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   The bill also requires the Secretary to study issues related to effective treatment for metabolic disorders, including PKU, and access to such treatments, in order to prevent worsening of these conditions. It is my hope that this study will be useful for employers, insurers, insurance commissioners and others who provide insurance or set coverage standards.

   Another major area where additional efforts are needed is dental care. Last May, the Surgeon General published a landmark report on oral health in America, emphasizing the need to consider oral health as an essential part of total health. There is no question that oral and dental health care should be included in primary care. Tooth decay is the most common childhood infectious disease, and it can lead to devastating consequences, including problems with eating, learning and speech. Twenty-five percent of children in the United States suffer 80 percent of the tooth decay, with significant racial and

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   According to a 1995 report by the Inspector General, only one in five Medicaid-eligible children receive dental services annually, and the shortage of dentists exacerbates the problem of unmet needs. Yet tooth decay is largely preventable. More effective efforts to educate parents and children about the causes of tooth decay--and initiatives to prevent and treat it--can lead to lasting public health improvements. Our legislation includes a variety of approaches to deal with this silent epidemic, including a new grant program to improve the understanding of prevention, diagnosis, and treatment of pediatric oral diseases and conditions, and grants to increase community-wide fluoridation and school-based dental sealant programs. It also directs the Secretary to undertake a coordinated oral health initiative to fund innovative activities to improve the oral health of low-income children.

   Research has long shown that childhood lead poisoning can have devastating effects on children, causing reduced IQ and attention span, stunted growth, behavior problems, and reading and learning disabilities. Yet too many children remain unscreened and untreated, and adequate services often are not available for children with elevated levels of lead in their blood. There is no excuse for not taking greater steps to eliminate childhood lead poisoning. Our bill includes screening for early detection and treatment, professional education and training programs, and outreach and education activities for at-risk children.

   Pediatric research discoveries promote and maintain health throughout a child's life span, and also contribute significantly to new insights that aid in the prevention and treatment of illnesses among adults. A growing body of evidence shows that risk factors for conditions such as coronary artery disease and stroke begin in childhood and persist through adulthood. Congress has a strong record of promoting basic and clinical research, and the steps taken in this legislation continue that priority with a special focus on children.

   The legislation establishes a pediatric research initiative, authorized at $50 million annually, that will increase support for pediatric biomedical research at the National Institutes of Health, including an increase in collaborative efforts among multidisciplinary fields in areas that are promising for children. The legislation also requires coordination with the Food and Drug Administration to increase the number of pediatric clinical trials, and to provide greater information on safer and more effective use of prescription drugs in children.

   Children have unique health care needs. They are not simply small adults. Nothing is more important to the future health of America's children than maintaining a steady supply of pediatricians, pediatric specialists and pediatric-focused scientists.

   Our legislation takes several important steps to improve the growth and development of a pediatric-focused medical community. It enhances support through the NIH expressly for training and career development activities of pediatric researchers, including establishing a loan repayment program for health care professionals who focus on pediatric research.

   It revises and extends the authorization of a program enacted last year to support graduate medical education at independent children's hospitals. These hospitals train half of all pediatric specialists, and 30 percent of all pediatricians. However, because GME activities have historically been supported by Medicare and because these hospitals serve very few Medicare patients, they have traditionally received very little federal financial support for this important and costly activity. As a result, children's hospitals are struggling to maintain the important training, pediatric research, and primary and specialty care services that they provide. Children's hospitals should be treated like all other teaching hospitals when it comes to support for their GME activities. I have sponsored other legislation to guarantee full funding each year, without being subject to the appropriations process. That proposal has been included in the Balanced Budget Refinement Act of 2000. It is awaiting consideration in the Finance Committee, and I hope it will be enacted this year.

   The bill also authorizes a new long-term study to monitor and evaluate health and development of children through adulthood. The kind of information that will be obtained by this study is long-overdue, and I look forward to its results.

   The bill also takes two steps to protect children who participate in clinical trials and other research. It requires all HHS-regulated and funded research to comply with current pediatric-specific human subject protection regulations. This provision is supported by the FDA and industry alike, and it is an important step toward assuring full public confidence in life-saving research activities. In addition, it requires the Secretary to review those regulations and report on their adequacy and recommendations, if any, for changes within six months. Our committee intends to look more broadly at the issue of human subject protections next year, and this report will help inform those discussions.

