2000
[DOCID: f:s1878is.txt]
107th CONGRESS
1st Session
S. 1878
To establish programs to address the health care needs of residents of
the United States-Mexico Border Area, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 20 (legislative day, December 18), 2001
Mrs. Hutchison (for herself and Mr. Bingaman) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To establish programs to address the health care needs of residents of
the United States-Mexico Border Area, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``United States/Mexico Border Health
Improvement Act of 2001''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The United States-Mexico Border Area is the area
located in the United States within 100 kilometers of the
border between the United States and Mexico.
(2) In the United States, the United States-Mexico Border
Area encompasses 46 counties in California, Arizona, New
Mexico, and Texas.
(3) Presently, the United States-Mexico Border Area is
experiencing explosive population growth. In the United States,
this region currently has 11,500,000 residents. However, this
number is expected to exceed 22,000,000 by the year 2025. The
population of the region in Mexico is growing at an ever faster
rate. In total, the population of the communities in both
countries is expected to double between the years 2020 and
2025.
(4) With 11,500,000 residents and a 2,000-mile expanse, the
United States-Mexico Border Area has the population and size of
a State of the United States. If the region was such a State,
it would rank--
(A) last in access to health care;
(B) second in death rates (due to hepatitis);
(C) third in deaths related to diabetes;
(D) first in the number of tuberculosis cases;
(E) first in schoolchildren living in poverty; and
(F) last in per capita income.
(5) In addition to the specific health problems listed in
paragraph (5), hundreds of thousands of Area residents also
each day face increased health risks due to being exposed to
the polluted water, soil, and air of the region.
(6) Every county in the United States-Mexico Border Area in
the United States has at least a partial health professional
shortage area designation. Twenty-five percent of such counties
have severe shortages and lack adequate primary care
physicians. The shortage of dentists is also severe in many
Area localities.
(7) According to GAO, the United States-Mexico Border Area
contains hundreds of colonias. Colonias are substandard
developments that typically lack running water, sewerage
systems, and electricity. Many of the residents of colonias are
migrant farmworker families.
(8) Due to the poor living conditions in the colonias, the
United States-Mexico Border Area has a much higher rate of
waterborne infectious diseases. The occurrence of hepatitis A,
for example, is 3 times the national rate, and the occurrence
of salmonella and shigella dysentery occur is 2 to 4 times the
national rate.
SEC. 3. DEFINITIONS.
In this Act:
(1) United states-mexico border area.--The term ``United
States-Mexico Border Area'' means the area located in the
United States within 100 kilometers of the border between the
United States and Mexico.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
SEC. 4. OFFICE OF BORDER HEALTH.
(a) In General.--There is established within the Department of
Health and Human Services an Office of Border Health (referred to in
this section as the ``Office'').
(b) Director.--The Secretary shall appoint a Director of the Office
to administer and oversee the functions of such Office.
(c) Authority.--In overseeing the Office, the Secretary, acting
through the Director--
(1) shall be responsible for the overall direction of the
Office and for the establishment and implementation of general
policies respecting the management and operation of programs
and activities of the Office;
(2) shall establish programs and activities to study and
monitor border health service delivery in general, the
coordination of Federal and State and Federal and local border
health activities, the health education available for border
residents, existing outreach for residents and the success of
such outreach, health service activities, particularly
prevention, and early intervention activities, and any other
activity that the Secretary determines is appropriate to
improve the health of United States-Mexico Border Area
residents, including the health of Native American tribes
located within the primary Area;
(3) shall review Federal public health programs and
identify opportunities for collaboration with other Federal,
State, and local efforts to address border health issues;
(4) shall coordinate activities with the United States-
Mexico Border Health Commission and State offices;
(5) shall award grants to States, local governments,
nonprofit organizations, or other eligible entities as
determined by the Secretary, in the United States-Mexico border
area to address priorities and recommendations established by--
(A) the United States-Mexico Border Health
Commission on a binational basis, including the Healthy
Border 2010 Program Objectives; and
(B) the Director, to improve the health of border
region residents;
(6) shall award grants to programs that seek to improve the
health care of Area residents, with priority given to
applicants such as the Health Resources and Services
Administration and other applicants that seek to provide
telemedicine and telehealth services; and
(7) shall collaborate with appropriate counterparts in
Mexico to coordinate actions and programs to improve health for
residents of the United States-Mexico border area.
