made by the President. It has to
do with the fact that almost 200,000 acres in this monument are owned
by a trust that administers these lands for the benefit of Utah's
schoolchildren. Under the monument designation, conceivably the trust
would lose that ownership unless there can be a pattern of swapping out
school acres for other acres outside the boundaries of the monument.
These are a few of the President's promises.
There was another one which I do not have on the chart but that
struck me personally. The President said, ``We will appoint an exchange
working group, including Congressman Orton and the two Senators as well
as the Governor and others, that will examine this issue of school
trust land.''
It has now been 6 months since the President made that statement, and
no such group has been proposed by anybody. It has been 6 months since
the President made that proclamation, and we don't see any indication
that he intends to instruct people to follow through on the promise
that the people will be able to use the canyon as they always have. And
we see no indication that the people in the administration are taking
any steps to make Utah's schoolchildren whole for the income that they
will lose as a result of the creation of this monument.
If I were to pick up the phone and call the White House today and ask
for Leon Panetta to remind him of the pledge he made to me, I would be
told, ``Mr. Panetta doesn't work here anymore.'' So I have decided to
take the promises that the President made in this speech, which was
before the entire country on national television, and write those
promises into law. Many people have said, ``Oh, you are going to do
terrible things if you write those into law. You are going to undo
every protection that is important to this monument.'' To them I say,
if you do not like these promises, argue with William Jefferson
Clinton. Don't argue with me because they were his pledges; not mine.
Some groups have seized on some language that I have in the bill
describing what will be permitted in the monument and say, ``You go far
beyond the President in the things you allow. Where did you get the
idea that mining and timber and those kinds of things should be
allowed?'' My answer is, I took the definition of ``multiple use''

[[Page S1572]]

that is in the FLPMA handbook produced by the Department of the
Interior and reproduced it, neither subtracting nor adding anything. I
made no attempt to put my judgment as to what ``multiple use'' means. I
used the manual that is produced by the Department of the Interior to
define what ``multiple use'' means.
By virtue of the introduction of this bill, we will now
have hearings. There will be hearings both in the House and the Senate.
I am told that a companion bill will be introduced on the other side of
the Capitol.

I myself point out that these hearings are open, unlike the process
the President followed, which was closed. These hearings will allow
those who disagree with me--and I heard from some people this afternoon
who disagreed with me quite vehemently--an opportunity to come before
the Congress and tell the Congress what they think the President meant
when he used these words. These hearings will give the Department of
the Interior the opportunity to come before the Congress and tell the
Congress what they think the President meant when he used these words.
If they can make a plausible case to the Congress, I am perfectly
willing to amend the bill and accept changes. The thing I am not
willing to do is to accept, as some have said, that ``This was merely a
campaign speech. The President should not be held to honor any
commitment he made in that speech because it was in the heat of the
campaign.''
We are talking, Mr. President, about 1.7 million acres of land in my
State. That is a land mass bigger than some of the States represented
by Senators who sit here in this Chamber. We are talking about a major
action that impacts the future of the people of southern Utah. That
being the case, we must codify what the President said so that these
commitments are kept whether they were made in a campaign speech or
not.
I ask unanimous consent that the text of the bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 357

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Grand Staircase-Escalante
Resource Protection Act''.

SEC. 2. FINDINGS.

Congress finds that--
(1) the designation of the Grand Staircase-Escalante
National Monument applies only to Federal land within the
boundary of the Monument;
(2) multiple use has been and continues to be the guiding
principle in the management of public land;
(3) in accordance with Proclamation 6920, issued by the
President on September 18, 1996 (61 Fed. Reg. 50223 (1996),
Federal land within the Monument should remain open for
multiple uses;
(4) the United States should not lay claim to Federal water
rights in lands within the Monument except in accordance with
the substantive and procedural requirements of the State of
Utah, and designation of the Monument and enactment of this
Act should not impair exercise of water rights by the State
of Utah;
(5) mining revenues from Federal and State School and
Institutional Trust Lands have generated considerable
revenues for Utah schools;
(6) an estimated 176,000 acres of surface land containing
significant coal and other resources managed by the School
and Institutional Trust Lands Administration for the benefit
of Utah's school children are located within the boundary of
the Monument;
(7) the creation of the Monument must not come at the
expense of Utah's school children;
(8) designation of the Monument will produce a considerable
loss of future Federal royalties, State royalties, and school
trust royalties resulting in significant revenue loss to
Utah's school children; and
(9) the lack of congressional, State, and local
consultation prior to designation of the Monument and the
failure of the Proclamation to establish a specific boundary
for the Monument are certain to give rise to disputes that
will require boundary adjustments.

