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Congress Adjourns; LHHSE Spending Bill Contains Medicare Payments

The 106th Congress adjourned on December 15 after giving final approval to three FY2001 appropriations bills, as well as a number of other pieces of legislation. The conference report for the FY2001 Labor, Health and Human Services, and Education appropriations bill (H.R. 4577) contained the FY2001 Legislative Branch appropriations bill, the FY2001 Treasury, Postal Service, and General Government appropriations bill, legislation to provide additional Medicare payments to health care providers, legislation to reauthorize a number of Small Business Administration programs, several tax extension provisions, as well as a number of miscellaneous provisions. On December 15, the House approved the final measure by a vote of 292-60, and the Senate approved it by voice vote.

The FY2001 Legislative Branch appropriations bill (H.R. 4516), which also contained the FY2001 Treasury-Postal Service appropriations bills (H.R. 4871), was originally approved by the House on September 8 (see The Source, 9/15/00, p. 1) and the Senate on October 12 (see The Source, 10/13/00, p. 2). However, the President vetoed the measure on October 30 in an effort to send a message to lawmakers that negotiations on the remaining issues would have to be completed. An unchanged version was included in the final budget agreement.

The FY2001 Commerce, Justice, State, and Related Agencies appropriations bill (H.R. 4690)—the fourth outstanding FY2001 spending bill—was sent to the President as approved by the House on October 26 and the Senate on October 27 (see The Source, 10/27/00, p. 5). Appropriators held the measure because of the President’s veto threat over immigration provisions; however, changes to those provisions were included in the FY2001 Labor, Health and Human Services, and Education spending bill, thereby clearing the way for the bill’s enactment.


Labor-Health and Human Services-Education
After months of negotiations, the final FY2001 Labor, Health and Human Services, and Education appropriations bill totaled $108.9 billion in discretionary funding, up from the $86.11 billion appropriated in FY2000, and the $106.15 billion requested by the President for FY2001. While both the House and Senate approved versions of the bill earlier this summer (see The Source, 6/9/00, p. 1; 6/16/00, p. 1; 6/23/00. p. 1; 6/30/00, p. 1), the final version included funding increases above the House and Senate bills for many programs that affect women and families.

Department of Labor: Under the final measure, dislocated worker assistance received $1.6 billion in FY2001, the same amount as FY2000.

The Occupational Safety and Health Administration (OSHA) received $425.98 million, a $44.36 million increase over FY2000. The final bill did not include language approved by both the House and Senate that would have prohibited OSHA from implementing ergonomics regulations. The language was dropped after OSHA issued its final ergonomics regulation in November 2000, prior to completion of the FY2001 spending bill. The final measure provided $1 million for the Women in Apprenticeships and Nontraditional Occupations Act, the same amount the program received in FY2000. Additionally, the Women’s Bureau at the DoL received $10.2 million in FY2001, an increase over the $8.82 million appropriated last year.

The Department received $20 million for its work on the Safe Schools/Healthy Students initiative. The program is a cooperative effort between the Departments of Education, Health and Human Services, Justice, and Labor.

Additionally, the Department received $10 million for a Global HIV/AIDS Workplace Initiative. The conference report noted that “there is mounting evidence that workplace-based HIV/AIDS education and prevention programs can help prevent the spread of HIV, especially in high-risk populations.”

The final agreement also included a Senate-passed provision to extend the availability of welfare-to-work funding from three to five years.

Department of Health and Human Services (HHS): Community health centers, including migrant health centers, health care for the homeless, and public housing health service grants, received $1.17 billion, a $69 million increase over last year.

Funding for the Maternal and Child Health Block Grant was increased by $5 million to $714 million. Healthy Start was level-funded at $90 million.

The Ryan White CARE Act received a $213 million increase to $1.8 billion in FY2001. According to report language, $109.2 million of this amount will be used for Ryan White activities that target communities of color.

Title X, the nation’s family planning program received a $15 million increase to $253.93 million in FY2001. A new adoption awareness program established by the Children’s Health Act (P.L. 106-310) received $9.9 million.

The Centers for Disease Control and Prevention (CDC) received $148.26 million for sexually transmitted diseases prevention, an increase over the $121.8 million appropriated in FY2000. According to the conference report, a $6 million increase was provided for chlamydia screening, and a $14.93 million increase was provided for syphilis prevention.