(d) Report.--Not later than 1 year after the date of enactment of
this section, the Secretary shall prepare and submit to the appropriate
committees of Congress a report describing Federal health programs'
limitations in addressing United States-Mexico Border Area health
concerns and recommending solutions to better address such concerns.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 5. UNITED STATES-MEXICO BORDER AREA ENVIRONMENTAL HEALTH PROGRAM.
(a) In General.--The Secretary shall award grants to eligible
entities as determined by the Secretary to establish environmental
health hazard programs for the United States-Mexico Border Area.
(b) Priority.--In awarding grants under this section, the Secretary
shall give priority to eligible entities that propose to establish and
carry out programs that address environmental health hazards in the
United States-Mexico Border Area f
2000
or pregnant women and children.
(c) Duties.--An eligible entity that receives a grant under this
section, shall use funds received through such grant to--
(1) establish an environmental health program that
addresses health hazards along the United States-Mexico Border
Area;
(2) identify and eliminate environmental health hazards;
(3) coordinate its program with any environmental health
programs, if applicable, administered by the Environmental
Protection Agency, the National Institute of Environmental
Health Sciences, the International Consortium for the
Environment (ICE), other relevant Federal, State, and local
agencies, and nongovernmental organizations;
(4) recruit and train health professionals and
environmental health specialists to identify and address
environmental health hazards in the United States-Mexico Border
Area; or
(5) support State and local public health, food safety, and
building inspection agencies to reduce environmental health
hazards, including hazards existing in or around private
residences in the United States-Mexico Border Area.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 6. COMMUNITY HEALTH CENTERS.
Part D of the Public Health Service Act (42 U.S.C. 254b et seq.) is
amended by adding at the end the following:
``SEC. 330I. UNITED STATES-MEXICO BORDER AREA GRANTS.
``(a) In General.--The Secretary shall award grants to eligible
entities as determined by the Secretary to establish community health
centers in medically underserved areas of the United States-Mexico
Border Area.
``(b) Definitions.--The term ``United States-Mexico Border Area''
means the area located in the United States within 100 kilometers of
the border between the United States and Mexico.
``(c) Duties.--An eligible entity that receives a grant under this
section shall establish and fund community health centers in medically
underserved areas of the United States-Mexico Border Area, and as
designated by the Secretary.
``(d) Application.--An eligible entity desiring a grant under this
section shall submit an application at such time, in such manner, and
containing such information as the Secretary may reasonably require.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be
necessary.''.
SEC. 7. NATIONAL HEALTH SERVICE CORPS.
Subpart II of the Public Health Service Act (42 U.S.C. 254d et
seq.) is amended by adding at the end the following:
``SEC. 339. UNITED STATES-MEXICO BORDER HEALTH SERVICE CORPS.
``(a) In General.--The Secretary shall establish a loan repayment
program and recruit National Health Service Corps members to provide
health services for United States-Mexico Border Area residents in
exchange for participation in such program.
``(b) Preference.--In selecting Corps members to participate, the
Secretary shall give preference to pediatricians and pediatric
specialists who are fluent in English and Spanish, and to applicants
who agree to serve along the United States-Mexico Border Health Area
for at least 2 years.
``(c) Program.--
``(1) In general.--The Secretary shall establish a loan
repayment program described in subsection (a).
``(2) Contract.--Under such program, the Secretary shall
enter into written agreements with individuals selected by the
Secretary to provide the health services described in
subsection (a) in exchange for the Secretary providing payment
for the individual for the principal, interest, and related
expenses on government and commercial loans received by the
individual regarding the graduate or undergraduate education of
the individual (or both).
``(3) Payment for years served.--For every 2 years of
service that an individual contracts to serve under this
section the Secretary may pay for 1 year of educational
expenses, including tuition, living expenses, and any other
such reasonable educational expenses.
``(d) United States-Mexico Border Area.--The term ``United States-
Mexico Border Area'' means the area located in the United States within
100 kilometers of the border between the United States and Mexico.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be
necessary.''.
SEC. 8. PROMOTOR(A) GRANT PROGRAMS.
(a) Program Authorized.--The Secretary shall award grants to
eligible entities to establish promotor(a) programs to recruit, train,
and retain bilingual lay health advisers to provide culturally
appropriate health education and other services for medically
underserved populations in the United States-Mexico Border Area.