SEC. 3. DEFINITIONS.

In this Act:
(1) Advisory committee.--The term ``advisory committee''
means the Grand Staircase-Escalante National Monument
Advisory Committee established under section 12.
(2) Director.--The term ``Director'' means the Director of
the Bureau of Land Management.
(3) Existing.--The term ``existing'' means in existence as
of September 18, 1996.
(4) Management plan.--The term ``management plan'' means
the management plan for the Monument submitted to Congress
under section 9.
(5) Monument.--The term ``Monument'' means the Grand
Staircase-Escalante National Monument established by
Proclamation of the President on September 18, 1996.
(6) Multiple use.--The term ``multiple use'' has the
meaning given in section 103 of the Federal Land Policy and
Management Act of 1976 (43 U.S.C. 1702).
(7) Secretary.--The term ``Secretary'' means the Secretary
of the Interior.
(8) Special management area.--The term ``special management
area'' means an area that is managed by the Secretary in
accordance with the principles of multiple use and sustained
yield in accordance with this Act.
(9) Sustained yield.--The term ``sustained yield'' has the
meaning given in section 103 of the Federal Land Policy and
Management Act of 1976 (43 U.S.C. 1702).

SEC. 4. MANAGEMENT OF THE MONUMENT.

(a) Special Management Area.--
(1) In general.--The Monument shall be managed by the
Secretary as a special management area in accordance with
this Act.
(2) Multiple use and sustained yield.--The Secretary shall
manage the resources within the Monument in accordance with
the principles of multiple use and sustained yield (including
recreation, range, timber, minerals, oil and gas, watershed,
wildlife, fish, and natural scenic, scientific, and
historical values), using principles of economic and ecologic
sustainability.
(3) Protection of resources.--The Secretary shall provide
for the protection, interpretation, and responsible use of
Monument resources.
(4) Economic sustainability.--The Secretary shall manage
the Monument resources in a way that provides for economic
sustainability of local communities.
(b) Management Authority.--
(1) Delegation to the director.--The Secretary shall
delegate authority to manage the Monument to the Director.
(2) Lead agency.--The Bureau of Land Management shall be
the lead agency in all management decisions concerning the
Monument, pursuant to all applicable legal authorities, and
shall act in consultation with other Federal agencies, State
and local government authorities, and the advisory committee.
(c) Future Action.--Nothing in this Act precludes the
revocation of the Proclamation 6920 by Act of Congress or by
Executive order, but, so long as land within the Monument
remains subject to designation as a national monument under
Proclamation 6920, any successor proclamation, or an Act of
Congress, the Monument shall be managed in accordance with
this Act.

SEC. 5. VALID EXISTING RIGHTS AND USES.

(a) Exercise of Valid Existing Rights.--
(1) In general.--The Secretary shall recognize and give due
deference to the exercise of any valid existing right, lease,
permit, or authorization under any law, including--
(A) the Federal Land Policy and Management Act of 1976 (43
U.S.C. 1701 et seq.);
(B)(i) sections 2319-28, 2331, 2333-2337, and 2344 of the
Revised Statutes (commonly known as the ``General Mining Law
of 1872'') (30 U.S.C. 22-24, 26-28, 29-30, 33-35, 37, 39-42,
47); and
(ii) the Act entitled ``An Act to promote the mining of
coal, phosphate, oil, oil shale, gas, and sodium on the
public domain'', approved February 25, 1920 (commonly known
as the ``Mineral Lands Leasing Act of 1920'') (30 U.S.C. 181
et seq.);
(C) section 2477 of the Revised Statutes (43 U.S.C. 932)
(to the extent of any rights-of-way existing on October 21,
1976);
(D) the Act of June 28, 1934 (48 Stat. 1269, chapter 865;
43 U.S.C. 315 et seq.) (commonly known as the ``Taylor
Grazing Act'');
(E) the Surface Mining Control and Reclamation Act of 1977
(30 U.S.C. 1201 et seq.); and
(F) any other applicable law.
(2) No restriction.--Neither designation of the Monument
nor adoption and implementation of the applicable management
plan shall restrict or prevent the exercise of valid existing
rights by persons that exercise those rights in compliance
with all applicable laws.
(b) Roads and Rights-of-Way.--The Secretary shall permit
routine maintenance and improvement of roads and rights-of-
way within Monument boundaries to ensure public safety and a
high-quality visitor experience.
(c) Takings.--Any valid existing right determined to be
taken as a result of designation of the Monument shall be
subject to compensation by the Secretary.