HIV/AIDS prevention programs at the CDC received $767.25 million, a $147.53 million increase over last year. Additionally, the CDC received $104.53 million for global HIV/AIDS activities, which will be available through September 30, 2002. That represents a $69.53 million increase over last year. The conference report urged the CDC to continue its collaborative efforts with other federal agencies to “halt the spread of the epidemic and lessen its impact.” The CDC also received $88 million to fund activities to address HIV/AIDS in communities of color.

Additionally the National Breast and Cervical Cancer Early Detection Program, administered through the CDC, received $173.93 million, a $17.9 million increase. Report language stated that adequate funding was provided to allow the CDC to expand its WISEWOMAN program to not more than 15 states. The program currently operates in three states.

Chronic and environmental diseases at the CDC received $417.04 million in FY2001, a $120 million increase. Of that amount, $9.55 million will be used for fetal alcohol syndrome prevention, $2.5 million for folic acid education, $13.3 million for teen pregnancy prevention, $103.4 million for smoking and health, and $1.5 million for women’s health. Report language also urged the CDC to continue its “research, surveillance, and health communications efforts, including the impact of lupus on women, within the framework of the National Arthritis Action Plan.”

The CDC received $14 million for a newly created safe motherhood surveillance and monitoring program (P.L. 106-310). Report language urged the CDC “to further its efforts to prevent deaths and complications during pregnancy and reduce racial disparities, with special focus on complications related to a lack of access to prenatal care and community support.”

The final measure contained language pertaining to surveillance of human papillomavirus (HPV), a sexually transmitted disease (STD). The bill requires the CDC to conduct surveillance on HPV, research prevention strategies, and prepare and distribute educational materials on HPV. Additionally, the language requires HHS to reexamine existing condom labels to determine whether they are medically accurate with respect to the effectiveness or lack of effectiveness of condoms in preventing STDs.

The final language was the result of a compromise between Rep. Tom Coburn (R-OK) and members of the Congressional Caucus for Women’s Issues. The language was originally attached to a bill (P.L. 106-354) to give states the option of providing treatment to women diagnosed with breast or cervical cancer under a federal screening program. However, in order to ensure passage and enactment of that bill, the HPV language was dropped. The language also was similar to a stand-alone bill (H.R. 3248) sponsored by Rep. Coburn.

Violence Against Women Act programs administered by HHS received $134.1 million, the same amount as last year. Of that amount, $15 million is for runaway youth. $2.16 million is for the national domestic violence hotline, and $116.92 million is for battered women’s shelters.

The National Institutes of Health received a $2.5 billion increase to $20.3 billion. Additionally, the bill appropriated $130.2 million for a newly created National Center on Minority Health and Health Disparities (P.L. 106-525). Report language encouraged the National Institute of Environmental Health Sciences to “enhance its research efforts to study the links between the environment and breast cancer through all available mechanisms, as appropriate, including establishing centers of excellence.” Report language also encouraged the National Institute of Arthritis and Musculoskeletal and Skin Diseases to expand its support for the Osteoporosis and Related Bone Diseases Resource Center.

The Substance Abuse and Mental Health Services Administration was funded at $2.96 billion, a $306.66 million increase over last year. Of this amount, $15 million will be used for fetal alcohol prevention and services, as provided by the Senate. The substance abuse block grant was funded at $1.67 billion, a $65 million increase, and the mental health block grant received a $64 million increase to $420 million. Of the amount provided for the substance abuse block grant, $53 million will be used to “provide targeted service expansion and capacity building to community-based substance abuse treatment programs with a history of providing services to communities of color severely impacted by substance abuse and HIV/AIDS.”

The Agency for Healthcare Research and Quality was funded at $269.94 million, an increase of $71.2 million. Child support enforcement received $3.51 billion, an increase of $314 million over FY2000. Additionally, refugee and entrant assistance was funded at $433.1 million, an increase of $7.3 million. Report language stated that adequate funding was provided under refugee and entrant assistance to implement the Trafficking Victims Protection Act (P.L. 106-386).

Under the final bill, the Child Care and Development Block Grant (CCDBG) received an additional $817.32 million in FY2001, bringing total FY2001 funding to $2 billion. The FY2000 omnibus appropriations bill (P.L. 106-113) provided $1.18 billion in FY2001 forward funding. Of the FY2001 amount, $19.2 million will be used for child care resource and referral and school-aged child care activities, $100 million will be used to improve the quality of infant and toddler care, and $10 million will be used for child care research, demonstration, and evaluation.