(b) Definition.--The term ``eligible entity'' means a school of
public health, an academic health sciences center, a Federally
qualified health center, a public health agency, a border health
office, or a border health education training center or any other
entity determined by the Secretary that is located in or that serves
the United States-Mexico Border Area.
(c) Duties.--An eligible entity that receives a grant under this
section shall, in addition to the duties described in subsection (a),
develop bilingual promotor(a) and other border-specific health training
programs.
(d) Application.--An eligible entity desiring a grant under this
section, shall submit an application to the Secretary at such time, in
such manner, and containing such information as the Secretary may
reasonably require.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 9. GRANTS FOR DISTANCE LEARNING.
(a) Program Authorized.--The Secretary shall award grants to United
States-Mexico Border Area State and local health agencies, community
health centers, and other appropriate organizations to fully
participate in the provider education distance learning/information
dissemination network of the Health Services and Resources
Administration.
(b) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 10. PREVENTION AND TREATMENT OF HIV/AIDS.
(a) Program Authorized.--The Secretary shall carry out a study to
review agency activities regarding reducing the spread of HIV/Aids
affecting the residents in the United States-Mexico Border Area.
(b) Coordinations.--In carrying out such study, the Secretary shall
coordinate activities with the appropriate Federal and State agencies
and with appropriate agencies in Mexico to develop early intervention
and treatment efforts to curb the spread of HIV/AIDS.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 11. PREVENTION AND TREATMENT OF TUBERCULOSIS.
(a) Program Authorized.--The Secretary shall carry out a study to
review agency activities regarding reducing the spread of tuberculosis,
particularly multi-drug resistant tuberculosis, affecting the residents
in the United States-Mexico Border Area.
(b) Coordination.--In carrying out such study, the Secretary shall
coordinate activities with the Immigration and Naturalization Service
and other appropriate Federal and State agencies and with appropriate
agencies in Mexico to develop diagnosis, detection, and early
intervention and treatment efforts to curb the spread of tuberculosis,
particularly multi-drug resistant tuberculosis.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 12. CHILDREN'S HEALTH INSURANCE PROGRAM.
The Secretary shall establish a targeted
2000
campaign of public
education and awareness in the United States-Mexico Border Area that is
culturally relevant to the residents of that Area.
SEC. 13. INTERVENTION AND TREATMENT GRANTS.
(a) Program Authorized.--The Secretary shall award grants to
eligible entities as determined by the Secretary to carry out
intervention and treatment programs for diabetes.
(b) Use of Funds.--An entity that receives a grant under this
section shall use funds received through such grant to--
(1) develop intervention programs oriented towards
increasing access to diabetes health care;
(2) increase venues and opportunities for physical activity
and exercise in the border area;
(3) address obesity as a risk factor for diabetes,
especially in juvenile populations;
(4) improve health choices in school nutrition; and
(5) develop diabetes networks and coalitions to encourage
communities to address diabetes risk factors.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 14. CENTERS FOR DISEASE CONTROL AND PREVENTION.
(a) Program Authorized.--The Centers for Disease Control and
Prevention shall establish a National Border Health Databank (referred
to in this section as the ``Databank'') to gather and retain data and
other information on the health of United States-Mexico Border Area
residents and on past, present, and emerging health issues in such
Area.
(b) Content.--The Databank shall include an Epidemiological
Information System that shall be linked, where feasible, to all
relevant State and local health agencies and other relevant national
and international health organizations.
(c) Availability of Data.--All information gathered and retained by
the Databank shall, where practicable, be made available for the public
via the Internet. The Centers for Disease Control and Prevention shall
publish no less than quarterly a publication reporting on activities,
studies, and trends regarding United States-Mexico Border Area health
issues, including, the resources available from the Databank.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 15. CENTER FOR DISEASE CONTROL PREVENTION.
(a) Program Authorized.--There is established within the Centers
for Disease Control and Prevention a Border Health Surveillance Network
(referred to in this section as the ``Network'').