SEC. 6. RANGE MANAGEMENT.

(a) Grazing of Livestock.--Grazing of livestock within the
Monument shall continue and shall not be curtailed by reason
of designation of the Monument. Designation of the Monument
shall not affect existing grazing leases, grazing permits,
and levels of livestock grazing within the Monument.
(b) Water Rights.--The Secretary shall not require a
grazing permittee or grazing lessee to transfer or relinquish
any part of the permittee's or lessee's water right to
another person (including the United States) as a condition
of granting, renewing, or transferring a grazing permit or
grazing lease.

SEC. 7. WITHDRAWALS.

No existing withdrawal, reservation, or appropriation shall
be revoked except in accordance with section 204 of the
Federal

[[Page S1573]]

Land Policy and Management Act of 1976 (43 U.S.C. 1714).

SEC. 8. NO FEDERAL RESERVATION OF WATER RIGHT.

(a) No Federal Reservation.--Nothing in this Act, any other
Act, or any action taken under any Act creates an expressed
or implied reservation of water rights in the United States
for any purpose.
(b) Acquisition and Exercise of Water Rights Under Utah
Law.--
(1) Acquisition.--The United States may acquire such water
rights as the Secretary considers to be necessary to carry
out responsibilities of the Secretary with respect to any
land within the Monument only in accordance with the
substantive and procedural requirements of the law of the
State of Utah.
(2) Exercise.--Any rights to water granted under the law of
the State of Utah may be exercised only in accordance with
the substantive and procedural requirements of the law of the
State of Utah.
(3) Eminent domain.--Nothing in this Act authorizes the use
of the power of eminent domain by the United States to
acquire water rights on land within the Monument.
(c) Facilities Not Affected.--Nothing in this Act or any
other Act relating to management of land within the Monument
authorizes any action to be taken that may affect the
capacity, operation, repair, construction, maintenance,
modification, or repair of municipal, agricultural,
livestock, or wildlife water facilities within or outside the
Monument or water resources that flow through the Monument.
(d) Water Resource Projects.--Nothing in this Act or any
other Act relating to management of land within the Monument
limits, or establishes any matter to be taken into
consideration in connection with approval or denial by any
Federal official of access to, or use of, the Federal land
within or outside the Monument for development and operation
of water resource projects (including reservoir projects).

SEC. 9. MANAGEMENT PLAN.

(a) Management in Accordance With FLPMA.--
(1) In general.--Not later than September 18, 1999, the
Secretary shall submit to Congress a management plan for the
Monument.
(2) Multiple use and sustained yield.--In the development
and revision of the management plan, the Secretary shall use
and observe the principles of multiple use and sustained
yield and shall use a systematic interdisciplinary approach
to achieve integrated consideration of physical, biological,
economic, and other sciences.
(b) Requirements.--In the management plan, the Secretary
shall specifically address--
(1) the multiple uses of all of the resources of the
Monument (including recreation, range, timber, mineral, oil
and gas, watershed, wildlife, fish, and natural scenic,
scientific, and historical resources) in a responsible
manner, under all applicable laws and authorities; and
(2) the economic impacts of the Monument on the economies
of local communities.
(c) Notice and Comment.--The management plan shall be made
available for public review and comment as required by law.
(d) Utilization of Monument Resources.--Development and
utilization of resources within the Monument shall be
authorized if--
(1) the President or Congress determines it to be in the
interests of the United States; or
(2) in case of a national emergency.
(e) Interim Management Plan.--
(1) In general.--Not later than 45 days after the date of
enactment of this Act, the Secretary shall modify any
guidelines in existence on the date of enactment of this Act
regarding management of the Monument to conform to the
requirements of this Act.
(2) Pending applications.--No lease on land within the
Monument with respect to which an application of any kind was
pending on September 18, 1996, or is pending on the date of
enactment of this Act shall expire if the Secretary has not
acted on the application.