The Social Services Block Grant received a $50 million decrease to $1.725 billion, while Head Start received a $933 million increase to $6.2 billion in FY2001. Of that amount, $1.4 billion is provided in FY2002 forward funding.

The Adolescent Family Life Act (AFLA) received $24.33 million, a $5 million increase over last year. The AFLA administers abstinence-based education programs. Such programs received $50 million in FY2001, as required by the 1996 welfare reform law (P.L. 104-193). Abstinence education programs also received $30 million in advance FY2002 funding. Abstinence education programs received $20 million in FY2000 emergency supplemental funding, but the FY2001 Labor, Health and Human Services, and Education spending bill prohibited the funding from being spent until March 1, 2001.

Under the final bill, the Public Health Service’s Office on Women’s Health (PHS-OWH) received a $1.78 million increase to $17.27 million in FY2001. Report language accompanying the final bill urged the PHS-OWH to provide funding to the National Osteoporosis Foundation to support a bone health campaign targeting adolescents. The PHS Office of Minority Health received an $11.38 million increase to $49 million.

A newly created National Family Caregivers Support program (P.L. 106-501) received $125 million under the final bill, $5 million of which must be designated for Native American caregivers. Additionally, $50 million was appropriated to HHS for minority HIV/AIDS activities; however, HHS must notify Congress of how it intends to use the money before funds may be spent. Specifically, the money will be used for “activities that strengthen the medical treatment and HIV prevention capacity within communities of color disproportionately impacted by the HIV/AIDS epidemic.”

The conference report also required HHS to report to Congress on “action steps taken in response to the Institute of Medicine’s report, ‘No Time to Lose: Getting More from HIV Prevention.’” The report found that the United States did not have a national HIV prevention strategy.

Additionally, HHS was appropriated $7.13 million to study the outcomes of welfare reform and its impact on low-income populations.

The final measure maintained several controversial funding restrictions with regard to human embryo research, needle exchange programs, and abortion. H.R. 4577 prohibited the use of funds for the creation of human embryos for research purposes as well as prohibited the use of funds to implement needle exchange programs. Additionally, managed care organizations were prohibited from providing abortion to Medicaid enrollees, except in cases of rape, incest, and to save the life of the pregnant woman. Medicare also was prohibited from providing abortion coverage to disabled women.

Several restrictions that were imposed on Title X family planning clinics in previous years were renewed. Title X clinics were required to encourage family participation in a minor’s decision to seek reproductive health services; to counsel a minor on how to refrain from engaging in sexual activity; and to report child abuse, child molestation, sexual abuse, rape, or incest to law enforcement authorities.

The final measure did not include a Senate-passed provision that would have prohibited the provision of emergency contraception in school clinics. Another Senate-passed provision that would have required the General Accounting Office to study federal fetal tissue research guidelines was not included in the final agreement. Additionally, a Senate-passed version of the patients’ bill of rights was not included in the final version of the appropriations measure.

The final version also dropped a House-passed provision that would have triggered an automatic rescission if advance appropriations under all FY2001 spending bills totaled more than $23.5 billion. The rescission would have come from the Child Care and Development Block Grant.

Department of Education: Under the measure education programs received a $6.5 billion increase to $44.5 billion in FY2001. Of that amount, special education received $6.34 billion, a $1.34 billion increase over last year, and impact aid was funded at $994 million, an $88 million increase.

Eisenhower professional development state and local activities grants received $485 million in FY2001, a $150 million increase. Report language stated that schools receiving an increase in Eisenhower professional grants funding over last year may use that increase “to improve teacher quality by reducing the percentage of teachers who are uncertified, teaching out of field, or who lack sufficient content knowledge to teach effectively in the areas they teach.” Eisenhower professional development national activities grants received $44 million. Of that amount, $10 million may be used for training early childhood educators in high-poverty communities to further children’s language and literacy skills. Thirty-four million dollars may be used for new teacher recruitment initiatives.

Goals 2000 received $38 million, a decrease from the $491 million appropriated in FY2000, but the program was repealed under last year’s omnibus appropriations bill (P.L. 106-113).