   Finally, this legislation also includes a variety of directives to increase activities at public health agencies on specific disorders and diseases affecting children. Children living with autism, Fragile X, diabetes, arthritis, muscular dystrophy, epilepsy, cystic fibrosis, and a number of other conditions have much to be grateful for today. We all have the highest hopes that the provisions in this bill will lead to successful efforts to combat these debilitating and often deadly conditions.

   Division B of the bill will enable the Substance Abuse and Mental Health Services Administration to meet the mental health and substance abuse needs of communities through its

   successful existing programs and through new and innovative initiatives.

   The recent National Household Survey on Drug Abuse indicates that we have made important progress in combating substance abuse, especially among the nation's youth. The goal of this legislation is to build on that progress with expanded prevention and treatment services. Several of the bill's provisions come from the Mental Health Early Intervention, Treatment, and Prevention Act, which Senator DOMENICI and I introduced in response to the Surgeon General's groundbreaking Report on Mental Health. These provisions take needed steps to give the mentally ill the services they need.

   This legislation is the product of bi-partisan cooperation, and I especially commend Senator FRIST for his leadership in bringing everyone together. His efforts have helped ensure that the measure we pass today is an effective response to the mental illness and substance abuse problems we face.

   Over the past two decades, we have made great progress in determining the causes of mental illnesses and developing strategies to treat them. We have also begun to understand the biological basis of substance abuse. Despite these scientific advances, mental illness and substance abuse continue to be a national crisis. One in five Americans will experience some form of mental illness this year--and two-thirds of them will not seek treatment. Substance abuse costs the country an estimated $270 billion in annual economic costs, and it leads to unacceptable violence, injury, and HIV infection in our communities.

   Too often, patients with mental illness are denied the state-of-the-art treatment that would be available if their illnesses were physical instead of mental. We have failed to provide them with the services they need to meet the overwhelming obstacles they face. We have not made an adequate effort to help them overcome their addictions. The bill we pass today is intended to correct these injustices.

   It will provide treatment to those who desperately need it and prevention services to those at risk. Much of the bill focuses on the unique needs of youths, adolescents, and young adults. It provides services for children of substance abusers, training for teachers to recognize the symptoms of mental illness, and a suicide prevention program for children and youth. In addition, it provides a range of community services for children with serious emotional disturbances and for youth offenders. Agencies will receive funding to study

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   For homeless individuals, the bill provides expanded mental health and substance abuse services, along with transition assistance. For residents of treatment facilities, it offers protections from the inappropriate and often harmful use of seclusion and restraints. The bill will help to divert persons with mental illness from the criminal justice system, which for too long has served as a dumping-ground, and give them the services they need. It will provide special treatment for those who suffer simultaneously from mental illness and addiction. It will also provide funds to designate facilities as emergency mental health centers, especially in underserved areas. In all the services included, there will be a special emphasis on meeting the unique needs of specific cultures and ethnic groups, and on giving states the flexibility they need to address the concerns of their individual communities.

   For too long, we have blamed the mentally ill and those addicted to alcohol and other drugs for their behavior, rather than extending a helping hand. Recent scientific advances have opened new windows onto the biochemical basis of mental illness and addictive behavior. This legislation will ensure that these advances are translated into practical services for those who need them. By creating this more effective framework to deliver appropriate services, we will help many more individuals to re-enter society as productive members, and do much more to dispel the stigma of diseases that affect the mind.

   This legislation deserves to be a major public health priority for the nation. Congress should send the President this legislation before the end of this session.

   I ask unanimous consent that the summary of the legislation be printed in the RECORD.

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

   The Children's Health Act of 2000: Division A--Children's Health

   Title I--Autism

   Under this provision, the Director of NIH shall expand, intensify, and coordinate the activities of the NIH with respect to research on autism. The Director of NIH will establish not less than 5 Centers of Excellence on autism research. Each center will conduct basic and clinical research into the cause, diagnosis, early detection, prevention, control and treatment of autism, including research in the fields of developmental neurobiology, genetics and psychopharmacology. The Director shall provide for the coordination of information among centers. The Director shall provide for a program under which samples of tissues and genetic materials that are of use in research on autism are made available for this research.

   The provision also establishes 3 CDC regional centers of excellence in autism and pervasive developmental disabilities, to collect and analyze information on the number, incidence, and causes of autism and related developmental disabilities. The Secretary shall also establish a program to provide information on autism to health professionals and the general public, and establish a committee to coordinate all activities within HHS concerning autism.

   Title II--Research and Development Regarding Fragile X

   Instructs the National Institute of Child Health and Human Development to expand, intensify, and coordinate research on Fragile X and authorizes the development of coordinated Fragile X research centers.