(b) Duties.--The Network shall--
(1) carry out activities to develop and electronically link
the health surveillance, assessment, and response capabilities
of the Centers for Disease Control and Prevention and all
border State and local health agencies; and
(2) award grants to State and local public health agencies,
medical schools, schools of public health, Border Health
Education Training Centers, or other entities as determined by
the Secretary located in or serving the United States-Mexico
Border Area for the development of border health epidemiology
training programs and to build upon the existing Health Alert
Network, the Information Network for Public Health Officials,
the Border Infectious Disease Surveillance (``BIDS'') Project, and a
Noncommunicable Disease Surveillance System.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 16. BORDER AREA BREAST AND CERVICAL CANCER SCREENING.
Section 1501 of the Public Health Service Act (42 U.S.C. 300k) is
amended by adding at the end the following:
``(e) Special Consideration for Border Area Residents.--In making
grants under subsection (a), the Secretary shall set-aside certain
funds described in give special consideration to any State that
proposes to increase the number of United States-Mexico Border Area
residents who are screened for breast and cervical cancer.''.
SEC. 17. GRANTS FOR BORDER AREA HEALTH TESTING.
(a) In General.--The Director of the Centers for Disease Control
and Prevention shall award grants to United States-Mexico Border Area
State and local health agencies to upgrade public health laboratories
and conduct rapid tests for disease organisms and toxic chemicals.
(b) Coordination.--A State or local health agency that receives a
grant under this section shall, to the extent possible, coordinate its
activities carried out with funds received under this section with
activities carried out under programs administered by the National
Laboratory Training Network.
(c) Application.--A State or local health agency desiring a grant
under this section shall submit an application to the Director at such
time, in such manner, and containing such information as the Director
may reasonably require.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 18. HEALTH PROMOTION ACTIVITIES.
(a) In General.--The Secretary shall establish new, comprehensive
guidelines for community- and family-oriented prevention and health
promotion activities focused on Guidelines under The Healthy Border
2010 Guidelines. The Director shall disseminate these guidelines in
both English and Spanish to all United States-Mexico Border Area health
professionals, utilizing all available tools, including the CDC
Prevention Guidelines Database.
(b) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 19. GENERAL ACCOUNTING OFFICE.
(a) Program Authorized.--The General Accounting Office shall
conduct a comprehensive study of Federal and Federal and State border
health programs.
(b) Content.--The study described in subsection (a) shall review
border health care programs to determine the manner in which such
programs may be improved. Such study shall also review any problematic
limitations of medicare and medicaid programs in serving United States-
Mexico Border Area residents.
(c) Report.--Not later than 1 year after the date of enactment of
this section, the General Accounting Office shall prepare and submit to
Congress a report describing the findings of the study described in
subsection (a) and recommending certain courses of action to improve
such border health care programs, with particular emphasis on
recommendations for improving Federal and State and Federal and local
coordinations. Such report shall also make recommendations for changes
with regard to medicare and medicaid payment laws and policies for
telemedicine and telehealth activities.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 20. AGENCY FOR HEALTH CARE RESEARCH AND QUALITY.
(a) In General.--The Agency for Health Care Research and Quality
shall conduct a comprehensive study of border health needs, trends, and
areas of needed improvement and shall utilize border academic
institutes to carry out such study and share the results of such study
with such institutes.
(b) Content.--The study described in subsection (a) shall study the
health needs of United States-Mexico Border Area residents and--
(1) residents' access to health care services;
(2) communicable disease control in the Area;
(3) environmental problems in the Area that contribute to
health care problems;
(4) health research being done on residents' health care
needs;
(5) make recommendations regarding environmental
improvements that may be made to improve health conditions of
Area residents; and
(6) make recommendations regarding long range plans to
improve the quality and availability of health care of Area
residents.
(c) Authorization o
1dcc
f Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 21. GRANTS TO INCREASE RESOURCES FOR COMMUNITY WATER FLUORIDATION.
(a) In General.--The Secretary, acting through the Director of the
Division of Oral Health of the Centers for Disease Control and
Prevention, may make grants to Southwestern border States or localities
for the purpose of increasing the resources available for community
water fluoridation.
(b) Use of Funds.--A State or locality shall use amounts provided
under a grant under subsection (a)--
(1) to purchase fluoridation equipment;
(2) to train fluoridation engineers; or
(3) to develop educational materials on the advantages of
fluoridation.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 22. COMMUNITY WATER FLUORIDATION.