Additionally, the bill funded the President’s class size and school construction initiatives. The Class Size Reduction program received $1.6 billion, $323 million more than last year. According to report language, schools may use the funds “for recruiting, hiring, and training fully qualified regular and special education teachers who are certified within the states, have a baccalaureate degree and demonstrate subject matter knowledge in their content areas.” Additionally, 25 percent of the funds may be used to test new teachers’ academic knowledge, to meet state certification requirements, or to provide professional development for existing teachers. Schools that have already reduced their class size in the early grades may use the funds to further reduce class size in grades K-3 or to improve teacher quality.

The School Modernization program received $1.2 billion. No money was appropriated for the program in FY2000. Funds may be used by schools for emergency school renovation and repair, activities under the Individuals with Disabilities Act, and technology activities. Of the total amount provided, $75 million must be allocated to schools “with at least 50 percent of their student population living on Native American or Native Alaskan lands.” Additionally, $3.3 million must be used for schools in “outlying areas for the renovation and repair of high-need schools.”

Safe and Drug Free Schools received a $44.25 million increase to $644.25 million in FY2001. Of this amount, $117 million was appropriated for the Department’s work on the Safe Schools/Healthy Students initiative. The 21st Century Community Learning Centers received $851 million, $392 million more than FY2000. Report language encouraged that applications submitted for the 21st Century Community Learning Centers grants be submitted “jointly by a local educational agency and a community-based organization.”

Total funding for the Elementary and Secondary Education Act was $9.5 billion, an $823.64 million increase over last year. Even Start, a program that provides grants for family literacy programs, received $250 million, an $100 million increase over FY2000.

The Women’s Education Equity Act was level-funded at $3 million. Vocational and adult education received $1.83 billion, a $143 million increase over last year. Additionally, under the final bill, the maximum Pell Grant award was increased by $450 to $3,750. The Child Care Access Means Parents in School program received a $20 million increase to $25 million in FY2001.

The final measure also provided $1 million for loan forgiveness for child care providers. Report language stated that “the conferees are aware of the significant need for and benefits of high quality child care services, and for that reason, have included start up funding for this program. Limited funding has been provided in fiscal year 2001 solely due to the fact that few individuals will meet the eligibility requirements.”

Also, the Department’s Office for Civil Rights, which oversees enforcement of Title IX, received a $4.8 million increase to $76 million.

The final measure also included the Early Learning Opportunities Act (S. 2866). Sponsored by Sen. Ted Stevens (R-AK), the bill is designed to help states increase the availability of programs, services, and activities that support early childhood education.


Tax Extensions
The final omnibus package included several tax extensions. Medical savings accounts were extended for an additional two years, and companies that donate computers to public schools and libraries may continue to take a tax deduction through 2003.

Additionally, the final bill included an expanded version of legislation (H.R. 5117) designed to ensure that families with missing children can claim certain tax exemptions and credits. Under the final language, the dependent child tax exemption, the child tax credit, the surviving spouse filing status, the head of household filing status, and the earned income tax credit are available to a taxpayer whose child has been kidnapped. The credits and exemptions only apply if there is no evidence of the child’s death and no evidence that the child was kidnapped by a family member. The House approved a narrower version of the final language, sponsored by Rep. Jim Ramstad (R-MN), on September 26.


Medicare “Givebacks”
Under the final bill, health care providers will receive $35 billion in additional Medicare payments over five years. The final measure provided for biennial coverage for screening Pap smears and pelvic exams for all women. Currently, Medicare covers a Pap smear once every three years. Women who are at risk of developing cervical cancer and those who have had an abnormal Pap smear in the past three years are eligible for a yearly Pap smear. The final bill also increased the payment limit for new technologies applied to screening mammography. Under the bill, beginning in 2002, two new payment rates will be established. For technologies that directly take digital images, the payment rate will be equal to 150 percent of the payment for bilateral diagnostic mammography. For technologies that convert images, the payment will be increased by $15. Additionally, the Secretary of Health and Human Services will be required to determine if a new code is necessary.

The final bill also provided a new Medicare benefit by covering medical nutrition therapy services for beneficiaries with diabetes and renal disease. The coverage will be effective January 1, 2001, and the Secretary of Health and Human Services will be required to report to Congress on the effectiveness of providing these services.

Provisions pertaining to racial and ethnic minorities also were included in the bill. One provision established cancer prevention and treatment demonstration projects for racial and ethnic minorities. The other provision expanded Medicare+Choice quality assurance programs to include a separate focus on racial and ethnic minorities. Additionally, the Secretary of Health and Human Services will be required to report to Congress on how quality assurance programs under Medicare+Choice focus on racial and ethnic disparities.