SEC. 10. STATE JURISDICTION WITH RESPECT TO FISH AND
WILDLIFE.

Nothing in this Act--
(1) affects the jurisdiction or responsibilities of the
State of Utah with respect to fish and wildlife management
activities (including hunting, fishing, trapping, predator
control, and the stocking or transplanting of fish and
wildlife); or
(2) precludes the State of Utah from developing water
resources for fish and wildlife purposes under State law.

SEC. 11. SCHOOL TRUST LANDS EXCHANGE.

(a) Expedition of Exchanges.--The Secretary shall provide
necessary resources to expedite all exchanges of school trust
lands within the Monument when sought by the School and
Institutional Trust Lands Administration of the State of
Utah.
(b) Valuation.--The Secretary shall value school trust land
sections as if surrounding unencumbered Federal lands were
available for mineral development, and all reasonable
differences in valuation shall be resolved in favor of the
school trust.
(c) Analysis of Lost Royalties.--Not later than 45 days
after the date of enactment of this Act, the Secretary shall
submit to Congress an analysis of the loss of Federal
royalties that can be expected to result from designation of
the Monument, based on research compiled by the United States
Geological Survey.
(d) Access to State Sections.--The Secretary shall not deny
access to school trust lands within the Monument by agencies
of the State of Utah and designated permittees of those
agencies.

SEC. 12. ADVISORY COMMITTEE.

(a) Establishment.--Not later than 90 days after the date
of enactment of this Act, the Secretary shall establish and
convene a meeting of an advisory committee to be known as the
``Grand Staircase-Escalante National Monument Advisory
Committee''.
(b) Duties and Responsibilities.--The advisory committee
shall advise the Secretary, the Director, and the Governor of
the State of Utah concerning the development, management, and
interpretation of Monument resources and the development,
exchange, or disposal of State school trust lands.
(c) Membership.--The advisory committee shall consist of--
(1) the Secretary, the Governor of the State of Utah, the
member of the House of Representatives from the third
congressional district, and the 2 members of the Senate from
the State of Utah; and
(2) 10 members appointed by the Secretary of the Interior
from among persons recommended by the Governor of Utah,
including--
(A) 1 representative of agricultural interests;
(B) 1 representative of mining and oil and gas interests;
(C) 1 representative of recreational interests;
(D) 1 representative of environmental interests;
(E) 1 representative of the School Institutional Trust
Lands Administration of the State of Utah;
(F) 1 representative of the Department of Natural Resources
of the State of Utah;
(G) 1 representative of other agencies of the State of
Utah;
(H) 1 representative of local communities;
(I) 1 representative of Native Americans; and
(J) 1 representative of the public at large.
(d) Terms.--A member of the advisory committee shall serve
for a term not to exceed 5 years, determined by the Secretary
in consultation with the Governor of the State of Utah, and
may serve more than 1 term.
(e) Vacancies.--A vacancy on the advisory committee shall
be filled in the same manner as the original appointment is
made. A member of the advisory committee may serve until a
successor is appointed.
(f) Chairperson.--The advisory committee shall select 1
member to serve as chairperson.
(g) Meetings.--The advisory committee shall meet regularly.
(h) Quorum.--A majority of members shall constitute a
quorum.
(i) Compensation.--Members of the advisory committee shall
serve without compensation, except that members shall be
entitled to reimbursement of travel expenses including per
diem while engaged in the business of the advisory committee,
in accordance with section 5703 of title 5, United States
Code.

SEC. 13. MONUMENT PLANNING TEAM.

The Secretary shall provide that the Monument planning team
formed by the Secretary to prepare the management plan for
the Monument includes at least 5 persons appointed by the
Governor of the State of Utah to represent the State and
local governments.

SEC. 14. AUTHORIZATION OF APPROPRIATIONS.

There are authorized to be appropriated such sums as are
necessary to--
(1) provide for development and implementation of
management plans, protection of Monument resources, visitor
services and facilities, law enforcement, public safety,
additional payments in lieu of taxes to impacted counties,
economic mitigation, and the operation of the Monument
advisory committee; and
(2) facilitate the exchange of school trust lands.

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