   Title III--Juvenile Arthritis and Related Conditions

   Requires the National Institute of Arthritis and Musculoskeletal and Skin Diseases to expand and intensify research concerning juvenile arthritis. Directs HHS to evaluate whether the supply of pediatric rheumatologists is adequate to meet the health care needs of children with arthritis.

   Title IV--Reducing Burden of Diabetes Among Children and Youth

   Directs the Secretary, acting through the CDC, to develop a sentinel system to collect incidence and prevalence data on juvenile diabetes. Requires NIH to conduct or support long-term epidemiology studies to investigate the causes and characteristics of juvenile diabetes, and to support regional clinical research centers for the prevention, detection, treatment and cure of juvenile diabetes. Provides for research and development of prevention strategies.

   Title V--Asthma Services for Children

   This provision authorizes the Secretary to award grants to provide comprehensive asthma services to children, equip mobile health care clinics, conduct patient and family education on asthma management, and identify children eligible for Medicaid, the State Children's Health Insurance Program, and other children's health programs. This provision amends the Preventive Health and Health Services Block Grant program to provide for the establishment, operation, and coordination of effective and cost-efficient systems to reduce the prevalence of asthma and asthma-related illnesses, especially among children, by reducing the level of exposure to allergens through the use of integrated pest management.

   This provision also requires the National Heart Lung and Blood Institute, through the National Asthma Education Prevention Program Coordinating Committee, to identify all federal programs that carry out asthma-related activities, develop a Federal plan for responding to asthma in consultation with appropriate federal agencies, professional and voluntary health organizations, and recommend ways to strengthen and improve the coordination of asthma-related Federal activities. CDC will collect and publish data on the prevalence of children suffering from asthma in each State, as well as mortality data at the national level.

   Title VI--Birth Defects Prevention Activities

   This provision expands CDC's folic acid education program to prevent birth defects. In partnership with the States and local, public, and private entities, CDC shall expand an education and public awareness campaign; conduct research to identify effective strategies for increasing folic acid consumption by women of reproductive capacity; evaluate the effectiveness of these strategies; and conduct research to increase our understanding of the effects of folic acid in preventing birth defects.

   This provision elevates the Division of Birth Defects and Developmental Disabilities to a National Center for Birth Defects and Developmental Disabilities within CDC. The purpose of this Center would be to collect, analyze, and distribute data on birth defects and developmental disabilities including information on causes, incidence, and prevalence; conduct applied epidemiological research on the prevention of such defects and disabilities; and provide information to the public on proven prevention activities.

   Title VII--Early Detection, Diagnosis and Treatment Regarding Hearing Loss in Infants

   Authorizes grants or cooperative agreements to develop statewide newborn and infant hearing screening, evaluation and intervention programs and systems, and provide technical assistance to State agencies. Directs the NIH to continue a program of research and development on the efficacy of new screening techniques and technology. Provides for federal coordination with State and local agencies, consumer groups, national medical , health, and education organizations. Coordinated activities shall include policy recommendations and development of a data collection system.

   Title VIII--Children and Epilepsy

   Authorizes the agencies of HHS to expand current epilepsy surveillance activities; implement public and professional education activities; enhance research initiatives; and strengthen partnerships with government agencies and organizations that have experience addressing the health needs of people with disabilities. Authorizes demonstration projects in medically underserved areas, to improve access to health services regarding seizures, to encourage early detection and treatment in children.

   Title IX--Safe Motherhood and Infant Health Promotion

   The provision authorizes the Secretary of HHS to develop a national surveillance program to better understand the burden of maternal complications and mortality and to decrease the disparities among populations at risk of death and complications from pregnancy. The provision allows the Secretary to expand the Pregnancy Risk Assessment Monitoring System to provide surveillance and data collection in each State. Furthermore, the provision would expand research concerning risk factors, prevention strategies, and the roles of the family, health care providers, and the community in safe motherhood. The provision also authorizes public education campaigns on healthy pregnancy, education programs for health care providers, and activities to promote community support services for pregnant women. Finally, the provision authorizes grant funding for research initiatives and programs to prevent drug, alcohol, and tobacco use among pregnant women.

   Title X--Pediatric Research Initiative

   This provision establishes a Pediatric Research Initiative within the National Institutes of Health to enhance collaborative efforts, provide increased support for pediatric biomedical research, and ensure that expanding opportunities for advancement in scientific investigations and care for children are realized.

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