Additionally, under the final bill, the national limitation for new clinical laboratory tests will be equal to 100 percent of the national median for such tests. This provision will apply to new Pap tests. The final bill also required HHS to study preventive interventions in primary care for older Americans.

Under the final measure, the application process for an extension of Medicaid expansion waivers (referred to as 1115 waivers) was streamlined. Under current law, states may petition the Health Care Financing Administration for a waiver to experiment with changes in Medicaid. Some states have applied for the Medicaid expansion waivers in order to provide family planning services to low-income women. The final bill streamlined the application process for an extension of the Medicaid expansion waiver and shortened the amount of time states wait for final approval of the extension.

The final measure also expanded the list of entities allowed to make Medicaid or State Children’s Health Insurance Program presumptive eligibility determinations for children to include elementary and secondary schools, including those run by Native American tribes.

The Transitional Medicaid Assistance program was extended until September 30, 2002, under the final bill. The program was created to help families transition from welfare-to-work by extending Medicaid coverage for up to one year.

Finally, the measure increased the authorization for the Maternal and Child Health Block Grant from $705 million to $850 million.


Small Business Administration (SBA) Reauthorization
The final version included a House-passed and Senate-passed bill (H.R. 2392) to reauthorize several SBA programs (see The Source, 10/6/00, p. 4). Under the bill, the National Women’s Business Council was reauthorized at $1 million. Additionally, SBA’s domestic microloan program, which provides loans in amounts less than $25,000 for entrepreneurs, was reauthorized through FY2003. The 7(a) and 504 loan programs also were reauthorized through FY2003, and women-owned businesses were added to the list of public policy goals for which the 504 loan program should do outreach.

Two bills (H.R. 4945/H.R. 4897) that were not originally included in the House- and Senate-passed SBA reauthorization package were included in the final budget agreement. H.R. 4945 requires the SBA to develop and maintain a database to track the federal government’s contract bundling, as well as the number of small businesses denied prime contracts. The bill also requires the SBA to provide the House and Senate Small Business Committees a report on contract bundling. H.R. 4945, sponsored by Rep. Jim Talent (R-MO), was passed by the House on September 20.

The Equity in Contracting for Women Act of 2000 (H.R. 4897), sponsored by Rep. Nydia Velazquez (D-NY), authorizes a federal contracting officer to set aside federal contracts to be awarded to small businesses owned and controlled by women if:

  • the contracting officer expects that two or more women-owned or controlled businesses will submit offers;
  • the contract is for the procurement of goods or services with respect to an industry where women-owned or controlled businesses are under- represented;
  • the anticipated award does not exceed $3 million;
  • the contract can be made at a fair and reasonable price; and
  • the business is certified as a women-owned or controlled small business.

Miscellaneous Provisions
The final agreement also included a $750,000 appropriation for the Commission on Online Child Protection, which is operated through the Department of Justice.

Additionally, the final measure included a bill (H.R. 3222) to increase the authorization for Even Start programs to $250 million for FY2001. The House approved a version of the bill on September 12, which would have increased the authorized amount to $500 million (see The Source, 9/15/00, p. 3). The measure was sponsored by Rep. William Goodling (R-PA).

The Children’s Internet Protection Act (H.R. 4500) also was included in the final version, as well as the Neighborhood Children’s Internet Protection Act (S. 1545). H.R. 4500, sponsored by Rep. Charles Pickering (R-MS), requires public schools and libraries to have Internet safety policies in place in order to receive universal service discounts. The measure also requires the National Telecommunications and Information Administration to study whether current Internet blocking and filtering software adequately addresses the needs of schools and libraries. S. 1545, sponsored by Sen. Rick Santorum (R-PA), requires public schools and libraries to adopt and implement an Internet safety policy that addresses:

  • access by minors to inappropriate matter in the Internet;
  • the safety and security of minors when using email and chat rooms;
  • unauthorized access and activities by minors;
  • unauthorized disclosure, use, and dissemination of personal identification regarding minors; and
  • measures designed to restrict minors’ access to material harmful to them.

Conference report language included in the final bill directs the Department of Defense to use funding appropriated for its medical research programs to investigate environmental factors that may be related to increased incidence of breast cancer.

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