(a) In General.--The Secretary, acting through the Director of the
U.S. Mexico Border Health Commission and the Director of the Centers
for Disease Control and Prevention, shall establish a demonstration
project that is designed to assist rural water systems in Texas, New
Mexico, Arizona and California in successfully implementing the Centers
for Disease Control and Prevention water fluoridation guidelines
entitled ``Engineering and Administrative Recommendations for Water
Fluoridation'' (referred to in this section as the ``EARWF'').
(b) Requirements.--
(1) Collaboration.--The Director of the U.S. Mexico Border
Health Commission shall collaborate with the Director of the
Centers for Disease Control and Prevention in developing the
project under subsection (a). Through such collaboration the
Directors shall ensure that technical assistance and training
are provided to sites located in each of the 4 States referred
to in subsection (a). The Director of the U.S. Mexico Border
Health Commission shall provide coordination and administrative
support to tribes under this section.
(2) General use of funds.--Amounts made available under
this section shall be used to assist small water systems in
improving the effectiveness of water fluoridation and to meet
the recommendations of the EARWF.
(3) Fluoridation specialists.--
(A) In general.--In carrying out this section, the
Secretary shall provide for the establishment of
fluoridation specialist engineering positions in each
of the Dental Clinical and Preventive Support Centers
through which technical assistance and training will be
provided to tribal water operators.
(B) CDC.--The Director of the Centers for Disease
Control and Prevention shall appoint individuals to
serve as the fluoridation specialists.
(4) Implementation.--The project established under this
section shall be planned, implemented and evaluated over the 5-
year period beginning on the date on which funds are
appropriated under this section and shall be designed to serve
as a model for improving the effectiveness of water
fluoridation systems of small rural communities.
(c) Evaluation.--In conducting the ongoing evaluation as provided
for in subsection (b)(4), the Secretary shall ensure that such
evaluation includes--
(1) the measurement of changes in water fluoridation
compliance levels resulting from assistance provided under this
section;
(2) the identification of the administrative, technical and
operational challenges that are unique to the fluoridation of
small water systems;
(3) the development of a practical model that may be easily
utilized by other tribal, State, county or local governments in
improving the quality of water fluoridation with emphasis on
small water systems; and
(4) the measurement of any increased percentage of
Southwestern border residents who receive the benefits of
optimally fluoridated water.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 23. COMMUNITY-BASED DENTAL SEALANT PROGRAM.
(a) In General.--The Secretary, acting through the Director of the
Maternal and Child Health Bureau of the Health Resources and Services
Administration, may award grants to eligible entities determined by the
Secretary to provide for the development of innovative programs
utilizing mobile van units to carry out dental sealant activities to
improve the access of children to sealants as well as for prevention
and primary care.
(b) Use of Funds.--An entity shall use amounts received under a
grant under subsection (a) to provide funds to eligible community-based
entities to make available a mobile van unit to provide children in
second or sixth grade with access to dental care and dental sealant
services. Such services may be provided by dental hygienists so long as
a formalized plan for the referral of a child for treatment of dental
problems is established.
(c) Eligibility.--To be eligible to receive funds under this
section an entity shall--
(1) prepare and submit to the Secretary an application at
such time, in such manner and containing such information as
the Secretary may require; and
(2) be a community-based entity that is determined by the
Secretary to provide an appropriate entry point for children
into the dental care system and be located within 100
kilometers of the United States Mexico Border.
(d) Coordination With Other Programs.--An entity that receives
funds from a State under this section shall serve as an enrollment site
for purposes of enabling individuals to enroll in the State plan under
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or in the
State Children's Health Insurance Program under title XXI of such Act
(42 U.S.C. 1397aa et seq.).
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
SEC. 24. UNITED STATES HISPANIC NUTRITION EDUCATION AND RESEARCH
CENTER.
(a) Establishment.--The Secretary shall establish a United States
Hispanic Nutrition Education and Research Center (referred to in this
section as the ``Center'') at a regional academic health center.
(b) Purpose.--The general purpose of the Center shall be to
undertake nutrition research and nutrition education activities that
sustain and promote the health of United States Hispanics, particularly
those United States Hispanics in the United States-Mexico Border Area.
The Center shall serve as a national clearinghouse for research, and
for data collection and information dissemination on nutrition in the
United States Hispanic population. In addition, the Center shall serve
as an educational resource on United States Hispanic nutrition for
students, universities, and academic and research institutions
throughout the United States.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary.
<all>
0